Environmental Health Continuous Improvement Board
Meeting Summary
Wednesday, July 8, 2015
9:00 a.m. – 1:30 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
Present
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
X
Absent
X
X
X
X
X
X
X
X
X
Other Meeting Participants:
Jeff Brown (City of Edina); Kim Carlton, Steven Diaz, Michelle Messer, Blake Nordin, Wendy Spanier,
(Minnesota Department of Health, Environmental Health Division); Kris Keller (Washington County);
Ryan Krick (City of Minneapolis); Mike Melius (Olmsted County Public Health)
Facilitators:
Stephanie Lenartz, and Megan Drake-Pereyra (Minnesota Department of Health, Health Partnerships
Division)
Welcome and Introductions
The Environmental Health Continuous Improvement Board (EHCIB) co-chair Dawn Beck, Olmsted
County welcomed everyone to the EHCIB’s July 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
Page | 1
EHCIB Meeting Summary – July 8, 2015
Meeting Objectives:
1. Make progress on the FPLS Program Evaluation Improvement Initiative by 1) identifying and
prioritizing issues with the current process and 2) brainstorming potential process
improvements.
2. Discuss constituent feedback and other relevant member updates.
Goal: Gather information and feedback to improve the FPLS program
evaluation process
Stephanie Lenartz, MDH, led Board members, non-board members, and staff from the Partnership and
Workforce Development Unit (PWDU) of the Food, Pools and Lodging Services (FPLS) section at MDH
through the second step of the improvement process. The group reviewed the map of the current FPLS
program evaluation process and relevant data/forms and identified and prioritized issues/waste in the
current process. The result is a prioritized list of areas for improving the current FPLS program
evaluation process (Appendix A). Board members will share this list with constituents for review and
feedback prior to the next EHCIB meeting in September. At its September meeting, the Board will
complete the next step in the process, which is to identify and prioritize solutions to fix the issues and
improve the current process.
Business Items
Participants discussed and made decisions about the following business items.
Approve January Meeting Summary
The May 13, 2015 EHCIB meeting summary was presented for approval. John Weinand, City of
Minnetonka, made a motion to approve the summary. Bill Groskreutz, Faribault County, seconded the
motion. The motion passed unanimously without discussion.
2015 Community Health Conference
Karen Swenson, Brown-Nicollet Counties, shared that the EHCIB’s concurrent session proposal for the
2015 Community Health Conference was accepted. It will focus on the role of environmental health in
public health and the EHCIB’s work to date. Ms. Swenson, Allie Freidrichs, Meeker-McLeod-Sibley
Counties, Tom Hogan, MDH, and Steven Diaz, MDH, will present at the conference. Ms. Swenson asked
how to make this session interactive. Meeting participants agreed that facilitated small group
discussions are a good idea and that the questions asked could focus on getting a better understanding
of how other agencies work with environmental health and also on specific questions that would help
the EHCIB with its FPLS work. Other EHCIB members who attend the conference will be expected to
help facilitate these small groups. Ms. Swenson will share session details and get feedback at the
EHCIB’s meeting in September 2015.
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 – July 8, 2015
Performance Improvement Steering Committee
Ms. Beck provided background information on the Performance Improvement Steering Committee
(PISC) and shared the environmental health measures it helped develop for local public health
reporting. She indicated that the EHCIB should be aware of and regularly updated about the work of
PISC related to environmental health because it is part of the bigger picture of public health in
Minnesota and how local public health agencies are meeting national performance measures. It allows
local public health agencies to see trends and use the data to drive improvement and state agencies to
see gaps to dedicate more resources towards and to show the statewide picture of public health.
Member Updates
 Mr. Hogan provided an update on the legislative session:
o General Environmental Health Legislation
 Radon Licensing of professionals passed
 Lead Renovation Repair Painting Licensing of contractors passed
 Drinking Water fee increase did not pass
 Revised Food licensing fee schedule based on risk category did not pass. This was
a joint proposal with the Department of Agriculture (MDA).
o Food, Pools, and Lodging Legislation
 Medical Lodging passed
 Manufactured Home Park spacing passed
 Lodging-Bunk Houses passed
MDH staff are working on fact sheets for these changes and will share them when
available.
