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Christopher J. Smith, RS, MPA Director of Environmental Health Wilson County Health Department

Evaluating Quality: Demonstrating the Need for a Formal Quality Assurance Program in Environmental Health. Christopher J. Smith, RS, MPA Director of Environmental Health Wilson County Health Department. Problem Statement.

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Christopher J. Smith, RS, MPA Director of Environmental Health Wilson County Health Department

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  1. Evaluating Quality: Demonstrating the Need for a Formal Quality Assurance Program in Environmental Health Christopher J. Smith, RS, MPA Director of Environmental Health Wilson County Health Department

  2. Problem Statement • In the State of North Carolina, and specifically Wilson County, there is not a method of routinely and consistently evaluating the fieldwork of Environmental Health Specialists (EHS) that inspect food establishments.

  3. Why is this a Problem? • EHS work independently but need support • Supervisors need to evaluate EHS in the field • Consistency is desired by everyone • The goal for QA is a staff that produces high quality and consistent work

  4. Contributing Factors • Lack of regional field staff at the state level leads to an inconsistent monitoring of quality and consistency of the counties • Local supervisors are often not properly trained on how to evaluate field staff and do not understand the importance of doing so • Local supervisors do not have the manpower to devote to quality assurance programs on an ongoing basis • Concerns have been raised regarding the consistency of staff  

  5. What is in Place Now? • Ad Hoc QA Program • Supervisor only works with EHS in response to public/industry concerns/complaints or request of EHS • Might happen very often or never • Some EHS feel “picked on” • Other EHS feel neglected • Potentially leads to lack of consistency and unknown quality

  6. Behavior Over Time Quality and Consistency of EHS Variables Staff Morale Supervisor addresses complaints/concerns on Ad Hoc basis Public/Industry Concern & Complaints Time

  7. Systems Thinking Model There isn’t enough time for a formal QA Program Symptom Correcting Process Supervisor addresses complaints on case-by-case basis: Ad Hoc QA Ad Hoc QA is easier for everyone O Staff Morale B O S S Concerns/ complaints about quality & consistency R Need to deal with staff member that complaint was received about Willingness to Embrace new QA program O S B S Development and Implementation of Formal Quality Assurance Program Need to include all staff to ensure long term consistency

  8. Assumptions • There isn’t enough time to conduct a full QA program • It is much easier for the supervisor and the staff to conduct QA on an ad hoc basis • Staff find it less intrusive and all do quality field work so oversight is generally not needed

  9. Challenging Assumptions • It is impossible to judge the quality of field work unless observed • If staff get used to a supervisor occasionally accompanying them on inspections then they will find it less intrusive and find a comfort level with it • As comfort level increases, staff will be more apt to seek second opinions from the supervisors both in and out of the field • Over a long period of time, it will take less supervisory time to routinely work with the staff in the field then to deal with the problems that will arise from an ad hoc QA program

  10. Next Steps • Begin working with staff in the field on a more regular basis to increase comfort level (In progress) • Add a staff position to alleviate workload (Complete 7/1/08) • Add an Environmental Health Program Specialist (EHPS) position to serve as program manager and QA specialist (Complete 7/1/08) • Research QA programs from other jurisdictions (In progress) • Develop policy and forms for QA program (In Progress) • Train EHPS on basic field QA methods (In Progress)

  11. Policy Ideas • Minimum number of joint inspections required between EHS and supervisor per year, quarter, etc. • Narrative feedback reports following joint inspections • Score comparison between supervisor and EHS following joint inspections • Supervisor visits to establishments between EHS inspections such as for critical violation visits and complaint investigations

  12. Policy Ideas • Standardized supervisory review of EHS inspection forms. • Minimum number of joint inspections required between EHS coworkers • Regularly scheduled staff meetings to discuss issues and promote consistency • Minimum number of continuing education hours completed by each EHS per year

  13. Conclusions • The goal should always be to constantly improve • We can’t afford to assume anything • Public scrutiny will continue to increase • Industry will continue to demand consistency

  14. Questions? Christopher Smith (252) 291-0468 ext 6662 csmith@wilson-co.com

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