Smart as trees in Sault Ste. Marie: Restaurant grades come to Seattle

The Sault (pronounced Sue) is on my mind today.

barf-o-meter_-dec_-12-216x300-216x3001-216x300-1-216x300-216x300Lots of feedback about the Esposito brothers (Tony and Phil) who hail from Sault Ste. Marie (in Ontario, Canada) and, more importantly, most excellent graduate student Katie, who hails from the Sault, got an undergrad at Guelph, did her Masters research in New Zealand and got her degree from Kansas State.

So when JoNel Aleccia of The Seattle Times e-mailed me to get my take on the county’s proposed restaurant inspection disclosure system, I used it as an excuse to get back in touch with Katie.

It’s taken nearly two years, but King County restaurants will soon start posting storefront signs that display their health-inspection status at a glance, giving diners a new view into food safety.

Exactly what those signs will say, however, is still up to the public to decide.

Starting in January, officials with Public Health — Seattle & King County plan to roll out a long-anticipated public grading system that rates restaurants based on an aggregate score of four recent inspections.

Depending on the results, a restaurant may be ranked excellent, good, fair or needs improvement on signs that could feature smiley-face emoji in shades of green and yellow.

“It’s exciting,” said Becky Elias, Public Health food and facilities section manager. “We feel like this is thorough and evidence-based.”

Local diners can vote on six variations of the placards online by Thursday, Nov. 17.

Elias and her crew originally thought a restaurant-grading system could be in place by the start of 2015, but it took longer than anticipated to get it right, she said.

Local health officials overhauled the system that regularly sends 55 inspectors to review more than 11,000 permanent food businesses and an additional 3,000 temporary sites in King County.

With the help of Daniel E. Ho, a Stanford University law professor who has studied restaurant-rating programs extensively, they refined and standardized the way inspectors make decisions and then came up with placards to convey that information to the public.

Throughout the process, they sought out opinions from everyone involved, including restaurant owners and food-safety advocates. Such collaboration was appreciated, said Patrick Yearout, director of recruiting and training for Ivar’s restaurant company, which operates 25 sites in King County.

Food-safety advocates said they’re pleased that King County is unveiling a new ratings system, but they’re not enthusiastic about the smiley-face signs.

Sarah Schacht, 37, of Seattle, is a two-time victim of E. coli food poisoning who has been lobbying the county to help warn consumers about restaurants with unsatisfactory inspections. She’d prefer to see numeric scores on the new signs, not just emoji.

“If you look at these placard examples, in the end, the information you’re supposed to absorb and make a decision on comes down to the size of the smile on the smiley face,” she said. “I think the options are better than nothing, but they’re problematic.”

seattle-rest-inspect-disclose-nov-16Doug Powell, a former Kansas State University food scientist who runs the food-safety site, barfblog.com, said the proposed King County signs “all seem too busy.” If he had to choose, however, he’d choose options B or D, he said.

“At least they are asking people, which is good,” he added.

Katie and I e-mailed, and she said she preferred C, because it was clearly visible from distance, the colour is prominent, the universal symbol avoids language barriers and has better use of space on the card.

I like B and D because the gauge reminded me of something Katie created years ago while goofing around.

And this is my favorite Tragically Hip song, but no live versions of it.

Filion, K. and Powell, D.A. 2009. The use of restaurant inspection disclosure systems as a means of communicating food safety information. Journal of Foodservice 20: 287-297.

The World Health Organization estimates that up to 30% of individuals in developed countries become ill from food or water each year. Up to 70% of these illnesses are estimated to be linked to food prepared at foodservice establishments. Consumer confidence in the safety of food prepared in restaurants is fragile, varying significantly from year to year, with many consumers attributing foodborne illness to foodservice. One of the key drivers of restaurant choice is consumer perception of the hygiene of a restaurant. Restaurant hygiene information is something consumers desire, and when available, may use to make dining decisions.

Filion, K. and Powell, D.A. 2011. Designing a national restaurant inspection disclosure system for New Zealand. Journal of Food Protection 74(11): 1869-1874
.

The World Health Organization estimates that up to 30% of individuals in developed countries become ill from contaminated food or water each year, and up to 70% of these illnesses are estimated to be linked to food service facilities. The aim of restaurant inspections is to reduce foodborne outbreaks and enhance consumer confidence in food service. Inspection disclosure systems have been developed as tools for consumers and incentives for food service operators. Disclosure systems are common in developed countries but are inconsistently used, possibly because previous research has not determined the best format for disclosing inspection results. This study was conducted to develop a consistent, compelling, and trusted inspection disclosure system for New Zealand. Existing international and national disclosure systems were evaluated. Two cards, a letter grade (A, B, C, or F) and a gauge (speedometer style), were designed to represent a restaurant’s inspection result and were provided to 371 premises in six districts for 3 months. Operators (n = 269) and consumers (n = 991) were interviewed to determine which card design best communicated inspection results. Less than half of the consumers noticed cards before entering the premises; these data indicated that the letter attracted more initial attention (78%) than the gauge (45%). Fifty-eight percent (38) of the operators with the gauge preferred the letter; and 79% (47) of the operators with letter preferred the letter. Eighty-eight percent (133) of the consumers in gauge districts preferred the letter, and 72% (161) of those in letter districts preferring the letter. Based on these data, the letter method was recommended for a national disclosure system for New Zealand.

Pay attention to food sources: Restaurant inspection grades and illness

Restaurants are important settings for foodborne disease outbreaks and consumers are increasingly using restaurant inspection results to guide decisions about where to eat. Although public posting of inspection results may lead to improved sanitary practices in the restaurant, the relationship between inspection results and risk of foodborne illness appears to be pathogen specific.

belgium-rest_-inspect-13To further examine the relationship between inspection results and the risk of foodborne disease outbreaks, we evaluated results of routine inspections conducted in multiple restaurants in a chain (Chain A) that was associated with a large Salmonella outbreak in Illinois. Inspection results were collected from 106 Chain A establishments in eight counties. Forty-six outbreak-associated cases were linked to 23 of these Chain A restaurants. There were no significant differences between the outbreak and non-outbreak restaurants for overall demerit points or for the number of demerit points attributed to hand washing or cross-contamination. Our analyses strongly suggest that the outbreak resulted from consumption of a contaminated fresh produce item without further amplification within individual restaurants. Inspections at these facilities would be unlikely to detect or predict the foodborne illness outbreak because there are no Food Code items in place to stop the introduction of contaminated food from an otherwise approved commercial food source.

