Multnomah County Health Department ►Essential Services ►FDA Food Standards ►PACE Tools for Food Program Excellence Lila Wickham March 17, 2004 ♣

Strategic Planning Tools FDA Essential Services PACE Tools

About Oregon County Health Departments provide restaurant and associated food program services in 25 counties Department of Agriculture performs inspections in retail food facilities State Health Department provides inspections in 11 counties County Health Departments provide epidemiology of food/water borne illness

Recent Changes By 2006 all 36 county health departments will provide restaurant and associated food program services FDA food program “standardization” is required of Environmental Health Specialists in county health departments

Local Statewide Strategic Planning Step 1. Articulated our mission: Promote and contribute to a healthy and safe environment through local public health authority Step 2. Articulated our vision: Safe and healthy communities in Oregon

Step 3. Articulated our values Policy decisions are made based upon public health principals Utilize national standards/best available science in developing policy Technical competence High quality service Results oriented approaches

Step 3. Values Continued Results oriented approaches Community engagement Meet community needs and expectations Empower the public Focus on the public Develop culturally competent materials & services

Step 3. Values Continued Encourage diverse perspectives Provide comprehensive services Honest and ethical communication, treatment of others and adherence to processes

Step 4. Identified tools for implementing our values Essential Services FDA Food Program Standards Protocol for Assessing Excellence in Environmental Health

Essential Services 1.Monitor health status 2. Diagnose & Investigate health problems 3.Inform Educate and empower people 4.Mobilize community partnerships 5.Develop policies and plans 6.Enforce laws and regulations 7.Link to provide care 8.Assure competent workforce 9.Evaluate quality 10.Research for new insights

Step 5. Created Food Program Indicators for Ten Essential Services Performance Indicator Criteria – Simple – Understandable – Acceptable – Measurable – Defensible

1. Monitor health status to identify community EH problems A system is in place to receive illness reports A system is in place to assure timely review of reports received A system is in place to identify barriers for timely and complete reporting A system is in place to identify at risk populations A system is in place to identify environmental health threats A system is in place to conduct active syndromic surveillance

2. Diagnose and investigate EH problems and hazards in the community A system in place for 24/7/365 coverage to assure timely investigations A system for reviewing, evaluating, and validating complaints and reported health hazards Appropriate and useful software is available to do FBI analysis, follow trends, identify risks, and make projections A system in place to communicate with other stakeholders to identify common trends, problems

3. Inform, educate, and empower people about EH issues System in place to inform the public about food safety issues and illnesses An active food safety/service advisory committee is in place Clear, consistent, and culturally appropriate education programs and documents are available for industry and the public A system in place to evaluate appropriateness and clarity of food safety messages

4. Mobilize community partnerships to identify and solve EH problems A process in place to identify food safety stakeholders A system in place to identify roles and responsibilities of partners A system for actively involving and utilizing food safety stakeholders and partners on issues of common interest A system is in place to partner with educational institutions

5. Develop policies and plans that support individual and community EH efforts and strategies A system is in place to include food safety stakeholders into the development of food safety policies and procedures. A system is in place to educate, brief, and inform policy makers about the status of food safety on a regular basis A system is in place to prioritize and rank food safety issues and threats for intervention strategy

6. Enforce laws and regulations that protect health and ensure safety A system is in place to assure consistency of program activities A system is in place to evaluate enforcement tools A system is in place to solicit and receive community feedback on the effectiveness of enforcement of laws and regulation A protocol is in place to assure the effectiveness, appropriateness, and clarity of food safety laws, regulations, and compliance requirements

7. Link people to assure EH services and assure EH services when otherwise unavailable A system is in place to provide food safety information and services to underserved and unserved populations An up-to-date directory of referral sources A system is in place for expanding beyond normal capacity or mutual aid agreements

8. Assure a competent EH workforce An on-going training plan is in place to improve the KSA’s of Environmental Health practitioners working in food safety programs A system is in place to identify and evaluate adequate staffing levels to meet food program standards A system is in place to review and evaluate the quality, consistency, and performance of food program staff

8. Continued A system is in place to assure the workforce is delivering food safety services in a culturally competent manner A system is in place to assure quality technical assistance to food program staff A system is in place to ensure competency of newly hired EH practitioners working in the food safety program

9. Evaluate effectiveness, accessibility, and quality of EH Services A system is in place to evaluate food program standards (to include performance and outcome) A system is in place to evaluate the effectiveness of local food programs against state standards and strategic plan A quality improvement plan is in place to evaluate food program interventions

10. Research for new insights and innovative solutions to EH problems A system is in place to access information from research orgs (DDA, CFSAN, NSF, universities, etc) A system is in place to disseminate and utilize new or innovative solutions to food safety problems A system is in place to seek grants, new funding opportunities, or partners for research project

Step 6. SWOT Analysis with Prioritization Identified our Strengths/Weaknesses/Opportunities and Threats to Prioritize the Essential Services

Step 7. Prioritized Services Essential Service #9 Evaluate effectiveness, accessibility, and quality of EH Services Essential Service #3 Inform, educate, and empower people about EH issues Essential Service #8 Assure a competent EH workforce

Food Program Standards Standard 1Regulatory Foundation Standard 2Trained Regulatory Staff Standard 3HACCP Principles-Based Inspection Program Standard 4Uniform Inspection Program Standard 5Food Borne Illness Surveillance Standard 6Compliance & Enforcement Standard 7Industry Recognition Standard 8Program Resources Standard 9Program Assessment

Step 8. Integration of FDA Standards Examples Essential Service #1 Monitor health status to identify community EH problems A system is in place to identify at risk populations? Utilize FDA Food Program Standard #5 to monitor illness and track trends of food borne illness Utilize FDA Baseline study analysis to determine most frequent risk practices

Step 8. Integration of FDA Standards Examples Essential Service # 6 Enforce laws and regulations that protect health and ensure safety A system is in place to evaluate enforcement tools? Utilize FDA Food Program Standard #6 to evaluate consistent enforcement mechanisms

Step 8 Integration of FDA Standards Examples Essential Service #8 Assure a competent EH workforce A system is in place to review and evaluate the quality, consistency and performance of food program staff? Utilize FDA Food Program Standards #4, #5, #8 to identify outcomes and food program activities

Integration of FDA Standards Examples A system is in place to ensure competency of newly hired EH practitioners working in the food safety program? Utilize FDA Food Program Standard # 2 to create comprehensive orientation

Oregon is in compliance with the following FDA Food Program Standards 4. Uniform Inspection Program 6. Enforcement 7. Industry and Community Relations

Multnomah County is in compliance with the additional FDA Food Program Standards 5. Food Borne Illness