After 10 years of effort, and 10 binders-worth of paperwork, Needham’s public health department secured national accreditation from the Public Health Accreditation Board on Feb. 12.
This stamp of approval makes Needham the fourth, and smallest, public health department in Massachusetts to receive accreditation, alongside Boston, Cambridge and Worcester. Accreditation, a major milestone for any health department, confirms that Needham’s department meets the highest national standards and provides community members with quality public health.
Lynn Schoeff, the accreditation coordinator, received the news while on vacation and shared it with the board during their Feb. 27 meeting.
“It’s a really big deal that we are a small health department and are now accredited. I don’t think that’s happened anywhere else,” she said. “I’m very, very proud of the work we’ve done.”
Tim McDonald, director of Needham’s Health and Human Services, said his initial response to the news was relief.
“We’ve been working on it for so long with so many members of the staff, and it’s kind of permeated everything we do,” he said, noting that accreditation was set as a long-term goal in spring of 2016.
Ed Cosgrove, Needham’s Board of Health chair, emphasized that this has been his primary initiative for the past 10 years. Cosgrove, who has been a board member for 30 years, has been pushing to pursue accreditation. On hearing of their success, he said he was “beyond thrilled”.
“I felt that Needham stood a good chance to be a leader in the state in terms of local public health, and even on a regional basis,” said Cosgrove. “And the best way to do that was to be fully recognized as a fully professional, well-run department — and accreditation does that.”
“Tim McDonald and the other members of the board were behind it, and they fully were invested in it,” he added. “And they worked diligently to make it happen. And let me tell you, it was a lot of work.”
Needham’s public health department encompasses a nursing team, environmental health team, traveling meals program, emergency preparedness, epidemiology, substance use prevention, recovery coach services and a biosafety committee. As part of the accreditation process, the department had to examine, measure and document every procedure and every service provided.
Documentation, updating policies and standards, developing strategic plans, ensuring the training and development of professional staff, assessing transparency and accountability to the public, all took “enormous effort,” said Cosgrove. “We had to have policies in place for virtually everything you can think of.”
“For example, [we had to examine] restaurant inspections: how we did them, what kind of standards we had, what kind of training and standards we required for the inspectors to be able to do that inspection in a professional manner, the rules and regulations we were adhering to when we were making up our inspection protocols,” he said. “Everything had to be written down and documented and referenced.”
The process itself was valuable, McDonald said, and sets the department up for success in the future.
“If one of my public health nurses won the lottery and just decided, ‘OK, see you later, I’m not transitioning out, I’m just gone,’ we wouldn’t be left trying to figure out, ‘What did she do and how do we do it?’” he said. “There’s a solid base of knowledge and processes and protocols and procedures, everything you need to start doing the work. It’s always sort of the goal to do that, but I think accreditation made us do it all the time, for everything.”
Evaluators assessed quality, accountability and performance. Cosgrove said the assessors, who came from around the country (none from New England), were unfamiliar with the significance of systems like Town Meeting, and the need to work with Town Meeting to get initiatives approved. They were impressed with the educational background, training and dedication of staff, support from the town, and the department’s initiative in finding alternate sources of funding through grants, Cosgrove noted. Areas of weakness they identified included the department’s financial dependence on tax base and grants, as well as communication with the public and with state partners.
At points in the evaluation process, designed more for county departments than town departments, Needham’s status as a small-town department felt like trying to fit a square peg in a round hole, McDonald said.
“They’re like, ‘Show us your health department’s IT policy.’ [We said] Well, we have a town IT policy. They’re like, ‘That’s not the same thing.’ [We said], that’s the best we’ve got, we don’t have an IT function within our small department,” he explained.
McDonald credits Needham’s successful — and ambitious — accreditation to town resources and support from the board. The town, he said, provides an “embarrassment of riches” and resources such as a municipally funded epidemiologist that strengthen the public health department.
He added that constant prioritization from the board has allowed the department to secure grants from external organizations to support accreditation efforts.
“If you have a governing body that’s switching its priorities all the time, it’s hard to make sustained progress, especially on multi-year projects,” said McDonald. “So the commitment and steady prioritization by the Board of Health is certainly something we’re fortunate in Needham that we have.”
Accreditation for public health departments has a shelf-life of five years, after which they need to seek reaccreditation — a reality which McDonald is trying not to think too much about.
Initial accreditation was the most difficult obstacle, but maintaining accreditation standards will require more work. Annual reports, continued documentation noting changes or improvements, and evidence of ongoing effort (i.e. have policies been developed to improve cooperation with hospitals and other community partners, enhancing access to care) are all required.
If maintained, the gold star of accreditation could come with financial benefits in the future by serving as a “proxy” for grant funders and demonstrating that the quality of the department’s work has already been verified at a high level.
Cosgrove said the health department’s standards have been at accreditation-worthy levels for a long time, and will not change with the department’s new status. “But people working with us should be more confident in what we’re doing and what and why we’re saying what we’re saying in terms of compliance.”
“It’s not just us saying that, ‘We’re number one, hey!’” McDonald said. “National people took a look and said, ‘Yeah, you do really good work — hopefully [Needhamites] know and understand that the town invests a lot in municipal services, and the people who work for the town are accomplished professionals that work hard, and the services we provide are best in class.”
Save as PDF