Missouri Voluntary
Local Public
Health Agency Accreditation Program
INTRODUCTION
The Missouri Institute for Community Health (MICH) is the accrediting body for
Missouri’s Voluntary Accreditation Program for Local Public Health Agencies. MICH is
a 501 C (3) corporation governed by a Board of Directors. Board members include
health care providers, academia, human service organizations, and state and local
government. The mission of MICH is “to facilitate and promote excellence in
community systems for health and quality of life.”
The Missouri public health system began exploring accreditation for local public
health agencies in the 1990s. Initial work began under the umbrella of the Missouri
Department of Health and Senior Services, but in 2002, MICH took the lead. The first
set of standards was piloted and then issued in 2003. The first local public health
agency was accredited in 2003.
When accreditation standards were revised in 2006, the Operational Definition of
a Functional Local Health Department created by the National Association of City and
County Health Officials (NACCHO), along with the work of the Robert Wood
Johnson/Multistate Learning Collaborative and the National Steering Committee on
Accreditation contributed to the revision.
The Accreditation Manual has two sections:
1. Standards for Agency Performance contain indicators to describe local public
health agency activities. Performance measures provide a means to evaluate the
agency’s execution of the 10 essential public health services. The ten essential
services are:
1. Monitor health status and understand health issues facing the community.
2. Protect people from health problems and health hazards.
3. Give people information they need to make healthy choices.
4. Engage the community to identify and solve health problems.
5. Develop public health policies and plans.
6. Enforce public health laws and regulation.
7. Help people receive health services.
8. Maintain a competent public health workforce.
9. Evaluate and improve programs.
10. Contribute to and apply the evidence base of public health.
2. Standards for Agency Infrastructure are divided into 8 domains that describe the
administrative capacity needed to carry out the core public health functions and
essential public health services. The performance indicators measure the following
dimensions:
• a planning process
• governance and leadership
• facilities/service delivery
• financial and resource management
• workforce
• information technology
• communications
• inter-governmental issues
TYPES OF ACCREDITATION
A local public health agency may seek one of three distinct types of accreditation:
primary, advanced, and comprehensive.
Performance Standards: Agencies, regardless of the level of accreditation they
pursue, will need to meet all Performance Indicators. However, not all agencies need tomeet all Performance Measures. The Manual distinguishes Performance Measures by a
(P) for primary, an (A) for advanced, and a (C) for comprehensive. Primary agencies
are required to demonstrate compliance with only those measures followed by a (P).
Advanced agencies are required to demonstrate compliance with those measures
followed by an (A). Comprehensive agencies are responsible for all Performance
Measures.
The numbers of Performance Measures to be met are:
• Primary Local Public Health Agency - 230 Performance Measures
• Advanced Local Public Health Agency - 305 Performance Measures
• Comprehensive Local Public Health Agency - 322 Performance
Infrastructure Standards: All agencies, regardless of the type of accreditation
they apply for, will need to meet the set of Infrastructure Standards and Measures
accounting for a possible score of 91 points. The variety of and qualifications of core
staff will vary by type of accreditation.
Agencies are encouraged to review the standards and performance measures
that must be met for each type of accreditation and seek the level that matches
resources, infrastructure, and level of involvement in the community health improvement
process.
Primary Local Public Health
Agency Accreditation
A primary accredited local public health agency may serve any size population or
geographic area. It will have documented capacity, expertise and leadership that
assures a fundamental public health presence within the community it serves.
Performance measures for primary accreditation describe agency activity in performing
some aspects of each of the 10 essential public health services. The agency will have a
core staff that includes a qualified administrator, public health nurse, environmental
public health specialist and support staff. The agency must also have full or part-time
staff, or otherwise have access to a medical consultant and individuals with expertise in
health education, nutrition, computer technology and epidemiology.
Advanced Local Public Health
Agency Accreditation
An advanced accredited local public health agency may serve any size
population or geographic area, but will typically serve a population of 16,000 or more.
An agency seeking advanced accreditation must meet 75 more performance measures than a primary agency. Some performance measures require additional analysis of
data to identify specific population segments at risk, environmental risk factors, and
behavioral or other risks that contribute to poor health outcomes. An advanced
accredited local public health agency will be collaborating extensively with others in the community to resolve health care access and utilization of services issues. The agency is involved in public policy development to improve health and will exhibit a high level of
participation in community health planning.
