Learn About Public Health Accreditation

To successfully achieve accreditation, it is important for leadership to understand the requirements and commit to the process first. To learn about accreditation and determine readiness to apply, the following informational resources offer answers to everything a health director may need to know when considering accreditation, including the process requirements, costs, and benefits. The following resources exist to assist with learning about PHAB and assessing feasibility.

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PHAB Online Orientation

PHAB has developed an online orientation to provide a solid overview of public health accreditation.

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PHAB Online Orientation

Public Health Infrastructure

PHAB Readiness Checklists

PHAB readiness checklists are available for local health departments here.

Public Health Infrastructure

PHAB Readiness Checklists

Accreditation Beta Test QI Efforts (2009-2010)


Accreditation Beta Test
In 2009 and 2010, The Public Health Accreditation Board (PHAB) conducted a beta test of its voluntary national public health accreditation program. Thirty health departments, including 19 local health department sites, took part. The goal of the public health accreditation program is to improve and protect the health of every community by advancing the quality and performance of public health departments. The 30 public health departments participated represented a diverse cross-section of health departments and varied in size, structure, population served, governance, geographic region, and degree of preparedness for accreditation.

Quality Improvement Projects

Each site conducted a quality improvement (QI) project, with NACCHO providing technical assistance to the local sites. Sites identified areas for their QI projects based on the PHAB self assessment tool and used QI techniques to identify ways to improve the process or focus area selected. LHDs used the Plan-Do-Check-Act (PDCA) process for their projects.

For a general description of each site’s project, click here. The links below contain final reports compiled by the local beta test sites, their PDCA process storyboards and additional graphs, charts and materials.


Austin/Travis County Health and Human Services Department (TX)

Full-Time Equivalents (FTEs): 475

Population Served: 1,008,000
QI Techniques: Prioritization Matrix, Root Cause Analysis, Force Field Analysis, Pareto Chart

Project Overview: Austin/Travis County Health and Human Services Department (A/TCHHSD) is located in Austin, TX, and serves the urban, suburban, and rural populations in the district. A/TCHHSD was a beta test site for the Public Health Accreditation Board’s (PHAB) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. A/TCHHSD’s goal was to strengthen internal departmental communications by developing and disseminating a departmental resource packet that provides information about internal and external services.

Austin/Travis County Health and Human Services Department QI Project Final Report
Austin/Travis County Health and Human Services Department Storyboard
Austin/Travis County Health and Human Services Department Appendices


Township of Bloomfield Department of Health & Human Services (NJ)

Full-Time Equivalents (FTEs): 15

Population Served: 53,000

QI Techniques: Process Mapping

Project Overview: The Township of Bloomfield Department of Health and Human Services (BDHHS) is located in northeast New Jersey and serves the suburban and urban population of Bloomfield and Caldwell. BDHHS was a beta test site for the Public Health Accreditation Board’s (PHAB) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. BDHHS’s goal was to address the low turnout at its biannual Rabies clinics.

Township of Bloomfield Department of Health and Human Services QI Project Final Report
Township of Bloomfield Department of Health and Human Services Storyboard
Township of Bloomfield Department of Health and Human Services Appendices


Cabarrus Health Alliance (NC)

Full-Time Equivalents (FTEs): 200

Population Served: 175,000

QI Techniques: Root Cause Analysis, Process Mapping

Project Overview: The Cabarrus Health Alliance (CHA), an independent governmental entity, is located in central North Carolina and serves a suburban, urban and rural population of 175,000. CHA was a beta test site for the Public Health Accreditation Board’s (PHAB) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. BDHHS’s goal was to address the area of verification and documentation of RN licensure with policy and procedure clarification and staff education.

Cabarrus Health Alliance QI Project Final Report
Cabarrus Health Alliance Storyboard
Cabarrus Health Alliance Appendices


Carson City Health and Human Services (NV)

Full-Time Equivalents (FTEs): 25

Population Served: 58,000

QI Techniques: Root Cause Analysis, Bone Diagram, Process Mapping

Project Overview: Carson City Health and Human Services (CCHHS) serves an urban and rural population. CCHHS was a beta test site for the Public Health Accreditation Board’s (PHAB’s) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. CCHHS’s goal was to improve lab auditing findings by developing and refining a quality assessment tool for regular internal audits of the on-site laboratory.

Carson City Health and Human Services QI Project Final Report
Carson City Health and Human Services Storyboard
Carson City Health and Human Services Appendices


Central Valley Health District (ND)

Full-Time Equivalents (FTEs): 22

Population Served: 22,000

QI Techniques: Process Mapping

Project Overview: The Central Valley Health District (CVHD) serves two predominantly rural counties in North Dakota. CVHD was a beta test site for the Public Health Accreditation Board’s (PHAB’s) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. CVHD’s goal was to improve data collection for environmental health services.

Central Valley Health District QI Project Final Report
Central Valley Health District Storyboard


Coconino County Health Department (AZ)

Full-Time Equivalents (FTEs): 132

Population Served: 135,000

QI Techniques: Prioritization Matrix, Process Mapping

Project Overview: The Coconino County Health Department (CCHD) is located in North Central Arizona and primarily serves a population of more than 135,000. CCHD was a beta test site for the Public Health Accreditation Board’s (PHAB’s) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. CCHHS’s goal was to increase staff understanding of public health through in-service training.

