Texas Health Departments’ Experiences with the Voluntary Retail Food Regulatory Program Standards
Jason Guzman
Texas Department of State Health Services
International Food Protection Training Institute
2015-2016 Fellow in Applied Science, Law and Policy: Fellowship in Food Protection
Author Note
Jason Guzman, Sanitarian II, Training and Standardization Officer, Texas Department of State Health Services.
This research was conducted as part of the International Food Protection Training Institute’s Fellowship in Food Protection, Cohort V.
Correspondence concerning this article should be addressed to Jason Guzman, Texas Department of State Health Services, P.O. Box 149347, Austin, TX 78714-9347. Email: Jason.Guzman@dshs.state.tx.us
Abstract
This exploratory study examines influences on Texas health departments’ experiences with the U. S. Food and Drug Administration’s (FDA’s) Voluntary National Retail Food Regulatory Program Standards (VNRFRPS) using a ten-question email survey to 13 enrolled and 3 non-enrolled departments serving from 2,889 to 1,436,697 persons. Enrolled departments reported improvements in four areas: training standardization; improvement in policy and procedures; foodborne illness/food defense preparedness; and protocols for response to foodborne illness. The survey identified four barriers to meeting standards: lack of funding; limited staff/high turnover; lengthy and sometimes confusing auditing process; and difficulty partnering with another enrolled department to carry out standardization and audits. The study also found a similarity among enrolled departments prior to their enrollment and non-enrolled health departments. Recommendations include the creation of a dedicated website for Texas health departments to share Texas-specific information and advice regarding the Retail Program Standards; to encourage communication among the 262 local health departments regarding opportunities and overcoming barriers to implementation; to identify funding and resources for enrollees; and to provide technical information on topics such as auditing and self-assessment.
Keywords: Texas health departments, Voluntary National Retail Food Regulatory Program Standards (VNRFRPS), retail program standards, food standards implementation, barriers to food standards implementation
Background
National uniformity among retail food protection regulatory programs has long been a subject of debate among industry representatives, regulators, and consumers; adoption of the FDA Food Code at the state, local, and tribal levels since its creation in 2001 has been a keystone in the effort to promote greater uniformity (U. S. Food and Drug Administration [FDA], 2015c). As part of that effort, the FDA’s Voluntary National Retail Food Regulatory Program Standards (Retail Program Standards) were developed to identify what constitutes a highly effective and responsive retail food program in order to provide a recommended framework for food regulatory programs within which active managerial controls can best be realized (FDA, 2015c).
Texas is a “home rule” state (National League of Cities, n.d.) that allows a great degree of independence to local governments such as promulgating their own food safety ordinances. As of 2015, only 65 of 262 (25%) local governments have chosen to enroll in the Retail Program Standards since their creation in 1999 (FDA, 2015a; Texas Department of State Health Services [DSHS], 2015). In addition, these 65 enrollees are making only very limited progress toward meeting the nine Retail Program Standards (FDA, 2015b); in fact, by 2015, no department had reached compliance with all nine standards.
Problem Statement
No current published research describes the influences that bring about or hinder adoption of the Retail Program Standards by Texas local health departments.
Research Questions
1. What do Texas local health departments perceive as the benefits of enrollment in the Retail Program Standards?
2. What do Texas local health departments perceive as the barriers to entry into the Retail Program Standards?
3. What barriers have local health departments in Texas encountered after enrolling in the Retail Program Standards?
4. What are the characteristics associated with the local health departments enrolled and those not enrolled in the Retail Program Standards?
Methodology
An online survey was sent to 16 local health departments using addresses from the Texas Department of State listing of Local Public Health Organizations and the FDA’s Listing of Jurisdictions Enrolled in the Retail Program Standards. The departments served populations ranging from 2,889 to 1,436,697 persons (United States Census Bureau, 2014). The survey asked why the department decided to enroll in the Retail Program Standards; which retail regulation was enforced before enrolling; which of the nine standards had been met; which of the nine standards were most challenging to meet; improvements since enrollment; the greatest areas of struggle in meeting the standards; whether there was a formal training program in place before enrolling and how the training program changed due to enrollment; the status of and issues involving the standardization officer; and a request to share their thoughts regarding the Retail Program Standards.
