The economic challenges facing the nation today impact homeowners, wage earners at all income levels, and local health departments (LHDs) alike. In days of budget cuts, the pressure on LHDs to convince policy makers and constituencies of their value and importance exists now more than ever. But, despite the realities of tough choices and shrinking purse strings, there is a buzz in the air. LHDs across the country are seizing this moment as a turning point, an opportunity, a time to prove why now, more than ever, public health professionals need to pave the way to a stronger public health infrastructure and, ultimately, healthier communities. A key point along this road to improvement is national accreditation.

Opportunity Is Knocking

Police departments have done it since 1979.1 Hospitals, fire departments, and universities regularly do it. Even your local library might be accredited. The movement toward LHD accreditation has taken many years and many great minds to come to fruition. Champions have been born in surprising places, and naysayers have challenged the field to create a better program. With the development of the Public Health Accreditation Board's (PHAB's) program for voluntary national accreditation of state, local, territorial, and tribal health departments, public health professionals now face an opportunity to transform public health into a recognizable and quality-focused discipline. Imagine the day when a young couple moving to a new area considers the LHD as well as the school system. The couple would understand the true value that the LHD brings to the community: protecting its water and restaurants, helping prevent teen pregnancy, and curbing the dangers of second-hand smoke. Public health is not there yet but may be well on its way.

PHAB's program is designed to promote the advancement of quality, accountability, and credibility of LHDs, regardless of the size, geographic location, or functional responsibilities of the agency. Many local health officials across the country are involved in the development of the accreditation program, and many want to be the first in line to apply.* They see the benefits of having that seal of approval-like their fire departments do-proving that they meet a national standard and serve their communities as they deserve to be served.

LHDs accredited by existing state-based accreditation programs cite benefits including improved staff collaboration, increased attention (and free labor by way of interns) from universities, enhanced credibility with policy makers, and receipt of new grant funding. Nearly all of these LHDs agree that the associated time and costs are outweighed by increased recognition and credibility, newly motivated and engaged staff, improved understanding of LHD functions by staff, improved relationships with governing bodies, and the pride of external recognition for the hard work that is taking place every day in LHDs across the country.

Open the Door

LHDs do not have to start from scratch. NACCHO is making it easy for LHDs to step into the accreditation arena.

During the past 2 years, 66 LHDs completed a self-assessment based on the Operational Definition of a Functional Local Health Department standards and measures, identified areas for improvement, and either worked on quality improvement (QI) or planned to allow for shared services between neighboring LHDs. The Operational Definition standards and measures served as a framework for PHAB's standards, making NACCHO's self-assessment a logical starting point. Identifying a priority area for improvement, examining the processes currently in place, and working to improve them by applying a plan-do-study-act cycle are integral parts to growing a culture of improvement within LHDs. Furthermore, LHDs working together to identify strategies for sharing services where they might not otherwise be able to provide them may well serve as examples for those who seek to apply jointly for accreditation. See the storyboards from these LHDs on NACCHO's Accreditation Preparation and Quality Improvement Web site at http://www.naccho.org/accreditation.

Peer learning also takes place through NACCHO's Web cast series. These free on-line events are intended to educate practitioners about accreditation and a variety of QI-related topics through examples from other practitioners. Archived Web casts include "QI in Action: Stories From Local Health Departments," "Where the Rubber Meets the Road: Implementing QI," and a session to prepare LHDs for the release of PHAB draft standards (among many others). View these and a calendar of upcoming live events on NACCHO's Web site.

NACCHO also offers a periodic e-newsletter, accreditNATION, to share news from NACCHO and other partners on events, tools, and stories from LHDs. The newsletter also serves as a means to share information on PHAB and the national accreditation program. Reaching over 1 000 subscribers, the newsletter is the chief way that NACCHO communicates about accreditation. Sign up on-line today at http://www.naccho.org/accreditation.

Carpe Diem

Decreasing budgets amid a rising number of clients utilizing services is a reality that nearly every LHD faces today. Turning this challenge into an opportunity to participate in a movement that has the potential to transform what is expected of governmental public health across the nation is truly an exciting notion. Transformation begins within each LHD as processes are understood, ways of doing business change, and innovative tools and programs generate improvements. NACCHO is here to help LHDs with that transformation as they navigate the road to accreditation.

For more information on NACCHO's Accreditation Preparation and Quality Improvement program, visit http://www.naccho.org/accreditation. For more information on PHAB, visit http://www.phaboard.org.

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