One additional public health nurse is needed to meet workforce standards for
advanced accreditation, and educational qualifications for some core staff members are
higher than primary accreditation.
Comprehensive Local Public
Health Agency Accreditation
A comprehensive accredited local public health agency may serve any size
population or geographic area, but will typically serve a metropolitan area. A
comprehensive accredited local public health agency must meet 17 more performance
measures than an agency seeking advanced accreditation. A comprehensive
accredited agency ensures all aspects of the 10 essential public health services to its
service area. The agency works with community partners to evaluate the health care
system and assure health care access for all members of the community.
In addition to core staff required for other levels of accreditation, the
comprehensive accredited agency will have a full-time assistant administrator, nursing
supervisor, health educator, nutritionist, epidemiologist, computer specialist, and
community planner. Additionally, the agency is required to have access to a medical
consultant, public information officer, and a statistician.
BENEFITS OF ACCREDITATION
FOR A LOCAL PUBLIC HEALTH AGENCY
Usually, an administrator considering accreditation will review the standards and
roughly measure how closely the agency’s performance matches standards
requirements. Then, the administrator might discuss accreditation with staff and the
agency’s governing body. At each phase in the process from consideration of
accreditation to actual application; from preparation and self-assessment to on-site
review, a few questions will be asked repeatedly:
• Why should our agency seek accreditation, knowing how much time and work
it might take?
• How will our agency and/or our community be rewarded if the agency is
successful?
• What happens if we fail to meet the scoring threshold?
Accredited agencies in Missouri and in other states share very similar comments
about their experiences. Common themes describe hard work that is rewarded many
times over. Agency staff describes non-monetary rewards that illustrate how
accreditation benefited agencies internally, and externally benefited the communities
they serve. Finally, some administrators affirmed that the self-assessment process was
the best quality improvement project their agency had ever undertaken.
Following are examples of what agencies cited as advantages for their agency
and their community at four stages of the accreditation process:
Pre-Application Benefits
• Merely exploring the possibility of accreditation sets in motion a process of
self-evaluation to identify agency strengths and areas for improvement.
• Identification of areas needing improvement, whether staff education and
training, administrative policy development, a documentation system, or a
more thorough community health assessment provides a focus for efforts in
planning for improvement.
• Deficits in capacity identified through standards review can be used to garner
support from the governing body or the community for resource development.
Self-Assessment Process Benefits
• Self-assessment compels agency leadership to think critically about what
services and programs are offered in relation to the identified community
problems and needs.
• Ineffective and inefficient processes are identified during self assessment and
addressed.
• Staff pride and morale improve as the agency works as a team toward a
common goal.
• Staff follow through with attaining additional education or training.
• Agencies organize documentation, logs, policy, personnel files, etc. which
improves operational systems.
• Actual improvement occurs in the thoroughness of mandated activities such
as community health assessment and dissemination of health status
information.
• Agencies are more involved and take on stronger leadership roles in
community partnerships and community health improvement planning.
• An opportunity is provided to identify new leaders within the agency.
• Obvious deficits in infrastructure, capacity, and performance are identified so
that planning for and implementing improvement changes can occur.
• Overall, the local public health agency as an organization becomes stronger,
and the community is better served as a result of the agency going through
the self assessment.
On-Site Review Benefits
• A team of reviewers evaluates agency performance and capacity in relation to
industry standards and provides feedback regarding strengths and areas for
improvement.
• Effective practices are identified by the on-site review team which, with
agency permission, are shared with peer agencies and lead to improvement
throughout the public health system.
Benefits of Accreditation Award
• Brings distinction and credibility to the agency among community partner
organizations.
• Strengthens community’s and policy makers’ confidence that the local public
health agency is fulfilling its responsibility.
• Demonstrates a commitment to excellence.
• Fosters continuous organizational development and continuous quality
improvement.
• Increases the agency’s effectiveness and capacity to protect and promote
health.
• Provides opportunity for public recognition and publicity.
• Provides an opportunity for agency staff celebration.
• Allows the promotional use of an accreditation seal with the media, as an
endorsement in grant applications, and to provide a competitive advantage
when marketing the agency.
Agency accreditation demonstrates to customers that agency leadership has
accepted the challenge to improve services and activities, so that the community is
served by an effective agency and a qualified public health workforce. |