Results
Overall, the departments surveyed provided complete information about each of the survey questions in a prompt manner. Thirteen departments were currently enrolled in the Retail Program Standards and three were not enrolled. The departments were chosen to represent very small departments serving populations of 100,000 or less (3 respondents), medium departments serving populations between 100,000 and 200,000 (5 respondents), and large departments serving populations of 200,000 and above (5 respondents). One each of the three non-enrolled departments were in the small, medium, and large categories. Currently 26 (40%) of the 65 enrolled health departments in Texas are in the small health department category; 16 (25%) are in the medium-sized health department category; and 23 (35%) are in the large health department category.
Departments identified three reasons for enrollment: creating uniformity in inspections completed by their departments (38.5%); improving public safety policies and procedures such as creation of a foodborne outbreak framework and updating food safety policies to the most current science-based FDA Food Code (23.1%); and promoting training and establishing a criteria for training by these departments (15.4%). Two of the 13 stated that they were unsure of the original reason for enrollment.
The departments were asked which standards they have met since enrollment. Eleven of the 13 enrolled health departments have completed standards since enrollment. Two departments have completed up to seven of the nine Retail Program Standards. Large health departments tended to complete two or more standards, whereas small to medium-sized health departments seemed to have only completed one or less. Departments were also asked which of the standards after enrollment have been the most difficult for them to achieve. Five of the 13 answered Standard 2 (focused on training regulatory staff) as the most difficult; however, the results varied by department size.
Table 1 summarizes the enrolled health departments' population, standards met by 2015, and the standards that they found most difficult to meet.
The departments were then asked about their improvements since enrolling. There were seven local health departments (53.8%) enrolled in the Retail Program Standards that had seen improvements in their training such as increased training opportunities, uniformity in their inspections, and ability to train more staff consistently. Two local health departments (15.4%) had seen improvements in development of policy and procedures including the use of a risk-based inspection frequency program for establishments conducting high-risk processes and thus increasing the frequency of inspections as needed. Another two local health departments (15.4%) reported improvements in foodborne illness/food defense preparedness and response which encompassed improved foodborne illness outbreak investigations and the creation of systems for addressing a foodborne illness occurrence. Two local health departments (15.4%) noted no change in their organizations: one due to its recent enrollment and lack of a self-assessment and the other due to an upper-management restructuring of its retail program that led to a reduction in progress toward the Retail Program Standards.
The departments were also asked about their struggles in meeting the standards. There were seven local health departments enrolled in the Retail Program Standards (53.8%) that noted difficulty in implementing the Retail Program Standards due to lack of funding and reduced staff caused by budget cuts and employee turnover. Another barrier cited by three local health departments (23.1%) was the requirement to standardize a training officer within their departments; all three were in the large category. The departments noted this process to be lengthy, time-consuming, and difficult to achieve.
Some local health departments also noted that the requirement to conduct 25 joint inspections during training was a barrier given that the standardizing officer in larger local health departments maintains other work responsibilities and is responsible for standardization of as many as 30-40 personnel. An additional area of struggle by two (15.4%) of the enrolled health departments was the lengthy auditing process which they found confusing and the cause of delay in meeting standards. One local health department (7.7%) noted a lack of enrolled local health departments nearby that would serve to provide assistance if federal or state offices were not available (Table 2).
Of the non-enrolled health departments, two of the three cited a lack of budget and workforce as a barrier to enrolling in the Retail Program Standards. No other reasons were given.
The departments were also asked whether there was a formal training program in place before enrolling and how that training program may have changed after enrollment. Ten of the 13 (76.9%) enrolled local health departments had no formal training program in place for inspectors before enrolling in the Retail Program Standard but instead referred to "hands-on" and "on-the-job" training, attendance of food safety courses provided in the area, shadowing of experienced inspectors, and completing joint inspections as their training before being released into the field to complete routine inspections. The same 10 enrolled local health departments reported a change in their training programs due to completion of the standardization and training process entailed in Standard 2, including the addition of a designated training officer that carries out training and standardization of inspectors as well as attending FDA courses on risk-based inspection techniques and application of HACCP principles.
Similarly, 2 out of 3 non-enrolled health departments showed no current formal training for inspector staff. Instead they used joint inspections under the supervision of senior staff and “on-the-job” training as their approach to training new inspectors in their departments.
The departments were also asked about their standardization officer status. Ten of the 13 enrolled health departments reported having a designated training officer who completes training and standardization of staff; however, only four health departments’ standardization officers were up-to-date on training of staff.
