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2011 NEHA AEC

FS1105 Improving Performance in a Retail Food Protection Program—Lessons from the Field

Lessons from the Field

Dawn Beck, RSOlmsted County Environmental Health ServicesRochester, Minnesota

Demographics� Population ~ 144,000

� Licensed food services ~ 500

� Mayo Clinic/IBM

Broad-based EH Services within Public Health agency� 10 FTE (Director, Manager, 6 EHS, 2 Techs)

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2011 NEHA AEC

FS1105 Improving Performance in a Retail Food Protection Program—Lessons from the Field

A dynamic, world-class county delivering excellence every day

Mission: Assist and empower people to prevent and address the environmental health hazards in our community.

Vision:People engaged in improving their environmental health.

� Guiding Principles

� Brief History

� The PTV Methodology

� In retrospect and Looking Ahead

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2011 NEHA AEC

FS1105 Improving Performance in a Retail Food Protection Program—Lessons from the Field

Focus on:

� Risk “Assessment”

� Our Customers

� Continuous Improvement

Integrated Planning:

� Community Health Assessment and Planning Process (every 5 years)

� Balanced Scorecard (“Managing for Results”)

“The system for identifying and preventing foodborne illnesses in use was largely created in the early 1900s. It must be modernized.”

A National Food-Safety Initiative Report to the President, 1994

Pre-1997

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2011 NEHA AEC

FS1105 Improving Performance in a Retail Food Protection Program—Lessons from the Field

The Traditional Approach Pre-1997Factors Most

Frequently

Contributing to Illness

Most Frequently

Cited Inspection Items

Practices and Procedures Facility

� Of little value to operators

� Lifeless

� Not keeping up with the “epi”

� “We spend so much time evaluating the condition of the facility and so little time on food safety.”

� Blah, blah, blah

� Like an assembly line process

� “Why didn’t you tell me this before we had an outbreak”?

�Our methodology was part of the problem

�Looking for a different approach

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2011 NEHA AEC

FS1105 Improving Performance in a Retail Food Protection Program—Lessons from the Field

FDA Food Program Leadership Conference

� Strategic planning session for state and local food protection agencies

� Participants challenged to change focus from traditional enforcement model to more effective paradigm

� Looking for “Paradigm Pioneers”

HunchesHunches

TheoriesTheories

IdeasIdeas

Changes thatChanges that

result inresult in

improvementimprovement

D A T

A

D A T

A

R A M

P

R A M

P

PPDDSS

AA

PPDDSS

AA

PPDDSS

AA

Source: Mayo Clinic

�From “Inspections to Assessments”�Evaluate the Flow of Food�Assess operator level of Active

Managerial Control (AMC)� Announced (unless in enforcement)

� Sit down discussion about “systems”

� Walk thru to verify what we heard

� Imbed education (food safety manual, other)

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2011 NEHA AEC

FS1105 Improving Performance in a Retail Food Protection Program—Lessons from the Field

Frequency of critical conditions* by food safety system identified at

Olmsted County, MN food service facilities, 1998-99 (*216

conditions identified during 100 inspections of 50 facilities)

0%

10%

20%

30%

40%

50%

60%

Emplo

yee/

Custo

mer

Illn

ess

Cooling

Cooking

Cross

-conta

min

ation

Cuts/

Burns/

Sores

on Hands

Food S

ource

Handwash

ing

Hot Hold

ing

Reheatin

g

Cold H

oldin

g

Systems Review Early Results

Olmsted County Public Health ServicesPercentage of Risk Factors Identified by Discussion vs. Observation

2001-2004(N=1142 assessments)

Risk factor

Percent Discussed vs. Percent Observed by Year

2001 - 2005

61% 64%49% 50% 55%

39% 36%51% 50% 45%

55%

48%

2001 2002 2003 2004 2005 Total

Discussed Observed

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2011 NEHA AEC

FS1105 Improving Performance in a Retail Food Protection Program—Lessons from the Field

THE BURNING QUESTION

Owner/operator responsible for ensuring:

� Hazard Identification

� Development of food safety Policies and Procedures

�Training staff to implement policies and procedures and apply corrective action as needed

� Periodic self-inspection of daily operations to assure

(Verify) polices and procedures are followed

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2011 NEHA AEC

FS1105 Improving Performance in a Retail Food Protection Program—Lessons from the Field

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2011 NEHA AEC

FS1105 Improving Performance in a Retail Food Protection Program—Lessons from the Field

� Adapted from The Omaha system

� Problem classification system

� 1-5 Rating Scale for assessing client

Knowledge, Behavior and Status 1 2 3 4 5

A bil it y o f the cl ie nt No knowledg e

M inimal know ledg e

Bas ic kn ow le dge

Ad equa te know ledge

Sup erior know le dge

Not

app ropria te beh av ior

Rarely

app ro pria te beh av ior

Incons isten tly

approp riate beha vior

Usual ly

app ro priat e beh av ior

Cons is te ntly

appro priat e beha vior

c lient in relation to

subjec tive d efinin g

Ex trem e s ign s/

sym ptom s

Se ve re s ign s/

sym ptom s

Mode rate signs /

symp tom s

Minimal s ign s/

sym ptom s

No s ig ns / symp tom s

�Aligns with CFP form:� Delineates between Risks (the focus) & Good

Retail Practices

� Documents “violations” - In/Out/COS/NA/NR

� Includes PTV evaluation for FBI Risk Factors

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2011 NEHA AEC

FS1105 Improving Performance in a Retail Food Protection Program—Lessons from the Field

1. Employee Illness

2. Handwashing

3. Food Source

4. Cross-contamination

5. Cooking Potentially Hazardous Foods

6. Hot Holding Potentially Hazardous Foods

7. Cold Holding Potentially Hazardous Foods

8. Cooling Potentially Hazardous Foods

1- Non-existent

2- Under developed

3- Basic

4- Well developed

5- Proactive

1- Non-existent- Systematic control of foodborne illness risk factors not understood by management. The operator does not demonstrate understanding of the risk factors present in the operation or the accepted methods for controlling those risks. Management is not able to provide information and/or examples of programs that are expected for managing food safety risk conditions in their establishments.