Coconino County Health Department QI Project Final Report
Coconino County Health Department Storyboard
Coconino County Health Department Appendices


Comanche County Health Department (OK)

Full-Time Equivalents (FTEs): 58

Population Served: 112,000

QI Techniques: Root Cause Analysis, Prioritization Matrix, Tree Diagram, Radar Chart, Process Mapping

Project Overview: The Comanche County Health Department (CCHD) is located in southwest Oklahoma and serves a mixed urban and rural population which includes three tribes and the residents of a major military post. CCHD was a beta test site for the Public Health Accreditation Board’s (PHAB’s) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. CCHD’s goal was to improve community sector participation in the community health assessment process.

Comanche County Health Department QI Project Final Report
Comanche County Health Department Storyboard
Comanche Count Health Department Appendices


Deschutes County Health Services (OR)

Full-Time Equivalents (FTEs): 56

Population Served: 158,000

QI Techniques: Root Cause Analysis, Process Mapping

Project Overview: Deschutes County Health Services (DCHS) is located in central Oregan and serves a primarily rural population along with three cities. DCHS was a beta test site for the Public Health Accreditation Board’s (PHAB) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. DCHS’s goal was to improve immunization data entry timeliness in clinics.

Deschutes County Health Services QI Project Final Report
Deschutes County Health Services Storyboard
Deschutes County Health Services Appendices


Franklin County Health Department (KY)

Full-Time Equivalents (FTEs): 70

Population Served: 50,000

QI Techniques: Prioritization Matrices, Fishbone Diagram, Process Mapping

Project Overview: Franklin County Health Department (FCHD) serves Kentucky’s capital, Frankfort, and its surrounding urban, suburban and rural areas. FCHD was a beta test site for the Public Health Accreditation Board’s (PHAB’s) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. FCHD’s goal was to streamline repair request process to ensure clean, safe, accessible and secure facilities.

Franklin County Health Department QI Project Final Report
Franklin County Health Department Storyboard
Franklin County Health Department Appendices


Hennepin County Human Services & Public Health Department (MN)

Full-Time Equivalents (FTEs): 2720 (including human services)

Population Served: 1.1million

QI Techniques: Fishbone Diagram

Project Overview: Hennepin County Human Services and Public Health Department (HCHSPHD) serves Minnesota’s largest county, which includes the Minneapolis/St. Paul metro area. HCHSPHD was a beta test site for the Public Health Accreditation Board’s (PHAB’s) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. HCHSPHD’s goal was to improve the numbers of homeless residents using the homeless health clinic.

Hennepin County Human Services and Public Health Department QI Project Final Report
Hennepin County Human Services and Public Health Department Storyboard
Hennepin County Human Services and Public Health Department Appendices


Mahoning County District Board of Health (OH)

Full-Time Equivalents (FTEs): 51

Population Served: 175,000

QI Technique: Process Mapping

Project Overview: The Mahoning County District Board of Health (MCDBoH) is the 12th largest of Ohio’s 130 health departments. MCDBoH was a beta test site for the Public Health Accreditation Board’s (PHAB’s) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. MCDBoH’s goal was to reduce the time it takes for conducting septic and well inspections generated by real estate transactions.  

Mahoning County District Board of Health QI Project Final Report
Mahoning County District Board of Health Storyboard
Mahoning County District Board of Health Appendices


Miami-Dade County Health Department (FL)

Full-Time Equivalents (FTEs): 884

Population Served: 2.4 million

QI Techniques: Root Cause Analysis, Process Mapping, Pareto Chart

Project Overview: The Miami-Dade County Health Department (MDCHD) is part of Florida’s centralized system and is the only health department serving metro Miami’s large population. MDCHD was a beta test site for the Public Health Accreditation Board’s (PHAB’s) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. MDCHD’s goal was to decrease the percentage of clients in the Family Planning clinic with wait times greater than two hours by improving the scheduling process. 

Miami-Dade County Health Department QI Project Final Report
Miami-Dade County Health Department Storyboard
Miami-Dade County Health Department Appendices


Northampton Health Department and Quabbin Health District (MA)

Full-Time Equivalents (FTEs): 3.5 & 4.5 (respectively)

Population Served: 29,000 & 25,000

QI Techniques: Root Cause Analysis, Process Mapping

Project Overview: The Northampton Health Department (NHD) and the Quabbin Health District (QHD) serve two small communities in Massachusetts. NHD and QHD acted together as a beta test site for the Public Health Accreditation Board’s (PHAB’s) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. Their joint goal was to address citizen complaints about environmental health issues by consistently obtaining customer satisfaction data and educating consumers about LHD functions.

Northampton Health Department & Quabbin Health District QI Project Final Report
Northampton Health Department & Quabbin Health District Storyboard
Northampton Health Department & Quabbin Health District Appendices


Norton County Health Department (KS)

Full-Time Equivalents (FTEs): 8

Population Served: 5,600

QI Techniques: Process Mapping

Project Overview: The Norton County Health Department (NCHD) serves a very small population in northwest Kansas. NCHD served as a beta test site for the Public Health Accreditation Board’s (PHAB’s) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. NCHD’s goal was to increase staff knowledge of disease investigation through training.

