Perspectives on Public Health Department Accreditation: Lessons Learned From Ohio's Accreditation Mandate

Context: Ohio is the only state that requires local health departments (LHDs) to be accredited by the Public Health Accreditation Board (PHAB). As of May 2024, 80% of Ohio's 111 LHDs achieved accreditation, making Ohio the state with the highest proportion of accredited LHDs in the country.

Objectives: This study examined the experience of public health accreditation in Ohio including the perceived value of PHAB accreditation for LHDs. It also explored the extent to which perspectives on the value of mandatory accreditation differed between state and local health officials.

Design: Data for this study was obtained from 5 focus group interviews with 41 participants, representing state and local perspectives on PHAB accreditation in Ohio. Interviews were recorded, transcribed, and coded using inductive and deductive coding for a thematic analysis.

Results: Focus group participants outlined numerous advantages that accreditation has brought to their organizations. Commonly cited benefits include enhancements in quality improvement and performance management, strengthened collaborations and partnerships, improved communications, and optimized resource use. Challenges in achieving accreditation involved the financial expenses associated with the process and constraints on staffing resources. State officials generally expressed positive views on the accreditation mandate, perceiving it as a pathway to modernize the public health system and ensure consistency in service delivery across communities. In contrast, local stakeholders offered more nuanced perspectives and voiced concerns about the intentions behind the mandate.

Conclusions: The experience of health officials in Ohio offers lessons for both PHAB and officials in other states working to increase public health department accreditation levels. Successful implementation of accreditation mandates requires trust between state and local partners, open communication, and clarity of purpose. Moreover, attaining accreditation necessitates substantial resources, including technical assistance, financial support, and a robust workforce.