Scorecard System in Public Health Work By James A. Tobey, Scientific Assistant, U. S. Public Health Service T HE scorecard system in pub lic health work has now been in use for a number of years and is increasing in scope and influence. A scorecard for dairies was first used in Washington, D. C., by Health Officer Woodward and soon produced excellent results. In fact, scorecards have proved useful and beneficial wherever they have been skillfully devised and intelligently applied. They help to systematize the keeping of records as they can be filed for reference and they serve as a ready comparison of conditions which can be easily presented to the public. The advantages of the system are many. It assists the inspector by putting before him in black and white the items he should look for, so that he overlooks none and soon learns to evaluate the various factors of sanitary importance. It serves to instruct the person scored by attracting his attention to those points in which he is deficient. This is best done by marking in red ink all scores which are below the allowable limit, while those which come up to standard are marked in black. Thus, at a glance he sees where his faults are and his interest is aroused. If a card is marked only in black, too often it is placed aside for future perusal and then forgotten. Stimulates Competition The system creates rivalry and stimulates competition. No man wants to be at the bottom of the list, especially if it is to be published. Publicity is one of the most inspirational factors in health work. Even the announcement that scores are to be published in newspapers or bulletins causes a sudden increase in interest and a decided improvement among those scored. To be fair, however, only an average of a number of inspections should be published, as this procedure gives a man a chance to improve. Copies of the score should always be sent to those who have been inspected. The one objection which might be offered against the system is that a score is general and not specific. It is a form of standardization but sometimes two equally good places, as measured by results like milk analysis with respect to dairy scores, may be given very dissimilar scores. A trained inspector, however, who has good judgment and common sense will usually get fair comparisons. Obviously, to prevent differences in opinion due to the personal element, one man should wherever possible do all the scoring for a set of inspections. Scorecard Essentials The scorecard itself should be so framed that it covers the im portant items of the sanitary code. which applies to that which is to be scored. Incidentally, the code itself should be accurate and up to date. The card should likewise be clear and so drawn up that the more important factors are emphasized. Simplicity and concentration are important, but above all accuracy should be sought. A scorecard which gives a dairy ten points for odors in the barn and only one for small top pails is from the sanitary standpoint worse than useless. The card should generally be arranged in two parts, no matter what it is scoring, for these two main headings apply to anything worth scoring. They are "Equipment" and "Methods". In some cases more divisions are used or indicate less directly these two points. Herewith are reproduced four original scorecards which are now in use and have proved satisfactory. DAIRY SCORECARD Name.... Address. I. Stables (15). Number cows. Quarts of milk daily. EQUIPMENT (25) Score Possible Allowed 3 6 3 a) Well lighted, 400 cu. ft. air per cow. b) Floors, walls, ceilings, windows, clean, no dust, barn whitewashed c) Tight floor and gutter. d) No contaminating surroundings. II. Milk House (10) a) Concrete floor, light and well ventilated, screens.. b) Floors, walls, ceilings, windows clean... c) No contaminating surroundings.. a) b) c) Not poured in cow stable. 5 d) Kept cool in transportation.. 75 Final score. % Date. Inspector > small dealer with a tumble-down barn consistently produced milk with about three or four thousand bacteria per cubic centimeter. Dr. North's experiments have led him to recommend a dairy score in which equipment is given only ten and methods ninety, but while concurring in his conclusions, the writer believes that the change is too radical for the present. The ideas of farmers and the vast quantity of small producers must be somewhat more gradually changed. If we wipe out our previous teachings with one fell swoop, as it were, the farmer will distrust what we give him now and say that we were wrong before and probably are now. There is also some psychological effect in good equipment, for a clean whitewashed barn induces a man to attempt to practice cleanliness. The Other Cards The second scorecard shown was devised for restaurants. It emphasizes the health of smployees, an item which should be backed up by requiring a medical certificate from every food handler. Protection of food, source and condition of same and garbage disposal are also given prominence. The third card is for barber shops devised when the author was health officer of West Orange, N. J. In these shops the relation of barber and customer is one of personal contact 2. Well lighted (artificial).. 3. Running water, hot and cold (allow 8 for heater). 4. Basin for washing hands... business 5. Unconnected by door or hall with room used for other 6. Sanitary toilet (proper plumbing) 7. Screens, free from flies...... METHODS (65) 9. 10. 11. 8. Mugs, shaving brushes, razors, clippers, etc.... 15 5 10 8 Deduct for spitting on floor or other unclean action... 4 100 Remarks: Equipment.. Methods... Inspector.. Total Score.. 5. Water tight floor...... 6. Water closet not opening into room where food is handled METHODS (66). 5 7. Floors, walls, ceilings, windows clean..... 8. Utensils, mixers, dough troughs, racks clean. 9. 10. 11. Protection of raw materials. Mechanical mixer Basin for washing hands, towels, sanitary plumbing.. 12. Employees free from disease, clean in person, clean uniforms 10 10 3 4 6 wear 10 5 7 6 5 100 Inspector. and the opportunity for infection is great. They deserve more attention than is generally paid to them. The fourth card is for bakeries and is modified after that used in Monteclair, N. J. Other uses of scorecards are in inspecting groceries and markets, ice cream factories and laundries. CHILLICOTHE INSTALLS MORE RIGID CODE OF SANITARY REGULATIONS Additions to Chillicothe's sanitary code, growing out of the campaign of sanitation which has been waged by representatives of the United States Public Health Service in the Camp Sherman zone, have been approved by the board of health in that city. By the new regulations, restaurants and their employees are compelled to submit to inspections whenever the health authorities desire, and employees of restaurants must submit to vaccination in case it is deemed necessary. A fee of $1 will be charged for restaurant permits. Such inspections have been going on for some time as a measure of protection for the soldiers' health. Inspection of private as well as public wells is provided for, and any found unsanitary may be condemned. Manure bins must be elevated one foot, and must be emptied twice weekly from March to November and once weekly from November to March. Privies must be screened. |