Environmental Health Continuous Improvement Board
Meeting Summary
Wednesday, March 11, 2015
10:00 a.m. – 2:30 p.m.
Minnesota Counties Intergovernmental Trust Building
Members Present and Absent:
Name
Dawn Beck (co-chair)
Allie Freidrichs
Bill Groskreutz
Tom Hogan (co-chair)
Daniel Huff
Ben Miller
Carol Schefers
Karen Swenson
Jeff Travis
John Weinand
Organization
Olmsted County
Meeker-McLeod-Sibley Counties
Faribault County Commissioner
Minnesota Department of Health
City of Minneapolis
Minnesota Department of Agriculture
Wright County
Brown-Nicollet Counties
Washington County
City of Minnetonka
Present
Absent
X
X
X
X
X
X
X
X
X
X
Other Meeting Participants:
Debra Anderson (Hennepin County), Cindy Weckwerth (City of Minneapolis), Steven Diaz (Minnesota
Department of Health, Environmental Health Division)
Facilitators:
Becky Buhler, Chelsie Huntley (Minnesota Department of Health, Health Partnerships Division)
Welcome and Introductions
The Environmental Health Continuous Improvement Board (EHCIB) co-chairs Dawn Beck, Olmsted
County, and Tom Hogan, Minnesota Department of Health (MDH), welcomed everyone to the EHCIB’s
March meeting. Ms. Beck proceeded to review the meeting agenda and objectives. Meeting
participants each introduced themselves. Ms. Beck acknowledged both Board and non-board members
and invited everyone to fully participate in the meeting activities.
Environmental Health Continuous Improvement Board
Minnesota Department of Health
Health Partnerships Division – Public Health Practice Section
P.O. Box 64975
St. Paul, MN 55164-0975
(651) 201-3880
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EHCIB Meeting Summary – March 11, 2015
Meeting Objectives:
1. Discuss progress and next steps on the Food Pools, and Lodging Services (FPLS) program reevaluation process
2. Discuss progress and next steps on a manager’s group/collaborative policy development
process
3. Adopt a recommendation and identify next steps for handling the remainder of the current
FPLS program evaluation cycle and improving the next cycle
4. Agree on a dissemination plan for the EHCIB’s “declaration of support” for state/local EH roles
5. Brainstorm potential performance measures for FPLS activities in MN
Co-Chair Remarks
Mr. Hogan shared that since the January meeting, he, Ms. Beck, and Steven Diaz met with the four
local agencies that need to be re-evaluated to gather feedback on how to conduct that re-evaluation
process. Mr. Hogan noted that moving forward he would like to see local partners to participate in the
evaluation process, not merely be a recipient.
Ms. Beck added that a lot of work occurred in the last few months. In addition to the interviews, there
has been an ongoing discussion at the Local Public Health Association (LPHA) about how to infuse
environmental health into the organization. There is interest in creating a forum for MDH to engage
locals on environmental health topics beyond food, pools and lodging issues.
Business Items
Participants discussed and made decisions about the following business items.
Approve January Meeting Summary
The January 28, 2015 EHCIB meeting summary was presented for approval. Steven Diaz provided an
update related to the summary. He noted that all local food, pools and lodging services programs have
been provided the opportunity to be evaluated under the current process; two programs choose to
undergo a paper-only process. Dan Huff, City of Minneapolis, made a motion to approve the summary.
Allie Freidrichs, Meeker-McLeod-Sibley, seconded the motion. The motion passed unanimously
without discussion.
Status Updates on January 2015 Action Items
• May EHCIB Meeting
o Chelsie Huntley shared that members voted on where to hold the May meeting, which
conflicted with the Minnesota Environmental Health Association’s (MEHA) preconference events in Alexandria. Options were to meet in Alexandria or change the
meeting time in St. Paul. Members chose to hold the meeting in St. Paul at MCIT, with a
revised schedule, 9am-1:30pm.
Environmental Health Continuous Improvement Board
Minnesota Department of Health
Public Health Practice Section – Health Partnerships Division
P.O. Box 64975
St. Paul, MN 55164-0975
(651) 201-3880
Page | 2
EHCIB Meeting Summary – March 11, 2015
•
2015 Work Plan Updates
o Chelsie Huntley reported that, based on feedback, an additional goal was added to the
2015 Work Plan. The goal focuses on evaluating the whole FPLS program evaluation
process, not just the re-evaluation portion. Ms. Huntley noted that the work plan
continues to be a working document.
