Risk Management

Risk is, and forever will be, synonymous with serving food to the public.

Poor hand hygiene is the single-most important contributor to the spread of foodborne illness

Centers for Disease Control

Foodborne illness is just one more factor to manage, but one that must be addressed more aggressively - sufficient to match up with the aggressive lawyers, armed with DNA technology and poised to defend any one of your customers. The threat is much greater than the Workman's Comp, a slip/fall and chipped teeth cases that have dominated the agendas of many risk management departments.

After very successful rounds of investment in temperature control, handwashing is now the biggest single remaining threat to serving safe food. Controlling equipment has proven to be considerably easier than controlling handwashing behaviors. Motivation, training and employee turnover become factors. We must now learn to control a process that has never been under control.

Ignoring handwashing as a priority is easy until faced with a crippling outbreak of foodborne illness. It is often trivialized, feeling that there is nothing that can be done, "we are doing everything we can." Some will correctly say the real problem is keeping ill employees out of the kitchen and keeping ill customers at home (i.e.cruise ship passengers). An understanding of the legal principle of Strict Liability will quickly change that attitude for all but the high-roller risk taker.

This intangible handwashing factor with its lack of standards must be met head-on with the same rigor and level of professionalism as major menu changes. Don't be discouraged by these three realities:

1. The risk will never be zero,
2. The risk is rising in spite of the food getting safer and
3. Ill employees and ill customers are a constant threat to the health of your business.

5 Faces of Foodborne Illness

Is eating out safer than eating at home?

Actually it can be thanks to the diligence of operators, regulators and food service workers. Unfortunately, even with the best intentions not all food service is safe. The five faces of foodborne illness is based on USA statistics provided by the Centers for Disease Control (CDC):

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• 54 billion Safe Meals served
• 54,000,000,000, at 884,000 locations. Eating out is one of our favorite activities: over 40% of adults eat in a restaurant every day. While most meals are wholesome, some cause illnesses. Just over 50% of the American food dollar is spent on food prepared or served away from home.

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• 48,000,000 foodborne illnesses
• 1 of every 6 people will "catch" a foodborne illness this year. Typically, you start to feel sick, develop diarrhea and/or vomiting, and start feeling better all in the same day - 24 hour flu that isn't the flu!
• The visible costs grossly understate the reality:
• Lost work: estimated at billions of dollars each year!
• Lost customers: will never return to that restaurant!

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• 2,400,000 Doctor Visits
• About 5% of the people who get sick from food see a doctor: they may be weak and dehydrated from the food flu, or they may have a more serious illness, such as Hepatitis A. Most recover in one to three weeks but chronic conditions often are an unexpected consequence.
• Regulatory action: tracking & shutting down that restaurant.

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• 128,000 Hospitalizations
• Some people become very sick, especially children less than 6 years old, pregnant women, adults over 60, and people with other medical conditions, such as liver disease, cancer, organ transplants or immunodeficiency. Many suffer long lasting effects, including rheumatoid arthritis, Crohn's disease and Guillain-Barre syndrome, causing life-long suffering and cost.
• Legal action: litigation, fines and settlement costs

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• 3,000 Deaths
• While most people recover from foodborne illness, many don't. About 8 people die each day from something they ate or drank. Highly susceptible people are most at risk, but some foodborne diseases have unusually high mortality rates even among the healthy (these include Listeria monocytogenes, Vibrio parahemoliticus, and E. coli 0157 H:7)
• Media: the worst publicity...Continues for weeks.
• Lost customers: other restaurants chosen.
• Depression: personal toll on owners/managers/staff

Damages Created by Foodborne Illness

The emotional and financial nightmares that accompany a serious outbreak of foodborne illness impacts you, and your business, immediately and it lasts a lifetime. In many cases businesses are forced to close their doors, if not for financial reasons, then for the emotional impact on owners.

When assessing the damages that a foodborne illness could inflict on your operation consider the impact of:

Sick Customers & Employees

The emotional distress experienced by operators when customers and/or employees die or suffer life-altering disabilities from foodborne illness will often far outweigh the impact of even the most punitive of financial damages.It is a life-altering event.

Loss of Public Confidence

Foodborne Illness is a major news event that becomes public knowledge immediately. A business, and personal reputation, built on trust and confidence over many years is dramatically impacted within hours.

Product Recall

Product recall, reworking, repackaging and disposal activity is a major expense that consumes all functions within an organization. It has an immediate impact on product availability, market presence and cash flow. Many times it also results in a permanent loss of distribution, retail space and retail support.

Lost Revenue

How long can your operation meet its financial obligations with 0% of its current revenue? How long at 80% of its revenue or at 50% of it's revenue? When foodborne illness occurs it impacts all products & outlets in your operation and not just the one infected. What actions will you need to take to dramatically cut costs to survive? What impact will these actions have on your business? On the lives of your employees? On your own family?