The results of our study suggest that the agent and food item pairing and route of transmission must be taken into consideration to improve our understanding of the relationship between inspection results and the risk of foodborne illness in restaurants.

Understanding the relationships between inspection results and risk of foodborne illness in restaurants

Foodborne Pathogens and Disease. September 2016, ahead of print. doi:10.1089/fpd.2016.2137.

Petrona Lee and Craig W. Hedberg

http://online.liebertpub.com/doi/abs/10.1089/fpd.2016.2137

 

First Denmark, now Norway for smiley-faced restaurant ratings

Nina Berglund of News in English.no reports inspectors from Norway’s state food safety agency Mattilsynet had little to smile about after their most recent visits to 1,100 restaurants in the Oslo area. Six out of 10 restaurants failed to earn the smiley face insignia that symbolizes good hygiene.

rest.inspection.smile.norway.aug.16Norwegian Broadcasting (NRK) reported Thursday that only 41 percent of the eating places inspected by Mattilsynet in Oslo, Asker and Bærum were awarded the smiley face, which means they met the authorities’ standards for good hygiene.

“We of course wished that the results were better, but we’re not surprised,” Marit Kolle, division chief at Mattilsynet, told NRK. The results show a decline from national inspections earlier this year, when more than 60 percent did well and received smiley faces.

Kolle said that half the restaurants inspected most recently were given a straight face, after inspectors found deficiencies and errors in hygienic routines. “Those establishments get a warning from us that they must improve their routines,” Kolle said.

Another 9 percent were hit with a sour face symbol, meaning they flunked the hygiene inspection. Inspectors can close them on the spot if the violations are severe, or fine them.

The system of symbolizing the hygiene of restaurants was launched January 1 as a means of advising patrons about food safety inspection results. After an initial round of visits to 2,279 restaurants nationwide, around a third failed to win smiley faces.

The restaurants are obliged to post the smiley-, straight- or sour-faced symbols at their front doors. NRK reported earlier this year that Mattilsynet inspectors claimed many were failing to do so, thus “sabotaging” the program.

Restaurant inspection results are also made public on the state agency’s own website, matportalen.no/smilefjes.

smiley.faces.denmark.rest.inspection

‘Oversimplified method’ Colorado seeks to ban letter grades

A Colorado House Bill aiming to update restaurant inspection regulations has Weld County leaders again fighting for local control.

qr.code.rest.inspection.gradeHouse Bill 1401, introduced late last week, would ban summarizing inspection results with a letter, number or any other “oversimplified method.”

County leaders overhauled the inspection page online in late 2014. Among the updates was a change in grading. Instead of using ambiguous words to rate a restaurant’s safety level, they began using an A-F system.

“It makes it much easier for the citizens of Weld County to look at a restaurant to see how they’re doing,” said Mike Freeman, chairman of the Board of Weld County Commissioners. “People don’t know what ‘critical’ is.”

The inspection process never changed; state law would forbid that. The update changed only how information was presented to the public.

Although various restaurant owners attended meetings to criticize the rule change, county leaders say they believe the change has been a boon to residents. Not only is the A-F grading system more transparent, it encourages restaurant owners to step up, Freeman said.

“They don’t want to see Ds and Fs,” he said. “It’s a very positive impact.”

Within the last year, Weld County saw 50 percent fewer inspections receiving an F, Environmental Health Director Trevor Jiricek wrote in a letter. Inspections getting either a D or an F dropped to 19 percent from 28 percent.

Web traffic on the new inspection page increased 100 percent over that time, Jiricek wrote. Leaders say it’s because residents can actually glean something from the page now.

The use of restaurant inspection disclosure systems as a means of communicating food safety information

Filion, K. and Powell, D.A. 2009. Journal of Foodservice 20: 287-297.

The World Health Organization estimates that up to 30% of individuals in developed countries become ill from food or water each year. Up to 70% of these illnesses are estimated to be linked to food prepared at foodservice establishments.barf.o.meter_.dec_.12-216x300-216x3001-216x300

Consumer confidence in the safety of food prepared in restaurants is fragile, varying significantly from year to year, with many consumers attributing foodborne illness to foodservice. One of the key drivers of restaurant choice is consumer perception of the hygiene of a restaurant. Restaurant hygiene information is something consumers desire, and when available, may use to make dining decisions.

Filion, K. and Powell, D.A. 2011. Designing a national restaurant inspection disclosure system for New Zealand. Journal of Food Protection 74(11): 1869-1874

The World Health Organization estimates that up to 30% of individuals in developed countries become ill from contaminated food or water each year, and up to 70% of these illnesses are estimated to be linked to food service facilities. The aim of restaurant inspections is to reduce foodborne outbreaks and enhance consumer confidence in food service. Inspection disclosure systems have been developed as tools for consumers and incentives for food service operators. Disclosure systems are common in developed countries but are inconsistently used, possibly because previous research has not determined the best format for disclosing inspection results. This study was conducted to develop a consistent, compelling, and trusted inspection disclosure system for New Zealand. Existing international and national disclosure systems were evaluated.larry.the_.cable_.guy_.health.inspector-213x300-213x3001-213x300

Two cards, a letter grade (A, B, C, or F) and a gauge (speedometer style), were designed to represent a restaurant’s inspection result and were provided to 371 premises in six districts for 3 months. Operators (n = 269) and consumers (n = 991) were interviewed to determine which card design best communicated inspection results. Less than half of the consumers noticed cards before entering the premises; these data indicated that the letter attracted more initial attention (78%) than the gauge (45%). Fifty-eight percent (38) of the operators with the gauge preferred the letter; and 79% (47) of the operators with letter preferred the letter. Eighty-eight percent (133) of the consumers in gauge districts preferred the letter, and 72% (161) of those in letter districts preferring the letter. Based on these data, the letter method was recommended for a national disclosure system for New Zealand.

