by Using the management skills we have to get the compliance we don’t have.
Financial risks for those serving food increase sharply where hand hygiene is not a senior management priority. Neither training nor science creates sustainable gains in handwashing compliance. That takes a management reporting system.
Start with a Team Risk Assessment
Standards are needed as a foundation for setting objectives, risk-based objectives. An internal advocate leader steps forward or is appointed by senior management to determine the current risk level arising from today’s practices and scientific realities.
Risk arises from decisions taken by different divisions. Thus a cross-functional team is needed to assess current practices. This temporary team is often led by a Quality Assurance manager which can work but the buy-in from Operations can cause delays in implementation.
This team of talent assesses current hand hygiene practices according to risk criteria. The customer base, the quality of the workforce, the span of management control and the range of facilities are considered. The team should minimally include Risk Management or Finance, Quality Assurance, Purchasing, Training and Operations. There should be no more than seven members, preferably five.
Setting & Agreeing Standards
A detailed review of current food handling practices creates the common ground to now set approximate standards for the quality and frequency of handwashing.
These approximations are distilled via the implementation of a model program.
In the initial phases the multi-disciplined team can expect to be challenged by those who feel this is a task purely for Quality Assurance or Training. Both have important roles but by having Operations lead the team, the implementation stage is accelerated and facilitated.
The Fragile Balance Between Efficiency and Food Safety
Senior management is currently not looking for hand hygiene reporting. Operations is focused on the indicators of profitability, service, and growth. No one asks, no one measures, no one reports, no one washes.
Converting the growing bank of knowledge surrounding bacterial foodborne outbreaks into preventive measures for our restaurants, food processors and retailers has traditionally been the domain of Quality Assurance. Keeping up on the mutations of the viral world is another task that falls squarely on these scientists.
Converting the scientific facts into operational interventions is yet a third critical function of Quality Assurance. Unfortunately, 1 + 2 + 3 is not adding up to good hand hygiene behaviors.
QA Starts with Standards
Quality assurance is the role of Quality Assurance – verifying that standards are met. QA monitors controlled systems. Quality control is in the jurisdiction of Operations – doing the things that actually control food storage, preparation and service.
The Person-In-Charge (PIC) concept has been an advancement in the restaurant’s ability to control some food safety factors like maintaining temperature logs and enforcing the ill employee policy. The PIC is not part of QA. He or she is a member of the Operations chain of command.
The Model Food Code View
2-101.11 Assignment. *
The permit holder shall be the person in charge or shall designate a person in charge and shall ensure that a person in charge is present at the food establishment during all hours of operation.
The Operations Reality
Nothing tends to happen in a restaurant until Operations understands, buys in and motivates their on-site teams through a controlled series of implementation steps. That’s how it works with menu additions, new uniforms and a myriad of Marketing, Training and Human Resource programs.
Operations is paid to be effective and efficient. Unfortunately it is easier to measure efficiency and almost impossible to measure anything with respect to handwashing effectiveness. In the area of hand hygiene the PIC has nothing to monitor other than an occasional glance at the handsink – dry or wet?
Safety Trumps Code Standards
Taking actions that prevent outbreaks should trump even obeying local laws. This is an uncomfortable reality as a restaurant can get closed for a non-compliance factor even if the restaurant’s hand hygiene practice is operationally superior. Take for instance a clean hand versus a soiled glove. By current inspection practices, a clean bare hand can be written up while the worker with soiled gloves is applauded.
Gary Ades, G & L Consulting, summed it up this way “Operations rules until there is an outbreak. Then for about a year senior management listens to QA.”
Who is in charge of food safety and hand hygiene? Operations!
How can Operations change handwashing behaviors? How does anybody change the behavior of another?
According to Albert Einstein: Setting an example is not the main means of influencing another, it is the only means. Seven hundred years earlier, a similar perspective was offered by educator St. Francis of Assisi: Preach the Gospel at all times and when necessary use words.
Translating these valuable reminders into action, we suggest these seven steps:
- Form the Hand Hygiene Risk Assessment Team.
- Agree standards and challenging but achievable goals. Communicate the why behind them.
- Empower the staff to maintain standards, 24/7, by taking timely corrective actions.
- Add equipment that makes it easier for the worker to comply with the new standards.
- Coach & Train.
- Monitor progress.
- Reward success.
Operations has the experience, the know-how and a roadmap to change handwashing behaviors. The solution is seeded in previously completed projects requiring behavior change.
Identifying a Pattern for Success
We suggest selecting one of the best-executed menu additions experienced by the group. This becomes the center of discussion at one of the early team meetings, listing the steps and relating them to the hand hygiene challenge they face.
When a new menu item is introduced it is wrapped in an intense research program followed by test kitchen development with near seamless input from the science of Quality Assurance. Once aligned, Operations picks up the item and works it into the realities of their operations – their equipment, menu, facilities, customer base, local management skills and workforce quality.
The new item is then rolled out to a region or more. Results versus standards are monitored. Cost/value analysis is verified. Positive ratios further expand the new item.
Implementing Handwashing’s Management 101
Now with the Hand Hygiene Risk Assessment team’s analysis complete, they issue an internal management statement summarizing the corporate risk, the foundation for further action. This Hand Hygiene Risk statement should have a headline of not more than 10 words that covers the reality and takes into account the culture and organizational structure of the company.
A Template to Reduce Risk Arising from Hand Hygiene Gaps
Our risk is moderately high based on our team’s assessment of current conditions and hand hygiene practices… Risk-based criteria included: (See Hands-On System)
- At-Risk Customer Ratio, Ill Customer Factor
- Menu
- Food Handling, Ready-To-Eat (RTE) Factors, Process Control
- Facility & Equipment Considerations
- Worker Quality, Health, Training & Turnover
- Management – Employee Motivation & Control
The Executive Summary
This is followed by a two page executive summary that includes a recommended solution, the building of a working model and budgets to accompany each phase. Agreed success moves the model to a multi-restaurant scale, 3-5 units.
Included in this report is a verbal expression of the ongoing tension between productivity and handwashing along with this reminder:
Measurement of direct costs can eclipse the bigger but less measurable indirect cost savings, things like reduced absenteeism, insurance premiums, brand value, image and the direct costs of foodborne outbreaks.
Consider adding this statement to an appropriate report: Productivity does not trump safety on my watch. (Signed by each PIC)
The total solution is written down, shared and implemented with the rigor and discipline of a new menu item. Now armed with a system, Quality Assurance helps Operations achieve their quality goals by periodic monitoring.
Management Reports Replace Risk Assessment Team
The Hand Hygiene Assessment Team disbands. Handwashing compliance becomes a line in periodic reports up through the Operations’ organization, to the Executive Committee and Board.
Best practice, Safe Level handwashing and sanitizing will cost more. Adding up soap, paper, sanitizer, employee time and depreciation costs for more handsinks might add up to a $ 0.10 handwash. Whatever it takes to achieve your hand hygiene Safe Levels must be worth considering as serving good food is first about serving safe food. As the risk will never be zero, insurance has its place in managing this risk.
A multi-unit operation always has a lot of experience in how problems are solved. Their confidence building and decision making process will first reflect values rather than budget limitations. It isn’t the budget that keeps handwashing issues unresolved. It is the lack of decision support information. Good management is starved by the handwashing information famine. They don’t know the current gaps and how little it would cost to substantially reduce the risk of an outbreak. If there ever was a silver bullet for this issue it is Management 101.
References to the Model Food Code are found at a Hand Hygiene version of the Food Code
