2. PROGRESSIVE ENGAGEMENT OF AN IMPLICATED PREMISE TO FACILITATE POSITIVE CHANGE

3. July 29, 2014: RECEIVE FBI CSR 2 lab confirmed cases linked to a premise with suspected exposure July 12 and July 13, 2014 …. there were other linked premises at this time

4. Investigation … July 30, 2014 No complaints received / no staff illnesses Business brisk over last 3 weeks with 70% of sales involving ‘shawarma’ chicken Consistent with previous routine inspections, no serious infractions noted at this time No change in food sources, menu items or routine Cleaning / sanitizing / good food handling recommended … now on to the other premises

5. .

6. COMPLIANCE k ə m ˈ plī ə ns (noun) action or fact of complying with a wish or command. tendency to yield readily to others, especially in a weak and subservient way

7. Michael Bayles … Fiduciary Model ($$$) … The weaker party (the operator) depends upon the stronger (the PHI) in ways which are not reciprocated and so ‘the powerless’ must trust ‘the powerful’ …

8. Non compliance … If you do not want our help … we have no alternative but to respect your choice and withdraw our offer to help …any associated consequences are beyond our influence or control

9. PHI as … Judge Enforcer Protector Educator ? … leaving the operator as the …

10. FEELINGS beget …

11. BEHAVIOUR

12. Change ? … Insight and understanding are useless unless … they are translated into action

13. Elizabeth Kübler-Ross … [2] Denial – imagines preferable reality Anger –becomes frustrated Bargaining –hope to avoid cause of grief Capitulation (Surrender) – perceived helplessness Acceptance –"If I can’t beat ‘em, I may as well join ‘em"

14. DENIAL … Owner interested in nature of complaints and potential other contact sites relative to time frame and food items implicated Very interested in science of disease transmission –Seeking plausible deniability … ? suspect foods given similar menu items elsewhere –Seeking ‘proof’ of guilt … ? Timing … delays reported exposure to notification Reluctantly compliant based on expressed ‘trust’ in PHI known to him

15. ANGER … I expect you guys are doing this to everyone else Should I get my own lab tests just in case yours are wrong? Why are so many people coming and asking me the same questions over and over again? I have a business to run … this is my living – my staff depend on their paychecks Presentation of ‘hearsay’ implicating others Challenging perceived slander I have consulted a lawyer

16. BARGAINING … What do I have to do to get everyone off my back? I will bring in a steam cleaner and sanitize everything … if that’s what you want! Confidential conversation with PHI requested by owner to discuss concerns focused on preventing ‘negative press’ …. Closure Discussions with Outbreak Team including potential closure – PROS AND CONS

17. Capitulation (Surrender) … ACKNOWLEDGEMENT OF ‘POSSIBILITY’ –August 13, 2014: Lab confirmation PARSLEY positive for S. Thompson OREGANO positive for S. HUMMUS positive for E. coli August 15, 2014: FORMAL HACCP AUDIT (TARGETING PARSLEY)

18. Acceptance … August 20, 2014: FORMAL MEETING (ACTIVE LISTENING) …MLHU MANAGER / OUTBREAK LEAD AND AREA PHI WITH PREMISE OWNER / MANAGEMENT Information to date suggests illnesses probably caused by ‘cross contamination’ and/or ‘under cooking’ – a food handler not following ‘mandated’ procedures. Acknowledgement of premise efforts to improve circumstances / cooperation including working closely with area PHI on a daily basis Negotiated plan of action to reduce ‘risks’ further including: –Clean and sanitize all food contact surfaces and cooling units thoroughly –Purchase parsley and oregano from alternative source until supplier is deemed safe by MLHU –Increase frequency of hand washing and routinely review proper glove use –Facilitate safe food handler training of ALL staff who work with food

19. Self Efficacy Perceived ability to perform a task Predicts future behaviour if … there are adequate incentives and skills

20. To facilitate change as a PHI, we should practice … EMPATHY … not sympathy COMPASSION … not unconditional regard RESPECT … to earn respect CONSISTENCY … to earn trust If we are overtly sympathetic, a client can easily misinterpret our actions/intents by seeing us as a “ friend ” BUT, we are not there to validate their situation or assume sole responsibility for the required changes.

21. Become a coach … CREATE …a supportive environment OFFER … honest discussion of behaviours ASSESS … performance and agree to objectives CREATE … a development plan together HAVE … follow-up meetings

22. …seek to shift focus from ADVERSARIAL to PROBLEM RESOLUTION

23. Clipart used with permission from Microsoft