Restaurant Inspection Research Articles

Dinesafe Toronto


 Background: The purpose of this research study was to analyse the success of Toronto’s placard system (Dinesafe) in reducing the number of violations in food service establishments. The placard system is designed to inform the public about restaurant inspection results and to boost operator compliance. Inspections are a point-in-time check of the facility’s ability to manage the risk it poses to public health. It is accepted that if best practices are implemented as designed by an establishment’s food safety and sanitation plan, the risk of a foodborne illness/outbreak can be minimized. Methods: From the Dinesafe program, the number of violations cited at each inspection from all relevant food service establishments receiving a conditional pass from two time periods, 2004-2006 (Before) and 2012-2014 (After), were compared to see if there was a decrease in violations. The reports, completed by Public Health Inspectors (PHI), were retrieved from a publicly available website. Data were analysed using a two-sample T-test. Results: The anticipated decrease in violations in the second time frame was not significant [p = 0.85] nor strong (α = 0.001). The means were similar (3.83 Before and 3.71 After), with standard deviations of 1.91 and 1.79 respectively. A greater number of restaurants were cited in the After analysis (3169 compared to 572). Inspections from 2004-2006 had fewer violations (12 or less) than 2012-1014 (14 or less). The majority of violations (71% Before and 73% After) were between 2 and 4. Reoffenders comprised of 16.3% of total violations in 2004-2006 and 17.5% in 2012-2014. Conclusion: There is no evidence that the placard system has decreased violations or that counting the number of violations a good measure for compliance. Pushback among operators could explain the increase in the number of establishments cited. The increase in maximum citation could be due to an increase in citations available from 2012-2014. The number of establishments that received a conditional pass twice in a time frame increased from 59% to 68%. The maximum number of times an establishment received a conditional pass dropped from 10 to 8. It is recommended that Health Units use plain language narrative on the website rather than violations as a measure to communicate findings to the public. The placard significance should be better communicated to the public.

Inspection technology, detection, and compliance: evidence from Florida restaurant inspections

In this article, we show that a small innovation in inspection technology can make substantial differences in inspection outcomes. For restaurant hygiene inspections, the state of Florida has introduced a handheld electronic device, the portable digital assistant (PDA), which reminds inspectors of about 1,000 potential violations that may be checked for. Using inspection records from July 2003 to June 2009, we find that the adoption of PDA led to 11% more detected violations and subsequently, restaurants may have gradually increased their compliance efforts. We also find that PDA use is significantly correlated with a reduction in restaurant‐related foodborne disease outbreaks.

Consumers’ Responses to Restaurant Inspection Reports: The Effects of Information Source and Message Style

Restaurant inspection reports are an important source of information for the public to evaluate food safety practices at restaurants. This study examined the effect of information source and reporting format on consumer responses to restaurant inspection reports. The study employed a three (information source: local health department, newspaper, or consumer blog) x three (reporting format: numeric, letter grade, or narrative) full-factorial experimental design. Results showed that perceived source credibility was significantly different among the information sources but consumer responses to the inspection results from the three sources were similar. In addition, the reporting format had a significant effect on both message strength and consumer responses. Restaurant inspection results reported in a narrative format elicited the strongest perceived message strength and consumer responses.

