Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
funded initiative demonstrating significant decreases in priority violations. Other jurisdictions have engaged exter- nal consultants to provide specialized technical assistance to operators. As consultative approaches become more widespread, comprehensive evaluation of their effectiveness in reduc- ing both violations and foodborne illness becomes increas- ingly important. Such evaluation can occur at both local and national levels to determine best practices and inform broader adoption of these innovative program models across the field.
The development of meaningful outcome measures is an emerging challenge for consultative visits, as these have not yet been well-established in the field. Consultative approaches present measurement difficulties because they are more conceptual than traditional violation-based inspections and are often co-mingled with standard reg- ulatory activities. Programs implementing consultative models could benefit from innovative metrics that cap - ture the preventive value and educational impact of these interactions, potentially including measures such as vol- untary compliance improvements, operator knowledge gains, or reductions in repeat violations following consul- tative interventions. As the field continues to evolve toward more collabora - tive and educational approaches, developing effective outcome measures for these activities can help demon- strate program value and effectiveness beyond traditional enforcement metrics. The following metrics were derived from the national field survey data.
Meaningful Outcome Measures
PURPOSE
METRIC
Program effectiveness
• Number of critical violations identified per 1,000 food establishments per year * • Number of complaints received per year *
Staffing
Workload management
• Average number of inspections per facility type per year
Public health protection
• Number of foodborne illness outbreaks per year • Number of foodborne illnesses per year
* EPH professionals who participated in focus groups, key informant interviews, and/or the national field survey consistently identified this metric as moderately to extremely useful. FDA reports that most agencies responsible for the over- sight of restaurants and other retail food facilities have adopted some version of the FDA Food Code . Additionally, many food safety programs also use the FDA Voluntary National Retail Food Regulatory Program Standards as a foundation for program evaluation. Risk factor analyses that examine trends in violation citations and foodborne illness patterns can inform targeted interventions, such as training programs for EPH staff and educational programs for food workers and operators. Common program effectiveness measures include track- ing violation patterns by facility type, which helps iden- tify systemic issues and target resources appropriately. Performance and workload evaluation measures typically encompass the number of inspections completed, as well as time efficiency metrics for inspection completion.
Food safety programs commonly use FDA Standard 8 (280–320 inspections per full-time employee [FTE] per year) as general guidance for staffing rates, though actual inspection volumes vary significantly across jurisdictions. Survey data from local departments show a median of 331 routine inspections per FTE annually (range 184–333), with some programs reporting as low as 280 inspections per FTE while others conduct up to 580 inspections per FTE. These benchmarks are specific to 1 FTE in food safety pro - grams and might need to be adjusted when EPH profes- sionals also perform duties in other programs. Workload calculations could account for non-food safety responsibil- ities, which might result in lower inspection targets. Addi- tionally, essential duties such as reporting, responding to
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