TURNOCK READING ROOM

Accrediting public health organizations: "The ducks is on the pond!"

Turnock BJ---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health

Jour Public Health Management & Practice 1998;4(4):vi-vii

The extensive collection of contributions on accreditation of public health organizations highlighting this issue of the Journal should stimulate both debate and action within the public health community. Although the various contributors address accreditation from widely disparate perspectives, each speaks to critical questions that will eventually determine its fate. Simply stated, these are whether the public health community in the United States is ready, willing, and able to be measured against benchmarks appropriate to its purpose and functions. These dimensions provide a useful prism for viewing the insights and experiences shared in this issue’s roundtable contributions.

Ready?

Our readiness for accreditation made the necessary jump to light-speed through the impetus of the now decade-old Institute of Medicine (IOM) report on The Future of Public Health. The IOM may have report provided more assertions than evidence of a poorly focused and widely under valued public health enterprise, but it also advanced an inspiring vision of how that system should function. The three core functions of public health, much maligned in recent years as too abstract for public health professionals and the public alike, embody that vision, but only in skeletal form.

If successfully deployed, a national accreditation program for state and local public health organizations would add flesh to the skeleton of the core functions. These concepts would finally move from creed to credibility as we begin to use the core functions as more than public health’s pledge of allegiance. Paying lip service to the core functions is one thing. But measuring our actions and results against core function-related performance expectations in a public and more accountable forum is quite another.

Willing?

As for our willingness, substantial concerns persist. Federal leadership to pursue accreditation has only recently been assumed by the Centers for Disease Control and Prevention (CDC). Unfortunately, CDC’s state and local colleagues have achieved neither solidarity nor consensus on such basic accreditation issues such as "Who?" "How?" and "Why?"

Some of this diversity is to be expected. There are more than 3000 local agencies that fit the current definition of local health department (basically an agency of a unit of government operating at less than a state level, with at least one full time employee and a budget, and with responsibility for some aspect of health). Studies to date suggest that a substantial number of these local agencies would not meet a functional (as opposed to structural) definition of a local public health agency. Why would these organizations support an initiative that would measure their activities against standards grounded in public health’s core functions? This is a special challenge for organizations that represent these organizations and their workers---such as the National Association of County and City Health Officials (NACCHO) and the American Public Health Association---impeding their willingness to lead the charge toward accreditation.

State agencies also are slow to embrace public health organization accreditation, but for somewhat different reasons. States are prone to view accreditation as a process that may be fine for local health departments but not appropriate for state health agencies. Many state agencies believe that their functions have matured beyond the role of traditional public health practice into monitors and overseers of the health service sector of our society. It is ironic that the same state agencies that seek to expand their roles as regulators and certifiers find little value in being certified themselves!

Able?

If this issue’s roundtable contributes nothing else, it certainly bolsters the claim that the tools and experiences necessary to fashion a successful accreditation program already exist. This is evident in the experiences of the Council on Education for Public Health, the Joint Commission on Accreditation of Healthcare Organizations, the Community Health Accreditation Program, and the American Accreditation HealthCare Commission among others. Although not readily comparable in terms of purpose and methods, the efforts of several states further attests to the ability of the public health community to successfully implement performance monitoring and accreditation initiatives. Just look at what’s happened in Washington State, Oregon, Illinois, Michigan, Missouri, South Carolina, and elsewhere (Australia) for evidence.

Ducks on the Pond

Perhaps the most colorful of the early television broadcasters of baseball games, Dizzy Dean, was fond of observing that "the ducks is on the pond. " He generally reserved this observation until the late innings of a close game when one team would put runners on base in scoring position. In many respects, the diverse contributions in this issue’s roundtable paint a picture of ducks on our pond with nearly everything in place for the public health community to move forward with a national accreditation program. There are important reasons, increasing support, and useful frameworks. Still, we must get beyond the discomfort of being the object rather than the enforcer of professional standards and the timidity that accompanies more than 75 years of piecemeal efforts to measure and improve public health practice performance. It is time to bring home our ducks, lest this opportunity not arise again.