Consumer perceptions on food safety in Asian and Mexican restaurants

Dining out is a frequent activity for most Americans. Ethnic-food restaurants like Chinese and Mexican are the most sought after dining experience after American cuisine. The Centers for Disease Control and Prevention (CDC) foodborne outbreak data from 1990 to 2000 shows an increase of foodborne outbreaks from ethnic restaurants. Focus groups and an online survey were conducted to explore consumer perceptions of restaurant food safety and attitudes toward ethnic restaurants. Twenty-seven Californians participated in focus groups and volunteers (n=994) in both California and Florida completed an internet survey. While respondents noted that they only dine at restaurants where they trust the food, Mexican restaurants scored higher in food safety confidence than Asian restaurants. Kitchen cleanliness was the most important factor influencing safety followed by restroom cleanliness and cooking temperature. People believed all restaurant employees should be trained in food safety, restaurant inspections should be more frequent, and the government should be more active in protecting consumers. Food safety is an underlying factor in restaurant selection and continued patronage. Women and seniors scored higher on seriousness of food safety adherence in restaurants while young males respondents reported to worry less about food safety when dining out. Word of mouth and the internet were the most frequently cited sources of food safety information. While respondents believed they are knowledgeable about food safety, they often failed to recognize signs of foodborne illness. Incorporating information about consumer attitudes into food safety training courses could help ethnic restaurant owners be mindful of their customers’ expectations.

Designing a national restaurant inspection disclosure system for New Zealand.

The World Health Organization estimates that up to 30% of individuals in developed countries become ill from contaminated food or water each year, and up to 70% of these illnesses are estimated to be linked to food service facilities. The aim of restaurant inspections is to reduce foodborne outbreaks and enhance consumer confidence in food service. Inspection disclosure systems have been developed as tools for consumers and incentives for food service operators. Disclosure systems are common in developed countries but are inconsistently used, possibly because previous research has not determined the best format for disclosing inspection results. This study was conducted to develop a consistent, compelling, and trusted inspection disclosure system for New Zealand. Existing international and national disclosure systems were evaluated. Two cards, a letter grade (A, B, C, or F) and a gauge (speedometer style), were designed to represent a restaurant's inspection result and were provided to 371 premises in six districts for 3 months. Operators (n = 269) and consumers (n = 991) were interviewed to determine which card design best communicated inspection results. Less than half of the consumers noticed cards before entering the premises; these data indicated that the letter attracted more initial attention (78%) than the gauge (45%). Fifty-eight percent (38) of the operators with the gauge preferred the letter; and 79% (47) of the operators with letter preferred the letter. Eighty-eight percent (133) of the consumers in gauge districts preferred the letter, and 72% (161) of those in letter districts preferring the letter. Based on these data, the letter method was recommended for a national disclosure system for New Zealand.

Restaurant QSC inspections and financial performance: an empirical investigation

PurposeThe purpose of this paper is to determine the relationship between QSC (quality, service and cleanliness) inspection scores and financial performance in quick service restaurants.Design/methodology/approachRestaurant QSC inspection data were collected from 25 quick service restaurants of an international chain over a period of 18 months. Audited financial data were also collected for these participating restaurants. Using SPSS software, the data were analyzed for possible relationships between the restaurant QSC scores and the financial performance measured as total unit sales per week, revenues per available seat per week, and gross operating income for each month. Restaurant unit size is measured by total revenues per month.FindingsContrary to the commonly held belief, the relationship between QSC variable and restaurant performance is weak. This study found there was a “V” curve in QSC inspections and financial performance when restaurant size was chosen as the moderating variable.Research limitations/implicationsThe specific items measured in the QSC may differ across organizations, although the broad categories remain constant. Certain operational factors such as price changes, special promotions, additional restaurant openings in the specific area, and local economic conditions could have confounded the results.Practical implicationsThe knowledge obtained from this study could help restaurant organizations determine the level of weighting given to a specific inspection variable. This study also suggests the use of FQSC inspections instead of traditional QSC to emphasize financial performance (F). This study demonstrates the liability and limitations of tying QSC inspections to merit raises and bonus plans as normally done in restaurants.Originality/valueThis paper is the first empirical study to analyze the QSC inspections of restaurants related to financial performance. In contrast to the past studies with food safety/health inspections, the current study focuses directly on QSC inspections conducted more frequently and in greater detail by the quick service restaurants with emphasis on operational and financial performance.

