Accreditation: How Cross-Jurisdictional Sharing Fits into the Picture

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On May 6, 2014, the Public Health Accreditation Board (PHAB) and the Center for Sharing Public Health Services cohosted a webinar focused on ways public health departments seeking accreditation could use cross-jurisdictional sharing (CJS) arrangements to achieve that goal. Over 250 people attended the webinar, which is available as a video recording on our website.

Patrick Libbey and Gianfranco Pezzino, Center Co-Directors, introduced the topic. They explained that interest in CJS has increased, in part because many health departments are concerned they will be challenged to meet voluntary accreditation standards in all domains on their own.

David Stone, Accreditation Education Specialist with PHAB, explained two ways CJS arrangements can be used to meet accreditation standards — several jurisdictions can apply as a single entity using a multijurisdictional application, or single jurisdictions can use documentation from sharing arrangements to show compliance with standards and measures. He noted there are currently three multijurisdictional applications in the system, though they are early in the process.

Key points from the webinar are listed below.

Multijurisdictional Applications

With this method, several jurisdictions apply as a single entity. All, or none, will receive accreditation status. Therefore, if one health department is missing documentation, it will affect the demonstration of conformity to the measure and could affect the entire group’s chance of achieving accreditation.

The application fee is based on combined total population size. Jurisdictions applying together should add their populations together. That total should be matched to the corresponding category within the fee structure. Since the fee structure starts at a population size of 50,000, several small counties could potentially apply as a single entity for the same price that one of those small counties could apply individually.

PHAB has a right to limit the number of jurisdictions in a multijurisdictional application, but has not yet done so.

PHAB’s current policy is that it prefers applicants to be geographically contiguous, unless a solid explanation for a working relationship that is not geographically contiguous can be made that is backed up by solid documentation.

The group must select a health department to serve as the lead. That health department would submit the application for the entire group.

The group must also select an overall accreditation coordinator. He recommends that the coordinator come from the lead health department. PHAB will not contact individual health departments, only the overall coordinator. That person must go to training. The group can send one other person to training at the cost of the group, if desired.

Each health department director within the group must submit a letter of support for the application.

The jurisdictions must share services in at least 50 percent of the domains (six of the twelve). PHAB doesn’t define which domains must include shared services or assign a weight to domains. The choice of domains which include shared services is completely up to the jurisdictions applying.

Within those shared domains, not every single standard has to be shared. There must be evidence within those shared domains that there is substantial cross-jurisdictional work occurring. There needs to be good documentation of that sharing.

The site visit team will assess shared documentation. Once approved one time and found acceptable, it will apply to all entities in the multijurisdictional application. If there is not shared documentation to cover the group, then each health department will need to provide documentation to show it meets the requirement individually.

In addition, documentation that shows a subset of the departments in the application share services can also be used, but it doesn’t apply to the 50 percent requirement. Each health department not included in the subset will need to provide documentation to show it meets the requirement individually.

Documentation Requirements for Shared Service Arrangements

Documentation that shows a sharing arrangement can be used in either single or multi-jurisdictional applications.

The basic requirements would apply in either situation. There is no required format, style or length; documents must be dated, must include evidence of authenticity, and must be able to be linked to the department that is under review. The content of the document should show conformity to standards and measures. It must be evident that the document is current and in use by department under review.

If an outside agency provides the service, the documentation would include an agreement or contract. It doesn’t need to be formal.

Site visitors will only look at the part of the documentation that is relevant to the department under review. They will ignore non-relevant items.

If you are interested in this topic, we encourage you to watch the full recording of the webinar. If you have questions, please email them to