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Attachment 2: Joint BOWBOCC 04/01/04 Comments on the Public Health Task Force 2004 Recommendations Orange County Board of Health Orange County Health Department Management Team March 2004 Accreditation Recommendations Recommendation 2: Fund local health departments on a one -time basis in their year of accreditation. ➢ Funding of $50,000 per county is welcome, but not adequate on a one -time basis. The work of accreditation and more importantly a solid quality assurance /quality improvement program, requires a continuous, not a one -time effort. We believe that very few local departments have a department -wide, ongoing quality assurance program developed and in place. In alternate, non - accreditation years, these funds could be used for a position that would maintain an ongoing quality assurance program and provide assistance to ongoing monitoring efforts key to a health department's success in the community. Such a required quality improvement program would go a long way towards assuring that the services offered by a local health department are efficient AND effective. There should be established measures of what is acceptable performance on all activities within the ten essential services. The benchmarks should be specific, reasonably tolerant (without being "soft "), and recognize that there is no perfect system (i.e., no "all" or 100% standards as witnessed in some of the accreditation instrument categories). Intolerance leads to manipulation of data and other disingenuous actions on the part of those being assessed. An example might include an acceptable rate of on -time restaurant inspections, is it 85 %, 95% or 100 %? The accreditation instrument should be balanced on all division program areas. The current one is heavy on clinical, community and Board of Health areas. There is little emphasis on health education (other than in clinical and personal health community settings), environmental health, and other programs that individual counties may offer through the health department (animal control, waste control, etc.). Recommendation 3: Accountability Make sure all measures; whether Community Wellness Index or other, span all fields of local health department programs. There needs to be a direct link between the accreditation process and accountability since capacity does not automatically indicate outcomes or proper performance as it should not be axiomatic to assume one drives the other. There are many unanswered questions regarding the funding surrounding the allocation, potential uses and recurrence (if any). Recommendation 4: Funding to improve capacity ➢ One task that has not yet been accomplished, or perhaps stated is to define what the core SERVICES are that each local health department must provide. As an example, will all local health departments be required to provide as specified in state law or adopted standards: Page 1 L:\ROSIE\130H\0404 Joint Boc -Boh mtg\Attach 2 0304 BOH Public Health Task Force 2004 Recommendations.doc