•
EHCIB introduction for new LPHA and MDH leadership
o The executive director of the Local Public Health Association (LPHA), the MDH deputy
commissioner, and the assistant commissioner overseeing the MDH Environmental
Health Division were part of the original group that formed the EHCIB. The new people
serving in those roles will be invited to participate in upcoming EHCIB meetings. Ms.
Beck will invite Lorna Schmidt, LPHA Executive Director, and Tom Hogan will invite Paul
Allwood, Assistant Commissioner, Health Protection Bureau, and MDH Deputy
Commissioner Dan Pollock. Ms. Huntley will add them to the EHCIB email list. It was
noted that the legislative session was a very busy time for LPHA and the MDH Executive
Office and that a more thorough introduction to the EHCIB might be better received
after the session.
•
LPHA Executive Committee discussions on engaging EH managers
o Allie Freidrichs and Carol Schefers reported on the meeting with the LPHA Executive
Committee and MDH EH Assistant Director, Dale Dorschner to discuss engaging local EH
managers. Discussion included suggestions to continue regional updates,
communication with the State Community Health Services Advisory Committee
(SCHSAC) and the Minnesota Environmental Health Association (MEHA), and to
encourage the SCHSAC Conference Planning Workgroup to have a stronger EH focus at
the annual Community Health Conference.
o It was noted that currently, LPHA and MEHA do not engage in regular communications.
o Clarity was provided on the relationship between the EHCIB and SCHSAC – the EHCIB
has a representative from SCHSAC, but is not a SCHSAC workgroup. Information on the
EHCIB is shared at quarterly SCHSAC meetings.
•
MDH FPLS discussion with EH Managers
o Mr. Diaz reported that instead of scheduling a separate meeting for all local agencies
that have EH staff or are interested in EH communications, he is attending the upcoming
EH Managers meeting and has been attending regional LPHA meetings.
o At the regional LPHA meetings Mr. Diaz has been opening communication channels and
sharing a dashboard of FPLS activities for each county. CHBs expressed appreciation for
the information and open communication. Mr. Diaz’s message has been that FPLS is part
of EH, which is part of public health. MDH and local agencies are part of the same team,
regardless of how FPLS is implemented.
Environmental Health Continuous Improvement Board
Minnesota Department of Health
Public Health Practice Section – Health Partnerships Division
P.O. Box 64975
St. Paul, MN 55164-0975
(651) 201-3880
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EHCIB Meeting Summary – March 11, 2015
o MDH FPLS staff have recently received and filled requests for accreditation
documentation from CHBs that do not have delegation agreements. As local agencies
move toward national voluntary public health accreditation, there are standards that
need to be met, regardless if an agency has a delegated program. It may be useful in the
future to create a document for EH similar to the Disease Prevention and Control
Common Activities Framework that describes the EH roles for local, state, and partners.
o Ms. Huntley noted that the current charge for the EHCIB is FPLS. Members agreed to
remain focused on that work, but to influence the broader discussion about EH and
public health. Ms. Huntley will add this topic to the next agenda.
Member Updates
• Mr. Hogan reported that the first legislative deadline is Friday, March 20th. MDH is tracking bills
of interest to EH, including bills on water quality, agri-tourism, Minnesota Food Council, Local
Public Health Grants, and e-cigarettes. Mr. Huff shared that alignment between MDH and the
MN Department of Agriculture (MDA) over food safety is supported, but Minneapolis is
opposed to local agencies collecting fees on behalf of MDA.
• Mr. Huff shared that Minneapolis is implementing a policy for food establishments that
eliminates the use of styrofoam packaging.
Word on the Street
No concerns were raised.
Constituent Engagement
Ms. Beck reminded members of their responsibility to engage with and represent their constituents
and asked members to share how each of them were carrying out this responsibility. The following
items were shared.
• Feedback was requested on recommendations to improve the FPLS program evaluation. It was
noted to watch the acronyms in materials for feedback to ensure that SCHSAC members and
others were clear about the information discussed.
• EHCIB members shared the recommendations via email and other meetings, including regional
LPHA meetings.
• Ms. Schefers discussed a recent food outbreak in her region. Local public health staff
appreciated hearing from the regional EH epidemiologist.
Goal: Gather information and feedback to improve the FPLS program
evaluation process
EHCIB members shared the feedback they received on the recommendation to improve the FPLS
program evaluation process (see the January Take-Home Points). Overall, feedback supported the
EHCIB recommendations. Comments and suggestions included:
Environmental Health Continuous Improvement Board
Minnesota Department of Health
Public Health Practice Section – Health Partnerships Division
P.O. Box 64975
St. Paul, MN 55164-0975
(651) 201-3880
Page | 4
EHCIB Meeting Summary – March 11, 2015
•
•
•
•
•
Redesign the evaluation to be conducted in partnership with opportunities to address
questions and concerns throughout the process.