Health inspection reports as predictors of specific training needs

This study examined the impact of inspector and operation type on restaurant inspection scores and estimated the probability of each violation found by each inspector and operation type. General linear models and a logistic regression model were employed to analyze 1,067 regular routine inspection results. The results of this study showed that inspector and operation type significantly impacted inspection scores, explaining 28.07% of the variation in scores. A significant difference was found in the prediction of the probability of each violation found by inspector and operation type. The estimated probability of each violation being found by inspector during a specific inspection of operation ranged from 0% to 47.9%. The probability of each violation occurrence by inspector and operation type was considered as specific training needs for inspectors and restaurant managers. Possible implications are suggested for training programs for inspectors and restaurant managers to improve standardized results of inspection.

Restaurant Food Safety: The Influence of Employee Outlooks on Transfer of Training

This exploratory case study hypothesized that improvements in food safety transfer of training were linked to employees' outlooks on key behavioral factors. Employee perceptions of 6 theorized, latent behavioral variables were analyzed to see if they had a relationship with health inspection outcomes of a casual-theme restaurant concept in the Southeastern U.S. A total of 15 restaurants were sampled, yielding 210 observations, which represented a 40% response rate. The results advocate that the employees' outlook played a significant role in the transfer of food safety knowledge and skills gained in training. There was also evidence that the employee's self-efficacy and sense of social responsibility had positive relationships with restaurant inspection scores.

A prolonged outbreak of Salmonella Montevideo infections associated with multiple locations of a restaurant chain in Phoenix, Arizona, 2008.

An outbreak of Salmonella serotype Montevideo infections associated with multiple locations of restaurant chain A in Phoenix, AZ, was identified in July 2008. One infected individual reported eating at a chain A catered luncheon where others fell ill; we conducted a cohort study among attendees to identify the vehicle. Food and environmental samples collected at six chain A locations were cultured for Salmonella. Restaurant inspection results were compared among 18 chain A locations. Routine surveillance identified 58 Arizona residents infected with the outbreak strain. Three chain A locations, one of which catered the luncheon, were named by two or more case patients as a meal source in the week prior to illness onset. In the cohort study of luncheon attendees, 30 reported illness, 10 of which were later culture confirmed. Illness was reported by 30 (61%) of 49 attendees who ate chicken and by 0 of 7 who did not. The outbreak strain was isolated from two of these three locations from uncooked chicken in marinade, chopped cilantro, and a cutting board dedicated to cutting cooked chicken. Raw chicken, contaminated before arrival at the restaurant, was the apparent source of this outbreak. The three locations where two or more case patients ate had critical violations upon routine inspection, while 15 other locations received none. Poor hygiene likely led to cross-contamination of food and work areas. This outbreak supports the potential use of inspections in identifying restaurants at high risk of outbreaks and the need to reduce contamination of raw products at the source and prevent cross-contamination at the point of service.

The use of restaurant inspection disclosure systems as a means of communicating food safety information

AbstractThe World Health Organization estimates that up to 30% of individuals in developed countries become ill from food or water each year. Up to 70% of these illnesses are estimated to be linked to food prepared at foodservice establishments. Consumer confidence in the safety of food prepared in restaurants is fragile, varying significantly from year to year, with many consumers attributing foodborne illness to foodservice. One of the key drivers of restaurant choice is consumer perception of the hygiene of a restaurant. Restaurant hygiene information is something consumers desire, and when available, may use to make dining decisions.

Certified kitchen managers: do they improve restaurant inspection outcomes?