 

California county food inspections turn up an array of eye-opening violations

Inspectors, according to The Modesto Bee, pop unannounced into more than 2,300 food service providers throughout Stanislaus County at least twice a year. In the past two years, they’ve suspended licenses 43 times for violations ranging from lack of hot water and warm refrigerators to roach and rat infestations and sewage on the floor.

larry.david.rest.inspec“We hope all our businesses stay viable, but our job is health and safety,” said Jami Aggers, director of the county’s Department of Environmental Resources. Her office deploys 14 inspectors throughout the county. In addition to food service, they also check wells, septic systems and tattoo shops.


Most of what they find, good or gross, is available to anyone with Internet access. Those who aren’t tech-savvy can ask to see hard copies of inspection reports, which must be produced at every food service business.

Some areas of California go a step further, posting letter grades in eateries’ windows reflecting general sanitation and food safety practices. Momentum for such seems lacking in the Northern San Joaquin Valley, although Aggers isn’t opposed.

Stanislaus’ website is the only one in the Northern San Joaquin Valley to post inspection reports of each of its more than 2,300 facilities. The website is limited, however, because the user must know a restaurant’s name or address from a broad field. Also, there is no way to search for time-based reports in case someone wants to avoid eateries with recent problems. To see for yourself, go to http://sbtapp1.co.stanislaus.ca.us/DERFoodFacilities.

Reports on San Joaquin’s website are color-coded, allowing a user to quickly see if an eatery has had major problems (red) as opposed to minor (blue) or those that have been corrected (green), but no specifics are listed. Go to www.sjcehd.com/Programs/Consumer_Protection/food_and_restaurant_inspections.htm

Seattle reinvents the wheel: A, B, C or E. coli? King County to get restaurant rating system

Seattle, self-proclaimed home of all things food safety, is finally going to get a restaurant inspection disclosure program, about 15 years after Toronto (there’s older programs, but that the one I was involved with).

 rest.inspec.grade.louisvilleKing County announced this week that it will begin posting food and health safety ratings for all to see. The new rating system will affect approximately 12,000 restaurants and food trucks in the area, starting in late 2015, according to the Seattle Times.

Schacht’s campaign for more transparency was also spurred by how difficult it was to find an establishment’s rating through King County’s existing health department site. Her petition called it a “convoluted inspection ratings system that confuses consumers.” More than 2,000 people agreed and signed her petition for clearer signs to be posted at restaurant locations.

Rating restaurants is already status quo in other major cities, like New York and Los Angeles. Now Seattle will join the ranks of this handy system, which lets customers get a good look at how clean a joint is before they enter.

The use of restaurant inspection disclosure systems as a means of communicating food safety information

Introduction

The World Health Organization (WHO) estimates that up to 30 per cent of individuals in developed countries become ill from food or water each year (World Health Organization 2007). Up to 70 per cent of these illnesses are estimated to be linked to food prepared at foodservice establishments (Lee & Middleton 2003; Olsen et al. 2000; Todd 1998; Center for Science in the Public Interest 2008). Media coverage of food safety issues is extensive and may fuel the view that hygiene standards are low among restaurants (Bruhn 1997; Worsfold & Worsfold 2008). Consumer confidence in the safety of food prepared in restaurants is fragile, varying significantly from year-to-year (Food Marketing Institute 2008), with many consumers attributing foodborne illness to foodservice (Fein et al. 1995). One of the key drivers of restaurant choice is consumer perception of the hygiene of a restaurant (Worsfold & Worsfold 2007). Restaurant hygiene information is something consumers desire, and when available, may use to make dining decisions (Worsfold & Worsfold 2007).

Restaurant food safety standards are assessed through routine examinations. These examinations, also called health, hygiene, foodservice or restaurant inspections, are principally designed to prevent restaurant-associated foodborne disease outbreaks (Jones et al. 2004; Reske et al. 2007). In addition, restaurant inspections may significantly impact consumer confidence in the safety of restaurant food, influence dining decisions, and provide incentives for establishments to promote a safe food environment (Fielding et al. 2001; Jin & Leslie 2003; Simon et al. 2005; Worsfold & Worsfold 2007) when publically available.

About the inspection process

The fundamentals of restaurant inspection are well established throughout developed countries. Municipal restaurant inspections are food safety risk management programs, an action, to demonstrate to consumers that food providers are cognizant of consumer concerns about food safety, and demonstrate that those within the farm-to-fork system are working to reduce levels of risk (Powell 2002).Methods of scoring inspection results vary between jurisdictions. The criteria for inspection is fairly well established, however inconsistencies between municipalities exist when defining a critical violation. Though often described as a violation more likely than others to contribute to food contamination, illness, or health hazards, the actual items that constitute a critical violation during the inspection process may vary. In some jurisdictions the presence of a critical violation elicits closure followed by re-inspection, and in others it simply results in a lower inspection score. As a result, many systems exist to quantify results during inspection. Starting with a value of 100 and subtracting violations (with critical violations being a larger deduction) is one method. In this method, a score of 100 is awarded to establishments that comply with food hygiene standards. Conversely, beginning with zero and tallying violations (with critical violations being worth a higher value), a larger numerical value indicates a riskier food establishment. Other jurisdictions simply tally violations, and may or may not indicate whether these are critical or non-critical. Variations not only exist between jurisdictions or municipalities, but between inspectors; though inspector training is designed to synchronize violation interpretations, it will vary from person to person. The many variables of the inspection process will affect inspection disclosure schemes, but are outside the scope of this paper.

OC.color.gradesInspection disclosure

Systems to communicate the information acquired through restaurant inspection to the public are common in developed countries; however, these systems are inconsistent, varying between countries, states or cities. In some jurisdictions, a consumer must formally request to view the most recent inspection, and may wait months before receiving the results (Center for Science in the Public Interest 2008). In other jurisdictions, it is available upon request at the restaurant. These methods are neither convenient nor reasonable for most consumers, as inspection reports are often difficult to understand (Center for Science in the Public Interest 2008). Disclosure systems in which inspection information must be requested by the consumer provide minimal incentive for foodservice establishments to produce safe food. Seiver & Hatfield (2000) suggest that the public disclosure of restaurant inspection results communicates the importance of risks and violations found during an inspection. With several of the key elements of a foodservice operation being hidden from consumers (such as food storage conditions, or where food is purchased) consumers will look to observable information cues during establishment selection (Henson et al. 2006). Restaurant inspection disclosure systems can provide such information cues.