Create a follow-up process for departments to submit additional documentation to adjust
evaluation scores.
Focus on continuous improvement. There needs to be opportunities to improve ratings in a
quick way; rating shouldn’t stay the same for five years.
Everyone, including MDH, should abide by the same rules and process
Involve evaluation staff in discussion/improvement of the evaluation process
The Board discussed the recommendation to evaluate an MDH “program” at length. Mr. Diaz, reported
that he sees the 2015 focus for MDH’s FPLS section to be conducting the four re-evaluations and
having MDH participate in the evaluation process. Discussion followed about the scope of the MDH
evaluation. Mr. Hogan commented that MDH would like to review all district offices as a program. A
number of members noted that the evaluation was designed to evaluate a local agency or a defined
geographic area, not the statewide system. Members agreed that it is important for MDH to be held to
the same standard as locals and that applying the current evaluation process to all of the district offices
at the same time would not allow for the level of detail that can be seen in a smaller jurisdictional area.
It was also noted that evaluating the district offices separately would allow MDH to see strengths and
areas for improvement for each office. Ms. Beck noted that looking at the full system is a next step and
different conversation.
Based on the feedback and the resulting Board discussion, the original recommendation was modified
to the following:
• MDH will undergo an evaluation of one of their district offices so that they have experience to
contribute to an assessment of the current evaluation process.
• The Board will use a structured quality improvement process, led by the MDH Office of
Performance Improvement, to gather information and make improvements to the FPLS
program evaluation process.
• The improved process will be pilot tested by one MDH program (district office) and one local
program. The two local programs that underwent a paper-only evaluation process will have the
opportunity to be evaluated first under the improved process. The evaluation order of the
remaining local programs will be determined by a lottery process. MDH’s remaining programs
(district offices) will be interspersed throughout the evaluation timeframe.
• The improved process will be implemented in the spirit of continuous improvement. The Board
will ensure that the evaluation process is reviewed on a regular basis.
Environmental Health Continuous Improvement Board
Minnesota Department of Health
Public Health Practice Section – Health Partnerships Division
P.O. Box 64975
St. Paul, MN 55164-0975
(651) 201-3880
Page | 5
EHCIB Meeting Summary – March 11, 2015
Goal: Determine how (and when) the FPLS program evaluation assessment
tools will be applied for re-evaluations
Ms. Beck shared a handout (attached) with the themes from the interviews with the four programs
seeking re-evaluation. The group reacted to and discussed the themes. In general, the themes
resonated with meeting participants. It was noted that the themes apply less to the re-evaluation
process and will be useful in examining the overall evaluation process. Additional discussion items
included the following:
• Mr. Diaz provided some potential reasons why the interaction (or lack of interaction) between
MDH and the local agency during the evaluation process was problematic. Initially, evaluation
staff and local staff would meet at the end of the on-site evaluation. In some cases, the
conversation that occurred onsite didn’t match the final score. For example the MDH evaluator
left the local agency with a favorable perception of the program and conveyed this to the local
program staff. Once the MDH evaluator got back to their desk, the scores actually indicated
that the program had some problem areas that resulted in a failing score. To avoid the
discrepancy, MDH evaluators stopped giving their perceptions in the field and eliminated the
in-person interaction. Ms. Huntley remarked that the PHAB Accreditation site visit concludes
with a discussion of three strengths, three areas for improvement with the score provided at a
later point. Ms. Beck noted that the PHAB process may be a model to guide the future FPLS
evaluation process revision.
• Ms. Beck commented that she heard during the interviews that clear expectations and the
concept of “no surprises” are important to local agencies and requested that summary
document be modified to reflect that theme. The requirement for multiple data points (i.e. four
inspection frequency data points) does not give programs credit for improvements. For
example a program could add staff to fix their frequency rates, but they aren’t deemed
acceptable until they’ve had four points of data that show acceptable performance. Participants
likened this practice similar to getting (and living with) a bad credit score.”
• In addition to having clear expectations, delegated programs would like to see a shift in
emphasis on public health risk versus compliance with the letter of the law. Examples were
shared in which MDH evaluators issued citations according to the letter of the code versus the
intent of the code to protect the public’s health. For example the code dictates pools are
inspected at certain intervals; those intervals do not line up with pool seasons based on
weather. It was also noted that some programs were allowed to weigh-in on the random
sample of files pulled by the evaluators and some were told which files to pull.
