Table 3.

Barriers to Public Health Accreditation Adoption by PHAB Domain and Informed by the PIM-enhanced CFIR, Indiana, 2016

Barriers	Domain	Strategies
Leadership
Funding	Domain 12 - Maintain capacity to engage the public health governing entity	Communication with local, state and federal agencies, boards of health, and legislative bodies (including commissions) – Develop networking and grant writing skills
Personnel	Domain 8 - Maintain a competent public health workforce Domain 11- Maintain administrative and management capacity	Develop a nationally shared public health conception about evidence-based operations. Develop skillsets and tools for data-driven operations in LHDs
Policy (favoring/facilitating accreditation)	Domain 11- Maintain administrative and management capacity Domain 12 - Maintain capacity to engage the public health governing entity	Communication with governing entities to invest in the development of policies supporting continuous quality improvement. Communicate the value of accreditation and its link to quality improvement with governing entities and community partners
Relevance	Domain 11- Maintain administrative and management capacity	Effective communication and training by PHAB trainers/staff in documenting LHDs’ functions and performance management
Organizational Structure and Culture
Workforce	Domain 8 – Maintain a competent public health workforce Domain 11 – Maintain administrative and management capacity	Develop a nationally shared public health conception about quality improvement Develop skillsets and tools for data-driven operations in LHDs Leadership development
Infrastructure	Domains 1&2 – Monitor health and investigate problems Domain 4 – Mobilize community partnership Domain 11- Maintain administrative and management capacity	Knowledge management Project management Talent management Social network
Governing Entities
Competing priorities		Effective communication from PHAB – focusing on perception and public health orientation; value proposition of accreditation