The Quest For Exceptional Performance: A Crosswalk B .

to competitors. Government agencies may not have direct competitors for public health services; however, theydo compete with other agencies for funding, for staffing, and there may be some overlap in service offerings.These other agencies, therefore, may be identified as your competitors/ comparators. Moreover, hHealthdepartment customers are entire communities, and this distinction changes the complexion of some of thecrosswalk and the relevance of some of the customer focus to a focus on community partnerships andpopulation based efforts.The purpose of the Baldrige process is to push an organization to continuous improvement. No matter howmature the organization, questions will always emerge for which there is no adequate response. These are"opportunities for improvement" and provide the next steps in the journey of continuous improvement.Overview of Public Health Accreditation Board (PHAB)PHAB is the national accrediting organization for public health departments. A nonprofit organization, PHAB isdedicated to advancing the continuous quality improvement of state, local, tribal, and territorial public healthdepartments. PHAB is working to promote and protect the health of the public by advancing the quality andperformance of all public health departments in the United States through national accreditation. Its vision is ahigh-performing governmental public health system that will make us a healthier nation.Incorporated in May 2007, and with support from the Centers for Disease Control and Prevention and theRobert Wood Johnson Foundation, PHAB works closely with several organizations that represent the widevariety of public health departments and structures across the country. These partners include: the AmericanPublic Health Association, the Association of State and Territorial Health Officials, National Association of Countyand City Health Officials, the National Association of Local Boards of Health, the National Indian Health Board,the National Network of Public Health Institutes, and the Public Health Foundation. All these partnerorganizations share the common objective of assuring that health departments meet a set of standards andmeasures to continuously improve their performance.PHAB standards were developed with input from a comprehensive group of public health practitioners,including: a Standards Development Workgroup made up of representatives of state and local healthdepartments; a Tribal Standards Workgroup made up of representatives of Tribal, state, and local healthdepartments; various Think Tanks; and expert panels on such topics as governance and community healthassessments. The standards, measures, and required documentation were tested through an alpha test (deskreview by eight state and local health departments), vetting (three months of public comment), and a beta testwhere feedback was collected from 30 beta site health departments and 97 beta test site visitors. Finally,Version 1.0 of the standards, measures, and required documentation was adopted by the PHAB Board ofDirectors in May, 2011. PHAB conferred the first accreditation of state, local and tribal health departments inJune 2012.Accreditation demonstrates the capacity of the public health department to deliver the three core functions andthe ten essential services of public health as represented in Figure 2. The accreditation process and standardsare intended to be flexible and inclusive, accommodating many different configurations of governmental publichealth departments at all levels – Tribal, state, local, and territorial. Participants may include: centralized anddecentralized state health departments; health departments that are part of a larger governmental agency;health departments that may have environmental public health responsibility; regional and district healthdepartments; and health departments that share resources to fulfill particular functions. Public healthdepartment accreditation standards address the range of core public health functions and services that supportall programs and activities including, for example, environmental public health, health education, health

promotion, community health, chronic disease prevention and control, communicable disease, injuryprevention, maternal and child health, public health emergency preparedness, access to clinical services, publichealth laboratory services, management /administration, and governance. Thus, public health departmentaccreditation gives reasonable assurance that a health department has the capacity to fulfill its roles andresponsibilities.FIGURE 2: PUBLIC HEALTH CORE FUNCTIONS AND TEN ESSENTIAL SERVICES 1Despite public health’s critical roles, there has previously not been a national accreditation program to ensurepublic health departments’ quality of service. Accreditation is based on standards that health departments canput into practice to ensure that they are continuously improving services to keep their communities healthy.Accreditation will drive public health departments to continuously improve the quality of their services and theirperformance.Relevance/Benefits – Why do this?BaldrigeMany organizations ask, why would we want to do this? There is a lot of work involved over a number of yearsto deploy and improve a Baldrige-based management system. You may rightly feel that you already run a goodorganization, so why make the additional effort? Mr. Rulon Stacey, President of Poudre Valley Health System,2008 Baldrige Award Recipient, states "I honestly in my heart believe that because we participated in theBaldrige program and because it gave us that consistent feedback, there are people who are alive today whowouldn't have been had we not been so committed to the Baldrige process."1www.cdc.gov/nphpsp

