Enforcing Public Health Law: Improving the Administrative Hearing Process to Reduce Staff Time

This project was initially chosen because of the cross-cutting impact it could have across OCHD. Several programs in different bureaus use administrative hearings as a means to enforce public health law. Each program's staff members were asked about their experience with administrative hearings and whether they thought there was room for improvement. The answer was a resounding "yes." After approval from the Commissioner of Health, a QI team was convened. The team began by meeting with the assigned QI coach, Dr. Bill Riley. Dr. Riley guided the team toward the use of Lean to examine the administrative hearing process. At this point, the team identified and contacted a local Lean facilitator to work with the Food Protection Section. Before meeting with the facilitator, staff members worked to create a process map to outline each step. The facilitator then led the group through a value stream mapping process, in which each step was assessed for task time, queue time, reliability, next step visibility, number of people trained, and frustration level. Starbursts were created when any extreme values were identified. After a thorough review, each team member was given an opportunity to prioritize the starbursts. Those deemed the highest priority were then subject to a brainstorming session to identify possible solutions. Discussion followed to determine which solutions would be implemented, and each solution was assigned a champion and a follow-up date. The Food Protection Section identified and implemented three interventions. Under the current practice, when a restaurant fails an inspection, a hearing is automatically scheduled. The inspector returns to the facility in approximately 2 weeks for a follow-up inspection to ensure that all violations are corrected. If the reinspection is satisfactory, the owner/operator has the option to pay a fine and cancel the hearing. Depending on the circumstance, the inspector will occasionally perform more than one reinspection to allow violations to be corrected over multiple visits. The interventions are as follows: 1. The violation letter sent to restaurant owners with a failed inspection was changed to indicate that a hearing would be scheduled if the follow-up inspection was not satisfactory. Previously, a hearing was automatically scheduled upon the first failed inspection. During the Lean process, the team discovered that about 60% of these hearings are ultimately canceled, which happens when the follow-up inspection is satisfactory and the owner/operator opts to pay a fine. By waiting to schedule hearings for only those establishments with a failed reinspection, staff time and mailing costs associated with scheduling the 60% (that would ultimately be canceled) could be saved. The bureau supervisor was charged with developing the procedure, securing approval from OCHD administration and the county legal department, and editing the violation letter sent to each owner/operator to reflect the changes. 2. The number of reinspections a facility could receive before a hearing was required was standardized across the program. Previously, on a case-by-case basis, inspectors would allow some establishments to receive multiple reinspections to correct violations before a hearing would be held. Under the new procedure, inspectors may perform only one follow-up inspection. If the violations have not been corrected at that time, a hearing will be required. The notice of violation letter was updated to reflect this change. This initiative could save staff time by reducing the number of trips into the field and could potentially increase overall compliance because owners/operators will know that they only have one chance to fix the violations. The bureau supervisor was charged with developing the procedure and securing approval from OCHD administration and the county legal department. 3. The third intervention was to move the scheduling of hearings from a paper-based process to an electronic process by creating a shared calendar through the e-mail system. This intervention would reduce staff time; eliminate the need for multiple paper copies; and save costs associated with copying, storing, and disposing of paper. The QI team leader was assigned to develop this initiative with assistance from department information technology staff and Food Protection Section clerical staff. Each of these initiatives affected employees of the Food Protection Section with respect to the amount of time spent on administrative hearings. The initiatives also affected the owners/operators of restaurants and food service facilities in the county. Those who received a satisfactory reinspection did not have to endure the hassle of having a hearing scheduled and subsequently canceled, whereas those with failed reinspections did not have multiple opportunities to correct violations.

The impact of the first two initiatives was measured by a pre-intervention/post-intervention comparison. The initiatives were implemented for a 4-month pilot period. Results were compared with the 4-month period immediately preceding the implementation. Data collected for both periods include the number of facilities with initial violations, the number of owners/operators who stipulated upon a satisfactory reinspection, the number of hearings held, and the number of facilities that received more than one reinspection. Completed inspections are logged into a database that served as the source of these data. The third initiative was not successfully implemented at this time because of the need to involve the county information technology department. The initial rollout had many glitches, and troubleshooting them has fallen victim to competing priorities. Upon full implementation, the impact will be measured by tracking staff time associated with the new process, tracking the number of paper copies made, and tracking the costs of paper usage.