Public health officials throughout the United States are currently preparing for a national accreditation initiative for local and state public health agencies. As a voluntary program, the accreditation process will measure the degree to which state, local, tribal, and territorial public health departments meet nationally recognized standards and measures. Proponents of the initiative feel that evaluating public health agencies on their capacities to achieve certain standards will lead to improved service quality, consistency of public health roles nationally, and a greater understanding of those roles among the general population. However, in planning for agency accreditation some potential barriers must be addressed, mostly related to varying agency size, urban vs. rural locations, and the diverse configurations of how state and local agencies coexist throughout the nation. Organizations such as the National Association of County and City Health Officials (NACCHO), and the American Public Health Association (APHA) exist, at least partially, on the basis that local public health agencies utilize and find value in the resources they provide. As more resources are made available, the pressure for their utilization increases. As such, a new process for agency accreditation may force smaller health departments, which have limited resources, to choose between agency accreditation and system performance capacity. A new conceptual model proposes to operationalize the 10 essential public health services by recognizing three distinct components: the assessment component, fulfilled by the local health department, the research component, fulfilled by collaborating colleges and universities, and the impact component, fulfilled by local system partners. The purpose of this study was to introduce the Performance Predictability Concept, and substantiate its proposed components by examining the interaction between them. The results were supportive of this purpose, as Assessment and Research were able to adequately explain the variability of Impact capacity (the average capacity of essential services 3 through 8), at nearly 75% of variability among systems with smaller health departments, and 65% of the variability for the systems with larger health departments.
