Evaluating Quality: Demonstrating the Need for a Formal Quality Assurance Program in Environmental Health

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

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Behavior Over Time
Quality and Consistency of EHS
Staff Morale
Variables
Supervisor addresses complaints/concerns on Ad
Hoc basis
Public/Industry Concern Complaints
Time
7
Systems Thinking Model
There isnt 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
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Assumptions

• There isnt 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

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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

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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)

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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

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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

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Conclusions

• The goal should always be to constantly improve
• We cant afford to assume anything
• Public scrutiny will continue to increase
• Industry will continue to demand consistency

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Questions?

• Christopher Smith
• [phone] ext 6662
• csmith_at_wilson-co.com