 Mr. Hogan and Mr. Diaz provided an update on other MDH environmental health business:
o Food Code Revisions continue to move forward. MDH received approval from the
Governor’s office to continue this work.
o Pool Code Revisions continue to move forward.
o MDH is pulling together a group to look at lodging rules. The first meeting will be
sometime in August 2015. Anyone who is interested is welcome to participate by
emailing Mr. Diaz ([email protected]).
o State agencies (MDH and the Department of Human Services) along with partner
organizations are also working on reviewing, updating, and improving the Patient Bill of
Rights.
 Ben Miller, Minnesota Department of Agriculture, provided an update on the legislative
session.
o The joint proposal from MDH and MDA did not pass. It was for a change and alignment
of the two agencies’ fee structures.
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 | 3
EHCIB Meeting Summary – July 8, 2015
o MDA did receive a significant General Fund increase of about $2.8 million. These funds
are to increase food safety activity including: inspections, food establishment plan
review, and local program oversight. As a result of this, MDA anticipates hiring a large
number of staff in the coming months.
o The dairy and meat inspection funding and fees increased, which helps to stabilize that
program.
o There is new language about cottage foods that allows sales from one’s home following
registration and training. The new language allows cities with their own local zoning
ordinances to restrict home-based sales, and the new exemption applies only to
individuals, not businesses.
Word on the Street
No concerns were raised.
Constituent Engagement
No updates were shared.
Take-home Points, Action Items, and Adjournment
Meeting participants agreed on the following take-home points and action items.
Take-home points:
 The Environmental Health Continuous Improvement Board (Board) and staff from the
Partnership and Workforce Development Unit of the Food, Pools and Lodging Services (FPLS)
section at MDH continued to follow a structured quality improvement approach to improve the
FPLS program evaluation process. Creating a map of the process at the May meeting was an
important first step in understanding all of the issues before jumping to solutions. At its July
meeting, the Board took what it learned from the map of the process and related information
about the process and used it to identify and prioritize issues.
 At its July meeting, the Environmental Health Continuous Improvement Board (Board)
identified and prioritized a number of issues in the current Food, Pools, and Lodging Services
(FPLS) program evaluation process (a full list of these issues is attached). The Board would like
to know if these issues resonate with those who participated in the FPLS program evaluation
process and will be asking for constituent feedback before their September meeting, where
they will identify and prioritize solutions to these issues.
 The Environmental Health Continuous Improvement Board (Board) will be presenting a
concurrent session at the 2015 Community Health Conference. The session will be interactive
and focus on the role of environmental health in public health and the history of the Board and
its work to date.
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 – July 8, 2015
Action Items
 EHCIB members will share a summary of the issues identified in the current FPLS evaluation
process with constituents and gather feedback.
 MDH EH staff and Health Partnerships Division staff will develop a draft map/inventory of
existing environmental health committees, networking groups, forums, etc. for the Board to
review at a future meeting.
 Karen Swenson, Allie Freidrichs, Tom Hogan, and Steven Diaz will develop the content for the
EHCIB’s concurrent session at the 2015 Community Health Conference and share it with the
Board at its September meeting.
The next EHCIB meeting will be held on Wednesday, September 9, 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 | 5
EHCIB Meeting Summary – July 8, 2015
Appendix A: Issues identified in the current FPLS Program Evaluation Process
EHCIB members were asked the following question: What are the issues, inefficiencies or problems in
the current FPLS evaluation process? Issues were collected and organized by impact and frequency.
Issues are listed below by process step. Step number is in parenthesis, if applicable.
Step 1: Notification and Request for Information
Step 2: Review of Submitted Information
Step 3: On site Meeting with Program
Step 4: Field Evaluation
Step 5: Records Review
Step 6: Reporting
Step 7: If not Acceptable
High Impact/High Frequency Issues
 Need for more communication. Process changes/document updates are not shared with all as
developed. (1)
 Self-evaluation: Not clear how often it is used. Need clear expectations. Self-assessment takes
a long time to complete. (1)
 Evaluation and associated tools have evolved – self assessment hasn’t. They don’t align. (1)
 Including low-risk establishments in sample doesn’t give a good picture of the program overall.
