Keys to the success of the San Diego County food safety program are the established partnerships within FHD and the broad range of stakeholders that have participated in the design and implementation of risk-based intervention strategies. The team approach to intervention strategies that evolved from the partnership efforts contributes to: decreasing trends in the occurrence of major risk factor violations in food facilities; improving food employee behaviors and food preparation practices; and enhancing foodborne illness surveillance methods that identifies other food safety risks in the community.
Another key to the success of the San Diego County food safety program is the reduction of foodborne illness risk factors in regulated food facilities by promoting an inspection methodology that focuses food facility inspection and education efforts on the food safety risk factors identified by the Centers for Disease Control and Prevention (CDC) as the most prevalent contributing factors to foodborne illness or injury. In 2002, our efforts culminated in establishing the long-range TEAM Excellence Performance Measurement System plan. This plan includes strategies for assessing risk, communicating risk, managing risk, and verifying the quality of service.
Our primary program planning efforts have been on reducing foodborne illness in San Diego County. To meet the challenge, we set our food safety program planning goals on achieving positive environmental/public health outcomes, measuring performance, and continuously improving quality of service. An important element of this process is the assessment of risks. Assessing risk is an ongoing process that is essential in identifying changing trends, new problems, relationships between lack of knowledge and violations found, and the effectiveness of implemented interventions. Trends in the occurrence of major food safety risk factor violations can also identify training or other intervention strategies needed to reduce risks. Annual reviews of: major risk factor violations found during inspections; contributing factors found during foodborne illness investigations; and total Salmonella, Campylobacter, and E. coli cases reported by medical providers assists us in continuously improving our processes, identifying new or emerging environmental/public health concerns, and in effectively diverting resources to areas of environmental/public health concern.
Traditionally, in conducting program planning activities, environmental/public health programs have been viewed as difficult to measure because they are preventive in nature. In other words, you can’t measure what you have prevented. So in response to this paradigm, programs have resorted to counting “things” rather than outcomes. These “things” have included number of inspections conducted or number of enforcement actions taken. But this approach does not tell us “the difference we are making”, or what public health issues are ongoing, new, or evolving in our community. Compliance approaches have also been short term in duration. Short term compliance leads to a “rebound” condition that contributes to “the place that is always bad” syndrome. Our challenge is to develop performance measures that identify “how we are doing”, answer the question “what’s going on here”, and assess whether or not we are working effectively. We also realize that we need to continue to seek interventions that change behavior, rather than simply “satisfying the inspector”.
Agency Community RolesThe FSAC partnering concept utilized by FHD was instrumental in developing the long-range TEAM Excellence Performance Measurement System plan in 2001-2002, new wholesale food warehouse inspection and education program in 2002, the food facility operator’s guidebook in 2003, and the new risk-based inspection process and report in 2004. Additionally, beginning in the spring of 2004, comprehensive training on risk factors and interventions and the new risk-based inspection report were conducted through workshops held throughout the county (in English and Spanish). These five accomplishments have had significant impacts in reducing the occurrence of food safety risk factors in retail food facilities by increasing knowledge and improving food employee behaviors and food preparation practices.
The FSAC is comprised of food industry stakeholders, San Diego food handler training schools, the San Diego State University Graduate School of Public Health, the Farm and Home Advisor, epidemiologists, public health nurses, the FHD, and interested consumers. The focus of the FSAC is on information sharing, input regarding program planning, and educating our stakeholders. A number of educational presentations are also provided on a regular basis to interested stakeholders and an e-mail distribution list is available to share new and important information.
On a statewide level, since 2001, the Chief of FHD and the Director of the Department, representing local jurisdictions on the California Retail Food Safety Coalition , have taken leading roles in rewriting the California Uniform Retail Food Facilities Law so it will be modeled after the FDA Model Food Code. Countless hours of effort both on and off the clock has been poured into this effort in order to improve public health in California. Additionally, our website (www.sdcdeh.org) is one of the main information portals used to communicate with both our internal and external customers. At present, more than 10,000 documents are downloaded monthly.
ImplementationIn 2001, we found that the Food and Drug Administration (FDA) National Retail Food Program Standards provided guidance on necessary food safety program components and that Healthy People 2010 provided national goals that we can contribute to. We also started to actively seek input from stakeholders. Our efforts culminated in establishing the long-range (2002-2007) TEAM Excellence Performance Measurement System plan.
1) Assessing risks that can contribute to illness, injury and death in health regulated facilities. Trends in the occurrence of risk factors can identify training or other intervention strategies needed to reduce risks. A dashboard report that monitors the occurrence of risk factor violations at regulated facilities is maintained and reviewed each month.
2) Communicating risks through educational outreach and training programs for health regulated facilities. A sound knowledge base is the first step in ensuring public and environmental health and safety. Maintaining excellence in customer service is also an important component to an effective system. Educational outreach materials and methodologies are being updated and developed to ensure a sound foundation of knowledge for operators and employees of regulated facilities.
3) Managing risks by promoting an inspection methodology that prioritizes inspections and investigations based on relative risk and ensures the focus of inspections is on risk factors and interventions. It is essential that a balance between output (inspections conducted) and outcomes (the reduction in risks) be achieved in order to accomplish desired goals and objectives of protecting the public’s health.
4) Verifying the quality of service, consistency and uniformity of operations, and identifying resource needs and training for staff are important components of a program to ensure excellence. An Excellence in Service program that is designed to assess and verify a quality inspection program is necessary. This process includes an evaluation process, annual standardization, and customer service surveys.
Goal: To reduce the number of foodborne illnesses caused by key pathogens in San Diego County.
Objective: To reduce food safety risk factor violations in retail food facilities (FDA Retail Food Program Standards goal) by improving food employee behaiors and food preparation practices (Healthy People 2010 objective):
Performance measures: Reduce food safety risk factor violations in retail food facilities by 10 percent per year over a five-year period beginning in 2003. By July 1, 2005, there was an overall 58% reduction of major risk factor violation occurrences found during inspections.
Data collection: 1) major food safety risk factor violations were tracked and reviewed each quarter in a digital dashboard report; 2) the data is collected from inspection reports completed by Registered Environmental Health Specialists; 3) the data is collected in an electronic data base where reports are run on a quarterly basis
Outcomes: From 2003 to 2005, and after the implementation of food safety interventions, major food safety risk factor violations have decreased by 58% overall. Trends in the occurrences of risk factor violations continue to decline indicating the outcome is long-term.
FHD is similar to many successful organizations that are geared toward achieving positive outcomes, measuring performance, and maintaining and improving the quality of service. However, FHD has achieved additional accomplishments by partnering with our community and the FSAC to develop and implement the model TEAM Excellence Performance Measures System for the San Diego County food safety program. This system, built on a foundation that utilizes the concepts of assessing risk, communicating risk, managing risk, and verifying quality of service has resulted in identification and reduction of food safety risks in the community. Its main focus is on achieving long term positive environmental/public health outcomes and will continue.
Long range planning has also helped us develop multi-year permit fee adjustments that ensure the stability of program revenue for a food safety program that demonstrates value to the community. The identification of risks using our Team Excellence Performance Measurement System also ensures that resources are diverted to critical areas, leading to cost effectiveness and cost efficiency of services provided. A tremendous amount of time and commitment by FHD staff and stakeholders have contributed to the success of our program in enhancing the quality of life for 3 million residents and nearly 15 million overnight guests that visit the County each year.