The New York State Department of Health (NYSDOH) in 2014 became one of the first large state health departments to be awarded accreditation through the Public Health Accreditation Board (PHAB). The department supports a broad range of services, policies, research, and regulatory functions to protect and promote the health of more than 19 million New Yorkers, and accreditation is a testament to the department’s high level of performance. The pursuit of accreditation helped NYSDOH implement a more deliberate approach to performance management and quality improvement (PM/QI) within its own programs. It also led to new collaboration with local health departments (LHDs), and the results have been outstanding.
In 2013-2014, public health law was amended to add an annual $1 million appropriation to support performance improvement in LHDs. With the new PM/QI capacity and expertise that was concurrently being developed through the accreditation process, the department designed a voluntary performance incentive program for LHDs that defined specific and measurable performance goals, and then distributed monetary awards to participating LHDs that achieved the goals. In the program’s first year, the department set communicable diseases as the area of focus, and then defined performance goals pertaining to timeliness and completeness of disease investigations.
In addition to funding, the program featured data analysis and reporting by NYSDOH, provision of technical assistance, and peer learning around best practices and process improvements. The accreditation process had taught us that communicating expectations and creating and supporting a learning organization would be essential to the success of this performance improvement initiative. Participants later pointed to these collaborative components as being critical to their success in the program, and to sustaining their improved performance after the program’s conclusion.
LHD investigations of suspected or confirmed cases for over 60 different reportable communicable diseases were evaluated. The program categorized the diseases by severity into three maximum response time categories, and set specific goals for their investigation completeness. The 57 LHDs that participated all achieved significant timeliness and completeness improvements at the end of the year. By severity category, 100%, 99%, and 99% of investigations were timely, as compared to 88%, 86%, and 83% at baseline. Moreover, 100%, 99%, and 98% met their respective completeness targets, as compared to 90%, 74%, and 33% at baseline. Based on these results, each participating LHD received state aid awards ranging from $12,000 to $30,000, depending on population size.
The participating LHDs made the incentive program a success by exceeding expectations, and NYSDOH has continued this collaborative approach to performance improvement. In Year 2, the program focused on sexually transmitted diseases reporting and evidence-based treatment, and on environmental health inspections in Year 3. Year 4 of the initiative will reward LHDs that demonstrate conformity with seven PHAB measures associated with chronic disease prevention with the goal of strengthening the capacity of LHDs to promote chronic disease through policy and system changes, as well as advance the Prevention Agenda, New York’s state health improvement plan. Just as important, these activities will support accreditation readiness among a growing number of interested LHDs.
The New York State Department of Health was awarded national accreditation through the Public Health Accreditation Board on Sept. 16, 2014.
About the authors: Sylvia Pirani is Director of the Office of Public Health Practice at New York State Department of Health. Contact her at 212-417-4216, or via email at [email protected]. Christopher F. Davis is a Research Specialist in the Office of Public Health Practice at the New York State Department of Health, and Isaac H. Michaels is a Health Program Coordinator in the Office of Public Health Practice at the New York State Department of Health.