Local Health Department

Local Health Department

Paper details Chapter 18 (Sollecito & Johnson, 2013) explains how accreditation has been instituted, and has become institutionalized, in healthcare sectors and jurisdictions around the world. It is a governance strategy that enables health organizations individually and collectively to self-govern their efforts at improving quality and safety. The case of North Carolina Local Health Departments Accreditation Program explains how inspection can be used in conjunction with an effective feedback mechanism to drive conformance to process standards and motivate process improvement. The site visit has long been a ritual of the healthcare environment, allowing both objective and subjective observations to come together to form a coherent picture of an organization, a project, or program. Conformance may be measured against a standard or a protocol. Self-reporting saves observer time and allows pre-visit preparation and a set of reference documents. Over time, accreditation of organizations and certification of individual professionals can involve an increasingly demanding set of standards that lead to improvement, if the collective will is there. Upon reading Case 15 (McLaughlin, Johnson, & Sollecito, 2011), answer the follow case assignment questions: 1. North Carolina Accreditation is mandatory. All local health departments, by statute, must obtain and maintain accreditation status. One argument against this is that the system is semi-regulatory and accreditation should be voluntary. Should the NC system be mandatory? What other approaches could encourage LHDs to seek accreditation? What are the pros and cons of a legislatively mandated system of process improvement? 2. The national voluntary public health accreditation program is a fully functioning accreditation program for all local, state, territorial, and tribal health departments supported through the Centers of Disease Control. The goal of the national accreditation program is to protect and improve the health of the public by advancing quality and performance. What are some ways that a state-based system could operate within a national system? Should there be a two-tier system with state systems operating separately from the national system? Can one national system provide standards and benchmarks applicable to all public health agencies? 3. One of the purposes of accreditation is to encourage quality improvement in the department. The report given to local health departments has a section of quality-improvement suggestions that the department may choose to use. Many health directors have embraced quality improvement and research shows that many have implemented QI initiatives. Yet, many feel that quality improvement lacks real value to the agency. How do we best use an accreditation system to promote quality-improvement initiatives? Should we incorporate quality improvement into the accreditation standards? 4. A goal of accreditation will be the improvement in health-status indicators for our communities. Since health status can be the result of the full healthcare system, of which the health department is but one component, is accreditation a necessary but not sufficient condition to lead to improved health outcomes? 5. The NC Accreditation program is fully supported by an allocation by the state legislature. As the only source of funding, this dependence led to a disruption in the program when funding was cut during the 2009-2010 fiscal year. What type of future business models should be used to ensure that the program is sustainable? 6. Since the NC system is mandatory, it is important to have legislator support and funding. Legislators also have expectations for health outcomes and accountability for local health departments. What approach to legislators is best to persuade their support of funding for accreditation?