Ms. Huntley noted that the themes will be modified to reflect the discussion and will be used as a
starting point for the FPLS program evaluation improvement project.
Environmental Health Continuous Improvement Board
Minnesota Department of Health
Public Health Practice Section – Health Partnerships Division
P.O. Box 64975
St. Paul, MN 55164-0975
(651) 201-3880
Page | 6
EHCIB Meeting Summary – March 11, 2015
Ms. Beck, Mr. Hogan and Mr. Diaz shared a draft proposal for a re-evaluation process designed to
address the issues identified in the themes. Discussion focused on the following three areas:
• Desired re-evaluation result: Affected meeting participants made it clear that they
wanted/needed to have a new score and rating posted as part of the public record based on
the re-evaluation findings. A primary driver of this need is governing body expectations.
• Timeframe for demonstrating improvement: Meeting participants again noted the challenges
that the requirement to have four frequency rate data points to be deemed acceptable. It was
also noted that having the re-evaluation look at the time between the initial evaluation and the
present was challenging in that some improvements took longer to make (e.g. hiring, ordinance
changes). To address the issue it was recommended that MDH and the delegated program
determine the appropriate timeframe for the re-evaluation to consider during the preparation
phase of the re-evaluation process.
• Language clarity: Meeting participants expressed a desire to have interaction and dialogue
elevated in the process. Meeting participants also noted the need to be clear that this was a reevaluation not an evaluation process
The proposal will be revised based on the conversation and sent to the EHCIB for feedback prior to
finalizing and posting online. Once finalized, MDH will implement the process. MDH will report their
implementation experiences back to the Board so that additional modifications can be made if
necessary and/or successes can be incorporated into the overall evaluation process.
Goal: Issue a statement about the value of state-local partnership and
delegation agreements
Ms. Huntley noted that Karen Swenson provided suggestions via email to revise the draft “declaration
of support.” Ms. Huntley will revise the statement and ask for feedback from board members via email.
Once the additional feedback has been incorporated the statement will be posted online and
distributed to environmental health managers.
Goal: Establish a common understanding of a quality FPLS Program and
develop corresponding metrics
Due to time constraints this agenda item was postponed to a future meeting.
Take-home Points, Action Items, and Adjournment
Meeting participants agreed on the following take-home points and action items.
Environmental Health Continuous Improvement Board
Minnesota Department of Health
Public Health Practice Section – Health Partnerships Division
P.O. Box 64975
St. Paul, MN 55164-0975
(651) 201-3880
Page | 7
EHCIB Meeting Summary – March 11, 2015
Take-home points:
• The Environmental Health Continuous Improvement Board reviewed feedback about the food,
pools, and lodging services program evaluation process provided by programs that are currently
in unacceptable status. The information was used to develop a re-evaluation process. The reevaluation process will be finalized and posted on-line prior to the May Board meeting.
• In January the Environmental Health Continuous Improvement Board understood that four
local programs had not yet completed the evaluation process. At the March meeting, the Board
received an update. All local food, pools and lodging services programs have been provided the
opportunity to be evaluated under the current process; two programs choose to undergo a
paper-only process.
• The Environmental Health Continuous Improvement Board appreciates the feedback it received
from its constituents regarding how to proceed with the current and future food, pools and
lodging services program evaluations. The Board decided that:
o MDH will undergo an evaluation of one of their district offices so that they have
experience to contribute to an assessment of the current evaluation process.
o The Board will use a structured quality improvement process to gather information and
make improvements to the program evaluation process.
o The improved process will be pilot tested by one MDH program (district office) and one
local program. The two local programs that underwent a paper-only evaluation process
will have the opportunity to be evaluated first under the improved process. The
evaluation order of the remaining local programs will be determined by a lottery
process. MDH’s remaining programs (district offices) will be interspersed throughout the
evaluation timeframe.
o The improved process will be implemented in the spirit of continuous improvement. The
Board will ensure that the evaluation process is reviewed on a regular basis.
• The Environmental Health Continuous Improvement Board identified a number of themes to
describe areas for improvement in the current evaluation process The Board will use these
themes as a starting point for improvement efforts.
• The Environmental Health Continuous Improvement Board, who is initially charged with making
improvements in the area of food, pools and lodging services, recognizes the need for a
broader conversation about environmental public health. The Board will raise the issue and
engage in conversations with stakeholder organizations such as the Local Public Health
Association, the Minnesota Environmental Health Association and the Minnesota Department
of Health.
