The State of Accreditation Readiness in Georgia: A Case Study

Background: Georgia’s public health districts first began exploring the idea of national public health accreditation in 2008 when Cobb & Douglas Public Health included accreditation in their strategic plan. In May 2015, Cobb & Douglas Public Health was the first Georgia public health district to achieve national accreditation status. This article discusses the current state of accreditation readiness in Georgia and explores strengths and barriers to accreditation. Methods: This study utilized a case study approach in order to examine PHAB accreditation efforts in Georgia within a reallife context. Data came from three sources: nine Accreditation Readiness Assessments, a PHAB Pre-Application Technical Assistance Survey, and state-wide Accreditation Readiness Survey. Results: The Accreditation Readiness Assessments resulted in several lessons learned about common strengths and barriers to accreditation. Strengths included a dedicated staff and supportive Boards of Health. Barriers included accreditation fees and a lack of personnel time. The PHAB Pre-application TA Survey revealed that the majority of those surveyed would recommend TA to other agencies pursuing PHAB accreditation (91%). The Accreditation Readiness Survey revealed that 14 of 18 GA public health districts are either PHAB accredited (1 district), actively pursuing PHAB accreditation (2 districts), or planning to apply (11 districts). This includes 116 of the 159 Georgia counties (73%). Conclusions: The results of this case study show that 72% of Georgia’s public health districts are engaged in accreditationrelated activities. This includes activities such as accreditation readiness assessment, community health assessment, QI council and plan development, strategic planning, and policy review

Health Districts as Quality Improvement Collaboratives and Multi-Jurisdictional Entities

Research Objective: The Georgia Public Health PBRN assessed the utility of the Multi-county Health District as a structured Quality Improvement Collaborative (QIC), and as multi jurisdictional entities for purposes of meeting standards for accreditation by the Public Health Accreditation Board. Data Sets and Sources: Data were collected from online surveys followed up with phone interviews or paper surveys to maximize participation. A newly developed clinical care QIC instrument (Schouten et al, 2010) was modified to collect data with a revised focus on QICs for public health. We retained QI culture constructs in the instrument while shifting the focus from healthcare to public health essential services related to accreditation standards. Study Design: Data was collected from a purposeful sample of local public health key informants in Georgia who were identified by the District Directors’ office as local key informants. Invitations Key informants included county and district staff and county board of health members. Analysis: Psychometric testing of the QIC assessment instrument included tests for validity and reliability. Census-based and self-reported demographic characteristics were used to compare responses. Principal Findings: Strong consensus emerged across various constituencies that Districts were critical for local public health to provide essential services. Key opinion leaders from both the rural and non-rural counties agreed that the Districts were important. Conclusion: Regionalization using Georgia Districts has major potential for supporting QI and meeting quality assurance standards associated with accreditation. Implications for Field of PHSSR: Accreditation has the potential to substantially clarify and enhance the role of public health in the 21st century. But local public health agencies, based on small municipality or county populations, are unlikely to possess and sustain capacity to meet the challenges of comprehensive essential services. Regionalization of local public health capacity is a critical emerging issue with the launching of public health accreditation

Clarifying and Expanding Concepts of Cross-Jurisdictional Sharing: Early Lessons Learned from Conducting QI with Georgia’s Health Districts

Research Objective: Assess the legal and organization cultural foundations for Cross-Jurisdictional Sharing (CJS) in support of local public health accreditation and QI in Georgia. Data Sets and Sources: Archival data (primarily state statutes), secondary data from previous qualitative comparative research on Deep South public health organization, secondary data from previous surveys, and oral interviews and written communication. Study Design: Primarily Qualitative design combining ethnographic and participatory research methods. Analysis: Qualitative Content analysis based on predetermined and emergent themes. Principal Findings: Georgia’s Health Districts have emerged as major CJS entities that support delivery of essential services and local public health (LPH) QI and LPH accreditation readiness, driven primarily by local organizational leadership and culture that is facilitated through enabling statutes in contrast to more top-down state-mandating statutes, regulations and directives. Conclusion: Georgia’s use of districts as multi-county public health entities serves as a primary structure for providing local public health services and has become a critical structure to address the looming demands for QI and accreditation, even though the statutes clearly establish the county as the primary local public health entity. Implications for the Field of PHSSR: This CJS structure to facilitate public health QI and accreditation in Georgia illustrates how agency cultures can emerge from local demands for economies of scale, more than formal policies generated at state level. This is a model that could be very important for advancing CJS in other regions of the country

