1. QUALITY IMPROVEMENT: FOOD PROTECTION & FACILITIES BRANCH Larry Michael, NC Division of Public Health Food Protection & Facilities Branch Head Jim Hayes, NC Division of Public Health Pools, Tattoos, and State Institutions Program Head

2. Center for Public Health Quality Focuses on building workforce QI capacity Develops, leads, and supports strategic QI initiatives for the DPH and local public health agencies Incorporates QI methods (e.g., Lean, MFI) that are commonly used by public health system partners Ultimately, aims to help all public health agencies have ability to continuously improve

3. Participants will be able to: Use QI methods & tools in daily activities to improve the effectiveness & efficiency of services Coach others within their organization/department to use QI methods & tools Develop a plan to incorporate QI methods & tools so that it becomes “the way we do business” Program Objectives

4. “A continuous and ongoing effort and culture to best achieve measurable improvements in the efficiency, effectiveness, quality, performance, and outcomes of services and systems with the goal of improving the health of North Carolinians and our communities.” NC DPH Management Team, 2009 Adapted from Accreditation Coalition QI Subgroup Consensus Agreement What is QI?

5. Reduce costs and redundancy Eliminate waste Streamline processes Increase accountability Boost morale and teamwork Enhance ability to meet service demand Improve outcomes - Public Health Memory Jogger, 2007 Why QI?

6. Key Features of QI Focus on systems, not individuals Ideas/changes from customers & front line staff Focus on small tests of change Frequent, ongoing measurement and data-driven decision making QI is a never-ending process…it’s continuous It should help staff, not hinder

7. Model for Improvement

8. QUALITY IMPROVEMENT PROJECT

9. Customer Satisfaction Survey Conducted January 2013 Positive Comments: Staff effort CIT & other training Program evaluation Authorization process and timeliness Consultation Response time to inquiries Accessibility Food Code What We Need to Work On Consistency and Communication

10. Comments from the Survey Consistency. Advice is vague at times

11. We need MORE PEOPLE!

12. Be more of the mindset to educate rather than just to regulate.

13. A WORKING COMPUTER DATABASE FOR FOOD AND LODGING INSPECTIONS TECHNOLOGY ………!!!!!!!

14. To better improve consistency from one part of the state to another when a regional makes a decision about an interpretation or something else, it should be sent on the listserv so others can benefit

16. The Food Protection & Facilities Branch AIMS To: Improve consistency of interpretation and enforcement of the North Carolina Food Code by better communicating interpretations of the food safety standards to local Environmental Health Specialists by September 30, 2013.

17. Better Consistency Will… Maintain program integrity Build public trust Protect public health Reduce liability Build credibility Potentially improve use of regional specialists’ time

18. Quality Improvement Program Establish Clearinghouse Committee to research and answer questions about interpretation and enforcement of NC Food Code Use a standard template for communicating questions and answers Organize all documents about interpretation and enforcement of the NC Food Code in searchable online NC Food Code Annexes Evaluate for possible expansion to other programs

19. Position Statements Clearly defines the topic Law or Rule Question/Issue Discussion and Rationale Response/Interpretation References

20. North Carolina Food Code Annexes Website Makes all documents about interpretation and enforcement of the NC Food Code available online Documents are sorted by which subchapter(s) of the Code they pertain to Links to documents from FDA Goal—To make it quick and easy to find answers to any questions that have already been asked

21. What We Hope to Learn Will formal position statements improve consistency of information? Will online access to program documents allow answers to be found quickly? Will the NC Food Code Annexes be a popular and useful tool that could be applied to other programs? Will regional staff see fewer repeat questions if initial answers are more widely distributed?

22. Goals

23. Goal 1: Decrease # of Questions Received

24. Goal 1: Decrease Response Hours

25. Goal 2: Increase # of web hits

26. Goal 3: Improve Communication

27. Goal 4: Improve Consistency

28. Goal 5: Improve Quality of Consultation

29. Assessment – Value Stream Map Current State

30. Assessment – Improvement Ideas 1. Web-based Food Code Annexes 2. SOPs for responding to customer questions 3. Question Submission form 4. Position Statements 5. Memo review 6. Q&A database 7. Clearinghouse Committee 8. Roll out to stakeholders

31. PDSA to Test Changes

32. Question Submission Form PDSA cycle Feedback applied Planning another PDSA cycle (technical challenges)

33. SOP - Clearinghouse Committee 1. Review and make final decision for draft position statements 2. Maintain Q & A database after questions are answered 3. Q & A and Position Statements will indicate training needs 4. Review and maintain jurisdiction chart for the Web 5. Maintain awareness of trade secrets for firms

34. Position Statements

35. Classifying Memos Revise…Review…Rescind

36. Classifying Memos

37. Q & A Database 200+ questions received so far from LHDs EH staff “frequently asked questions” Sorting ability eliminates duplicate efforts Resource on web for quick reference

38. Anticipated Benefits for ROI (Return on Investment) Reducing time in Q&A will increase face to face time Improving consistency is a customer satisfier “Real Time” web access reduces inequities across NC Website promotes public awareness and trust Creates transparency Creates a standard for other states Portable for other entity use (states, industries, public) Compliant with FDA food standards 4, 6, & 7 Builds program integrity and credibility Reduces liability

39. Next Steps Develop customer request tracking log to promote transparency Reprioritize performance plans to support QI Finalize flow chart routing, etc. Evaluate web approach adaptability to other EH programs Develop web maintenance plan and protocol for updating information Conduct follow-up customer satisfaction survey

40. AHA! We can see how it is all coming together More productive being together vs silos Understand how the different components of our project link together Question Submission Form will help us save time and be more efficient This identifies our program weaknesses Realized the need for standardized processes Outstanding issues not being high priority