Grading systems enforced by public health agencies have spread worldwide since being established in 1924, at which time letter grades were introduced to classify milk in the United States (Boehnke 2000). Disclosure systems are growing in popularity, largely due to consumer demand for such tools.After seven years of discussion, the U.K. Food Standards Agency began a pilot program, “Scores on Doors”, with local authorities to establish a U.K.-wide system to provide restaurant inspection results to the public. The U.K. pilot programs used a variety of codes, including star ratings, smiley faces, letter grades and the phrases “pass” or “improvements required” (Worsfold & Worsfold 2007). The first of the U.K. “Scores on Doors” program was introduced in 2004, and only 3 years later over 30 different schemes were operating throughout U.K. municipalities (Worsfold & Worsfold 2007). Similar inspection disclosure systems involving these codes, and others, are in place in several cities, states and provinces around the world. The codes attempt to simplify inspection results into a format that is understandable and intriguing to consumers dining at an establishment.

Inspection disclosure systems can be organized into three categories: those that provide information through municipal or state health departments, those that provide information online, and those that provide information at the establishment. Inspection reports disclosed through health departments often must be accessed through a Freedom of Information Act (Worsfold 2006a). Online databases vary in content, and may be used to compliment disclosure at the premise. Maintenance of online restaurant inspection databases may be by local health departments, news stations, or increasingly, consumer blogs. Disclosure systems displaying information at the establishment do so in the format of a card, with most inspection authorities requiring the cards to be posted in designated, conspicuous locations visible to patrons entering the restaurant (North Carolina Administrative Code 2005).

The following are examples of restaurant inspection disclosure systems:

Online database of results. Many disclosure systems at the establishment are complimented by an online database of inspection results, with the format and content of these websites varying between municipalities. Since the first posting of inspection results online in Los Angeles (L.A.) County in 1998 (Fielding et al. 2001), many inspection authorities have adopted this medium to present a database of results searchable by establishment name or code, neighborhood, location, or results from the latest inspection (New York City 2008; DPR Online Services 2008; Office of Environmental Health Services 2008). Some of these databases provide only the number of critical violations, or of both critical and non-critical violations, while others elaborate with details of the cited infractions. Some jurisdictions, such as the U.S. state of Alaska, provide online copies of all food establishment inspection reports completed by inspectors (Division of Environmental Health 2008). Other inspection authorities allow consumers to receive e-mail updates when new inspection results are posted (Central District Health Department 2007).

Presently in the U.K., food establishments may voluntarily post inspection scores or symbols at their premises, but are not required. However, all inspection reports are available through local inspection authority websites (Worsfold & Worsfold 2008). Websites appear to be a popular method of restaurant disclosure, with many municipalities adopting this medium. Several areas in Scotland began posting inspection results in November 2006 after a survey found 82 per cent of consumers wanted to see inspection information at local eating establishments, and 94 per cent thought it should be accessible online (Worsfold & Worsfold 2007). Consumers and businesses reported that the posted results were valuable, according to research by the Food Standards Agency of Scotland several months later (Worsfold & Worsfold 2007). However, a review of the DineSafe disclosure scheme in Toronto, Canada revealed only 10 per cent of the public was aware of the online component, compared to 75 per cent being aware of inspection notices posted at the premise (Toronto Staff Report 2002). Additionally, though initially popular, online disclosure websites may receive decreased visits after the initial novelty of the system wears off, as the city of Waterloo, Canada experienced (Barrick 2009).

Online name-and-shame. Rather than a database of results, online name-and-shame notices are published by the Food Safety Authority of Ireland, where foodservice establishments that fail to improve conditions of practices deemed “likely to pose a risk to public health” are issued an Improvement Order that is posted on the Authority’s website until the situations are corrected. Following correction, the Improvement Order remains visible to the public for another three months. A Closure Order is issued if “there is likely to be a grave and immediate danger to public health” or an Improvement Order is not complied in a timely fashion. These orders are likewise posted to the website until situations are remedied, and for three months afterwards (Food Safety Authority of Ireland 2008).

qr.code.rest.inspection.grade grades. The California county of San Diego was one of the first regions in the U.S. to create a disclosure system to convey inspection results to the public, introducing letter grades to rate establishments in 1947 (Foley 2009) L.A. County followed suit, and since 1996, has required food establishments to display the results of their most recent restaurant inspection in the form of an A, B, or C letter grade; except in the case of restaurants scoring below a ‘C’, for which the actual numerical value is provided (Teledas Co. 2004). Multiple major U.S. cities have adopted similar systems, as have several states. In Auckland, New Zealand, a food hygiene grade from A to E is assigned to inspected establishments, with the exception of ‘C’, as it may be mistakenly thought of as a ‘passing’ grade, and the addition of a Gold A, which recognizes establishments that demonstrate safe practices above full compliance with food hygiene laws. The hygiene grade must be displayed “in a prominent position on the premises that is visible to the public” (Auckland City Council 2007). Other examples of letter grade systems include: AA, A or B grades; A or B grades; and A, B, C or D grades (Pytka & Fellow 2005).

Numerical scores. A common checklist for restaurant inspection used in the U.S. is the FDA-approved Foodservice Establishment Inspection Report. This is a 44-point list of violations assigned a weight based on their risk to human health. The highest possible score is 100, which is reduced when violations are cited. Though the inspection checklist may be consistent, what constitutes establishment closure is not. In Danbury, Connecticut, an establishment must score 80 and not receive any 4-point violations to receive a pass; in Nashville, Tennessee, a score of 70 is required to pass inspection. In Mobile, Alabama, a score below 85 elicits closure and re-inspection (Mobile County Health Department 2008). The numerical score and copy of the inspection report are required to be posted at the establishment. Inspection authorities that do not deduct violations from 100, but rather a more unattractive number, will often later convert this value to one out of 100 for the sake of simplicity. Converse to deducing points for violations, in New York City, health officials assign a numerical score during inspections that tallies violations. Scores greater than 28 denote the restaurant as a public health hazard, and must be re-inspected to ensure corrections are made (New York City 2008). New York City has recently proposed a plan to disclose inspection results to the public using a letter grade system similar to that of L.A., rather than posting a numerical score card at the premises (Collins 2009).

