Tony Mak

CIPHI Manitoba Branch Workshop

September 15, 2011

ROLE OF WORK PLACE SOCIAL AND ENVIRONMENTAL FACTORS ON

COMMERCIAL WORKERS’ FOOD SAFETY PRACTICES

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Food Safety

• Significant public health resources have been invested

in Canada promoting food safety through education and

regulatory activities (Mitchell et al. 2007).

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Evidence of effectiveness?

It is estimated

• 5.4 million cases of food-borne illness take place

annually in Australia (Australian Government 2005);

• 11 to 13 million cases in Canada (Health Canada 2006);

• 76 million cases in the United States (Mead et al. 1999).

WHO believes incidence rates in OECD countries are similar (Rocourt et al. 2003)

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Who is responsible for food safety?

• “…responsibility for food safety…rests with the person

or entity under whose control the management of that

risk most plausibly lies.” (Rollin, 2006).

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Key messages

• Food safety by tradition depends on inspection to ensure regulatory

compliance. Effectiveness is questionable. We must think outside

the box and look beyond the traditional.

• Work place environment and culture are critical in shaping food

handlers‟ food safety behaviour, and behaviour is key to food

safety.

• Public health should consider a system approach consists of

multiple strategies to promote favourable workplace

environment/culture that could internalize desirable food safety

practices in commercial facilities.

‘If you do what you’ve always done, you’ll get what you always got.’

Mark Twain

'Some people think you are strong when you hold on. Others think it is when you let go'.

Sylvia Robinson

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Road map of this presentation

• Part I. Our pilot study

– A brief description of the

study and what we have

learned

• Part II. Background

information. Literature in

“work place culture”

• Final thoughts

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Why?

Part I. The Pilot Study

• The pilot study explored the possible relationship

between work place social/environmental factors and

the occurrence of food-borne illness in commercial

eateries.

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Who?

Case definitions

• Commercial food workers working in restaurants

meeting the case definitions:

– Restaurants were located in the Capital Health region and had

been associated with food borne illness outbreaks during the

period of October 1 – December 31, 2007; or

– Restaurants located in the Capital Health region which had

been alleged to have caused food borne illness by a

complainant(s) in the period of October 1 - December 31, 2007,

that were deemed a “plausible” source for the illness reported in

that complaint

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Who?

Control definition

• Control facilities must not have received any complaint

or must not been implicated in any food-borne illness in

the past 12 months (Jan. 1 – Dec. 31, 2007).

– Controls were selected by matching, as much as possible, the

following:

• seating capacity

• number of staff

• menu, and

• locale (located in the same neighbourhood and inspected by the

same inspector)

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Who?

The Team

• Environmental Health Officers, epidemiologists, bio-

statisticians

• Health authority and two universities‟ ethics review

committees

• Concordia student public health inspectors (6) as

interviewers

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How?

• A closed ended quantitative study using a 5-point Likert

scaled questionnaire;

• An environmental public health epidemiologist assisted

in defining “case” and “control”;

• Surveyors were “blinded”;

• Used languages familiar to informants;

• Adhered to ethical practices;

• Data analyzed by 2 bio-statisticians.

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What (findings)?

• When employees felt “unhappy” about his/her job, then

the restaurant‟s chance of having food-borne illness

incidences would be 4.18 times higher than of that of a

restaurant with “happy” employees.

• The ratio of probabilities of disease outbreak when

workload was considered “heavy” was 2.12.

• The ratio of probabilities of disease outbreak for

Location of hand-basin was 3.00.

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What (findings)?

• We also computed the sample size required for a full-

scale study at which the power would reach 90% at the

above settings, for example, if the case to control ratio

is 1:4, then 210 (42+168) facilities would be required to

reach a statistical power of 90%.

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Limitations

• Small sample size

• Selection bias

• Recall bias

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Summary and recommendations

• Preliminary findings have suggested differences

between „outbreak‟ and „non-outbreak‟ restaurants in

workers‟ “happiness”, the amount of workload, and the

locations of hand-basins.

– Public health agencies may want to include workplace “culture”

development as an integral part of food safety program

planning.

– EHOs should embrace more than microbiology.

• This pilot study has provided valuable information on

the exposure rates of factors that can be used for the

sample size calculation for a future full scale study.

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Acknowledgements

Funding: Alberta Agriculture

Administration: Concordia University College of Alberta

Methodology: Lance Honish, Nelson Fok, Nyall

Hislop, Rick Dimock

Data Analysis: Dr.Dengzhong Wang, Dr. Peng Zheng

Data Collection: Ali Ranna, Ashley Yu, Eleanor

Tyerman, Kelsie Dale, Manny Ahmad,

Pam Stewart

And…All Participants!

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Part II

Work place environment, culture and

workers‟ food safety behaviour

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Background and literature

• Social, organizational, and physical environments are important determinants of behaviour (McLeroy et al. 1988; Smedley and Syme 2000).

• Tones et al. (1990) integrated work place environmental and social factors in behaviour modification.

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Background and literature

• Human behaviour is an integral part of food safety in

both problems and solutions (Fineberg et al. 1994;

Green 2008).

• Ehiri et al. (1997) suggested that effective food safety

control strategies must take into account the social and

environmental influences.

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Background and literature

• Mortlock et al. (2000) have supported that coordinated

workplace reinforcement such as management

encouragement and incentives is essential in workers‟

adoption of new food safety behaviours.

• Mitchell et al. (2007) referred to the PRECEDE-

PROCEDE health promotion model; predisposing,

enabling and reinforcing factors can be effective in

alluring good food handling behaviour and in preventing

food-borne illness in food service establishments.

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Background and literature

• Organizational culture has important implications to the

organizational performance (Kotter & Heskett 1992;

Harris & Mossholder 1996; Dwyer et al. 2000; Kemp &

Dwyer 2001; Dolan & Garcia 2002; Tepeci & Bartlett

2002).

• Yiannis (2008) has observed food safety equals

behaviour; it requires a better understanding of

organizational culture.

• Griffith et al. (2010) have found workplace culture is the

real underlying cause for foodborne illness.

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A summary

Entity Management

Work place

culture/environment

Food safety practices

Group/Individual

behaviour

Public health protection

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Our food safety programs

Our current food safety strategies are made up of:

• Regulation/policy

• Inspection

• Prosecution/enforcement

• Publication of inspection reports (Name and shame,

Score on the door, etc.)

• Food safety education

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How to begin the next step?

• It is evident that facility management and work place

can influence commercial food workers‟ food safety

behaviour.

• We need to re-orient our professional training, in

addition to microbiology, by paying more attention to

empowering restaurant management to nurture a

workplace culture for food safety practices.

• Your innovations and suggestions…

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Actually, my preferred topic for this presentation would

have been…

Restaurant Food Safety Program: "Got a full 6-pack,

but we need that plastic thingy to hold it all together.”

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Thank you!

QUESTIONS?