Lost Market Share

Where will your customers go when your product or service is temporarily unavailable? Will they return when the problem is resolved? Why? What will it take for them to regain confidence in your operations? Can you afford the time and money necessary to rebuild their confidence and trust? Fines Under the principles of strict liability and constructive knowledge expect to pay damages to your customers and their families. Also expect fines. What will insurance cover?

Closure

Unfortunately, an often occurrence. Sometimes temporary, sometimes forever. 

Damages Created by Foodborne Illness

Foodborne illness has left a number of victims. The following are statistics on a few businesses, owners and employees impacted:

Jack-in-the-Box 1993

• E-coli outbreak
• 4 children died
• >600 sick
• >$100 million in settlement
• 20% drop in sales across chain
• Still feeling effects

Cecilis BBQ Hut 1996

• Newspaper report of worker with Hep A
• Sales plummet immediately
• Newspaper reports worker NOT sick
• Business closes

Iwaus Deli 1998

• E-coli outbreak
• 5200 sick
• >$3 million settlement
• Business closed

Subway 1999

• Hep A outbreak
• 31 people affected
• $1.6 million settlement
• Outlet closed

Crab House 2001

• Hep A outbreak
• Worker-to-worker-to-customer
• 29 sick, 1 dead

Chilis 2003

• Salmonella outbreak
• 13 people hospitalized
• location closed, litigation in progress

Chi-Chi's 2003

• Hepatitis A
• field contaminated green onions from Mexico
• severe financial impact, litigation in progress

Friendly's 2004

• Hepatitis A
• 5000 emergency vaccinations
• litigation pending

Odwalla Juice 1996

• 1 child dead
• 70 sick
• $15 million settlement
• $1.5 million fine

BilMar Meats 1998

• Listeria outbreak
• 21 people dead
• >100 sick
• Across 22 states
• 35 million lb recall of hot dogs

Bauer Meat 1988

• E-coli outbreak
• 1 child with HUS
• 38,000 lb. Burger recall
• Company closed
• President commits suicide

Hudson Foods 1995

• 20,000 lb product recall
• Company closed
• foodservice operations
• producers

Foodborne Illness: Process Assessment Checklist

Foodborne Illness: Risk Self-Assessment

The best prevention programs start with an understanding of the risk factors that mangers control. Managers who understand these risk factors can then set acceptable goals, make informed decisions and actively manage their food safety program—Active Managerial Control.

Customer Assessment:

In the world of foodservice, customers do the choosing. They decide where they eat, what they eat, and when they eat. Their general state of health may be in question when they eat at your location. The simple fact is that on any day the average foodservice operation will have 20% of their customer base in the high risk category for foodborne illness. This means that 20% could be susceptible to severe repercussions, including death, from any illness they contract because their immune system is compromised. It also means these same customers could be unknowingly contaminating your facilities and your staff with pathogens. It is important to understand the inherent risk of your customer base. Knowing this risk can help you make better decisions on menu selection, sanitation processes, hand hygiene frequency and even facility design. The Handwashingforlife Institute (HFLI) customer assessment guide provides a simple means of assessing your customer risk and is the first place to start in determining your overall risk for foodborne illness.

Process Assessment:

When it comes to food safety and personal hygiene every operation and every employee is unique. Good processes and good process management is critical to providing a “Safe Food” environment. Steps can be taken to manage risk at both the individual level and the total operation level. Do you have the proper hand hygiene processes in place? Complete the Handwashingforlife Institute (HFLI) Process checklist to assess your “Safe Hands” policies and practices.

Basic “Quick Start” Assessment:

The quick start assessment is a paper based approach that facilitates a logical analysis of the most critical factors contributing to the risk of foodborne illness. It utilizes a simplified Higher-Moderate-Lower rating system to categorize the risk of foodborne illness in a foodservice operation. If your assessed risk is in the Lower range then this approach to risk assessment is probably all you need. However, if your risk is Moderate to Higher then completing the electronic Self-Assessment Worksheet (SAW) should be a priority.

Self-Assessment Worksheet (SAW):

SAW is an electronic worksheet to cut through the hand hygiene risk factors. It includes more variables impacting upon the risk of foodborne illness than the “quick start” version allows. It is also interactive allowing managers to test the impact of changes in processes, menus, and hygiene programs on the overall risk level. While still simple to complete, it does require access to a computer and the Internet (or a CD of program). SAW allows managers to take control of the risk factors in their environment to make informed decisions.

