Reducing Food Establishment Violations

Summary

Impact Statement:

By using Kaizen, Cabarrus Health Alliance (CHA) in North Carolina reduced food establishment violations by 22% and further protected residents from foodborne illness.

Summary:

As part of the Public Health Accreditation Board (PHAB) Quality Improvement (QI) Leaders Academy, CHA facilitated a 5-day Kaizen event in its Environmental Health Department. The project's goal was to reduce the number of Priority/Priority Foundation (P/PF) violations in risk category IV establishments by 30% within 6 months after Kaizen. P/PF violations are those most likely associated with foodborne illnesses. Reducing P/PF violations in the establishments would decrease the risk of foodborne illness in the community. Risk category IV establishments are facilities that can cook and cool an unlimited amount of potentially hazardous foods and can have an unlimited amount of raw potentially hazardous foods. This category also includes facilities that use specialized processes or serve a highly susceptible population.

Other goals that CHA hoped to achieve were to improve the quality of the working relationship with owners and operators of the establishments and to increase the ongoing knowledge of P/PF violations with the person in charge (PIC). During the event, the QI team analyzed aggregate data to determine the top P/PF violations over the past four quarters. The team used QI tools and methods to determine the root causes of the violations, identified the potential issues and wastes, identified potential gaps leading to violations on the establishment side, prioritized the root causes of the violations, and identified potential solutions to the issues.

During the event, the QI team developed 10 job aids related to the identified issues with input from environmental health specialists, establishment/industry representatives, and a "wildcard" employee. At midweek during the event, the team tested several of the job aids in the field with restaurants from the previous quarter that had P/PF violations. The job aids were brought back to the team to make changes based on survey results and feedback from the PICs. At the end of the week, the job aids were ready to be implemented in all risk category IV establishments (English and Spanish). Over the next 6 months, the team used the new tools to educate the PICs on P/PF violations that were noted on inspections.

Organization that conducted the QI initiative:

CHA

Citation:

Hatley, J. Public Health Quality Improvement Exchange. Reducing Food Establishment Violations . Mon, 02/12/2018 - 16:29. Available at http://phqix.org/content/reducing-food-establishment-violations. Accessed April 18, 2024.

Background and Aim

Aim statement:

TO decrease the number of P/PF violations in risk category IV establishments. FOR • CHA Environmental Health Department food and lodging staff; • owners, general managers, and employees of food service establishments in Cabarrus County; and • residents or visitors who eat at establishments in Cabarrus County. BY conducting a 5-day Kaizen event during the week of August 17 to 21, 2015. SO THAT • the risk of foodborne illness is decreased, • the quality of working relationships with owners/operators is increased, and • the ongoing knowledge of P/PF violations for the PIC is increased.

Need For The QI Initiative:

This project was selected as part of the PHAB QI Leaders Academy for Kaizen training and application. In particular, the Environmental Health Department wanted to decrease the number of P/PF violations (~1,600) that were noted in the risk category IV establishments on inspections over the past year and hopefully prevent foodborne illness and increase food safety awareness in the community. In turn, this decreased the number of follow-up visits that the registered environmental health specialists (REHSs) made to those establishments for critical violations.

Area for Improvement:

CHA wanted to reduce the number of P/PF violations during routine food inspections in risk category IV establishments, therefore reducing the number of critical violation follow-ups and critical violation follow-up visits by REHSs. By determining the top 10 P/PF violations over the past four quarterly inspections, CHA determined the root cause of the violations (identified the gap on the establishment side) and determined how to effectively close the gap in the top 10 P/PF violations that have been documented. This in turn decreased the risk of foodborne illness in establishments in Cabarrus County. The vision is • to maintain a decreased number of P/PF violations noted during routine inspections, • to decrease the risk of foodborne illness among residents and visitors of Cabarrus County, • to maintain continued/improved compliance with the North Carolina Food Code Manual, and • to earn improved sanitation scores. Current State Effects on customers • Disruptive to the establishment’s daily activities • Potential additional expenses to correct any P/PF violations immediately or within the required 10 days • Decreased revenue because of low or lower sanitation scores Financial effects • More critical violation follow-ups and follow-up visits are required because of P/PF violations (staff time) • Increased travel time to make critical violation follow-up visits Actions taken • Provided reactive solutions to current violations • Followed up on P/PF violations not corrected during inspections within 10 days

Root Cause:

The following issues and wastes were identified using cause-and-effect analysis: • Managers were too busy to review inspection reports or ask questions.* • Employees did not date or put the wrong date on items (incorrect marking of ready-to-eat food items).* • The team did not follow up to see whether CDI items (marked corrected during inspection) resulted in long-term improvements.* • Just-in-time preparation* • The team did not prepare for inspection daily. • Cold holding temperatures were not maintained. • There was a lack of management experience and control. • The manager was confused by the importance of P/PF versus core violations. Refer to the attached PrISM diagram for more information. *Root cause analysis was performed for these items.

Attachment	Size
10 Priority and priority foundation examples Eng & Span.pdf	639.34 KB
Active Managerial Control Duties - Eng & Span.pdf	262.49 KB
chemical storage Eng Span.pdf	380.39 KB
Date Marking for Ready to Eat Foods Eng & Span.pdf	360.11 KB
Hot and cold holding Eng & Span.pdf	349.41 KB
How to Temp Foods Eng & Span.pdf	388.64 KB
Manual Dish washing process Eng Span.pdf	437.66 KB
Personal Cleanliness Eng Span.pdf	192.32 KB
Proper Cooking Time and Temperatures Eng & Span.pdf	525.04 KB
Proper cooling procedures Eng & Span.pdf	371.95 KB
Proper Food Storage Order Eng Span.pdf	519.54 KB
SRLD.jpg	495.78 KB

Reducing Food Establishment Violations

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Contact Information of the Submitter

QI Spotlight

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Reducing Food Establishment Violations

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Contact Information of the Submitter

QI Spotlight