MPH 540 Module 2 Accountability and Accreditation Example

Answering to the Public: Accountability and Accreditation in Governmental Public Health

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Master of Public Health Program, Aspen University

MPH 540: Public Health Administration

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Month Day, Year

Answering to the Public: Accountability and Accreditation in Governmental Public Health

Governmental public health spends public money and exercises public authority, so it must answer to the public. Accountability takes many forms, from elected boards and budget audits to published performance data. Over the past decade, national accreditation has become a major tool for demonstrating that health departments meet standards. This paper examines public accountability in public health, with a focus on accreditation, and follows a composite county department through the process.

Why Accountability Matters

The 1988 national review of public health found wide variation in what health departments did and how well, and called for clearer standards and stronger capacity to carry out assessment, policy development and assurance (Institute of Medicine, 1988). Without standards, residents cannot know whether their health department provides the services they need, and policymakers cannot judge whether investments are paying off.

Forms of Accountability

Health departments answer to elected officials who approve budgets, to boards of health that set policy, to state agencies that fund and oversee them, to federal grantors that require performance reports, to courts that review their orders and to the public through open meetings and published data. Accreditation adds a voluntary, peer-reviewed assessment against national standards.

National Accreditation

A national accreditation program for state, local, tribal and territorial health departments began in 2011. By 2016, accredited departments served nearly 167 million people, about half the US population, ranging from a local department serving 17,000 people to the state health department of California. In surveys, more than 90% of departments accredited for a year reported that accreditation had stimulated quality and performance improvement, increased accountability and transparency and improved management processes (Kronstadt et al., 2016).

The Standards

Accreditation standards are organized into domains aligned with the essential public health services and with administration and governance. The table summarizes them.

The Process

A department prepares by completing a community health assessment, a community health improvement plan and a strategic plan, the three prerequisites. It then uploads documentation showing conformity with each measure, hosts a site visit by trained peer reviewers, receives a decision and submits annual reports. Reaccreditation every five years focuses on performance and improvement over time.

Building a Quality Culture

Accreditation is linked to quality improvement. A study of local health departments preparing for accreditation found that leadership commitment, dedicated staff time and the structure of accreditation itself helped sustain quality improvement, while staff turnover, budget cuts and emergencies were the main barriers (Verma & Moran, 2014). Accreditation provides a framework that keeps improvement on the agenda.

Costs and Barriers

Preparing for accreditation takes staff time, often a year or more of work by an accreditation coordinator, plus fees. Small and rural departments with few staff find this hard, which is why fewer of them are accredited. Some states fund coordinators or offer technical assistance, and some small departments pursue accreditation together through shared services.

A Composite County's Path

A composite county health department serving 95,000 people decided to pursue accreditation after a budget debate in which commissioners questioned the value of its programs. It appointed an accreditation coordinator, completed a community health assessment with the local hospital, wrote an improvement plan focused on obesity and mental health and adopted its first strategic plan. Staff formed teams for each domain and found gaps in written policies and performance data.

Filling the Gaps

The department wrote a communication plan, built a performance management dashboard with 30 measures, trained all staff in basic quality improvement and completed two improvement projects, one reducing wait times at the immunization clinic and one improving inspection report timeliness. It achieved accreditation two and a half years after starting.

Results for Accountability

After accreditation, the department presented its dashboard to commissioners each quarter. Commissioners could now see measures such as immunization rates, inspection timeliness and outbreak response times. The following year, the county maintained the department's funding and added a position for data analysis, citing the improved transparency.

Limits of Accreditation

Accreditation shows that a department has processes in place; it does not by itself prove better health outcomes. Evidence linking accreditation to population health remains limited, and outcomes depend on many factors beyond a department's control. Accreditation is best seen as one part of accountability alongside outcome reporting and community engagement.

Public Reporting

Some health departments publish performance dashboards showing measures such as inspection timeliness, vaccination coverage and outbreak response. Public reporting lets residents see what they receive for their taxes and gives staff clear targets. It also exposes weak areas, which requires leaders willing to be transparent.

Accountability to Communities

Accountability runs not only upward to officials and funders but outward to communities. Community advisory boards, public meetings on health assessments and plain-language reports allow residents to shape priorities and judge results. Departments that involve communities in setting goals tend to earn more trust when hard decisions arise.

Accountability and Trust

The pandemic tested public trust in health departments. Transparent reporting of decisions, data and performance can help rebuild trust, particularly when paired with honest acknowledgment of mistakes. Accreditation's emphasis on documentation and communication supports this effort.

Accountability for Equity

Departments are increasingly asked to show not only average performance but whether services reach all groups fairly. Breaking measures down by neighborhood, race and language shows whether gaps are closing.

Conclusion

Public accountability in public health runs through elected officials, boards, funders, courts and the public. National accreditation adds a structured, peer-reviewed check that has reached departments serving half the population and has strengthened quality improvement and transparency. For the composite county, accreditation turned a budget challenge into an opportunity to show its value and improve its work.

References

Institute of Medicine. (1988). The future of public health. National Academy Press. https://doi.org/10.17226/1091

Kronstadt, J., Meit, M., Siegfried, A., Nicolaus, T., Bender, K., & Corso, L. (2016). Evaluating the impact of national public health department accreditation: United States, 2016. MMWR. Morbidity and Mortality Weekly Report, 65(31), 803-806. https://doi.org/10.15585/mmwr.mm6531a3

Verma, P., & Moran, J. W. (2014). Sustaining a quality improvement culture in local health departments applying for accreditation. Journal of Public Health Management and Practice, 20(1), 43-48. https://doi.org/10.1097/PHH.0b013e3182a5a4a0