Organizations that effectively implement Baldrige outperform those who do not. For example, a 2011 reportfound that health care organizations that have won Baldrige National Quality Awards or been considered for aBaldrige Award site visit, outperform other hospitals in nearly every metric used to determine the 100 TopHospitals, a national recognition given by Thomson Reuters. Commissioned by the Foundation for the MalcolmBaldrige National Quality Award, and conducted by Thomson Reuters, the report found that Baldrige hospitalswere six times more likely to be counted among the "100 Top Hospitals", which represent the top 3 percent ofhospitals in the United States, and that they statistically outperform the "100 Top Hospitals" on core measuresestablished by the U.S. Centers for Medicare & Medicaid Services. There have been numerous other studies withsimilar results. 2PHABPHAB has identified the following as the benefits of achieving accreditation status:High Performance and Quality ImprovementThe accreditation process will highlight strengths and also allow health departments to identify and addressareas for quality and performance improvement. Improvements to achieve and maintain public healthdepartment accreditation will lay the groundwork for improved health outcomes for the jurisdiction that thehealth department serves. Once a health department has begun the process of preparing for accreditation, itwill gain immediate benefits in the form of identified strengths and weaknesses and opportunities for qualityimprovement.Recognition, Validation, and AccountabilityAccreditation verifies the meeting of nationally adopted standards that are recognized as validating the servicesprovided by health departments. Public health department accreditation raises the visibility of public health tothe citizens who are served by the health department. It also provides accountability to the public, funders, andgoverning entities at all levels.Improved Communication and CollaborationWithin a health department, accreditation improves the understanding of the functions and roles of healthdepartment staff. It promotes staff understanding of how their job contributes to the health department’smission and the delivery of essential services. It encourages better communication and collaboration amongstaff, governing entities, partners, community members, and other external stakeholders.Potential Increased Access to ResourcesAccreditation highlights the capacity and capability of the health department. This may result in increasedopportunities for resources. These resources might include: Access to funding to support quality and performance improvement; Funding to address infrastructure gaps identified in the accreditation process; Opportunities to pilot new programs and processes; Streamlined application processes for grants and programs; and Acceptance of accreditation in lieu of other accountability processes.As the public health department accreditation movement grows and as PHABʼs accreditation system develops,other benefits may also 11.cfm

Performance Assessment ReviewBaldrigePerformance IndicatorsThe evaluation system is based on the applicant’s responses to the detailed Criteria questions. In responding tothe questions, applicants speak to four different evaluation factors. For the six categories that address process(1-6 in Figure 1), the factors are Approach, Deployment, Learning and Integration (ADLI). As a results-basedsystem, Baldrige seeks to validate improved outcomes. Therefore, the Baldrige "Results" section (Category 7,Figure 1) is evaluated according to Performance Levels, Trends, Comparisons and Integration (LeTCI). AppendixA contains a detailed explanation of ADLI and LeTCI.DocumentationOrganizations that apply for the Baldrige Award must submit an Eligibility Application as well as a 50 pageApplication plus a five page Organizational Profile. To be eligible to apply for the national award, an organizationmust first win its own state award (if available). These application documents provide the organization'sresponse to the Criteria questions regarding the seven categories. It is expected that the answers to the Criteriaquestions will reflect how the organization applies the evaluation factors (ADLI and LeTCI) as well. There is norequirement for submit

Baldrige Award for Excellence (Baldrige) and the Public Health Accreditation Board (PHAB) programs offer nationally-recognized programs to support and promote performance and quality improvement. This crosswalk tool describes the similarities, differences, and complementary nature of the Baldrige and PHAB programs, and is intended to facilitate the application process for health departments .