Procedures There are no methods for risk-factor control that are organized, adequately developed, and implemented.

Training Employees have not been specifically trained to carry out the

procedures necessary for risk-factor control in this operation.

Verification Management is not verifying that employees are carrying out the

procedures necessary for risk-factor control.

Immediate corrections are needed, and administrative discussion is warranted. Prompt enforcement action may progress as necessary

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2011 NEHA AEC

FS1105 Improving Performance in a Retail Food Protection Program—Lessons from the Field

2- Under-developed (beginning)- Food establishment

management has low focus on food safety risks and provides limited information on managing food safety risks. There is low involvement for

encouraging employees to do the same. Major compliance issues to food

safety requirements may be present.

Procedures There is limited or sporadic evidence of food safety procedures being organized, adequately developed, or

implemented within the establishment

Training Training is lacking or inadequate to inform employees of the establishment’s food safety policies/procedures.

Verification Unclear or inconsistent systems in place to ensure control and improving on the establishment food safety risk

factors.

Immediate corrections are needed, follow-up will be necessary

3- Basic (developing)- Food safety risks are being addressed, but

there are still crucial gaps. Inconsistent or ambiguous food safety programs exist and implementation of these programs in the establishment is

elementary. Management is able to provide some information or examples (but less than adequate) of systems in place used for managing some of the

food safety risk conditions.

Procedures SOP’s (Standard Operating Procedures) exist in some form

(written or verbal)

Training Employees are trained to the Standard Operating Procedures but there is no system for addressing ongoing training needs.

Verification A simple focus on management of controlling and improving on

food safety hazards exists. Some verification systems in place, but may be incomplete or inconsistent

Some uncontrolled food safety risks may be present. Follow up may be needed.

4- Well developed (accomplished)- Food safety risks are being

addressed systematically (SOP’s developed and in place) with no significant

gaps. Food safety is a priority in the establishment and understood by all employees. Management is able to provide adequate information of systems

in place that illustrate fundamental awareness and management of food safety risks.

Procedures SOP’s developed, in place, and match current food

service operations (written or verbal).

Training Employee training is active to educate for food safety risks. It is complete and ongoing.

Verification Verification that Procedures are being correctly and completely carried out is sufficient and systematic

Food safety risk compliance is satisfactory. (This is the goal for all operations). Watchful maintenance of food safety programs is evident.

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2011 NEHA AEC

FS1105 Improving Performance in a Retail Food Protection Program—Lessons from the Field

5 - Proactive (exemplary)- Food safety efforts go above and

beyond. Food safety is a high priority and stressed to all employees.

Management is able to provide information and numerous examples of proactive practices used to manage and control food safety risks.

Procedures Proactive procedures - comprehensive, clearly written,

verbally articulated and regularly reviewed

Training Comprehensive system in place for training and to ensure

continual training of employees in food safety (often including multiple CFMs engaged in training).

Verification Creative and/or redundant verification systems. Outside

audits and/or consultants often used

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2011 NEHA AEC

FS1105 Improving Performance in a Retail Food Protection Program—Lessons from the Field

� From Process Improvement

“Are we doing the work right” ?

� To Innovation/Redesign

“Are we doing the right work” ?

� Asking Both Questions is Imperative as we proceed in the New Normal

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2011 NEHA AEC

FS1105 Improving Performance in a Retail Food Protection Program—Lessons from the Field

The Old Normal+ The Great Recession + Long Run Demographic Changes= The New Normal

Tom Gillaspy, State Demographer

MN Dept of Administration

� “Doing more with less”

� “Work smarter not harder”

� An action that a customer is willing to pay for

� An activity that transforms a product or service

� An activity done correctly the first time.

� An activity that consumes resources without creating value for the customer

� An activity that is unpredictable in creating value

� An activity that requires more time, effort or resources than necessary.

� Meets the needs of operators – Value added

� Systematic approach to conducting risk-based assessments

� Root cause analysis of why risks are uncontrolled� Identifies focal points for improvement

� Enforcement more focused � failure to comply with CFM Duties very

compelling� typically resolved with a simple administrative

hearing

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2011 NEHA AEC

FS1105 Improving Performance in a Retail Food Protection Program—Lessons from the Field

� Update MN Food Code to “merge” CFM duties with PIC responsibilities

� Integrate with FDA Assessment of Training Needs (ATN) – tool for staff and program

� Assess as part of the CFP Uniform Inspection Program Audit Pilot Project

� Align with the Minnesota Department of Health Program Evaluation and Local Program Self Assessment

Questions?

NACCHO Model Practicehttp://www.naccho.org/topics/modelpractices/database/practice.cfm?practiceID=144

NACCHO Foodborne Illness Demonstration Site http://www.naccho.org/topics/environmental/foodsafety/resources/FBISystemsDemo/Olmsted.cfm

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2011 NEHA AEC

FS1105 Improving Performance in a Retail Food Protection Program—Lessons from the Field

Dawn Beck

Environmental Health ManagerOlmsted County Public Health Services

Rochester, Minnesota

Beck.dawn@co.olmsted.mn.us

507-328-7404