TY - JOUR
T1 - Drivers and Barriers for Adopting Accreditation at Local Health Departments for Their Performance Improvement Effort
AU - Liu, Sandra S.
AU - Meyerson, Beth
AU - King, Jerry
AU - Yih, Yuehwern
AU - Ostovari, Mina
N1 - Funding Information:
Local health departments reported that their governing entities served as mediators in the strategic decision-making process. Examples include working with the city or county councils funding, working with the board of health to address policy and project concerns, and working with federal agencies, such as CDC, for relevant information and guidance. The LHDs reported occasionally receiving grant funding for emergency preparedness from Homeland Security and the CDC through the state government. Those LHDs that have designated personnel to write grants tend to have better funding. Both LHDs A and B had a better outcome in this aspect as a result. Overall, the state entities did not support the local departments in the accreditation efforts. These grants usually were funded with designated use or desired health outcomes, such as smoking cessation, or emergency preparedness. The local governing entities guided the LHDs in creating their budgets by providing a specific budget target for annual spending. Participant LHDs reported that these local governing entities were important forces in determining the goals and direction of the health department. Government efficiency seemed to be the major concern of these entities. Local health departments shared similar views about the importance of requesting appropriation in line with the council’s target.
Funding Information:
This research was supported, in part, by the Project Development Team (PDT) within the ICTSI NIH/NCRR grant number UL1TR001108. The authors appreciated the guidance from the PDT members and the editorial board of JPHMP. The authors also thank all the undergraduate students and the staff members from the local health departments who contributed to this research projects. This article was developed from the winning abstract in the first annual Research to Practice Award, co-sponsored by JPHMP and the APHA Health Administration Section. Nominations were requested for best examples of current research, which has effectively been put into the practice of health administrators. To be considered, papers were required to demonstrate translation of research findings to inform decision making and action by public health practice and policy stakeholders, development of new and/or effective
Publisher Copyright:
© 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2017
Y1 - 2017
N2 - Context: A national system of voluntary public health accreditation for state, local, and tribal health departments (local health departments [LHDs]) is part of a movement that aims to improve public health performance with ultimate impact on population health outcomes. Indiana is a good setting for the study of LHD accreditation adoption because several LHDs reported de-adopting accreditation in a recent statewide survey and because 71% of Indiana counties serve populations of 50 000 or less. Design: A systematic method of analyzing qualitative data based on the Performance Improvement Model framework to expand our understanding of de-adoption of public health accreditation. Setting/Participants: In 2015, we conducted a key informant interview study of the 3 LHDs that decided to delay their engagement in the accreditation based on findings from an Indiana survey on LHD accreditation adoption. The study is an exploration of LHD accreditation de-adoption and of the contributions made to its understanding by the Performance Improvement Model. Result: The study found that top management team members are those who champion accreditation adoption, and that organizational structure and culture facilitate the staff's embracing of the change. The Performance Improvement Model was found to enhance the elucidation of the inner domain elements of Consolidated Framework for Implementation Research in the context of de-adoption of public health accreditation. Conclusion: Governing entities' policies and priorities appear to mediate whether the LHDs are able to continue accreditation pursuit. Lacking any of these driving forces appears to be associated with decisions to de-adoption of accreditation. Further work is necessary to discern specific elements mediating decisions to pursue accreditation. This study demonstrates the added knowledge of Performance Improvement Model (PIM) to the CFIR framework. A large scale study is called to further clarify and discern supports of specific to the needs of individual LHDs for their performance improvement effort.
AB - Context: A national system of voluntary public health accreditation for state, local, and tribal health departments (local health departments [LHDs]) is part of a movement that aims to improve public health performance with ultimate impact on population health outcomes. Indiana is a good setting for the study of LHD accreditation adoption because several LHDs reported de-adopting accreditation in a recent statewide survey and because 71% of Indiana counties serve populations of 50 000 or less. Design: A systematic method of analyzing qualitative data based on the Performance Improvement Model framework to expand our understanding of de-adoption of public health accreditation. Setting/Participants: In 2015, we conducted a key informant interview study of the 3 LHDs that decided to delay their engagement in the accreditation based on findings from an Indiana survey on LHD accreditation adoption. The study is an exploration of LHD accreditation de-adoption and of the contributions made to its understanding by the Performance Improvement Model. Result: The study found that top management team members are those who champion accreditation adoption, and that organizational structure and culture facilitate the staff's embracing of the change. The Performance Improvement Model was found to enhance the elucidation of the inner domain elements of Consolidated Framework for Implementation Research in the context of de-adoption of public health accreditation. Conclusion: Governing entities' policies and priorities appear to mediate whether the LHDs are able to continue accreditation pursuit. Lacking any of these driving forces appears to be associated with decisions to de-adoption of accreditation. Further work is necessary to discern specific elements mediating decisions to pursue accreditation. This study demonstrates the added knowledge of Performance Improvement Model (PIM) to the CFIR framework. A large scale study is called to further clarify and discern supports of specific to the needs of individual LHDs for their performance improvement effort.
KW - Consolidated Framework for Implementation Research (CFIR)
KW - implementation science
KW - local health department (LHD)
KW - Performance Improvement Model (PIM)
KW - public health accreditation
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U2 - 10.1097/PHH.0000000000000567
DO - 10.1097/PHH.0000000000000567
M3 - Article
C2 - 28492448
AN - SCOPUS:85030101980
VL - 23
SP - e25-e35
JO - Journal of Public Health Management and Practice
JF - Journal of Public Health Management and Practice
SN - 1078-4659
IS - 6
ER -