APPLYING QI TO FOOD SAFETY:
INITIAL STORIES FROM THE
NNPHI QI AWARD PROGRAM
Ted Talley, Northern Kentucky Health Department
Liz Mack, Webster County Health Department
Drew Downing, Toledo-Lucas County Health Department
Applying QI Techniques
to Mobile Food Vending
Ted Talley
Environmental Health Manager
Northern Kentucky
Health Department
 Combined district
Boone, Kenton, Campbell, Grant
 Population ~ 400K
 Approximately 160 employees
Environmental Services
• 26 employees
• 16 Registered Sanitarians
• 3000 permitted establishments
Fixture Requirements
 Hand sink
 3C sink
 Hot & cold running water under pressure
 Supply tank
 Waste tank
50% larger
 KY plumbing approval
 $120/year
Recognized throughout KY
Discovery
 Affinity Diagram
Need for improvement
Impact on public health
Increased interest in mobile food vending
Operation
By November 30, 2012, increase the percentage of properly licensed
mobile food vendors providing lunch to employees of businesses
located in the counties of Boone, Kenton, Campbell, and Grant from
25% to 100%
QI Tools
 Affinity Diagram
 PDCA
Flow chart
Fishbone diagram
Indentifying improvements
Key Lessons
 Embrace the process
 Documentation & organization
 Participation
Challenges
Challenges
Planned Outcomes
 Improved process
Communication channels
Sustainable solutions
Collaboration with local businesses
 Properly licensed vendors
Requirements
Educated food handlers
 Better protection of public health
Ted Talley
Environmental Health Manager
Northern Kentucky Health Department
610 Medical Village Dr
Edgewood, KY 41017
859.363.2027
ted.talley@nkyhealth.org
Preserving and protecting public health within our community
Environmental Health
Quality Improvement Project:
Food Safety
Liz Mack, EPHS/CEHS
Webster County Health Unit:
Background

Webster County, MO is East of
Springfield/Greene County, MO & Northeast of
Branson, MO
–
Comprised of several small towns


–
–
Marshfield, Niangua, Elkland, Seymour, Fordland & Rogersville
The Health Unit is located in Marshfield, the County Seat
Stakeholders include tourists, entrepreneurs:
including farmers market vendors and wineries,
business owners, citizens, Mennonite and Amish
communities
Interstate I-44 and US Highway 60 run through the
county
Webster County Health Unit:
Background

In April of 2011, the Webster County Health
Unit Board of Health & the County Commission
adopted a Food Ordinance proposed by the
Webster County Health Unit:
–
–
Effective June 18th, 2011
Requires all managerial staff plus two additional
employees on duty at all times to have food safety
training documentation on-site at the food
establishment
Webster County Health Unit:
Background

Food Ordinance Requirements Continued:
–
Food Establishment permit fees were based on
priority risk assessments and categorized into: High,
Medium or Low Priority Food Establishments



High Priority Establishments receive three annual
inspections
Medium Priority Establishments receive two annual
inspections
Low Priority Establishments receive one annual inspection
Webster County Health Unit:
Background

How did we decide to focus on Food
Safety?
–
After providing food safety classes and
training for one year, to over 500 trainees, a
high priority food establishment was closed
for several days due to several public health
risk factors or critical code violations
Webster County Health Unit:
Background
–
This was a major concern and raised several
questions for the Health Unit’s Environmental Staff:

Is the two-hour training we are providing sufficient?
–

No, the manager tied to the closed facility had attended the
training twice
Are educational visits needed outside of the mandatory
two-hour training in order to communicate managerial
responsibilities?
–
–
Yes, at this point, only having had the Food Ordinance for
one year, changes to the length of the course are not
feasible
Keeps the political climate calm, especially during election
year, without creating a risk of losing the ordinance
Webster County Health Unit:
AIM Statement

“Webster County Health Unit will increase the
knowledge and skill of food managers and employees
by 25% from pre to post-managerial course surveys
and improve results on post-surveys or follow-up
contact for education visits in 10% of medium and high
priority establishments by December 31st, 2012.
Improving these educational opportunities will help
increase compliance with the Food Code and decrease
public health risk factors or critical violations
associated with foodborne illness.”
Webster County Health Unit:
AIM Statement
Short term improvement outcomes:
1)
Percent of food manager and employees with
improved scores on food manager and employee course
results
2)
Percent of food managers with improved responses on
post survey (from pre-visit surveys) for educational visits


Improvement Action to Test: Adding Active Managerial
Control content in the managerial course and in the
educational visits.
Webster County Health Unit:
What work has been completed thus far?





A pre-test and post-test have been revised for the two hour
manager/employee food safety class
 Tests have been administered since April, 2012
 Provides a measurable source of data
 Data gathered from the tests will help focus on the most needed
principles of Active Managerial Control
Active Managerial Packets and training materials have been compiled
Establishments for educational visits have been identified using a random
sampling method
Educational pre and post-surveys have been developed
Surveys and visits will commence at the start of the 2nd permitting year,
June 18th, 2012.
–
Great opportunity to show owners and operators that we are continually offering quality
improvement and that the Health Unit is vested in their training.
Webster County Health Unit:
What key lessons have we learned thus far?

