As more and more health departments recognize the value of PHAB accreditation, one question that we often hear at Ascendient is, “Where would I even begin?” With guidelines that run 350 pages, the whole process can seem opaque and overwhelming, so part of our job is to map out the accreditation journey and break it down into a series of manageable steps.
Kelly Conley is the perfect guide for that journey. Prior to joining Ascendient as a Senior Manager, Kelly worked in public health for more than 25 years, and more than a decade ago, she began volunteering as a PHAB site visitor – giving her own time to help other help departments get through the process successfully.
It’s not every day that you get to pick the brain of a PHAB volunteer site visitor, so we had a number of questions about her experience in the field and the things she’s seen over the years.
RJ: How long have you been a PHAB volunteer site visitor, and why did you think it was important to make that commitment?
KC: Many reasons come to mind about why I decided to apply to become a voluntary site visitor over 10 years ago. Initially it started out as an opportunity for professional growth and development. Michigan has a state accreditation process, but national accreditation was a new opportunity to further improve the services and capabilities within our health department. Not only was I looking to further my understanding of the national accreditation process and standards, but I am passionate about making things better, even if that is one more audit or an accreditation review process. When I experienced firsthand all the foundational improvements that becoming accredited did for our local health department, I wanted to be able to give back to the process and help provide evaluation and feedback to other local health departments around the country. When one does better, we all do better.
RJ: When you're on site with a local health department, how do you view your role -- as a coach, mentor, analyst, critic, cheerleader? Maybe a combination?
KC: The role of a site visitor has changed over the years, with the most changes happening mid and post pandemic. PHAB has specific requirements that site visitors are only reviewing the departments’ submitted and required documentation against the minimum PHAB standards. Evaluating all the evidence after written reviews and observations, site visitors then provide our interpretation of the documentation and decide if they conform to the measure. Voluntary site visitors are truly just local health department peers who utilize our expertise in this evaluator/analyst type role.
There used to be a team of three local health department staff that went on a three-day site visit to a department seeking to become PHAB accredited. However, most recently, site visits were completed virtually throughout the pandemic and have since evolved into a hybrid/shortened visit. There is still the documentation review component in advance of the site visit, but the team now consists of only two local health department staff and the PHAB Accreditation Specialist. This change has provided more consistency in the process and the PHAB staff provide more support throughout the process from beginning to end. These changes have made the advance work and the one-day site visit more manageable and efficient for everyone involved – PHAB, site visitors and the local health department staff.
"When you become recognized as a leader within your community, local collaboration increases, and you can provide more efficient and effective public health interventions." – Kelly Conley
RJ: What's the core purpose of a site visit? Presumably, the LHD has already invested many hours in gathering data and preparing documents, so why is an in-person visit even needed?
KC: The site visit is the final step in the evaluation and is scheduled for two to three months after the review process of all submitted documentation to support each PHAB Standard and Measure has concluded. Typically, the written review provides enough support to determine if the department meets the accreditation guidelines or not. However, some things can only be observed in person such as signage and branding, observation of the actual facility for accessibility, security, and safety.
In addition, the site visit provides an opportunity to meet individually with the department’s governing body, key leadership staff and community partners. All these meetings are facilitated by the lead site visitor and are used to gather additional information and they provide context and verification for the team to make our recommendation if the department meets or conforms to all the PHAB standards.
RJ: What is the experience like for as a site visitor? Can you describe the typical duration or intensity? What's your workday like? Are you following a strict protocol or kind of seeing how things unfold?
KC: The day is busy with multiple meetings with internal and external staff. The site visit team also has sessions where we further discuss our findings and work on final reports. We often identify a few key themes to share with the department at the conclusion of the site visit and these are also listed in the final narrative report. Being that it is only one day, it is very busy, but provides an opportunity for open communication and time to validate our findings from written submissions. We have very intentional and robust discussions as a site visit team regarding each of the measures. There are some strict protocols for confidentiality and site visitor roles, but they are all to make sure that every site visit is thorough and a great use of everyone’s time throughout the full process.
RJ: What's the first thing you say when you arrive at a new site? I'm sure the local professionals have a range of doubts or misgivings, so how do you kind of level-set or put their minds at ease?
KC: I have served several times as the site visit lead. I always share that we commend them for their hard work in preparation and thank them for everything they do for public health. I feel it is important to gain their trust, so I also share that we as site visitors have been on their side of the table.
We want to set their minds at ease. I tell them that we are not the ones who will make the final determination of their department becoming PHAB accredited or not, but rather that decision comes from the actual PHAB Board. The site visit team is just here to gather information, speak with staff and community members about the department, and confirm the documentation of everything that we have been reviewing. We provide a schedule of all meetings and times in advance, so the departments are typically ready for us to come so that they can share and showcase all their hard work. It has been a pleasure to work with so many great health department staff over the years.
RJ: On the other side of the coin, what do you most often hear when you're leaving an assignment? Every LHD has some kind of expectation going in, but what do they tell you when it's done?
KC: Upfront we tell them that we will not share our results of the visit, nor give indications if they meet or do not meet any standard or measure. This takes the pressure off from the very beginning. We do share a few high-level observations such as areas of opportunity for improvement and greatest areas of strength. The department staff do like hearing this information, and our team gives them some things to consider and potentially work on.
Overall, they have always been very appreciative of our time, even though we do not give any recommendations or other insights. We are there to listen and observe and we let the department showcase all their hard work – I do think it is a relief when we leave, but that is often just the beginning of the work to come in public health.
RJ: Finally, any advice or insights for a health department leader who may be considering PHAB accreditation - but isn't entirely sure of the cost-benefits calculus?
KC: First and foremost, it will undoubtedly improve the services within your department and the health of the community you serve. Accreditation helps ensure that you are providing high-quality services by adhering to nationally recognized standards and best practices in public health.
Secondly, in the local health department where I worked for many years, becoming nationally accredited demonstrated our department’s commitment to accountability and transparency in its operations, which also helped to build trust and stronger relationships with community partners and stakeholders. When you become recognized as a leader within your community, local collaboration increases, and you can provide more efficient and effective public health interventions.
Lastly, accreditation can strengthen a health department's position when applying for grants and other funding opportunities, as you are demonstrating a commitment to excellence and continuous quality improvement. Not only offering more opportunities to remain sustainable through funding and partnerships, but your department will be more efficient and have practices in place for a stronger workforce with increased professional development and recognition opportunities. Being nationally accredited will put you among an elite group of other nationally recognized state and local health departments, demonstrating your dedication to meeting high standards and improving the health of our nation.
