“Factors Associated with Local Health Department Decisions to Undertake Voluntary Accreditation”

National voluntary public health agency accreditation with a quality improvement (QI) focus begins in 2011. The purpose of this study was to explore factors influencing the decisions of local health departments (LHDs) to participate in a voluntary accreditation program. The study was conducted between August 2007 and April 2009. Seven (7) Illinois LHDs that participated in the Illinois Voluntary Accreditation Pilot Project were matched by size and geography to 7 nonparticipant LHDs. Using a mixed methods approach, data was collected on how perception of accreditation's value, organizational capacity, and leadership impacted the decision to participate in Illinois' pilot. Both participant and nonparticipant LHDs viewed accreditation as an opportunity that could lead to QI, but to varying degrees. Leaders serving in the top administrative position of participant LHDs were more likely to have a higher degree of educational attainment; these leaders were also undergoing an existing organizational change process before participating in the pilot. LHDs did not participate in Illinois' pilot primarily because the costs of participating outweighed what they perceived to be the benefits; additional incentives would be needed before they would consider participating in accreditation. Several possible practice-based and research implications of this study include: 1) Enhanced training on transformational change and QI for LHD leaders; 2) Additional research to fully understand the need for and ways to provide incentives for a voluntary accreditation process; and 3) Improvements in the marketing of voluntary accreditation to more fully explicate the relation to other improvement processes and the benefits of participation.