Restaurants are associated with a significant number of foodborne illness outbreaks in the United States. Certification of kitchen managers through an accredited training and testing program may help improve food safety practices and thus prevent foodborne illness. In this study, relationships between the results of routine restaurant inspections and the presence of a certified kitchen manager (CKM) were examined. We analyzed data for 4461 restaurants in Iowa that were inspected during 2005 and 2006 (8338 total inspections). Using logistic regression analysis, we modeled the outcome variable (0 = no critical violations [CVs]; 1 = one or more CVs) as a function of presence or absence of a CKM and other explanatory variables. We estimated separate models for seven inspection categories. Restaurants with a CKM present during inspection were less likely to have a CV for personnel (P < 0.01), food source or handling (P < 0.01), facility or equipment requirements (P < 0.05), ware-washing (P < 0.10), and other operations (P < 0.10). However, restaurants with a CKM present during inspection were equally likely to have a CV for temperature or time control and plumbing, water, or sewage as were restaurants without a CKM present. Analyses by type of violation within the temperature and time control category revealed that restaurants with a CKM present during inspection were less likely to have a CV for hot holding (P < 0.05), but the presence of a CKM did not affect other types of temperature and time control violations. Our analyses suggest that the presence of a CKM is protective for most types of CVs, and we identify areas for improving training of CKMs.

Public Knowledge and Attitudes Regarding Public Health Inspections of Restaurants

Foodborne diseases cause 76 million illnesses in the U.S. each year, and almost half of all money spent on food is spent in restaurants. Restaurant inspections are a critical public health intervention for the prevention of foodborne disease. A telephone survey of randomly selected Tennessee residents aged > or =18 was performed. Data were collected on respondents' demographics, knowledge, attitudes, and expectations regarding restaurant inspections. Of 2000 respondents, 97% were aware that restaurants are inspected regularly by the health department. More than half of the respondents believed that inspections should be performed at least 12 times per year; only one third were aware that inspections currently occur only twice per year in Tennessee. More than one third of the respondents considered an inspection score of > or =90 acceptable for a restaurant at which they would eat; the mean score in Tennessee is 82. When presented with a variety of scenarios, an overwhelming number of respondents felt that public health responses to safety violations should be far more draconian than they actually are. Survey answers did not differ consistently based on respondents' race, gender, or history of having worked in a restaurant. This study identified a number of public misconceptions and unrealistically high expectations of the public health restaurant-inspection system. It is important to improve consumers' understanding of inspection scores and the limitations of regulatory inspections, as well as the role of such inspections in disease prevention.

DO CUSTOMER COMPLAINTS PREDICT POOR RESTAURANT INSPECTION SCORES? THE EXPERIENCE IN ALEXANDRIA, VIRGINIA, 2004–2005

ABSTRACT Routine inspections of retail food service facilities by public health authorities serve as a major method of ensuring food sanitation. The objectives were to determine whether customer complaints received by restaurants in Alexandria, VA, during 2004 predicted the number of critical violations issued on subsequent food safety inspections. Using a retrospective cohort study design, we defined “exposed” restaurants as those that received ≥1 complaints from January 1 to December 31 of 2004 and “unexposed” restaurants as those that received none. We then counted the number of critical violations cited on food safety inspections conducted immediately after receipt of customer complaints (exposed restaurants) or on the first inspection conducted in 2005 (unexposed restaurants). A total of 144 exposed and 233 unexposed restaurants were enrolled in the study. Compared with unexposed restaurants, exposed restaurants were less likely to have received one or more critical violations (relative risk = 0.84, 95% confidence interval of 0.74–0.96, P = 0.01). Restaurant inspections conducted specifically in response to customer complaints may not identify critical violations any more often than inspections conducted at restaurants free from such complaints.

