Beitsch and Corso Respond

In “Accountability: The Fast Lane on the Highway to Change,”1 we recommended a suite of strategies that act synergistically to improve public health performance at multiple levels. Besides accreditation for state, local, and tribal health departments, we suggest improvement efforts directed at the public health system as well as quality improvement for defined processes and programs. From our perspective, the attainment of desirable public health goals (the ultimate aim being improved community health) is less likely without such a comprehensive approach. We agree that the pathway to accreditation should be approached thoughtfully and deliberately. In fact, the journey toward accreditation has not been a hasty one. Even when narrowly defining the history to the start of Exploring Accreditation in 2005,2 this program represents a longer timeline than many other accreditation programs undertook before their launch.3 But most importantly, the work of the Public Health Accreditation Board (PHAB) is building heavily on numerous predecessor and concurrent public health efforts,4–9 diligently considering how benefits can outweigh costs, and engaging hundreds of public health professionals through workgroups, testing, and public input.10 Moreover, at least 10 state accreditation or standards programs have informed the draft PHAB standards and measures, thus indirectly drawing from an even wider range of consensus building and testing. We likewise agree that accreditation should be evidence-based, but contend that the launch of accreditation can best accomplish this very aim. The assertion—that accreditation programs can facilitate progress toward evidence-based practice—is derived from experiences from other accreditation programs.11 PHAB's Research and Evaluation Committee has been established to ensure attention to this purpose. Further, PHAB will sample health department programs in accreditation reviews and also require health assessments and health improvement plans. This approach is designed to drive action toward improving health outcomes and will not neglect the critical need to focus public health attention on the public's health in a data-driven manner. We should remind ourselves of the long-term evolution experienced by other accrediting bodies and the considerable time required to move from process measures to greater emphasis on outcome measures. Nevertheless, we can be inspired by the findings of newer accreditation programs, which are likewise largely comprised of process measures, and the positive impacts they report.1,12 Therefore, we seek to learn what public health can do to improve accreditation; but as we move boldly ahead, we also look forward to what accreditation can do for public health

MEDLINE · Political science · Climate Change and Health Impacts · Healthcare cost, quality, practices · Law · Public Health Policies and Education

• Accountability

  Leslie M Beitsch, Liza Corso et al.•American Journal of Public Health•2009

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