The New PHAB Standards (2026): What Changes for Your Health Department

On July 1st, FABS— FAB refreshed their standards, and their refreshed standards and measures took effect. About 40 fewer required documents, new ways to demonstrate conformity, and the same 5-year clock. I'm Ted Jackson, co-founder of ClearPoint. I've spent about 15 years working with health departments on performance management. The next 30 minutes are about one thing: what actually changed and what a health department should do about it between now and its next submission. I'm going to be specific about what got easier, honest about what got harder. At the end, I will tell you when not to buy software, including ours. So this lands differently depending on where you sit. So let me name 4 different situations. If you're pursuing initial accreditation, the headline is there are roughly 40 fewer required documents than in the version you were probably reading last year. If you're reaccrediting, you're on a 5-year clock. The version changed underneath you midstream. The crosswalk conversation matters most to you, and we'll spend real time there. If you are in an annual report year, there is no site visit, but focus narratives are now part of how conformity gets shown. So this is not a quiet year. And if you're exploring pathways or deciding whether to start at all, the refresh has made the decision easier, not harder. Everything between here and the last few slides apply to all 4 situations. So where you diverge is kind of sequencing at the end. So here are 3 numbers to think about when these new standards came into place on July 1st. First, there are about 40 fewer required documents for the initial accreditation. That's your headline. And that's your real relief. There are 10 domains and not 12 domains. I'll come back to that because it trips up more people than anything else on this slide. And 5 years— the reaccreditation clock did not move, so it does not pause for a version transition, does not pause for a busy quarter, and it does not pause because your health officer left in March. FAB describes this change in standards as a refinement rather than as an overhaul, and that's fair. It's also true that it changes what a well-prepared department should be doing this month. So let's talk about some of these changes. Here are 4 changes with practical consequences. You know, the first one, I've said this several times, you know, there are 40 fewer required documents. That's less volume, but the stakes per document went up, right? A weak artifact in the past used to just be on one page within a bigger binder of submissions, and now it's a much larger share of your case. 2, and this is one that, that almost nobody's really internalized, is that FAM expanded how you can demonstrate conformity. Demonstrations, site visit conversations, focused narratives during annual report years. You may be asked to show the system working rather than hand over a document about the system. And 3, Enhanced clarity. Those are expanded examples, practical guidance, best practices, pro tips. Generally pretty useful. It means that there are fewer judgment calls about what counts as evidence. And then finally, this 4th one, there are updated content areas. There's workforce retention, healthy aging, artificial intelligence, and planetary health. So this 4th one is a little bit of a sleeper. You know, most departments I talk to, most health departments I talk to, collect essentially nothing on AI, and that's caused some level of panic. It shouldn't. Don't worry. PHAB, the Public Health Accreditation Board, is not asking whether you built a model. They're asking whether your departments thought about the thing. You know, a documented conversation about how you're approaching AI is the evidence they're looking for. A policy position, that's evidence. Silence is not evidence. So this is the, the trade here, right? So Fewer documents and more ways to show your work. That's the whole story, and everything else today follows from it. What got easier? Less paper to assemble and diversion, clearer guidance. Your existing version 2022 evidence still counts. There's more flexibility for your community context. What got harder? is every remaining document carries more weight. You have to demonstrate the system live, uh, and there are new content areas you may not have anything on. So, so the one thing to think about, right, is a binder, right, an accreditation binder can be built in weeks, a couple of months, right? But the history of how you manage Cannot. Right, so cutting 40 documents removes the place where some departments were hiding. Like, if you operate a real performance management system, this refresh is a gift. You've been doing the work, and now you get to show it instead of writing about it. If you don't do performance management, kind of removes that hiding place, that document you write about that's more Theory about how you manage than actual management. So to be fair, every department I've worked with is in both categories at once, kind of depending on which domain you ask about. Nobody is uniformly good at this. So if you started building under version 2022. Want to be direct with you. You did not waste that work. FAB published official crosswalks that map version 2022 compared, you know, the, the 2022 requirements forward to version 2026, measure by measure. Like, they exist exactly for one reason, so departments mid-cycle do not have to rebuild. Most of your work will still count, and the crosswalk is how you prove it. So there are 3 things you need to, to make sure you're doing right. First, pull the right crosswalk, right? There is an accreditation and a reaccreditation crosswalk, and they're different documents. So get the right one for your pathway. Hate to have you start working off the wrong one for a month. Second is walk your existing evidence against your new crosswalk, right? And mark every artifact in one of 3 ways: it carries forward, we need adjustment, or this is a new requirement, right? And third, this is the part people skip: work only on the last 2 piles. Don't restart whatever conforms, right? The instinct when standards change is to start again from scratch, and this instinct will really slow you down because Because remember, this is a revision or a tweak to the 2022 guidance, not a brand new set of standards. So let me show you. Let me show you just a