            Colored cards. Officialsin the city of Toronto, Canada, require food establishments to display their most recent inspection results in the main entrance of premises in the form of a green, yellow or red card, indicating a pass, conditional pass, or closed notice, respectively (City of Toronto 2008). During the development of the Toronto disclosure system, a review of current literature indicated that color could be used to draw attention and suggest caution (Powell 2002). A similar system used in Columbus, Ohio, includes the green, yellow and red color cards, with the addition of a white notice that is issued when an establishment is on probation and requires a follow-up inspection. The red card in this case is used when an establishment on probation failed re-inspection (Columbus Public Health 2006). Using a combination of numerical and color disclosure schemes, Lexington-Fayette county in Kentucky discloses scores of 85 or above, and no four- or five-point violations, receive the score posted in green; 84 and under, or those with four- or five- point violations will be posted in red; and those below 70 will be issued “Notice of intent to Suspend Permit” (Lexington-Fayette County 2008).

            Statement cards. The Niagara Region of Ontario, Canada conducts inspections similar to those in the city of Toronto, however its disclosure system describes inspected establishments as simply “in compliance” or “not in compliance.” This region also maintains an online database to convey the most recent inspection results to consumers, with details of critical and non-critical violations (Regional Municipality of Niagara 2008). A study in Hamilton, Ontario (Hensen et al. 2006)—a municipality which initially used only “pass” and “fail” notices, but was considering utilizing the “conditional pass” notice—found that the additional “conditional pass” option had a “significant and negative impact” on survey respondent’s self-reported likelihood to patronize a restaurant. Other examples of information statements include: “approved” or “not approved”; “satisfactory” “conditionally satisfactory” or “unsatisfactory”; “exceeds minimum standards” “meets minimum standards” or “does not meet minimum standards” (Pytka & Fellows 2005).

            Symbols. Since 2001, the Danish Veterinary and Food Administration has used smiley faces as a means to disclose restaurant inspection results to the public. The full details of Danish inspection reports are published on a website (www.findsmiley.dk), with a “smiley” face depicting five different scenarios, which range from a sad, “sour smiley”—assigned to establishments that were issued a fine, reported to the police, or had approval withdrawn—to an ecstatic “happy smiley” for restaurants that received no negative remarks. The newly added Elite-Smiley may also be awarded when establishments receive the happy smiley in four consecutive inspections. These reports and respective smiles must be posted at the restaurant premises, and visible to consumers outside the establishment who are making a choice to dine there (Danish Veterinary and Food Administration 2008). Inspection results in the northern region of the U.S. state of Iowa are conveyed using the 5-Star Program in which colored stars assigned to establishments correspond with positive food handling behaviors observed during inspection. A yellow star is awarded when proper holding temperatures are respected; a blue for proper cooking; red for clean equipment; brown for good employee hygiene; and a green star when the establishment’s food ingredients are received from safe sources. For each inspection the restaurant’s awarded stars are displayed online alongside the number of critical and total violations cited (Cerro Gordo County 2008). In the U.S. state of Connecticut, Farmington Valley and Norwalk counties, respectively, use waiter or lighthouse symbols to disclose inspection information: a score of 90-100 receives 3 waiters or lighthouses, 80-89 receives 2, and below 80 receives 1 (Farmington Valley Health Department 2009; Norwalk Health Department 2009).

            Award schemes. In addition to inspection disclosure systems, several municipalities have elected to provide awards for establishments that exceed food safety standards. The aforementioned Gold A granted in Auckland, New Zealand, or the Elite Smiley in Denmark, are examples of these award schemes, and often are in addition to existing disclosure systems at the establishment. During evaluation of the Eat Safe award scheme in the U.K., Worsfold (2005) found 79 per cent of those surveyed said they would be influenced by the presence of a hygiene award. However, it is noted in previous evaluations that there is little public awareness of a similar award scheme in Scotland (Worsfold 2005).

There is no agreed upon best method to communicate inspection results with the public, with many vehicles being used throughout the world (Powell 2002). Although many restaurant inspection disclosure systems exist, further research could determine which of these existing schemes are most effective.

Benefits of disclosure systems

Consumers both desire and deserve accessible and understandable information on the conditions and practices of foodservice establishments. Consumer interest in the website that discloses inspection results for the U.K. city of Liverpool generated 100,000 hits within two days of posting the first inspection results (Chartered Institute of Environmental Health 2007). Information provided on such mediums can be a comfort to diners, demonstrating that restaurants are being monitored for food hygiene standards. According to the director of public health for L.A. County, Dr. Jonathan Fielding, the grading system used in L.A. bolsters consumer confidence in the county’s restaurant inspection system (Center for Science in the Public Interest 2008). Consumers in the city of Hamilton, Canada were asked how important the presence of an inspection notice in a restaurant’s window was when choosing where to dine, and respondents assigned it an average importance of 4.44 on a 5-point scale (Henson et al. 2006). As many as 95 per cent of residents surveyed in Toronto, Canada, indicated they made dining decisions based on the colored inspection cards posted at establishments (Toronto Staff Report 2002).

By influencing restaurant choice, inspection result postings can provide incentives for those within the foodservice industry to focus on food safety endeavors. Restaurateurs and patrons react emotionally to posted scores (Wiant 1999). Public reporting of poor inspection results may lead to negative consumer attitudes towards an establishment, and consequently influence foodservice workers and managers to comply with regulations in order to improve food safety scores (Almanza et al. 2002). According to the Ministry of Food Agriculture and Fisheries in Denmark, over half (59 per cent) of consumers have changed their dinner plans after reviewing the smiley face posted at a restaurant. The Ministry asserts that the smiley scheme is one of the best-known consumer public schemes in Denmark, and a recent survey found that 97 per cent of consumers felt the scheme was a “good” or “very good” idea, as did 88 per cent of foodservice businesses. Additionally, 8-out-of-10 managers or owners reportedly discussed practices with their staff that would lead them to attain the coveted “happy smiley” (Danish Veterinary and Food Administration 2008).