Comparison of practice based research network based quality improvement technical assistance and evaluation to other ongoing quality improvement efforts for changes in agency culture

Abstract Background Public health agencies in the USA are increasingly challenged to adopt Quality Improvement (QI) strategies to enhance performance. Many of the functional and structural barriers to effective use of QI can be found in the organizational culture of public health agencies. The purpose of this study was to assess the impact of public health practice based research network (PBRN) evaluation and technical assistance for QI interventions on the organizational culture of public health agencies in Georgia, USA. Methods An online survey of key informants in Georgia’s districts and county health departments was used to compare perceptions of characteristics of organizational QI culture between PBRN supported QI districts and non-PBRN supported districts before and after the QI interventions. The primary outcomes of concern were number and percentage of reported increases in characteristics of QI culture as measured by key informant responses to items assessing organizational QI practices from a validated instrument on QI Collaboratives. Survey results were analyzed using Multi-level Mixed Effects Logistic Model, which accounts for clustering/nesting. Results Increases in QI organizational culture were consistent for all 10- items on a QI organizational culture survey related to: leadership support, use of data, on-going QI, and team collaboration. Statistically significant odds ratios were calculated for differences in increased QI organizational culture between PBRN-QI supported districts compared to Non-PBRN supported districts for 5 of the 10 items, after adjusting for District clustering of county health departments. Conclusions Agency culture, considered by many QI experts as the main goal of QI, is different than use of specific QI methods, such as Plan-Do-Study-Act (PDSA) cycles or root-cause analyses. The specific use of a QI method does not necessarily reflect culture change. Attempts to measure QI culture are newly emerging. This study documented significant improvements in characteristics of organizational culture and demonstrated the potential of PBRNs to support agency QI activities

Geographically touring the eastern bloc: British geography, travel cultures and the Cold War

This paper considers the role of travel in the generation of geographical knowledge of the eastern bloc by British geographers. Based on oral history and surveys of published work, the paper examines the roles of three kinds of travel experience: individual private travels, tours via state tourist agencies, and tours by academic delegations. Examples are drawn from across the eastern bloc, including the USSR, Poland, Romania, East Germany and Albania. The relationship between travel and publication is addressed, notably within textbooks, and in the Geographical Magazine. The study argues for the extension of accounts of cultures of geographical travel, and seeks to supplement the existing historiography of Cold War geography

Informatics Capacity of Georgia Public Health Agencies: Current Uses and Comparison With National Trends

This presentation was given during the Public Health Informatics Conference

Health Informatics Capacity and Meaningful Use Readiness of Georgia’s Health Districts

This presentation was given at the Georgia Public Health Association Annual Meeting

Health Informatics Capacity and Meaningful Use Readiness of Georgia’s Health Districts: Preliminary Findings

This presentation was given during the Public Health PBRN Monthly Virtual Meeting

FOR COPYING)

it available for inspection and circulation in accordance with its regulations governing materials of this type. I agree that permissions to quote from, to copy from, or to publish this thesis may be granted by the author or, in his/her absence, by the professor under whose direction it was written, or in his/her absence, by the Associate Dean, College of health and Human Sciences. Such quoting, copying, or publishing must be solely for scholarly purposes and will not involve potential financial gain. It is understood that any copying from or publication of this dissertation which involves potential financial gain will not be allowed without written permission of the author

Do LHDs with Better Health Informatics Capacity Have Better Preparedness Capacity?

This presentation was given at the Keeneland Conference for Public Health Systems and Services Research