Foodborne Pathogens: Microbiology and Molecular Biology

Foodborne pathogens can create a considerable amount of work at state and local health departments. Between foodborne outbreaks, restaurant inspections, environmental testing, botulism reports, customer complaints, and confirmation of isolates referred for testing, many health department resources are directed toward these pathogens and preventing illness from them. Moreover, the mass media are increasingly interested in food safety, particularly after large, multistate outbreaks caused by Escherichia coli O157:H7 and Salmonella, among other pathogens, and increasing public interest in raw and unpasteurized foods that are perceived as more natural or healthy. The audience for Foodborne Pathogens: Microbiology and Molecular Biology appears to be public health practitioners working on epidemiologic, environmental, and laboratory aspects of foodborne illness. One of the book's strengths is that it attempts to include reference material on epidemiology and on the molecular and microbiologic aspects of the various pathogens. However, as the title suggests, the emphasis is on molecular and microbiologic aspects, and much of the information is extremely technical and primarily for the laboratory scientist. The book includes a range of food pathogens, from bacteria and viruses to mycotoxins. The primary omission is bovine spongiform encephalopathy. Chronic wasting disease is included briefly in a chapter on potential food pathogens, which makes the omission of bovine spongiform encephalopathy all the more striking. In addition to separate chapters on individual pathogens or groups of pathogens, the book covers laboratory issues, including animal and cell culture models, molecular approaches for detection, and stress responses of foodborne pathogens. Other chapters are based on more sensational topics, such as bioterrorism and food, although this chapter discusses the subject in general terms. In a chapter on biosensor-based detection of foodborne pathogens, the authors conclude, not convincingly, that biosensors will soon be as widespread as glucose kits and home pregnancy tests. Overall, the book is a good reference for health departments, especially the chapters on individual pathogens. However, the book could have used stronger editorial oversight. Books like this one, in which experts in highly specialized fields are each invited to write a chapter, will by their very nature lack an overriding point-of-view, but at the very least, the book should have had a strong introduction to put the content in context. A large number of pathogens have emerged or been identified in the past 30 years, and a great deal of media attention is given to food-related illness. This book appears to be aimed at industrialized countries, despite the perception that the food supply in these countries is safe. Because much food is imported and exported throughout the world, including to and from industrialized nations, some basic discussion of the extent of foodborne illness in different parts of the world, and the resulting risk to the overall food supply, would have helped to frame the need for the book and the resources many health departments are putting toward foodborne illness.

Assessment of Food Safety Risk

Food service operations vary in their exposure to food safety risks. The Marion County, Indiana Health Department employs a system of risk assessment in determining the frequency of annual restaurant inspections to obtain an optimal balance between public safety and a maximization of departmental resources. Risk assessment classification criteria currently stem from the Food and Drug Administration Food Code without consideration of restaurant type. The utility of the current system of risk assessment was examined to see if restaurant type should be considered in the process. The analysis revealed significant differences in the number of health inspection violations among restaurant types, supporting the study's proposal. Of note, full-service chain restaurants had more violations than full-service independent operations and cafeterias had a greater number of violations than all other restaurant types combined.

Restaurant inspection scores and foodborne disease.

Restaurants in the United States are regularly inspected by health departments, but few data exist regarding the effect of restaurant inspections on food safety. We examined statewide inspection records from January 1993 through April 2000. Data were available from 167,574 restaurant inspections. From 1993 to 2000, mean scores rose steadily from 80.2 to 83.8. Mean inspection scores of individual inspectors were 69–92. None of the 12 most commonly cited violations were critical food safety hazards. Establishments scoring <60 had a mean improvement of 16 points on subsequent inspections. Mean scores of restaurants experiencing foodborne disease outbreaks did not differ from restaurants with no reported outbreaks. A variety of factors influence the uniformity of restaurant inspections. The restaurant inspection system should be examined to identify ways to ensure food safety.

The Effect of Information on Product Quality: Evidence from Restaurant Hygiene Grade Cards

This study examines the effect of an increase in product quality information to consumers on e rms’ choices of product quality. In 1998 Los Angeles County introduced hygiene quality grade cards to be displayed in restaurant windows. We show that the grade cards cause (i) restaurant health inspection scores to increase, (ii) consumer demand to become sensitive to changes in restaurants’ hygiene quality, and (iii) the number of foodborne illness hospitalizations to decrease. We also provide evidence that this improvement in health outcomes is not fully explained by consumers substituting from poor hygiene restaurants to good hygiene restaurants. These results imply that the grade cards cause restaurants to make hygiene quality improvements.