(3)
 Randomization sometimes results in over-representation of certain types of establishments (i.e.
schools, residential lodging). (3)
 Field evaluation: Is the resulting data worth the resources spent? What is the value of this
step? Is there another more efficient way for this confirmatory step? The process is unclear and
seems labor intensive for ROI. (4)
 Can Field evaluation and Records Review be improved/streamlined so conclusions can be
shared at Exit Interview? (4 & 5)
 Program staff are not allowed to go with on field evaluations, if requested. (4)
 Incomplete picture if evaluators do not accompany staff for field assessment. (4)
 How far back in time do you go to gather reports? Don’t judge program on work done four
years ago if there have been changes. What is the relevance of old history? (4)
 There are inconsistent messages “looks good, no real concerns” between exit interview and
written report. (5)
 Requirements and best practices are not clearly separated. (5)
 Appears to be an overemphasis on citing the correct code citation. (5)
 Evaluation tools for each program area isn’t specific, so we are evaluated on items that we
weren’t expecting (i.e. some of the tic sheet items). (5)
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 – July 8, 2015
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Inconsistent code interpretations from MDH (i.e. pool closure requirements combine chlorine).
(5)
Need clearer expectations for what is needed for reports. Need for protocol and training
around records review. (5)
Need for clarity on status at pre-report stage. (at sit-down interview).
PWDU report writing takes too long. (6)
Scoring: lack of standardized metrics. There are double/triple scoring deductions for same
issue. 0-2 doesn’t leave much room for flexibility. (6)
Improvement plan/action plan follow up is not being done. No formal mechanism for reevaluation. Need to clarify and reinforce next steps. (7)
Not all agencies are informed on changes to re-evaluation process. (7)
Inclusion of elements not required in the evaluation process.
Does PWDU staff have authority to use professional judgement when faced with questionable
or borderline issues (uncertainty – i.e.…seasonal pool frequency)?
Need to allow reasonable interpretation/explanation to inform evaluation outcome even if it
differs from scoring matrix (i.e.. seasonality of outdoor pools).
Evaluators are not consistent. There are aspects of “gotcha” in the process.
Evaluators don’t get to assess program staff knowledge, skills, and ability in the field. Need to
evaluate inspectors.
Lack of a set of concise agreed upon performance measures that support on-going
understanding (real-time?) of our collective performance. Lack of standardized metrics for
program elements.
There is waiting to perform the evaluation because the entire program is evaluated at the same
time.
Lack of sufficient # of FTEs n PWDU to accomplish all they are tasked with doing.
High Impact/Low Frequency Issues
 Inconsistencies. Sit down review of self-assessment described by Washington County didn’t
happen at my County. (1)
 Clear expectations don’t exist for in-site meeting. Perhaps on-site meeting should occur prior to
submittal of information. Eliminate questions – over production. (3)
 Program doesn’t have an opportunity to explain their self-assessment. Some have done this
voluntarily – not consistent but has been helpful when done. (3)
 What is the purpose/value of supervisor/manager review of report? Applied inconsistently? (6)
 When/what is truly acceptable vs. continuous improvement?
 Local state collaboration on building the process stopped before process was completely
developed.
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 – July 8, 2015
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Don’t fish for additional establishments, i.e. Twins hot tubs.
Requirement to inspect 10% of all hotel rooms. Hotels over 100 rooms should only need 10
inspected.
Local feedback didn’t seem to impact final report.
Need to do a better job of identifying resources for program to use for improvement.
Low Impact/High Frequency Issues
 Self-assessment and supporting documents are not submitted in a standard format (i.e. some
submit a binder some submit electronics). (1)
 Pre-notification – protocol terminology is confusing and inconsistent. (1)
 Pre-notification/protocol – protocol is confusing, terminology, consistency/flow/ease of
reading. (1)
 List of establishments is not submitted in a standard format. Evaluators spend time reorganizing
and renumbering (to be used in randomization). (2)
 Reporting takes too long. (6)
 3-4 weeks for program info analysis – too long. (6)
 30 days for comments back – too long. (6)
 60 days for report writing – too long. (6)
 30 days for program response – too long. (6)
 Reporting – Resource intense, infrequent, point in time. Can some elements be from ongoing,
real time delegated programs themselves? (6)
 Outdoor pool inspection frequency should be once per season, not 365 + 30. Inspection
frequency related to pools/seasonal needs to be revisited.
Low Impact/Low Frequency Issues
 Tic sheet: is it consistent with Delegation Agreement? Is it shared w/Delegated Agencies (and as
it is updated/improved? (5)
 There is no common understanding of “Lack of enforcement”, “Compliance period too long”,
and “Wrong code citation.” (5)
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