Download Self Assessment Worksheet (SAW) »

Quick Start: Risk Assessment

Self-Assessment Worksheet Guide

In this section you can use the Self-Assessment worksheet to:

• Measure the level of risk currently being experienced within your operation
• Determine what actions are needed/desired to lower your risk
• Set goals

How to complete the Handwashingforlife Self-Assessment Worksheet (SAW):

• Open SAW excel file in the Learning Center tab at www.handwashingforlife.com
• It is best to have at least 3 different people complete the worksheet so that different perspectives can be compared.
• Open the Excel sheet and click on SAW tab at bottom of worksheet.
• Review the content before starting.
• It may be easier to complete the worksheet on-site in the kitchen. Print off a copy to facilitate answering the questions on-site. Then return to fill in the worksheet on-line since the program will need to calculate the results.
• The blanks to fill in are highlighted in red. Read the comments section for help in filling in the red sections (just type over existing content).
• The numbers highlighted in blue are calculated numbers
  (do not type in these areas).
• Print out a copy of the final document for your files and future reference.

How to read the Self-Assessment Worksheet (SAW):

The blue numbers in bold represent your RISK scores related to foodborne illness. A few comments on these numbers:

• Every operation will have it's own unique risk based on menu, customer base, facilities, prep process, controls and hand hygiene factors. Changing your input/decision on these variables will impact the level of risk.
• The total risk for foodborne illness can never be eliminated but it can be managed.

Total Risk Factor:

The blue number at the bottom of the page is the risk associated with your TOTAL
food management program.

Step One: Assess the Risk

The manager or Person-In-Charge (PIC) of a foodservice operation is directly responsible for any disease, or foodborne illness, contracted by their customers or their employees as a result of eating, visiting and/or working at their establishment.

Understanding the nature of pathogens, the legal liability of owners and managers, and the history of human and financial losses related to foodborne illness is important background knowledge for every foodservice operator.

Assessing the risk currently, and often unknowingly, being taken in a foodservice environment is the key to managing the critical control points that can increase, or decrease, that risk.

After completing this section the Person-In-Charge will:

• Understand the impact that foodborne illness can have on their customers, their business and their financial well-being.
• Learn the legal realities of “strict liability” and “constructive knowledge”.
• Know the sources, behavior, resistance to control and devastating human impact of pathogens.
• Assess the RISK for a foodborne outbreak in their operation.
• Establish the RISK tolerance level and the key steps needed to manage the RISK in their operation.
• Completing this Hands-On program will achieve a level of management control in hand hygiene consistent with the principles of HACCP.

The Law & Foodborne Illness

Understanding the law surrounding foodborne illness is an important step in helping establish your risk and your position under the law. Foodborne illness lawsuits are on the rise, and settlements continue to increase.

A widespread outbreak of foodborne illness is a public health crisis. When government authorities implicate a foodservice operation as the cause of the outbreak, it is a crisis with implications both legal and commercial.

Breaking the law is clearly a risk, but the bigger risk is any injury or loss of life sustained by your customer. Virtually all those whoprepare food do so within the parameters of the law. The industry'sPlan Review process assures the basics of facility compliance.Unfortunately, many operators stop there.

While most operators understand that an outbreak of foodborne illness makes for bad publicity and it is therefore bad for business,few fully understand the legal standard that will determine their liability to the people injured as part of the outbreak. Indeed manyoperators assume that so long as the operation was “state of theart”, and that they did “nothing wrong”, there is no risk of lawsuits.They also assume that if the problem that gave rise to the outbreakhad not yet been discovered, the restaurant operation cannot beheld responsible. Both of theses assumptions are wrong.

Doctrines of strict liability and constructive knowledge hold that a restaurant operation is liable regardless of fault or actual knowledge.

The Pathogen Pathways

The Science of Foodborne Illness

Microbes: Stronger

Unfortunately, this enemy fights a guerrilla war. In the right conditions (your kitchen) Microbes
mutate and evolve at astonishing pace, resisting efforts to control their impact. New information
regarding the Bird Flu confirms this disturbing trend. The Invaders chart provides details on
some of the more common pathogens that can inflict their damage thanks to inadequate food
handling practices and poor hand hygiene.

Customers: More Vulnerable

Unfortunately, as the pathogens mutate to resist our efforts, many of our customer's immune systems are becoming more vulnerable with age, disease and more frequent exposure.

• 20% of the North American population falls into the highly vulnerable at-risk category. This percentage grows each year as our population ages.
• Global travel creates the opportunity for new pathogens to move rapidly across natural borders as seen most recently with H1N1, swine flu.
• The over 50 and traveling segments of population represent a high percentage of away-from-home dining (what is your share of "at risk" customers?)

Regulations: Better Equipped

Combine these increasing risks with the continuing advancement in trace-back technology, science can now, better than ever before, tell us the HOW, WHEN and WHERE of foodborne illness incidents. The pathogens can hide but the source of infection can not.

Hepatitis A: Act Now!

Hepatitis A is an infection of the liver caused by the hepatitis A virus (HAV). The incidence of infection is increasing with serious implications for customers, employees, managers and owners.
Are you properly managing the risk of hepatitis A in your operation?

Science: On Your Side

Fortunately, science is on your side. It tells you a great deal about how, when and where to fight back. Most importantly, research has proven that good handwashing is the most effective means of preventing the spread of foodborne illness.

The “High Risk” Population