Finally, the local health departments were asked to share their thoughts about how the DSHS might assist them regarding the Retail Program Standards. The majority of enrolled local health departments very strongly called for more assistance from the FDA and state partners including guidelines for the Training Standardization Officer. Enrolled local health departments also requested improvement in communication from the FDA and state partners; conference calls or webinars that could address specific issues and eliminate travel cost and time spent away from the office; and standard-specific courses and workshops. Other comments included a request for additional support, such as a quick reference guide regarding the requirements for standardization officers.
The non-enrolled departments did not want any involvement by the Department of State Health Services in their retail regulatory activities. They stated that they felt uniformity was not a priority to them and their current regulatory program was sufficient.
Conclusions
After enrollment, the primary benefit perceived by the surveyed local health departments was implementation of formal training programs. A limited number of departments also cited as benefits the creation of policy and procedures (two departments) and foodborne illness/food defense preparedness and response (two departments). The primary difficulties in implementation reported by enrolled departments were budget limitations; the complexity of the auditing process; and barriers to partnering with another agency to help perform the audit.
Recommendations
The study recommends that a website dedicated to the Retail Program Standards in Texas be created for the following four reasons: to share Texas-specific information and advice regarding the Retail Program Standards; to encourage communication among the 262 local health departments regarding opportunities and overcoming barriers to implementation of the Retail Program Standards; to identify funding and resources for enrollees; and to provide technical information on topics such as auditing and self-assessment. A website containing materials related to those topics is likely to address some of the problems cited by enrolled health departments in the study such as the perceived lack of guidance documents from the FDA and the State of Texas.
The website could also aid departments in addressing the barriers to entry found in the study as well as offsetting outdated information on the current FDA website. An updated contact list, easily located on a dedicated website, would encourage communication among local health departments and may solve the issue of finding similar local departments in neighboring jurisdictions that can aid in answering questions related to those specific health departments. The website would also be able to inform departments of the funding and grant opportunities available to departments that are enrolled and allow easy access to this information on the FDA website. Finally, the lengthy auditing process which caused confusion among enrolled health departments could be resolved with links and simplified guidance documents on the website that break down the process in a basic way to aid the departments that have never addressed a self-assessment and audit.
Acknowledgements
I would like to acknowledge DSHS upper management members Mr. Jon Huss, Section Director, Dr. Rod Moline, Unit Manager, and Mr. Christopher Sparks, Public Sanitation and Retail Food Safety Manager that allowed me to take advantage of this rare opportunity to be a part of the International Food Protection Training Institute (IFPTI) Fellowship Program. I would also like to recognize the DSHS Public Sanitation and Retail Food Safety Team that was supportive of and flexible in allowing me to present ideas and questions relating to this project to them for their professional thoughts and guidance. I would like to thank my Fellowship mentor Mr. Cameron Smoak for the valuable time he made for me during this year-long Fellowship Program—his knowledge and experience were greatly appreciated. Lastly, I would like to thank Dr. Paul Dezendorf and the rest of the IFPTI staff members that assisted in the guidance and completion of this project. It has been an exceptional opportunity to be a part of such a unique learning experience.
References
National League of Cities. (n.d.). Local government authority. Retrieved from http://www.nlc.org/build-skills-and-networks/resources/cities-101/city-powers/local-government-authority
Texas Department of State Health Services. (2015). Texas local public health organizations. Retrieved from http://www.dshs.state.tx.us/regions/lhds.shtm
U. S. Census Bureau, Population Division. (2015, May). Annual estimates of the resident population for incorporated places of 50,000 or more, ranked by July 1, 2014 population: April 1, 2010 to July 1, 2014 - United States. Retrieved from http://factfinder.census.gov/bkmk/table/1.0/en/PEP/2014/PEPANNRSIP.US12A
U. S. Food and Drug Administration. (2015a). Listing of jurisdictions enrolled in the Voluntary National Retail Food Regulatory Program Standards: Listing of jurisdictions. Retrieved from http://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/ProgramStandards/ucm121796.htm
U. S. Food and Drug Administration. (2015b). Voluntary National Retail Food Regulatory Program Standards. Retrieved from http://www.fda.gov/food/guidanceregulation/retailfoodprotection/programstandards/default.htm
U. S. Food and Drug Administration. (2015c). Voluntary National Retail Food Regulatory Program Standards—September 2015. Retrieved from http://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/ProgramStandards/ucm245409.htm