little bit about what I'm referencing here. This is the fab website, which is. publichealthaccreditationboard.org, and this is their resource library. So they do have the standards for that initial accreditation and the standards for reaccreditation and the standards for pathways. This is kind of for organizations getting started their first run-through. But then when you scroll down a little bit, you're going to find the crosswalk, right? This is The how you think about comparing the reaccreditation, in this case version 22 to version 2026, or the accreditation version 22 to 26. So these documents are there, they're free, easily downloaded. You don't have to sign up or anything like that. So let's, let's jump ahead. Right, so, so really, you know, before you, before you trust your secondary sources, right, you need to, to think about it because there's been a lot of information that's been published and some consultant material, some state technical assistant documents, some blog posts, and some of it will still describe version 1.5, or that's even 2 versions out of date. And you might see the standards containing 12 domains. Well, version 2022 reorganized them into 10 domains. So if someone hands you something with 12 domains, you're way out of date, right? And so you just want to confirm that your domain, your measure numbering against the current documents in the FAB Resource Library. Right? So that's kind of the one thing you want to think about. And one more, the exact standard numbers, they differ between initial accreditation and reaccreditation pathways. So don't try to take the initial accreditation if you're doing reaccreditation because you'll get a little bit messed up, right? Then things to think about, like in Domain 1, this is where your community health assessment sits. Your community health improvement plan sits under Domain 5, and performance management sits under Domain 9, which is where, you know, this refresh hits the hardest and where we're going to spend most of our time is thinking about Domain 9. So let's do a quick test. Why don't you take your own performance management system, the one you do now, and let's see how you're doing, right? Open your performance management system and walk me through how one measure performed last quarter and what you did about it. OK, so if this takes more than 2 minutes, or it requires building a spreadsheet or a Word document or something like that, then, you know, what you have is a, is a reporting exercise versus a management system, right? Like, this should be pretty easy to do if you are already reporting on a regular basis. So when we, when we do this with some of our clients or in other settings where we're talking to a lot of public health departments, we see departments landing in kind of one of 4 different places, right? You can do it in under 2 minutes. That's great. You have a system that's generally being run. The conformity evidence already exists as a byproduct. If this takes you 5 to 10 minutes, the data is there, but finding it depends on one particular person being available that day. If you get to where you build a spreadsheet first, that might mean the data exists, but a real management system does not exist. Or if you'd rather not answer, right, which, you know, in my experience is Unfortunately, one of the most common honest answers in the room— maybe we don't really have a system like this. And just to be clear, this isn't really a competence question. The health departments I know are excellent at public health, and they're structurally set up to be bad at this one specific thing. That's not a character flaw, it's an organization design. It has a fix, and the data explains why it happens. You know, this evidence trail or documentation trail fails, you know, for one big reason. And at ClearPoint, what we've done is we've analyzed over 20,000 strategic plans on our platform. Right? And one pattern shows up everywhere is that assigning an owner and having an owner are 2 different things, right? 76% of assigned metrics owners never update their metrics. The name is in the system that the the record you know that name should be generating. doesn't exist, right? It's like, oh, Mary owns this, but there's no evidence that Mary is doing something, right? And among healthcare and public health organizations, runs harder, right? 89% of strategic objectives have no owner at all, or 76% are never updated, 77% are never updated. So, you know, an objective in that condition produces no evidence trail, Right? There's nothing to submit, not because someone forgot to write it down, because nothing happened that could be recorded. This is a real reason departments end up reconstructing evidence 8 weeks before a site visit. It's not procrastination, it's just that nothing was accumulating. So what actually brings a measure back, right? And here we looked at more than 6,000 healthcare measures that had gone off target to find out what actually pulled them back. And 2 variables really mattered, right? A measure with a named owner came back 37% of the time. Without an owner, only 18%. A named owner roughly doubles that recovery effort. And a measure that got rechecked regularly after the first review Came back 24% of the time. Measures that were left alone, under 2%. Basically never, right? Here's what I want you to take from this. Neither of these is a documentation practice. Both of them produce documentation as a byproduct. Nobody got into public health to build an evidence trail. The good news is that you don't have to. Assign real owners, recheck on a cadence, And the trail builds itself because the system someone's actually running generates dates, names, and decisions on its own. So briefly on domains number 1 and number 5, because the evidence logic is the same, right? Your community health assessment has to prove 3 things. That the assessment happened, that it was genuine— genuinely collaborative, and that its findings drove what came next. Partner rosters, minutes, attendance records, signed MOUs prove the second thing, right? A traceable table mapping each finding to a CHIP priority proves the third, and that table is often the single most useful page in a submission. The chip is where most departments lose points on work they actually did. The plan is strong, the measurement trail behind it is thin. Reviewers look for evidence the plan lived between its adoption date and today. Dated progress records, review meetings with attendees and decisions, documented revisions with the reasoning attached. So a plan showing 3 years of quarterly updates including the quarters that went badly, beats a pristine plan with no history. Reviewers trust a record with red in it. A plan that was green every quarter for 3 straight years reads as a plan no one was really measuring. And keep the CHIP distinct from your department strategic plan. The CHIP belongs to the community. The strategic plans belong to you as an organization. So different documents, and you should be able to explain how they relate. So there's 6 artifacts that carry domain number 9. One, a written framework naming the structure, the roles, the review cadence, and how results feed decisions. 