Maintaining a Competent Public Health Workforce: Lessons Learned from Experiences with Public Health Accreditation Domain 8 Standards and Measures

DUCTION 31 Public health accreditation is an ongoing national movement to improve the quality of 32 public health departments and the public health system in the United States (US). This 33 voluntary accreditation program is based on national standards for health department quality and performance as per the 10 Essential Public Health Services.1-13 34 A basic structure and set of 35 guidelines are provided to public health departments to assist them with the process of 36 initiating new or reorganizing existing policies, plans, and programs to meet criteria and documentation standards for the 12 Domains included in the accreditation program.1,3 37 38 Since the program began in 2011, 178 million people or 58% of the US population reside 39 in a jurisdiction that is accredited by the Public Health Accreditation Board (PHAB), which is a total of 187 health departments (data as of March 2017).4 40 While the evidence is mounting that 41 the accreditation process is beneficial for the health department and there seems to be 42 ongoing momentum toward accrediting additional health departments, to date research 43 evidence regarding the impact of specific accreditation domains and activities remains limited.14 44 In fact, the majority of the studies conducted on public health accreditation have 45 been focused on factors that may facilitate or serve as barriers to a health department’s decision to pursue PHAB accreditation15-20 and case studies about accreditation experiences.21- 46 23 Findings suggest that facilitators include collaboration with other stakeholders,24,25 47 presence of leadership and incentive structures,26,27 having larger jurisdictions,15 48 being situated in a proaccreditation centralized state health department19,20, certain legislative factors,22,28 49 the presence of established quality improvement initiatives29,30 50 , and higher numbers of full-time 51 employees. Conversely, studies have also examined health department barriers to pursuing o