Environmental Health Food Protection Program Improves Policy and Rule Communications for Local Health Departments


The Environmental Health Section, Food and Facilities Branch surveyed its stakeholders to learn where improvements are needed.  Response to the survey was outstanding and clearly identified lack of consistency in communicating program policies and procedures as potential improvements. 

Program policies were being communicated to local health departments through regional consultants, which created regional silos variation in information given across regions, even though regional consultants communicated with one another regularly.  Many respondents commented that when a policy question is answered for one county, the answer should be shared with every other county in the state to build consistency.

The Food and Facilities Branch created a quality improvement team to examine and improve how policies and rule interpretations were communicated.  The team decided to scrap the old process and develop a new process to communicate to everyone when major policy and rule decision were made.  A standardized process for researching questions about rule interpretation and enforcement issues was developed and a format for issuing program-wide position statements was tested and adopted. ehfpp quote

The position statements give background on each issue, what the laws and rules say about the issue and what program policies apply to that issue.  Position statements are reviewed by all program staff, attorneys, and some key stakeholders for concurrence before communicating the policy statewide.  The position statements are communicated via an email list and published on the North Carolina Food Code Annexes web page as a collection of all policy documents.  The North Carolina Food Code Annexes are sorted by the subchapter of the NC Food Code Manual and are key word searchable, serving as a reference tool for anyone searching for answers to questions that may have been answered in the past.

The Food and Facilities Branch marketed the North Carolina Food Code Annexes Website as a research tool and introduced the new decision-making process and position statement format for communications.  As a result, web site activity increased from zero to 1,400 document visits including 350 visits to the Food Code Annexes Main Page in the third month of operation.   Regional consultants are now spending much less time searching for copies of old policy documents and answering questions.  More staff time is spent reviewing position statements, but not having to research answers to questions individually provides greater consistency and prevents duplication of effort going forward.  These changes have now been implemented in all other programs in the Environmental Health Section so that all communications with local health departments follow the same format.

Throughout this process the Center for Public Health Quality (CPHQ) assisted the improvement team with using QI tools, including the customer satisfaction survey, process mapping to visualize where to implement changes, Plan-Do-Study-Act (PDSA) cycles to evaluate forms and position statement templates with stakeholders, and measuring the improvements. 



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