Using Public Health Accreditation (PHAB) Standards to Improve Efficiency and Effectiveness in A Local Health Department (Bourbon County, Kentucky)

Objectives: Small and rural local health departments face unique challenges in maintaining their operations amongst budget cuts. Accreditation of local health departments by the Public Health Accreditation Board (PHAB) has been identified as a strategy to help struggling health departments improve their efficiency and effectiveness. These health departments may be able to enjoy the benefits of accreditation even without ultimately achieving it by deliberately aligning themselves with PHAB standards. Methods: This capstone report presents a case study of the Bourbon County Health Department (BCHD). Using PHAB accreditation standards as a playbook, the public health director (PHD) reorganized BCHD to focus on population health, cut staff positions, and convinced a reluctant board and fiscal court to raise taxes while shifting away from the provision of clinical services and emphasizing essential public health services. Results: BCHD now provides its community with all ten essential public health services with a staff of twelve full-time and two part-time employees. The health department is now financially solvent, finishing fiscal year 2015 with a budget surplus of $110,781.20 and, as of September 2015, reserves of $331,842.25. Conclusions: Deliberate alignment with PHAB standards and guidance may help improve operations and financial solvency in small health departments. Struggling small health departments should explore the option of reducing or eliminating clinical services. PHAB may wish to consider adopting a tiered accreditation system using its existing standards to give small health departments a greater chance of achieving formal accreditation and the commensurate benefits