Hospitalization rates linked to suspect foodborne illnesses were seen to decrease by approximately 20 per cent in the year a mandatory letter grade disclosure system was implemented in L.A. County (Simon et al. 2005; Jin & Leslie 2003). However, limitations in surveillance data make it impossible to determine in which settings the majority of foodborne illnesses occur (Powell 2002), let alone the relationship between inspection disclosure systems and a reduction in illness rates. Restaurant grade cards in L.A. did promote food safety awareness in the public, and provided incentive for restaurants in the county to comply with food safety regulations and increase inspection scores (Fielding et al. 2001; Jin & Leslie 2003). A similar system in Las Vegas, Nevada also found that establishments were more likely to increase diligence in food safety practices to maintain compliance (Hahn 2000). A review of the color-coded disclosure system in Toronto, Canada, concluded it successfully “increased compliance and continuous improvement in food safety” among Toronto restaurants (Basrur 2003). Food safety violations were also reported to decrease for the city’s restaurants (Toronto Staff Report 2002).

Tools that compliment inspection disclosure schemes, such as hygiene information on a respected website, can and will be used by a proportion of consumers, though it should not be used to substitute disclosure at the premises (Spear 2006). The Toronto, Canada study indicated that consumers were more aware of disclosure at the premise, in the form of colored cards, than the website (Toronto Staff Report 2002). According to Worsfold & Worsfold (2008), online disclosure systems provide the computer-literate consumer quick and relatively easy access to inspection information.

 

Issues with inspection disclosure

The process of restaurant inspection itself is fraught with issues (Chapman et al. 2008):

  • frequency of inspection varies between jurisdictions;
  • inspections may be scheduled or unannounced depending on the jurisdiction;       and,
  • time of day an inspection occurs may affect an establishment’s performance, as busier times result in increased food hygiene infractions .

Criteria for inspection is inconsistent — most notably the definition of ‘critical violation’ varies between jurisdictions. During the inspection process there are several food safety issues that are difficult to assess in the brief timeframe of an inspection, such as acquiring food from a safe source. Perhaps one of the most significant issues with the inspection process is the variation between inspectors due to subjective interpretation: what one inspector may view as a violation may not be a violation to another inspector (DeNucci 2007). Though standardized training is often required for health inspectors, subjective interpretation is a continuous issue.
The purpose of restaurant inspection is ultimately to reduce the incidence of foodborne illness, yet research has indicated that inspection scores are not predictive of foodborne illness outbreaks. In a review of 167,574 inspections in the U.S. state of Tennessee between January 1993 and April 2000, Jones et al. (2004) found that mean inspection scores of establishments experiencing foodborne illness outbreaks did not differ from establishments without reported illnesses. Cruz et al. (2001) reviewed inspection scores for 51 food establishments associated with confirmed foodborne illness outbreaks in Miami-Dade County, Florida, in 1995 and compared these reports to randomly selected establishments without outbreaks. The study suggested that inspections in Miami-Date County did not reliably identify restaurants with increased risk of foodborne illness (Cruz et al. 2001). Though other studies have focused on the relationship between restaurant inspection scores and foodborne illness, methodological problems decrease the veracity of these studies.

While inspection scores are not predictive of foodborne illness outbreaks, creating a study that accurately measures the relationship between restaurant inspection scores and foodborne illness outbreaks is difficult. As Jones et al. (2004) suggest that “reported foodborne outbreaks are rare in relation to the number of restaurants and the small percentage of suspected foodborne illnesses linked to epidemiologically confirmed, restaurant-associated outbreaks make such analyses difficult.” With numerous variables and inconsistencies in the restaurant inspection process itself, health inspectors and those within the foodservice industry debate whether consumers are able to understand the meaning of posted inspection information (Almanza et al. 2002). Multiple studies suggest consumers may have little understanding of the meaning of posted letter grades or inspection scores, though their interpretations play a role in their choice to patronize a restaurant (Dundes & Rajapaksa 2001; Hensen et al. 2006).

Accurately quantifying all of the aspects of inspection to create a risk communication tool that can convey a message about the safety of a food establishment is a daunting task. Jones & Grimm (2008) found that, in a region where restaurants were required to make inspection results publicly visible on their premises and allow information to be disclosed on the Internet, survey participants indicated the availability of this information had an effect on where they chose to eat. However, the researchers also found that consumers have a number of misconceptions and unrealistic expectations of the restaurant inspection system (Jones & Grimm 2008). Worsfold (2006b) suggested that restaurant patrons are not well informed about the role of local authorities in protecting food safety and how the food safety laws are enforced. For example, consumers may be confused as to how often inspections take place and, therefore, how frequently violations occur at an establishment (Hensen et al. 2006). Restaurant inspections report on the conditions of an establishment at a single point in time, and may not reflect the overall (good or bad) culture of food safety at the restaurant (Chapman 2008). Though an inspection is only designed to evaluate an establishment at one moment in time, patrons interpret scores as an overall indicator of quality (Wiant 1999).

Details of inspection reports may also be difficult to understand. Consumers may have difficulty assessing the severity of violations cited in terms of their risk to food safety (Worsfold 2006b). Additionally, inspection and disclosure systems can vary between jurisdictions, which may lead to confusion among consumers who dine in multiple jurisdictions. An examination by the San Diego Union-Tribune of inspection data in San Diego County, California, found that restaurants receiving an A grade—the top rating for that jurisdiction—may have also been cited for up to two major violations, which are those thought to “pose an imminent health hazard.” The newspaper noted that most jurisdictions throughout the U.S. are reluctant to award establishments a top grade with even one major violation in their report (Williams & Armendariz 2007). These variations in what constitutes a score between jurisdictions can be confusing for consumers, but even with a unified system problems will arise. Hatfield & Siever (2001) found with numerical grading schemes, consumers still think in terms of pass/fail. This may be true in the case of letter grades, colored cards, or any other disclosure methods.

