Reducing Food Establishment Violations


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.

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: 

Hatley, J. Public Health Quality Improvement Exchange. Reducing Food Establishment Violations . Mon, 02/12/2018 - 16:29. Available at Accessed May 20, 2024.

Submission Status: 
In Progress
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