Ensure adequate staff is available to handle
the project:



WCHU lost a full-time EPHS to military deployment shortly
after receiving the QI award
For a small local public health agency, EPHS staff must
delegate and pull from other Health Unit programs to
complete work; we have created an Environmental Health
Technician part time position as a result of the award.
Daily Environmental Health functions must carry on: food
establishment inspections and food safety training; child care
inspections (three counties); on-site sewage permitting,
including complaints and new systems; and well water
sampling
Webster County Health Unit:
What key lessons have we learned thus far?

Focusing and narrowing down the topic is vital to prevent:



Working on what you cannot control
– i.e. Our AIM statement was very broad initially: ‘reduce the
number of critical violations’.
Selecting a sample size that is too large & unattainable
Course tests had to be simple due to diversity in education levels
–

Managers and employees receive the same level of training
Focusing on the most important area or key impact area first

WCHU has several QI areas within Environmental Health to
improve upon; filtering through the issues and deciding was
difficult
–
Working with our operators directly will provide the biggest public
health impact, collaborating to prevent foodborne illness in our
community
Webster County Health Unit:
What results do we hope to see?



Overall: our operators, managers and owners
engaging in an Active Managerial role, using a food
safety system that is proactive rather than reactive
Short term:
– 1. an increase in improved scores on food manager
and employee test results
– 2. percent of food managers with improved
responses on post-surveys, from pre-visit surveys
Long term: Fewer public health risk factor violations
directly related to foodborne illness
Questions

Webster County Health Unit
–
Contact, Liz Mack:
(417) 859-2532 ext. 206
–
E-mail:
lmack@webstercohealth.com
Thank You!
Refining Foodborne Response
Applying CQI to the Foodborne Outbreak
Investigation Process at the
Toledo-Lucas County Health Department
June 2012
Portland, Oregon
A little background…
• Previously
– Sanitarians were housed in
Environmental
– Epidemiologists were housed in
Disaster Preparedness, Response, &
Community Services
• TLCHD recently merged divisions to
form the Community Services and
Environmental Health Division
A little background…
• From January 2009-October 2011, open-toclose time for foodborne response cases:
Mean = 44 days
OK, but we can do better…
Introducing Team…
• Tanika Redmond – Epidemiologist
• Patricia Fraker – Epidemiologist
• Karim Baroudi – Supervisor of the Food
Protection Unit
• Greg Moore – Toledo-APC Proj. Coordinator
• Drew Downing – Toledo-APC Proj. Lead
Work Completed
GOAL CLARITY
Work Completed
• “
AIM STATEMENT
“Between May 30 and November 30,
2012, the mean open-to-close time for
foodborne response cases will decrease
from average of 44 days to 37 days, a
reduction of seven days (15%) when
compared to foodborne cases from
January 2009 - October 2011.”
Work Completed
PROCESS MAP & FISHBONE
DRAFT
Work Completed
PROBLEMS IDENTIFIED
Problems Identified
Inconsistent communication between Sanitarians and Epis
Incomplete data for Sanitarians and Epis
Work roles/assignments for investigations – not clear
Work Completed
BRAINSTORM & PRIORITIZE POSSIBLE SOLUTIONS
Prioritized Solutions – First Tier
standardize and update initial interview form
create “training” for Sanitarians and Epi’s based off the new
initial interview sheet
incorporate Epis into Sanitarians’ weekly meetings to
enhance communication
create shared folder for RS and Epi’s on shared computer
drive
Work Completed
BRAINSTORM & PRIORITIZE POSSIBLE SOLUTIONS
Prioritized Solutions – Second Tier
update and enhance the field report form to incorporate
needed information from Epi’s grant
create an ICS format team that meets immediately after a case
is suspected to be a foodborne to better launch the
investigation
Prioritized Solutions – Third Tier
clean and reorganize supply room used for field kits
Work Completed
TURNED SOLUTIONS INTO ACTION ITEMS
Action Item
standardize and update initial
interview form
create “training” for Sanitarians and
Epis from the new interview sheet
incorporate Epis into Sanitarians’
weekly meetings to enhance
communication
create shared folder for RS and Epis
on shared computer drive (HIPPA
compliant)
Person
Due Date
Patti and RS
June 5
Tanika
June 12
Karim
June 5
Karim
June 5
Expectations
• decrease in the mean open-to-close
time and increase in efficiency for
foodborne illness investigations
• enhanced communication between
Epis and Sanitarians
• better standardized response
procedure
Lessons Learned So Far…
• Select diverse team
members
• Be flexible where
necessary
• Dive deeper
Works Cited
NY Times
http://www.nytimes.com/2007/03/08/nyregion/08office.html
psdGraphics
http://www.psdgraphics.com/psd-icons/psd-3d-business-graph-icon/