2, a named system owner with documented authority. One person, not a community, not a committee, sorry. 3, a measure inventory listing for every measure its owner, date source, collection frequency, and target. 4, dated review minutes with attendees every cycle, not just the good ones. 5, a decision log tying specific decisions to specific measures that trigger them. And 6, project records, you know, running, running problems, methods, intervention results, right? 2 of these get skipped almost universally. Number 2, most, most departments name a coordinator who's got responsibility and no authority. And a reviewer can tell in about 90 seconds. And number 5, almost nobody keeps a decision log, and it's the most persuasive artifact in the whole submission. So if you do one thing after this session, start a decision log today. One decision per line. Date, measure, you know, what we decided, who decided it. That's the whole format. In 6 months, it's the most valued— valuable document that you own. Then run the currency test. Open your system, count what share of measures were updated in the last reporting period. If your number looks like the ones in the previous slide, the framework document will not save you. So let's talk about how we at ClearPoint support this accreditation process. Let me show you what this looks like in practice. So let's say you've gone in, you've downloaded your fab accreditation standards. These are 300 pages long, right? So it's a pretty big set of standards. You go into measure 1.31. You can start seeing information about this measure. You see the number of examples you need. You say, well, wait a minute. Let me just check and see what's changed here. So you scroll down. You— this is the crosswalk. Both of these documents are from the Public Health Accreditation Board. You can see I'm pulling them from their website. We see there's been some changes to simplify 1.31. So you go into ClearPoint. So I'm starting here on the accreditation page, and on the accreditation page we can see our domains, our standards, and our measures all the way through. We can see whether these measures have been approved by our FAB coordinator and whether they've been approved by our public health director. And if I want a reference for where, you know, page you know, or Measure 1.31 is, I know I can go back to the standards on page 44 to 49. But I can drill into 1.31. Remember, it should have an owner, and then it could also have collaborators along the way, additional people. You can see the approval process. You can see the purpose and significance of this measure. What standard it's related to, what domain it's in, where the pages are there. And then we can see the required documentation. Same thing, it was one example within 5 years. You get all of the information all the way through. There was a second requirement for number 2. And then you have an ability, if I just double-click here, We could drag and drop attachments. Those are our evidence forms. Remember now, they, they show up in a wide variety of places, and then you can put in the number of examples that you've completed, right? And so in doing this, this will automatically evaluate this measure to be green or on track or yellow or caution, and that will ultimately take you to a place Where when you look overall, you'll be able to see how you're doing with your measures, which ones have been approved, and the data from here will roll up to your standards. So then your standards will automatically turn green when they're— when you have all the documentation for the appropriate measures, and that will automatically turn your domain green as well. So it's very easy, and this is where people get really tripped up with trying to do accreditation, is they're trying in SharePoint to have folders. They're not sure what documents. They're having trouble keeping their evidence separate and all of their different measures. This is just a very straightforward way, and these donuts will build as your measures— sorry, I should scroll up a little bit— as your measure snapshot They improve your standards, ultimately domains, and of course we can download our accreditation standards really quickly right here. But one other thing to think about while I'm here, and one thing to know, because you might remember I said this a few slides ago, is you then need to be able to track your CHAA and your CHIP You might even be tracking a full separate strategic plan for your health services around, you know, maternal child or your women, infants, and children, your administration services, your epidemiology, all of your different departments you'll be able to track here in a different section of ClearPoint, right? So this will just take a second to load here. You'll be able to see your categories, have all of your measures, and be able to track your plan across your needs assessment and your improvement plan. And it would be different if you were tracking it within your county health services. And we even have some organizations that, independent of this, will also track their entire county or their city plans. So separate from public health, they may also be tracking public safety or police and fire, airport, all kinds of other information along the way. So this isn't meant to be a software demo, but just showing you back, you know, on your accreditation or your reaccreditation along the way, these are, are tools that you can use to make it very easy to track that accreditation process along the way. So let's, let's continue along, right? I have no idea when I went on mute. So with that, happy reporting.