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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 to food safety: initial stories from the nnphi qi award program. Applying QI Techniques to Mobile Food Vending. Ted Talley

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Applying qi to food safety: initial stories from the nnphi qi award program

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  1. Ted Talley, Northern Kentucky Health Department Liz Mack, Webster County Health Department Drew Downing, Toledo-Lucas County Health Department Applying qi to food safety: initial stories from the nnphi qi award program

  2. Applying QI Techniques to Mobile Food Vending Ted Talley Environmental Health Manager

  3. Northern KentuckyHealth Department • Combined district • Boone, Kenton, Campbell, Grant • Population ~ 400K • Approximately 160 employees • Environmental Services • 26 employees • 16 Registered Sanitarians • 3000 permitted establishments

  4. 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

  5. Discovery • Affinity Diagram • Need for improvement • Impact on public health • Increased interest in mobile food vending

  6. 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%

  7. QI Tools • Affinity Diagram • PDCA • Flow chart • Fishbone diagram • Indentifying improvements

  8. Key Lessons • Embrace the process • Documentation & organization • Participation

  9. Challenges

  10. Challenges

  11. Planned Outcomes • Improved process • Communication channels • Sustainable solutions • Collaboration with local businesses • Properly licensed vendors • Requirements • Educated food handlers • Better protection of public health

  12. Ted Talley Environmental Health Manager Northern Kentucky Health Department 610 Medical Village Dr Edgewood, KY 41017 859.363.2027 ted.talley@nkyhealth.org

  13. Preserving and protecting public health within our community Environmental Health Quality Improvement Project: Food Safety Liz Mack, EPHS/CEHS

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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.”

  20. 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.

  21. 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.

  22. 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

  23. 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

  24. 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

  25. Questions • Webster County Health Unit • Contact, Liz Mack: (417) 859-2532 ext. 206 • E-mail: lmack@webstercohealth.com Thank You!

  26. <?xml version="1.0"?><AllQuestions /> <?xml version="1.0"?><Settings><answerBulletFormat>Numeric</answerBulletFormat><answerNowAutoInsert>No</answerNowAutoInsert><answerNowStyle>Explosion</answerNowStyle><answerNowText>Answer Now</answerNowText><chartColors>Use PowerPoint Color Scheme</chartColors><chartType>Horizontal</chartType><correctAnswerIndicator>Checkmark</correctAnswerIndicator><countdownAutoInsert>No</countdownAutoInsert><countdownSeconds>10</countdownSeconds><countdownSound>TicToc.wav</countdownSound><countdownStyle>Box</countdownStyle><gridAutoInsert>No</gridAutoInsert><gridFillStyle>Answered</gridFillStyle><gridFillColor>0,0,0</gridFillColor><gridOpacity>100%</gridOpacity><gridTextStyle>Keypad #</gridTextStyle><inputSource>Response Devices</inputSource><multipleResponseDivisor># of Responses</multipleResponseDivisor><participantsLeaderBoard>5</participantsLeaderBoard><percentageDecimalPlaces>0</percentageDecimalPlaces><responseCounterAutoInsert>No</responseCounterAutoInsert><responseCounterStyle>Oval</responseCounterStyle><responseCounterDisplayValue># of Votes Received</responseCounterDisplayValue><insertObjectUsingColor>Blue</insertObjectUsingColor><showResults>Yes</showResults><teamColors>User Defined</teamColors><teamIdentificationType>None</teamIdentificationType><teamScoringType>Voting pads only</teamScoringType><teamScoringDecimalPlaces>1</teamScoringDecimalPlaces><teamIdentificationItem></teamIdentificationItem><teamsLeaderBoard>5</teamsLeaderBoard><teamName1></teamName1><teamName2></teamName2><teamName3></teamName3><teamName4></teamName4><teamName5></teamName5><teamName6></teamName6><teamName7></teamName7><teamName8></teamName8><teamName9></teamName9><teamName10></teamName10><showControlBar>Slides with Get Feedback Objects</showControlBar><defaultCorrectPointValue>100</defaultCorrectPointValue><defaultIncorrectPointValue>0</defaultIncorrectPointValue><chartColor1>187,224,227</chartColor1><chartColor2>51,51,153</chartColor2><chartColor3>0,153,153</chartColor3><chartColor4>153,204,0</chartColor4><chartColor5>128,128,128</chartColor5><chartColor6>0,0,0</chartColor6><chartColor7>0,102,204</chartColor7><chartColor8>204,204,255</chartColor8><chartColor9>255,0,0</chartColor9><chartColor10>255,255,0</chartColor10><teamColor1>187,224,227</teamColor1><teamColor2>51,51,153</teamColor2><teamColor3>0,153,153</teamColor3><teamColor4>153,204,0</teamColor4><teamColor5>128,128,128</teamColor5><teamColor6>0,0,0</teamColor6><teamColor7>0,102,204</teamColor7><teamColor8>204,204,255</teamColor8><teamColor9>255,0,0</teamColor9><teamColor10>255,255,0</teamColor10><displayAnswerImagesDuringVote>Yes</displayAnswerImagesDuringVote><displayAnswerImagesWithResponses>Yes</displayAnswerImagesWithResponses><displayAnswerTextDuringVote>Yes</displayAnswerTextDuringVote><displayAnswerTextWithResponses>Yes</displayAnswerTextWithResponses><questionSlideID></questionSlideID><controlBarState>Expanded</controlBarState><isGridColorKnownColor>True</isGridColorKnownColor><gridColorName>Yellow</gridColorName><AutoRec></AutoRec><AutoRecTimeIntrvl></AutoRecTimeIntrvl><chartVotesView>Percentage</chartVotesView><chartLabelsColor>0,0,0</chartLabelsColor><isChartLabelColorKnownColor>True</isChartLabelColorKnownColor><chartLabelColorName>Black</chartLabelColorName><chartXAxisLabelType>Full Text</chartXAxisLabelType></Settings> <?xml version="1.0"?><AllAnswers /> Refining Foodborne Response Applying CQI to the Foodborne Outbreak Investigation Process at theToledo-Lucas County Health Department June 2012Portland, Oregon

  27. 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

  28. A little background… • FromJanuary 2009-October 2011,open-to-close time for foodborne response cases: Mean = 44 days OK, but we can do better…

  29. 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

  30. Work Completed GOAL CLARITY

  31. 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.”

  32. Work Completed PROCESS MAP & FISHBONE DRAFT

  33. Work Completed PROBLEMS IDENTIFIED

  34. Work Completed BRAINSTORM & PRIORITIZE POSSIBLE SOLUTIONS

  35. Work Completed BRAINSTORM & PRIORITIZE POSSIBLE SOLUTIONS

  36. Work Completed TURNED SOLUTIONS INTO ACTION ITEMS

  37. 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

  38. Lessons Learned So Far… • Select diverse team members • Be flexible where necessary • Dive deeper

  39. Works Cited NY Timeshttp://www.nytimes.com/2007/03/08/nyregion/08office.html psdGraphics http://www.psdgraphics.com/psd-icons/psd-3d-business-graph-icon/

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