Pressure from the restaurant industry may hinder implementation (Wiant 1999). Worsfold (2006a) found some objection among hospitality and food service management to the ‘Scores on Doors’ program in the U.K. Some managers were averse to implementing public disclosure systems for fear of confusing consumers, as mentioned above, or the difficulty and cost of implementing such a program (Worsfold 2006a). Additionally, concerns have been raised in simplifying the complexities of the restaurant inspection report into a single score, grade, or symbol (Worsfold 2006a).

 

Research needs

Previous research has focused on assessing the effectiveness of implemented inspection disclosure systems, but has not determined which system or medium is most desired by consumers. Research should focus on determining which medium consumers and those within the food industry prefer inspection information to be disclosed through, and whether complimentary tools are something consumers and restaurant operators want.

Do consumers prefer disclosure at the premise in the form of cards, and if so, which format — letter grades, numerical scores, symbols, colored cards, or phrases — is preferable? Various scores and grades have been used to communicate restaurant inspection results to the public, but which of these is most effective is not known. Even within a particular score category, such as letter grades, there are unknowns. For example, how effective is a 3-tier scheme of A, B, and C compared to a similar 4-tier letter scheme? Are consumers misled with those middle terms, like ‘C’, as some jurisdictions predict? Are multi-tier schemes the best way to communicate inspection results to the public, or do consumers solely think in terms of pass/fail as some research has shown (Hatfield & Siever 2001)?

Additionally, it is unknown to what degree inspection information should be disclosed to consumers. Examples of score schemes vary from a simple notification of “pass”, “conditional pass”, or “fail” (City of Toronto 2008), to detailed pictograms color coordinated to expose various elements of the inspection process (Cerro Gordo County 2008).

It is unknown whether a combination of mediums is most effective – e.g. score cards displayed on premises with basic information, and further details of infractions available online – or, whether one medium alone is most desired by consumers. Research should focus on determining the most compelling method for communicating results to the public. Once this method is determined, creating a consistent system within states or countries can be assessed.

Food safety is not the only factor affecting consumer patronage to dining establishments. Many studies have researched these factors, indicating that friends/relatives/colleagues, media (newspapers and TV programs), image, atmosphere, food quality and cost, and overall cleanliness are factors affecting one’s decision to dine in a particular establishment (Worsfold 2006a; Gregory & Kim 2004; Leach 2003; Cheang 2002). Although some research has indicated consumers rate food safety as more important than any other factor (Worsfold, 2006b), and it is self-reported that consumers would not dine at an establishment with a poor inspection rating (Worsfold 2006b; Leach 2003), whether this would, in reality, affect a diner’s decision is unknown. The ‘loyalty’ factor—consumers who dine at an establishment in support of a cause/friend/relative/colleague—also may affect one’s decision to dine at an establishment, regardless of the above-mentioned qualities. Research could determine whether pairing restaurant food safety scores with that of quality, cuisine and atmosphere is attractive to consumers. Finally, what approach is best to acquire information about consumer preference of disclosure systems?

 

Conclusions

Restaurant inspections are flawed and may appear complicated, but foodservice safety information is something consumers desire. Public disclosure of inspection information helps foster a culture of food safety by encouraging dialogue about food safety issues among both consumers and those within the foodservice industry. Research cannot assume that because inspection is complicated it is beyond the scope of a public disclosure scheme. Research should focus on providing compelling information through the most consumer-desired medium or combination of mediums, while encouraging those within the foodservice industry to promote a safe food-handling environment. Once these tasks have been accomplished, disclosure system consistency within a state or country should be developed. Perhaps ultimately public inspection disclosure systems will be embraced by those within the foodservice industry and be a way for restaurants to market food safety.

 

Acknowledgements

The authors would like to acknowledge the assistance of Casey J. Jacob in the preparation of this manuscript.

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Pennsylvania county wary of proposed letter grades for restaurants

While San Jose, Calif., embraces public information, Pittsburgh, Penn., appears stuck in a steel town past as six of the seven Allegheny County Council members who attended a public hearing asked questions that were critical of the proposed A-B-C letter-grade proposal, and none voiced support.

larry.david.rest.inspec“I just think it puts something up that’s causing a lot of angst without a lot of reason,” said Councilman Michael Finnerty, D-Scott, who chairs the Budget & Finance Committee on the 15-member council.

Dr. Lee Harrison, chair of the Board of Health, said the lack of support among the council members doesn’t spell defeat. A similar measure failed in 2011.

“We think from a public health standpoint that this is the right thing to do,” Harrison said.

Donna Scharding, the Health Department’s food safety program manager, said that in 2013, 56 percent of inspections found a high-risk violation, such as improper food handling or temperatures. In Los Angeles County and New York City, instances of foodborne illnesses decreased once grading systems started, Scharding told council members (tough to prove that one – dp).

I still prefer name and shame: Name and Fame for Dubai restaurants

Customers will soon be able to view a food safety grade on the entrance of Dubai food outlets as part of an upcoming “Name and Fame” scheme, an official said on Sunday.

scarlet.letterThe scheme will reveal whether the outlet has passed, failed or obtained a conditional pass in official food safety inspections.

It will also assign what will probably be a letter grade indicating the level of compliance, with “A” being the highest and “E” the lowest.

The scheme was announced during the ninth Dubai International Food Safety Conference, which lasts until Tuesday.

“We want to let consumers know who’s doing well. It’ll invite people to make food safety their priority,” Sultan Al Tahir, head of inspections at Dubai Municipality’s food control department, said.

“The grade will be posted outside the place. We’ll implement this in the future.”

Al Tahir said more than 200 out of 13,000 food establishments in Dubai are of A-grade standing. Those falling in the E category are 430.

It is understood the grades will be revised if necessary after scheduled and spot food safety inspection results.

Also planned for consumers is a smart barcode system which will let smartphone users scan the product information on the packaging of all food products in the UAE, said Khalid Mohammad Sharif, the municipality department’s executive director.

qr.code.rest.inspection.gradeUsing an app in their smart device, customers will be able to scan a code that will reveal a catalogue of information, such as nutrition facts, expiry date, ingredients, and country of origin.

