The magazine of the UW School of Public Health

Accreditation as Opportunity for Organizational Empowerment

By Lindsey Krywaruchka, Denny Haywood, Jane Smilie

September 2011 was a landmark month for the public health system in the United States. The Public Health Accreditation Board (PHAB) released the final version of its accreditation standards for state, local, and tribal public health departments. Public health departments that wanted to participate in the voluntary accreditation process could use these standards to not only apply for accreditation but improve overall performance. This broader vision is expressed by PHAB on their website: “Accreditation through PHAB provides a means for a department to identify performance improvement opportunities, to improve management, develop leadership, and improve relationships.”

Although PHAB created the standards for accreditation, each health department that uses them is responsible for designing processes to measure and document their organization’s performance against the standards. This responsibility provides an opportunity for organizations to create systems, which, in addition to being useful for accreditation, can improve overall leadership and management.

After the PHAB standards were released, the Public Health and Safety Division of the Montana Department of Public Health and Human Services committed to the accreditation process. The process is currently led by a management team that is staffed by the Division’s executive leadership team. The Division Administrator leads the management team.

To create an action plan, the management team first completed a review of the Division’s perceived conformity with the PHAB standards. While the management team felt strongly that the work being done by Division staff was of high quality, the team struggled to consistently quantify this performance across the entire Division because evaluation and management processes varied from unit to unit. After some deliberation, the team prioritized the creation of a standardized management system called the integrated management system (IMS). The IMS would employ methods that had been successfully used in other organizations, and the team hoped the system would give all Division employees the opportunity to fully contribute their skills and expertise to the accreditation process.

The IMS would be guided by these principles:

  • First and foremost, the system must manage work to achieve improvements in the health status of Montanans;
  • The system must be developed with input from Division staff, be user-friendly, and not create unnecessary burdens or bureaucracy;
  • Key components should include a standard cause-and-effect logic model, a standard work plan, and a regular system of reporting progress for each and every program within the Division; and,
  • The system would enable all staff to lead because it would give all Division staff a role to play in the leadership process.

Building an Integrated Management System

The first phase of building an IMS was to pilot the process within one program within the Division. Throughout the pilot, the management team solicited feedback from program staff to assure the process was viewed as beneficial and not simply more paperwork.

The process began with a facilitated work session. Program staff answered questions such as “What health outcomes are you trying to achieve?” and “What work is being done to achieve those outcomes?” Answers to these questions identified core activities. (The Division defines a core activity as “a discrete unit of work with a common purpose—a one-time project or continual work process that requires a work plan.”) A single program in the Division can be responsible for multiple core activities.

From this work, staff created a program logic model. The logic model created explicit, agreed-upon linkages between the core activities of the program, the desired outcomes for each core activity, and ultimately the health outcomes the program was attempting to affect. In addition, the logic model showed how the work of the program aligned with the Division’s strategic goals. Working from the logic model, staff then used a standard work plan template to develop a work plan for each core activity.

After completing the pilot project with one program, all programs within the Division’s Chronic Disease Prevention and Health Promotion Bureau went through this process. During this second phase of IMS implementation, 12 programs participated, resulting in 12 standardized logic models and 84 work plans. After phase two was completed, the management team met with the program managers who had been using the IMS. Program manager feedback was positive and cited the benefits of a standardized approach to planning, tracking, and evaluating their work.

As of this writing, implementation of the IMS throughout the entire Division is 80 percent complete. It is projected that the Division will submit its accreditation application in March 2013.

Core Activities

Early Stage
Cancer Detection

Maintain Cancer
Data Systems

Goal: Age and income eligible
Montanans have access to
breast, cervical, and colorectal
cancer screening.
Goal: Complete and quality
cancer data are readily available
  • Quarterly number of women screened for breast and cervical cancers.
  • Quarterly number of men and women screened for colorectal cancer.
  • Quarterly number of American Indian women screened for breast and cervical cancers.
  • Annually achieve NAACCR Gold Certification for data quality, completeness, and timeliness.
  • Annual percent of breast and cervical screening data (MDE data) that meets all 11 core performance indicators.

so that —>


Cancer Program
Goal: Fewer Montanans experience late stage cancer and fewer Montanans die of cancer.
  • Biannual percent of Montanans who are up-to-date with colorectal cancer screening. Data source: BRFSS
  • Biannual percent of Montanans who are up-to-date with breast cancer screening. Data source: BRFSS
  • Biannual percent of Montanans who are up-to-date with cervical cancer screening. Data source: BRFSS

Leading with an Integrated Management System

The IMS manages work and tracks performance across the Division. When it is fully in place, the system will equip upper-level managers, as well as frontline staff, to lead by keeping outcomes in mind as they perform day-to-day work. Program staff can see their contributions not only to the work of their program, but also to the overall outcomes of the Division. The result is a system of leadership that begins with the management team setting the strategic direction for the Division and cascades down through clearly defined operational plans developed by all Division program staff.

Regular review of progress, as it is defined and charted by the IMS, is essential for this system to work. The Division’s management team has created a schedule for this review and hopes that this process will give all staff the opportunity to

  • facilitate dialogue between program staff and management at all levels;
  • take a structured “time out” to identify and resolve operational performance problems early on;
  • proactively remove barriers to performance or change direction if needed; and
  • ensure high productivity and continuous quality improvement.

Accreditation provides an opportunity for public health agencies to improve performance. Building an IMS to standardize and track performance not only supports accreditation standards but builds high performance and shared leadership throughout public health organizations.


Lindsey Krywaruchka, BSBA, is the Coordinator for the Office of Public Health System Improvement in the Public Health and Safety Division of the Montana Department of Public Health and Human Services.

Denny Haywood, MBA, is a Performance Management Consultant for the Office of Public Health System Improvement at the Montana Department of Public Health and Human Services.

Jane Smilie, MPH, is the Administrator of the Public Health and Safety Division of the Montana Department of Public Health and Human Services.