When the Maryland Department of Health (MDH) began preparing for Public Health Accreditation Board (PHAB) Reaccreditation in 2022, the road ahead was not easy. MDH had recently experienced significant staff turnover, and many of the people who helped lead its Initial Accreditation in 2017 had since moved on. The COVID-19 pandemic also redirected time, resources, and attention across all areas of public health, including Accreditation.

Despite these challenges, MDH successfully achieved Reaccreditation thanks to Public Health Infrastructure Grant (PHIG) funding and technical assistance, PHAB resources, and strong leadership buy-in.

Reaccreditation was a chance for MDH to reflect, plan, and fortify its commitment to public health quality and continuous improvement. MDH’s journey offers practical insights for other health departments, especially those navigating Reaccreditation after periods of change or disruption.

Here are five takeaways from MDH’s Reaccreditation experience:

1. Start by identifying and preparing for key challenges

MDH is a “superagency,” meaning it oversees multiple statewide functions, including Medicaid, behavioral health, developmental disabilities, and Public Health Services. It also provides oversight for nearly all of Maryland’s local health departments. This structure makes internal coordination essential, but during the pandemic, Accreditation work took a backseat to emergency response.

“With our Initial Accreditation, we had a Quality Improvement (QI) Council and dedicated staff for Accreditation,” said Pamela Tenemaza, MPA, Public Health Accreditation Manager in the Office of the Deputy Secretary for Public Health Services. “But that went away with COVID, and a lot of my time went to our COVID response. That lull was a challenge to overcome.”

When it was time to start Reaccreditation activities, MDH knew it had to first rebuild its internal infrastructure.

“Those who were part of the Initial Accreditation process shared that it was a heavy lift,” Tenemaza said. “So, we focused on assessing and building our capacity early on.”

Tip: See PHAB’s Workforce Plan Template and User Guide for guidance on aligning your department’s workforce with strategic goals, identifying skill gaps, and proactively addressing staffing challenges. Health departments may use this template to demonstrate the workforce development plan requirements within the Version 2022 Standards & Measures. Also see the Association of State and Territorial Health Officials (ASTHO’s) Workforce Planning Guide and the University of Nebraska Medical Center (UNMC) College of Public Health’s Workforce Planning and Facilitation Guide (available on UNMC’s learning management system, login required).

2. Leverage external support

Support from PHIG was essential during MDH’s path to Reaccreditation. In addition to funding, MDH accessed PHIG-facilitated technical assistance to help fill in gaps.

Tenemaza shared that one of the most valuable forms of PHIG-funded technical assistance was the Site Visit Preparation Training hosted by PHAB.

“PHAB helped us understand what to expect during the site visit,” Tenemaza explained. “The site visit preparation session allowed our subject matter experts and the Accreditation team to prepare. It helped us identify our strengths and weaknesses and gave us time to address them before the real visit.”

Technical assistance from ASTHO, a PHIG national partner, also helped MDH develop core documents and plans such as the State Health Assessment (SHA) and State Health Improvement Plan (SHIP).

“The SHA and SHIP process helped create relationships, gather buy-in, and align our work to state priorities,” Tenemaza said. “It added value to the work we were already doing.”

PHIG support also enabled training in QI and performance management, not just for MDH, but for local health departments across Maryland.

PHAB and other organizational partners can also support health departments prepare for their accreditation journey, regardless of PHIG funding.      

Tip: Register for the PHAB Site Preparation Training to better understand the components of the site visit, the roles and responsibilities of the site visit team, and get tips on preparing staff, leadership, partners, and the governing entity. Peer organizations are additional sources of insights, expertise, techniques, and tools. See PHAB’s guidance on service and resource sharing to learn more. If you would like information about a tailored Site Visit Preparation Training for your department and/or PHAB’s State/Territorial Accreditation Learning Community, please email askPHAB@phaboard.org.

3. Use PHAB’s tools and trainings to build confidence

PHAB also offers an expansive catalog of free resources and trainings for departments working through Reaccreditation. PHAB’s training and guidance demystified the process and provided a clear roadmap forward.

According to MDH, the three most helpful PHAB resources were:

• Online trainings, including Introduction to PHAB
• Documentation Intensive for Reaccreditation (Open to Accredited health departments)
• PHAB’s Communication Toolkit for Accredited Health Departments
  (Available on The Learning Center and by emailing educationservices@phaboard.org)

Even in a large department, PHAB’s resources and trainings filled critical gaps caused by staffing transitions and resource constraints.

Tip: See PHAB’s Learning and Resource Catalog and explore PHAB’s resources, trainings and events, recorded webinars, and Learning Center courses for help navigating every aspect of Reaccreditation. Also see PHAB’s customizable technical assistance offerings.

4. Secure leadership buy-in

Another key factor in MDH’s success was visible and ongoing leadership support.

At the time, Dr. Nilesh Kalyanaraman, MD, served as MDH’s Deputy Secretary for Public Health Services and demonstrated his commitment to MDH’s Reaccreditation process in these visible, tangible ways:

• Attending the Reaccreditation launch
• Providing input on documentation
• Sharing during senior leadership meetings
• Chairing the State Health Improvement initiatives
• Staying actively engaged by tracking progress, addressing barriers, and participating in weekly check-ins

This high-level support sent a strong message to staff: Accreditation matters.

Leadership support also helped reestablish MDH’s QI Council, drawing members from across Public Health Services. This investment gave staff a space to collaborate, share progress, and align their frontline improvement efforts with leadership priorities.

“Leadership also encouraged staff participation in QI trainings and supported professional development opportunities,” Tenemaza explained. “Staff earned Greenbelt-level certifications and completed QI projects. These efforts gave leadership a clear view of how QI can strengthen performance, increase efficiency, and promote accountability.”

Dr. Kalyanaraman now serves to champion Accreditation for health departments across the country on PHAB’s board of directors.

Tip: See PHAB’s Value and Impact of Accreditation Report, a valuable tool for communicating the value and impact of Accreditation leadership. If your department needs additional assistance to galvanize leadership to support Accreditation or Reaccreditation efforts, please reach out to PHAB to askPHAB@phaboard.org.

5. Remember the bigger picture

While MDH focused on achieving Reaccreditation, its broader mission to support and strengthen Maryland’s public health infrastructure remained clear.

“Staying Accredited communicates to the community that MDH consistently meets national public health standards and is committed to continuous improvement,” said Tenemaza. “Despite the evolving political and funding landscape, MDH can stay the course and ensure delivery of effective public health services.”

Tip: See PHAB’s collection of publications and reports that contribute to an understanding of how Accreditation is linked to improved outcomes, stronger emergency preparedness and response, and more.

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MDH’s experience is proof that with the right support, Reaccreditation can be a powerful tool for public health transformation.

By sharing its Reaccreditation story and tips, MDH hopes to encourage other health departments to make the most of available resources and see Accreditation and Reaccreditation as an opportunity to unify and energize teams, especially those facing change or uncertainty.

“Reaccreditation was a lot of work, but it was rewarding for MDH because it brought together staff from across the department who represented many public health programs,” said Tenemaza. “In the end, it was very gratifying and great to see all the hard work pay off.”

Ready to start or strengthen your Reaccreditation journey? PHAB offers free tools, guidance, and one-on-one support. Reach out at askPHAB@phaboard.org or PHABTA@phaboard.org. We are here to help.

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