1. City of San Antonio Health Inspections Lean Six Sigma Consortium
June 12, 2017

2. About San Antonio Population: 1.4 M 12,000 employees
Office of Innovation established in 2007

3. Office of Innovation Study
Project Goals
The Office of Innovation was asked to analyze food inspections process
Increase public awareness of food vendor compliance
Analyze Department processes and procedures
Evaluate customer complaints

4. Office of Innovation Study
Interviews &
Surveys
Process
Improvements
Restaurant
Location Visits
Comparative City Research
Data Analysis

5. Data Analysis

6. Inspections by Risk Level
Completion Rate
Risk Category
Level of Risk
Frequency of
Inspections
Risk 1
Inspection
Low Risk- Prepackaged
1x per year
Risk 2 Inspection
Medium Risk- Warming
2x per year
Risk 3 Inspection
High Risk-
Full Preparation
3x per year
FY2012
104%
85%
52%
FY2013
122%
90%
61%
FY2014
96%
84%
58%

7. Inspections by District

8. Inspections by District
This chart is an example of the differences in the make-up of the different districts and sectors. This chart is categorized by license type that includes everything from routine food inspections, follow ups, re-inspections, etc. It represents the amount of cases that the Sanitarians touched in FY The license types with a very small number were removed from the chart.
The license type that sticks out are Temporary Food Inspections in District C which has almost 12 times more Temporary Food Inspections versus District A.
Why is this important? Well Temporary Food Inspections take far less time to complete than the inspections in the Food Category. This means that Sanitarians in District C are able to complete more inspections than someone in District A or District D because all inspections are counted in the same way. On avg. Temporary Food Inspections take about 12 minutes to complete while Food establishments take 30 minutes to over an hour depending on the risk level.

9. Scoring System

10. 5 95 or Which Score is Better
Before we move along we want to know from you if you were presented one of these scores, which one would you prefer a 5 or 95?
Why do you think a 95 is good? It’s intuitive to what you’ve been taught in school right? In this case, a 5 is a better score because the closer you are to 0 demerits the better.
But you aren’t the only one that believes this. One of the main things we learned from our visits is that the current system is not very intuitive or effective for customers and restaurant owners because they don’t understand the scoring system and for a customer the report provides very little information they can understand.
Customers want to know: (a) is the food safe to eat, (b) is the area it is being prepared in clean environment and (c) does the restaurant pass the local authority’s health inspection?

11. Posting Requirements
Inspection Report must be posted “in a conspicuous place within the premises”
One very important issue we encountered is written within our own City code which says the Inspection Report must be posted….what does that mean? In some cases we saw it means that the report is out of the customer’s view, perhaps behind a counter or at a distance where the particulars of the report are not visible just like in the picture in the previous slide.
So, as a customer you don’t understand that 5 is a better score than a 95 and you can’t tell what the score is because the report is not intuitive and it is not displayed where you can see it.
If you receive a good score as a food operator then you’re customers don’t quite understand why you got a good score.
If you get a bad score, then you can just bury it until the next inspection or until you get a chance to permanently correct the items which could be never with all the demands placed on you. But in the meantime, there’s a potential that the public could be placed at risk of getting sick.
We needed an extra layer to help customers understand it better.

12. How did Food Operators Feel?
Case in point….this restaurant received 0 demerits on their inspection, but instead of just posting their report they decided to create their own homemade sign for their customer to know they are eating at a restaurant that received a “perfect score.”

13. Results

14. Project Outcomes Update scoring
System and make it more transparent for public
Proactive
education for
food operators
Establish long-term and
short-term
strategic plan
The recommendations we made to Metro Health on how they could improve based on the project goals were to:
Update the scoring system and make it more transparent for the public
Provide proactive education for food operators – whether its online or in print form
We heard quite a bit from the operators about how they wanted more information from the City on how they could do better. So we responded by developing easier to understand information in various languages that we will distribute them through various mediums.
Establish a long-term and short-term strategic plan to guide the work of the staff. We will target those restaurants that need the most help and that have a greater risk of getting the public sick.

15. Updated Scoring System
The recommendations we made to Metro Health on how they could improve based on the project goals were to:
Update the scoring system and make it more transparent for the public
Provide proactive education for food operators – whether its online or in print form
We heard quite a bit from the operators about how they wanted more information from the City on how they could do better. So we responded by developing easier to understand information in various languages that we will distribute them through various mediums.
Establish a long-term and short-term strategic plan to guide the work of the staff. We will target those restaurants that need the most help and that have a greater risk of getting the public sick.

16. Updated Scoring System
0-9 critical violations
on a routine inspection
10-19 critical violations on a routine inspection
20+ critical violations
The recommendations we made to Metro Health on how they could improve based on the project goals were to:
Update the scoring system and make it more transparent for the public
Provide proactive education for food operators – whether its online or in print form
We heard quite a bit from the operators about how they wanted more information from the City on how they could do better. So we responded by developing easier to understand information in various languages that we will distribute them through various mediums.
Establish a long-term and short-term strategic plan to guide the work of the staff. We will target those restaurants that need the most help and that have a greater risk of getting the public sick.
CLOSURE: Establishment with imminent health hazards such as no water, sewage
back-up, no electrical service, rodent/pest infestations, or other circumstance that
may endanger public health.

17. Changes to Reporting Develop an annual performance plan
Define areas of focus
Align metrics with performance plan
Monthly, quarterly and annual reports t o measure Division’s performance
Our recommendation is for the F&E Division to develop and implement an annual performance plan. Within that plan, their areas of focus need to be defined and the expectations for the Sanitarians need to be properly outlined (example of El Paso & Ft. Worth)
In addition, the performance of the Sanitarians and the division needs to be tracked more closely through the use of monthly, quarterly and annual internal reports.

18. Sample Report Monthly / YTD Status Sanitarians’ annual performance
Trend data on different inspections
Action Items
This is an example of what a report could look like (this is something that can be set up in Excel once and then be updated)
At the top, you have the monthly and YTD status and the Sanitarian’s annual performance.
At the bottom left, you have trend data on the different types of inspections.
At the bottom right, you have potential action items that the supervisor needs the Sanitarian to follow up on.
This ensures everyone understands their performance. The best part is this can all be done in Excel and is relatively easy to keep track of.
(pick two elements to quickly explain how this would be useful)