The code will also reveal if the product has ever been flagged by authorities.

“Consumers will know if it has had any previous history. It means more control and transparency, which is good for everybody. All of that will be on your smartphone,” Sharif added.

The system will also reveal if the product is registered with federal authorities, which will become mandatory some time in 2015, he said.

The Dubai Municipality plans to shut down food outlets that do not raise their food safety standards to the highest level before the emirate hosts the World Expo in 2020, a senior official revealed on Sunday.

“We want all food outlets in Dubai to be in ‘A’ and ‘B’ categories. We don’t want any restaurant or hotel below those grades by 2020,” Khalid Mohammed Sherif Al Awadhi said.

Speaking to Khaleej Times on the sidelines of the 9th Dubai International Food Safety Conference (DIFSC) on Sunday, Al Awadhi said it is high time that eateries raised their standards to make Dubai the best place to dine in.

Food safety ratings: Time to change system in Nebraska county?

Would you rather eat at a restaurant with food safety practices that are “fair” or “standard”? What makes a kitchen that’s “superior” better than a competitor that’s merely “excellent”?

barf.o.meter.dec.12Those are the four categories the Douglas County Health Department uses to rate restaurant food safety, and the ratings are the only information available online to the public about how restaurants perform in inspections.

Some members of the department’s Board of Health would like to replace that system with one that rates establishments with a letter grade — an A, B or C.

“It’s easily understood,” said Lawrence Albert, a food manufacturing industry consultant who is the health board’s vice president. He has raised the issue at board meetings but said it has not advanced past discussion.

The top county health official, however, doesn’t believe a change is needed to the current rating system.

“We know that our community feels pretty comfortable, and knows what it means” when they see “fair” or “standard,” said Dr. Adi Pour, county health director.

Some in the restaurant industry disagree.

“The public doesn’t understand how the grading

system works, and the media doesn’t understand how the grading system works, and that’s a problem,” said Jennie Warren, executive director of the Omaha Restaurant Association.

Warren said she’s glad the health department is evaluating its system and said the association will work with the department.

rest.inspection.grade.colorThis might help guide your work:

Filion, K. and Powell, D.A. 2009.

The use of restaurant inspection disclosure systems as a means of communicating food safety information.

Journal of Foodservice 20: 287-297.

The World Health Organization estimates that up to 30% of individuals in developed countries become ill from food or water each year. Up to 70% of these illnesses are estimated to be linked to food prepared at foodservice establishments. Consumer confidence in the safety of food prepared in restaurants is fragile, varying significantly from year to year, with many consumers attributing foodborne illness to foodservice. One of the key drivers of restaurant choice is consumer perception of the hygiene of a restaurant. Restaurant hygiene information is something consumers desire, and when available, may use to make dining decisions.

Filion, K. and Powell, D.A. 2011. Designing a national restaurant inspection disclosure system for New Zealand. Journal of Food Protection 74(11): 1869-1874
.

The World Health Organization estimates that up to 30% of individuals in developed countries become ill from contaminated food or water each year, and up to 70% of these illnesses are estimated to be linked to food service facilities. The aim of restaurant inspections is to reduce foodborne outbreaks and enhance consumer confidence in food service. Inspection disclosure systems have been developed as qr.code.rest.inspection.gradetools for consumers and incentives for food service operators. Disclosure systems are common in developed countries but are inconsistently used, possibly because previous research has not determined the best format for disclosing inspection results. This study was conducted to develop a consistent, compelling, and trusted inspection disclosure system for New Zealand. Existing international and national disclosure systems were evaluated. Two cards, a letter grade (A, B, C, or F) and a gauge (speedometer style), were designed to represent a restaurant’s inspection result and were provided to 371 premises in six districts for 3 months. Operators (n = 269) and consumers (n = 991) were interviewed to determine which card design best communicated inspection results. Less than half of the consumers noticed cards before entering the premises; these data indicated that the letter attracted more initial attention (78%) than the gauge (45%). Fifty-eight percent (38) of the operators with the gauge preferred the letter; and 79% (47) of the operators with letter preferred the letter. Eighty-eight percent (133) of the consumers in gauge districts preferred the letter, and 72% (161) of those in letter districts preferring the letter. Based on these data, the letter method was recommended for a national disclosure system for New Zealand.

Pittsburgh restaurant operators express distaste for proposed grading system

Over a dozen local restaurant operators Tuesday evening convened in an Allegheny County Health Department public hearing, where they chewed and spat out an A-B-C grade system based on compliance with food safety procedures.

restaurant_food_crap_garbage_10If passed, Allegheny County residents will see letter grades posted on the doors of all public eating facilities by early September — including restaurants, church kitchens, schools, supermarkets, nursing homes and pool snack bars.

“We’re basically providing an easily interpretable mechanism by which the consumer can interpret our inspections,” said Jim Thompson, deputy director of environmental health.

Grading would be based on compliance with 33 categories of safety provisions that span from tossing expired food and washing used cutlery to providing separate changing facilities and toilets for employees. Any grade below an “A” will require a follow-up inspection of the establishment. Further reinspections may be requested once every calendar year for a fee of $150 at the owner’s expense. Imminent health hazards — such as roof leakage onto food or major cockroach infestations — will warrant the immediate closure of the eatery.

The grading system is a hot potato for Allegheny County restaurant owners, who successfully challenged a similar proposal in March 2011. “It feels a little bit like Groundhog Day,” quipped Kevin Joyce, owner of the Carlton, Downtown.

As in 2011, the central concern of local operators is an alleged misallocation of $3.4 million in federal funds to combat foodborne illnesses. “There are only 17 inspectors for over 9,000 facilities and no measures to ensure consistent grading across the board,” said Mehrdad Emamzadeh, a veteran of the hospitality industry.

Opponents of the program also noted that letter grades would constitute but a “snapshot in time,” unreasonably penalizing human error in a public fashion that would “virtually ruin reputations.” Mr. Emamzadeh, along with two restaurant owners, vowed not to open new establishments in the county if the grade plan were enacted.