Standards, Accreditation, and Improvement -- Raising the Bar of Public Health Performance


Health department office sceneWhat is the relationship between public health agency performance and health status? How does a local or state jurisdiction assess its current services and activities and achieve better health outcomes for the public it serves? Why is there so much attention to quality improvement and accreditation in public health these days … and does it really matter? How do these efforts connect with other longstanding efforts such as the CDC National Public Health Performance Standards Program (NPHPSP)?

To answer these and other questions, this program will provide information about national and state efforts in accreditation and improvement as well as provide some on-the-ground insight into what it really means for a local health department.

Groundbreaking work is occurring to develop a voluntary national accreditation program for state and local public health agencies. The national accreditation model, which was developed through a practice-driven model and was heavily endorsed by the field, has led to the creation of the new Public Health Accreditation Board (PHAB). The national accreditation program, slated to be launched in 2011, is particularly intended to catalyze quality improvement in public health practice.

North Carolina is among the handful of states that have led the way in quality improvement and accreditation. In 2002, the North Carolina Division of Public Health and the North Carolina Association of Local Health Directors undertook the initiative to develop a mandatory, standards-based system for accrediting local public health departments throughout the state.

The focus of North Carolina’s Local Health Department Accreditation (NCLHDA) is on the capacity of the local health department to perform at a prescribed, basic level of quality as defined by the same ten essential services used in the CDC NPHPS Program. Using the same principles, the state health department also has piloted an accreditation process – the only state in the nation to do so.

Our case study at the New Hanover County Health Department in coastal North Carolina looks at the entire process improvement initiative—the successes, pitfalls, lessons learned, and plans for the future. The case study describes:

  • The department self assessment, including benchmarks and activities
  • The three-day visit by a multidisciplinary team of peer volunteers
  • The accreditation process by the North Carolina Local Health Department Accreditation Board

Our distinguished faculty and nationally recognized panel of experts will discuss the specifics of the case and how the processes, tools and resources from the North Carolina experience, and other states, can be applied across the nation to improve health for all. The panel also will reflect on the relationship with current national initiatives such as the NPHPSP.


This Public Health Grand Rounds program focuses directly on the priorities of many public health policy makers and practitioners, at all levels, including:

  • Executive directors, medical directors, and program directors and managers in local, state, tribal, and provincial health departments
  • Elected and appointed public health policy makers (e.g., city council members, county commissioners, state legislators, and members of local and state boards of health)
  • Leaders of community-based and faith-based organizations working for better community health.