1. “Proactive Public Protection: A Risk Based Approach” Derek J. Jakovich, J.D., M.B.A., M.H.A., Manager, Patient Quality Care Unit, Texas Department of State Health Services Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri

2. Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri What Does A “Risk Based” Approach to Regulation Mean? Define “Risk” Who or what do you regulate? Identify your resources Develop a risk matrix Develop and implement a work plan based on risk assessment Evaluate your results

3. Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Risk Analysis Risk is defined as “the element of uncertainty in an undertaking.” Goal is to reduce the risk to the public that we are mandated to protect = Be Proactive! Analysis: - who should you “target” ? - is there a mandated frequency of inspection? - prioritize complaints based on risk

4. Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Risk Analysis Continued –Is an onsite visit necessary? –Is self-inspection an option? –What is the average inspection/complaint investigation time? How many? –Are there any political factors to consider with certain regulated activities? –Are there required response times? –Is it a heavily regulated activity ?

5. Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Know Who/What you Regulate Does the regulated activity affect a large or small # of the public ? Do you inspect? Conduct complaint investigations? Where is the licensed population – to focus resources where needed? What is the compliance history of the “targeted” group?

6. Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Resource Issues Adequate number of staff Location of staff – regionally based, central office, or even home based? Staff experience Budget ($$$) Geographic limitations of state Law and rules – enforceability issue

7. Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Risk Matrix Develop a risk matrix tool which identifies and analyzes the criteria which determine the level of risk associated with each regulated activity In the following example, every firm is assigned a risk assessment of high (6-12 months), medium (12-18 months), or low (18-24 months) to determine inspection frequency Assessment based on # value of key criteria associated with risk of food borne illness

8. Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Inspection Frequency Assessment/Profile Inspections of Retail Food Establishments in Texas 8 Criteria - type of facility - main menu items - type of water system - type of sewage disposal - type of food preparation (POH) - food served or sold - average # meals served per day - population served

9. Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Inspection/Investigation Workload Plan Identify your data base inventory and determine who must be inspected and how often, e.g.., Firm X every 6 months, Firm Y every 18 months etc. Analyze your complaint workload, based on categories of assigned risk Focus resources where the greatest identified need is in the state Adjust work plan as appropriate

10. Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Evaluate Monitor and evaluate your work plan monthly, quarterly, yearly, and as needed Perform quality assurance/CQI on performance results, including feedback to staff Develop management reports to analyze efficiency, effectiveness, and resource utilization

11. Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Proactive Public Protection: A Risk Based Approach Speaker contact information: Derek J. Jakovich, J.D., M.B.A., M.H.A., Manager, Patient Quality Care Unit Texas Department of State Health Services 1100 W. 49 th Street, Austin, Texas 78756 PH# (512) 834-6700, Fax# (512) 834-6736 E-mail: derek.jakovich@dshs.state.tx.us Website: www.dshs.state.tx.us