PROGRESSIVE ENGAGEMENT

OF AN IMPLICATED PREMISE

TO FACILITATE POSITIVE CHANGE

July 29, 2014: RECEIVE FBI CSR

2 lab confirmed cases linked to a premise

with suspected exposure July 12 and July 13, 2014

…. there were other linked premises at this time

Investigation … July 30, 2014No complaints received / no staff illnesses

Business brisk over last 3 weeks with 70% of sales involving ‘shawarma’ chicken

Consistent with previous routine inspections, no serious infractions noted at this time

No change in food sources, menu items or routine

Cleaning / sanitizing / good food handling recommended

… now on to the other premises

.

COMPLIANCEkəmˈplīəns (noun)

• action or fact of complying with a wish or command.

• tendency to yield readily to others, especially in a weak and subservient way

Michael Bayles … Fiduciary Model ($$$)

… The weaker party (the operator) depends upon the stronger (the PHI) in ways which are not reciprocated and so ‘the powerless’ must trust

‘the powerful’ …

Non compliance …

If you do not want our help … we have no alternative but

to respect your choice and withdraw our offer to help

…any associated consequences are beyond our influence or

control

PHI as … Judge

• Enforcer • Protector• Educator

?… leaving the operator as the …

FEELINGS beget …

BEHAVIOUR

Change ? …

Insight and understanding are useless

unless …they are translated into

action

Elizabeth Kübler-Ross …[2]

• Denial– imagines preferable reality

• Anger– becomes frustrated

• Bargaining– hope to avoid cause of grief

• Capitulation (Surrender)– perceived helplessness

• Acceptance– "If I can’t beat ‘em, I may as well join ‘em"

DENIAL …

• Owner interested in nature of complaints and potential other contact sites relative to time frame and food items implicated

• Very interested in science of disease transmission –Seeking plausible deniability … ? suspect foods given similar menu items elsewhere–Seeking ‘proof’ of guilt … ? Timing … delays reported exposure to notification

• Reluctantly compliant based on expressed ‘trust’ in PHI known to him

ANGER …

• I expect you guys are doing this to everyone else

• Should I get my own lab tests just in case yours are wrong?

• Why are so many people coming and asking me the same questions

over and over again?

• I have a business to run … this is my living – my staff depend on their paychecks

• Presentation of ‘hearsay’ implicating others• Challenging perceived slander

• I have consulted a lawyer

BARGAINING …• What do I have to do to get everyone off my

back?

• I will bring in a steam cleaner and sanitize everything … if that’s what you want!

• Confidential conversation with PHI requested by owner to discuss concerns focused on preventing ‘negative press’ …. Closure

• Discussions with Outbreak Team including potential closure – PROS AND CONS

Capitulation (Surrender) …

• ACKNOWLEDGEMENT OF ‘POSSIBILITY’– August 13, 2014: Lab confirmation

• PARSLEY positive for S. Thompson

• OREGANO positive for S.

• HUMMUS positive for E. coli

• August 15, 2014: FORMAL HACCP AUDIT (TARGETING PARSLEY)

Acceptance …

August 20, 2014: FORMAL MEETING (ACTIVE LISTENING)…MLHU MANAGER / OUTBREAK LEAD AND AREA PHI WITH PREMISE OWNER / MANAGEMENT

• Information to date suggests illnesses probably caused by ‘cross contamination’ and/or ‘under cooking’ – a food handler not following ‘mandated’ procedures.

• Acknowledgement of premise efforts to improve circumstances / cooperation including working closely with area PHI on a daily basis

• Negotiated plan of action to reduce ‘risks’ further including: – Clean and sanitize all food contact surfaces and cooling units thoroughly– Purchase parsley and oregano from alternative source until supplier is

deemed safe by MLHU– Increase frequency of hand washing and routinely review proper glove use – Facilitate safe food handler training of ALL staff who work with food

Self Efficacy

Perceived ability to perform a task

Predicts future behaviour if …

there are adequate incentives and skills

To facilitate change as a PHI, we should practice …

EMPATHY … not sympathy COMPASSION … not unconditional regard

RESPECT … to earn respect

CONSISTENCY … to earn trust

If we are overtly sympathetic, a client can easily misinterpret

our actions/intents by seeing us as a “friend”

BUT, we are not there to validate their situation or assume sole responsibility for the required changes.

Become a coach …• CREATE

…a supportive environment

• OFFER … honest discussion of behaviours

• ASSESS … performance and agree to objectives

• CREATE … a development plan together

• HAVE … follow-up meetings

…seek to shift focus from

ADVERSARIAL to

PROBLEM RESOLUTION

Clipart used with permission from Microsoft