Developing and Implementing the Accreditation Program: The Pilot Process
In September 1996, the Michigan Association for Local Public Health, with administrative support from the Michigan Public Health Institute, convened an 18-member Accreditation Steering Committee comprised of representatives from local health departments and the Michigan Association of Counties, Michigan Department of Agriculture, Michigan Department of Community Health, Michigan Department of Environmental Quality, and the University of Michigan School of Public Health.The Steering Committee was responsible for identifying the structure of the accreditation process; developing the necessary assessment tools; overseeing pilot testing of the tool; and refining the assessment tools.
Over an eight-month period, the Accreditation Steering Committee reviewed accreditation literature; examined the experiences of other states with local health department accreditation processes (such as, Illinois, Indiana, Kentucky, and North Carolina); and consulted with national accrediting organizations (such as the Community Health Accreditation Program). After completing this exhaustive research, the Committee concluded that a two-step accreditation process that includes an internal self-assessment followed an on-site review would be most appropriate.
The pilot Self-Assessment Tool developed by the Accreditation Steering Committee was released to the public health community and other interested parties for broad comment in April 1997. The Accreditation Steering Committee reviewed the responses and revised the Tool as appropriate.
The accreditation process was then piloted at four local health departments prior to statewide implementation. The objectives of the pilot process were as follows:
- Are accreditation tools comprehensive and functional?
- How can the tools be improved?
- How can the process be improved?
- How is the process completed by LHDs?
- How much time is needed to complete the process?
- What are the costs of the process?
The Branch-Hillsdale-St. Joseph District Health Department, Kalamazoo County Human Services Department, Greater Thumb Community Health Department, and the Marquette County Health Department generously agreed to serve as the pilot sites.These sites were selected because they represented different organizational structures (i.e., district versus single county) and different geographic considerations (i.e., urban versus rural).
The pilot sites began their Self-Assessment in August 1997 and completed in November 1997. The on-site reviews occurred throughout the Spring of 1998 and were completed in May, 1998.
The pilot sites played an integral role in assisting the Accreditation Steering Committee in refining and improving the accreditation process prior to the statewide implementation.
The Accreditation Quality Improvement Process (AQIP)
The Michigan Departments of Community Health (MDCH), Agriculture & Rural Development (MDARD), and Environmental Quality (MDEQ) and Michigan’s 45 local health departments are committed to providing strong, effective local health programs, services, and care for Michigan citizens. Because an efficient, valuable, and credible accreditation process is fundamental to effecting that commitment, in December 2002, the Michigan Local Public Health Accreditation Commission recommended that the Michigan Departments of Community Health, Agriculture & Rural Development, and Environmental Quality commence a structured process for accreditation quality improvement. In January 2003, the on-site review component of the accreditation program was paused, in part, to enable stakeholders to focus on the improvement initiative.
AQIP Vision and Principles:
In improving the quality of programs, services, and care provided to the public, stakeholders recognized that improvement options must be congruent with the mission and goals of the Accreditation Program. Additionally, improvement mechanisms should enhance or preserve the gains achieved through the current accreditation process and recognize that rule, regulation, and statute based Minimum Program Requirements (MPRs) are the crux of the accrediting tool. The improvement process seeks to:
- Increase the real value of accreditation to accredited local health departments
- Increase external customer, local health department staff, and state agency satisfaction
- Respond to local health departments’ reduction in state funding levels
- Respond to local health departments’ role in reacting to urgent/emergent public health issues
In March 2003, an Accreditation Quality Improvement Process (AQIP) Workgroup was organized and convened in collaboration with the Michigan Association for Local Public Health (MALPH). The locally-driven, 14 member AQIP Workgroup comprises 10 representatives from local health, 3 from state agencies, and 1 from the Michigan Public Health Institute (MPHI). Collectively, their charge is to provide leadership and direction for accreditation quality improvement. Specifically, the workgroup’s primary goals are to:
- Ensure that improvement activities engage all key stakeholders
- Identify opportunities for process improvement
- Determine which improvement opportunities will have the most positive impact on stakeholder satisfaction
- Develop recommendations based on priorities
- Develop recommendations for ongoing process improvement
The AQIP Workgroup recognized that improvement requires an understanding of “what” to improve and “how” to improve. To engage stakeholders and listen to the voice of the local health community the workgroup developed a survey focusing on key accreditation process components.
In June 2003, 161 local public health professionals and 19 state agency program reviewers responded to the 60-question on-line survey as coordinated by the MPHI Center for Collaborative Research in Health Outcomes & Policy.
AQIP Survey Final Report
- Executive Summary
- Analysis of Survey Responses
- Appendix A (Survey Methodology)
- Appendix B (Survey Results-All Respondents)
- Appendix C (Survey Results-Local Public Health Department Respondents)
- Appendix D (Survey Results-State Agency Reviewer Respondents)
- Appendix E (Open-Ended Response Coding)
- Appendix F (Survey Instrument: Includes Summary Statistics of all Close-ended Responses & Full Text of All Open-ended Responses)
AQIP Final Recommendations (PDF)
AQIP Implementation Cover Letter and Report (presented at the March 2004 Commission meeting)
MDCH Local Health Services Accreditation Supplemental Report (May 2004)
2nd AQIP Implementation Report (presented at the December 2004 Commission meeting)
Boilerplate Workgroup’s Final Report
A-G Workgroup’s Final Report (MS Word; if a dialogue box appears requesting a password, simply click “Cancel”)