Op Def Capacity Assessment
Tool Demonstration Site Project
The Operational Definition of a
Functional LHD: Perceptions
of Small and Rural Health
Departments & Implications
for Accreditation
GOAL: Help local health departments prepare for national
accreditation, and to inform the development of standards in the
national program.
Michael Meit, MA, MPH
Jessica Kronstadt, MPP
Tom Briggs, MPS
Alexa Brown
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Demonstration Site Project
Group
Funding Number Project
of Sites Period
Notes
Round 1
CDC
10
Interactive PDF selfassessment
Kansas
RWJF
21
Round 2
RWJF
56
•30 single LHDs
•25 LHDs in 5
collaboratives
•1 tribal health
program
11/200705/2008
Geographic Distribution of Sites
Regional aggregation of
self-assessment data
4/200811/2008
Online self-assessment
tool; collaboratives
aggregating selfassessment data
In total, 87 LHDs used the LHD self-assessment tool.
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NACCHO Scoring Tools
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NORC Evaluation
• In December 2007, NACCHO contracted with
NORC to conduct an evaluation of the
Operational Definition Prototype Metrics and
determine their relevance and importance for
accreditation.
• Specifically, NACCHO asked NORC to focus on:
Round 2
–
–
–
–
Round 1
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Usability (ease of use)
Clarity
Relevance of metrics to standards
Importance to voluntary national accreditation
process
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Findings Related to Health
Department Size
NORC Research Design
• Interviews on usability and clarity of metrics
– Round 1 & Kansas Demo Sites (n=6)
– Round 2 Demo Sites (n=12)
• Survey on usability and clarity of metrics
– All Demo Sites (n=83)
– Asked respondents to rate each indicator on 4point scale:
Very Easy to
Use
Somewhat Easy
to Use
Difficult to Use
Very Difficult to
Use
• Survey on relevance and importance of tool
on voluntary accreditation system
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Findings Related to Rurality of
Health Department
Essential Service
Rural (n=36)
Not Rural (n=38)
I
1.95**
1.46
II
1.49**
1.22
III
1.92**
1.45
IV
1.87**
1.43
V
1.86**
1.45
VI
1.77**
1.29
VII
1.85**
1.42
VIII
1.67**
1.25
IX
2.05**
1.53
X
2.12**
1.46
Essential Service
Small (n=28)
Not Small (n=46)
I
1.94**
1.56
II
1.51**
1.24
III
1.96**
1.51
IV
1.90**
1.50
V
1.96**
1.46
VI
1.87**
1.31
VII
1.98**
1.43
VIII
1.68**
1.32
IX
2.13**
1.59
X
2.18**
1.55
** p <0.01
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Qualitative Findings
• LHDs may not have adequate workforce to go
through the process of capacity assessment
(and therefore accreditation) or to meet all the
indicators.
– Low pay makes it difficult to recruit and retain an
adequate workforce.
– Small and rural health departments might face
challenges in building a qualified and certified
workforce.
– Even though an agency might have skilled and
knowledgeable workers, there are “not enough
bodies to do it all.”
** p <0.01
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Qualitative Findings
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Qualitative Findings
• Smaller LHDs might not have health planners,
statisticians, and epidemiologists on staff.
• Many rural LHDs are headed by nurses who
might not have the training on some complex
management issues that might facilitate the selfassessment process.
• Concern was expressed about standards that
required collaboration with academic institutions.
– There may not be universities easily accessible to
health departments in rural areas.
– “Research and academia are over my head.”
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• Small LHDs might need to rely on providing direct
services to generate revenue to meet local
needs. These LHDs have not followed public
health’s move away from direct services.
• Laboratory capacity, sophisticated disease
reporting systems, and health promotion
programs may be difficult.
• Rural LHDs may face other infrastructure
challenges, such as spotty cell phone coverage
that limits available modes of communication.
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Rural Public Health Accreditation
Conclusions
• Rural LHDs present a unique set of needs and
motivations for accreditation
• Inadequate fiscal and human resources
identified as major barriers
• Potential strategies for implementing a national
accreditation system included multi-level or
“tiered” approaches
• Educating HD staff and policy makers are key
strategies for rural LHD accreditation
• Accreditation can be used a tool to
communicate the functions of public health
• Funding and improved capacity and quality of
services were identified as top incentives
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Questions
Please contact:
Michael Meit, MA, MPH
Deputy Director
Walsh Center for Rural Health Analysis
NORC at the University of Chicago
4350 East West Hwy, Suite 800
Bethesda, MD 20814
PH: 301-634-9324
Fax: 301-634-9301
Email: meit-michael@norc.org
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