• The Minnesota Department of Health’s (MDH) Food, Pools and Lodging Services Section is
available to provide information to Community Health Boards who do not have a food, pools
Environmental Health Continuous Improvement Board
Minnesota Department of Health
Public Health Practice Section – Health Partnerships Division
P.O. Box 64975
St. Paul, MN 55164-0975
(651) 201-3880
Page | 8
EHCIB Meeting Summary – March 11, 2015
and lodging services delegation agreement. MDH can provide data about the services provided
in the county(s) and documentation for public health accreditation. For more information
contact Steven Diaz, Environmental Health Manager, Food, Pools and Lodging Services at
[email protected].
Action items:
• Health Partnerships Division to re-draft the re-evaluation process based on the Board’s
discussion and send to members for further input and approval.
• Tom Hogan and Dawn Beck to invite MDH Assistant Commissioner Paul Allwood, MDH Deputy
Commissioner Dan Pollock and LPHA’s Executive Director Lorna Schmidt to the Board’s May
meeting.
• Health Partnerships Division to re-draft the statement of support based on the Board’s
discussion and send to members for further input and approval.
The next EHCIB meeting will be held on Wednesday, May 13, 9am-1:30pm (REVISED Time) at the
Minnesota Counties Intergovernmental Trust Building in St. Paul.
Environmental Health Continuous Improvement Board
Minnesota Department of Health
Public Health Practice Section – Health Partnerships Division
P.O. Box 64975
St. Paul, MN 55164-0975
(651) 201-3880
Page | 9
EHCIB Meeting Summary – March 11, 2015
FPLS Re-Evaluation Process Development Interview Themes
The following themes were compiled based on interviews and feedback received from four FPLS
programs in February, 2015 to assess the re-evaluation process. The themes identified within this
summary highlight areas of the re-evaluation process that could benefit from additional improvement.
Top Themes
1. Interaction- Program staff would like more interaction with MDH during the review process.
There is very little interaction with the evaluators. Ongoing dialog and communication is
needed. Preferably a face-to-face conversation about what the evaluators are seeing. Program
staff would also like the opportunity to sit down with an evaluator to discuss the issues they’ve
identified for their program.
2. Quality Improvement- MDH should focus on applying a quality improvement approach/lens to
the entire evaluation process. Provide recommendations for improvement so programs can
assess their current standing and take corrective actions to improve their rating. The reevaluation process should serve as a tool for continuous improvement and should reflect a
programs progress and efforts towards making improvements. Make the evaluation about the
program not the people.
3. Clear Expectations- Ensure the messaging from MDH is consistent. Program staff voiced
concern about not knowing what is acceptable to MDH. The programs would like to know what
MDH’s expectations are in terms of how to use the code and rules as a tool to achieve positive
public health outcomes.
4. Acknowledge Improvements- Program staff indicated that receiving acknowledgement for
improvements to processes and procedures identified in the original evaluation is important.
Programs would also like to receive recognition in areas where they have gone above and
beyond to make improvements.
5. Transparency- MDH should provide supporting documentation explaining why a particular
rating was received. MDH should also provide programs with feedback and guidance about the
required elements of the evaluation.
6. Partnering Relationships- Learning to work together by fostering relationships among peers
and having peers participate in each other’s evaluations is important. Partnerships help to
Environmental Health Continuous Improvement Board
Minnesota Department of Health
Public Health Practice Section – Health Partnerships Division
P.O. Box 64975
St. Paul, MN 55164-0975
(651) 201-3880
Page | 10
EHCIB Meeting Summary – March 11, 2015
enhancement improvement. Program staff also expressed interest in build cooperative and
trusting relationships with MDH.
7. Help Programs Meet the Standards- MDH should be more involved in helping programs
develop plans for improvement. Program staff would like help with marking instructions. They
suggested MDH create templates and forms containing acceptable ordinance language.
8. Requirements known in Advance - Requirements for the re-evaluation process should be made
known in advance. MDH should communicate what will be evaluated and how it is going to be
evaluated. Let programs know if a face-to-face site visit is required so that the program can
dedicate time and resources to preparing for the re-evaluation.
9. Consistency and Standards- Program staff stressed the importance of having consistent
processes for all delegated agencies and holding each program to the same standards. MDH
should standardize the evaluation process such that it is more uniform and consistent across
local programs.
Environmental Health Continuous Improvement Board
Minnesota Department of Health
Public Health Practice Section – Health Partnerships Division
P.O. Box 64975
St. Paul, MN 55164-0975
(651) 201-3880
Page | 11