Norton County Health Department QI Project Final Report
Norton County Health Department Storyboard
Norton County Health Department Appendices


City of Portland, Public Health Division (ME)

Full-Time Equivalents (FTEs): 89

Population Served: 276,000

QI Techniques: Root Cause Analysis, Process Mapping, Fishbone Diagram, Prioritization Matrices

Project Overview: The City of Portland’s Public Health Division (CPPHD) serves an urban, suburban and rural population in Maine and is the only comprehensive public health department in the state. CPPHD was a beta test site for the Public Health Accreditation Board’s (PHAB’s) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. CPPHD’s goal was to decrease no-show rates at an HIV clinic by enhancing the process for updating patient information update forms.

City of Portland, Public Health Division QI Project Final Report
City of Portland, Public Health Division Storyboard
City of Portland, Public Health Division Appendices


Public Health Solutions District Health Department (NE)

Full-Time Equivalents (FTEs): 11

Population Served: 38,000

Project Overview: Public Health Solutions District Health Department (PHS), a newly formed health agency, serves a rural population in Nebraska. PHS was a beta test site for the Public Health Accreditation Board’s (PHAB’s) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. PHS’s goal was to develop and implement a comprehensive new employee orientation process.

Public Health Solutions District Health Department QI Project Final Report
Public Health Solutions District Health Department Storyboard
Public Health Solutions District Health Department Appendices


County of San Diego Health and Human Services Public Health Services (CA)

Full-Time Equivalents (FTEs): 524

Population Served: 3.1 million

QI Techniques: Fishbone Diagram, Process Mapping

Project Overview: The County of San Diego Health and Human Services Public Health Services (SDHHS) serves the urban, suburban, and rural populations of metro San Diego. SDHHS was a beta test site for the Public Health Accreditation Board’s (PHAB’s) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. SDHHS’s goal was to adapt a formal language interpretation policy for public health centers and clinics and increase staff knowledge of providing services to non-English speaking clients.

County of San Diego Health and Human Services Public Health Services QI Project Final Report
County of San Diego Health and Human Services Public Health Services Storyboard
County of San Diego Health and Human Services Public Health Services Appendices


Tioga County Health Department (NY)

Full-Time Equivalents (FTEs): 54

Population Served: 51,000

QI Techniques: Root Cause Analysis, Process Mapping

Project Overview: The Tioga County Health Department (TCHD) is located in southwestern New York and serves a rural population. TCHD was a beta test site for the Public Health Accreditation Board’s (PHAB’s) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. TCHD’s goal was to improve the timeliness of communications between Environmental Health and Clinical Divisions regarding human rabies exposures.  

Tioga County Health Department QI Project Final Report
Tioga County Health Department Storyboard
Tioga County Health Department Appendices


Tooele County Health Department (UT)

Full-Time Equivalents (FTEs): 44

Population Served: 59,000

QI Technique: Process Mapping, Root Cause Analysis, Fishbone Diagram

Project Overview: The Tooele County Health Department (TCHD) is located in adjacent to Salt Lake City in UT and serves a predominantly rural population. TCHD was a beta test site for the Public Health Accreditation Board’s (PHAB’s) voluntary national accreditation program in 2010. As part of the beta test process, sites completed a QI project to address an area identified through their self-assessment. TCHD’s goal was to review, update and train employees on departmental internal policies.

Tooele County Health Department QI Project Final Report
Tooele County Health Department Storyboard
Tooele County Health Department Appendices

Guide to Communication about Performance Improvement

As local health departments engage in performance improvement activities, including quality improvement, community health improvement planning, and accreditation preparation, they may encounter challenges communicating about the benefits of these activities. These challenges can be internal with agency leads and staff, or external with governing entities, community partners, and the public. To help LHDs overcome these challenges, NACCHO has developed a Guide to Communicating about Performance Improvement.

This easy-to-read guide is designed to help LHDs share their performance improvement stories with key audiences. The guide uses a step by step approach to help LHDs craft tailor-made messages and strategies to help build support and understanding of performance improvement with staff members before reaching out to governing bodies and the media.

Download the Guide to Communicating About Performance Improvement

In order to access the guide, you must download it through NACCHO's Toolbox by clicking the link above. NACCHO's Toolbox is free and open to the public, but you must register for a NACCHO account to download items. Instructions for creating an account are available during the download process

Access the Performance Improvement Communication Worksheets

Additional resources related to communicating about performance improvement

Public Health 101 PowerPoint

These customizable presentations can help LHDs educate their staff or governing entity about the basics of public health and the importance of accreditation.

Electronic Training for LGEs
These short videos can be used to introduce LGEs to some important accreditation concepts.

NACCHO’s LHD Communications Resources
NACCHO has a number of resources to help LHDs engage in effective communications efforts. Topics include communications planning, media outreach, community engagement, and branding.

For more information, contact accreditprep@naccho.org.