The Impact of Publishing Foodservice Inspection Scores

ABSTRACT The publishing of food safety inspection scores in the media has been the subject of much debate and controversy among consumers, health inspectors, and reporters. Part of the debate centers around whether publishing the results of health inspections by the media influences foodservice establishments to gain better scores, since the media influence consumers' decisions as to whether or not to patronize an establishment. Using a case study approach, the health inspection scores obtained from Tippecanoe County, Indiana, US are analyzed prior to and after media reporting began to determine if the publishing of scores does impact the scores foodservice establishments receive. The results show that overall inspection scores and individual inspector's inspection scores increased and the number of consumer complaints to the health department decreased. This suggests that the reporting of restaurant inspections in the media not only provides information to consumers, but may also impact the inspection process itself.

The Effect of Information on Product Quality: Evidence from Restaurant Hygiene Grade Cards

This study examines the effect of an increase in product quality information to consumers on firms' choices of product quality. In 1998, Los Angeles County introduced hygiene quality grade cards to be displayed in restaurant windows. We show that the grade cards cause (i) restaurant health inspection scores to increase, (ii) consumer demand to become sensitive to changes in restaurants' hygiene quality, and (iii) the number of foodborne illness hospitalizations to decrease. These results imply the grade cards cause restaurants to make hygiene quality improvements. The regulatory change also provides an opportunity to separately analyze the effects of mandatory disclosure of grade cards and voluntary disclosure of grade cards, because in some cities the posting of grade cards is at restaurants' discretion. We find that the effects from voluntary disclosure are statistically different, but not economically different, from mandatory disclosure.

A Risk-Based Restaurant Inspection System in Los Angeles County

The majority of local health departments perform routine restaurant inspections. In Los Angeles County (LAC), California, approximately $10 million/year is spent on restaurant inspections. However, data are limited as to whether or not certain characteristics of restaurants make them more likely to be associated with foodborne incident reports. We used data from the LAC Environmental Health Management Information System (EHMIS), which records the results of all routine restaurant inspections as well as data regarding all consumer-generated foodborne incidents that led to a special restaurant inspection by a sanitarian (investigated foodborne incidents [IFBIs]). We analyzed a cohort of 10,267 restaurants inspected from 1 July 1997 to 15 November 1997. We defined a “case restaurant” as any restaurant with a routine inspection from 1 July 1997 to 15 November 1997 and a subsequent IFBI from 1 July 1997 to 30 June 1998. Noncase restaurants did not have an IFBI from 1 July 1997 to 30 June 1998. We looked for specific characteristics of restaurants that might be associated with the restaurant subsequently having an IFBI, including the size of restaurant (assessed by number of seats), any previous IFBIs, the overall inspection score, and a set of 38 violation codes. We identified 158 case restaurants and 10,109 noncase restaurants. In univariate analysis, middle-sized restaurants (61 to 150 seats; n = 1,681) were 2.8 times (95% confidence interval [CI] = 2.0 to 4.0) and large restaurants (>150 seats; n = 621) were 4.6 times (95% CI = 3.0 to 7.0) more likely than small restaurants (≤60 seats; n = 7,965) to become case restaurants. In addition, the likelihood of a restaurant becoming a case restaurant increased as the number of IFBIs in the prior year increased (χ2 for linear trend, P value = 0.0005). Other factors significantly associated with the occurrence of an IFBI included a lower overall inspection score, the incorrect storage of food, the reuse of food, the lack of employee hand washing, the lack of thermometers, and the presence of any food protection violation. In multivariate analysis, the size of restaurant, the incorrect storage of food, the reuse of food, and the presence of any food protection violation remained significant predictors for becoming a case restaurant. Our data suggest that routine restaurant inspections should concentrate on those establishments that have a large seating capacity or a poor inspection history. Evaluation of inspection data bases in individual local health departments and translation of those findings into inspection guidelines could lead to an increased efficiency and perhaps cost-effectiveness of local inspection programs.