Over the years I have spoken to many public health leaders who were proud of the daunting accomplishment of gaining accreditation for their agency. When the fickle cycle of business began fluctuating and many health departments began to struggle with less funding and a downward trend in both clinical services and visitors, some began looking at accreditation as a sliver bullet.

Many believed that gaining this designation would help reverse the trend mentioned above and might even help reverse low employee morale. What’s not to like about having a system that is peer reviewed and approved?

Just recently, I had a conversation with the administrator of a midwestern health department. She was candid about her experience with the process that really didn’t produce what was expected. She shared that after spending over $40,000 she was under the impression that her agency would qualify for two grants due to accreditation, that never happened.

You need protection

The other day I was interviewing another director of a health department and when the subject of accreditation came up, she joked that it reminded her of a movie scene where two thugs come into an inner-city grocery store and tell the clerk he needs protection. The clerk asks, “Why do I need protection?” and they clobber him. When they come back next week, he pays them for protection and the beatings stop.

A look at other health related fields and their experience with accreditation underscores my point. In a recent article in Managed Care, Chief Medical Officer Mark Kaufman, MD, who sits on a committee with the CEO and the COO as well as other physicians stated, “The cost, the resources it requires, and what edge it gives us in the marketplace are the kinds of things we talk about. The financial investment and the staff time spent on accreditation are significant, and those resources could be used in other ways, such as to pursue service and clinical care initiatives.”

In her article for the International Journal for Quality in Health Care, Virginia Mumford concluded that “The lack of a clear relationship between accreditation and the outcomes measured in the benefit studies makes it difficult to design and conduct such appraisals without a more robust and explicit understanding of the costs and benefits involved.”

I speak with hundreds of health departments every year and hear a lot of the same things; “Business is down, there are less people coming in, staff are hard to keep and harder to hire, competition is fierce for clinical services, funding is down….”

For agencies with deep pockets who are doing well with more business than they can handle, accreditation makes sense. For others that are struggling and need to see a return on investment, I submit that an agency could spend much less money (and time) than the cost and effort of gaining accreditation, and instead, invest in developing and implementing an automated marketing system that could be used to gain more traffic/customers, promote the health department and convey its value to the community. My experience has been that employees are more apt to stay engaged if they are offered CE courses on how they can take an active role in growing the agency. They are more likely to step out of their silos and take a vested interest in the success of the agency. That kind of success has more reach than approval from a group that will not write you a check to stay in business or stop that nurse from leaving for greener opportunities.

If nobody outside of your door can name three of the services you provide, your audience, target customers and community probably do not care about whether your agency is accredited.

When I asked the administrator mentioned above what tangible benefits her agency received from accreditation, she answered, “I don’t know. Employee morale is still low at our health department. We didn’t get the grants we were promised. We did develop a more systematic approach to some things, but it wasn’t worth it.”

She shared that her agency is about to write an $18,000 check to renew their status and then pay $5,000 per year for five years!