Too Small to Be Accredited Is a Matter of Perspective

by Kaye Bender, PhD, RN, FAAN


Focus on Accreditation and Innovation addresses current issues related to the Public Health Accreditation Board’s national public health department accreditation program, and the Public Health National Center for Innovations. This series highlights the experiences and perspectives of accredited health departments and explores topics related to the Standards and Measures, research and evaluation findings, and the latest innovations in public health practice.

Local health departments (LHDs) that serve populations of fewer than 50,000 and/or who have fewer than ten full-time equivalent (FTE) staff often struggle with the idea of becoming nationally accredited. Despite those struggles, 66 local and Tribal health departments in the PHAB system serve populations of less than 50,000. Nineteen of those are already accredited and the others are somewhere in the process. The smallest accredited health department serves a population of 17,000. Of the 66 small LHDs in the PHAB system, the average population is 32,101, but the smallest health department serves a population of 725. The average number of FTEs is 23, but one health department has 3 FTEs. They come from all over the country in that they represent 18 states and 9 of the 10 Department of Health and Human Services Regions.

PHAB has been working for a while now on how to best support smaller health departments that wish to achieve national public health department accreditation. Over a two-year period PHAB has held several open forums, interactive webinars, town halls, and other discussions to obtain input from health departments that are interested in accreditation but feel there are substantial barriers to their achieving accreditation. PHAB has also convened a group of health department thought leaders to serve on a think tank to discuss which of the standards and measures pose the most barriers for small health departments. PHAB understands that these smaller health departments may need some additional or different technical assistance to achieve national accreditation. In that regard, PHAB is working with the National Association of County and City Health Officials (NACCHO) to explore in more detail what that special technical assistance might entail and how it might best be provided. With adequate planning and support from partners, both locally and at the national level, too small to be accredited is just a matter of perspective.


Kaye Bender, PhD, RN, FAAN

Kaye Bender, PhD, RN, FAAN, is the President and CEO of the Public Health Accreditation Board (PHAB), which administers the national, voluntary accreditation program for state, Tribal, local, and territorial health departments. Prior to joining PHAB in 2009, she worked in both local and state public health practice in the Mississippi State Department of Health, including serving as Deputy State Health Officer for 12 years. Prior to that, she served as Dean of the University of Mississippi Medical School of Nursing and Associate Vice Chancellor for Nursing for six years. She was inducted as a Fellow in the American Academy of Nursing in 2000.

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