The U.S. restaurant industry has enjoyed continuous growth in the last decade (Ghiselli, 2014) with 1 million restaurants and expected sales of $709.2 billion in 2015 (National Restaurant Association, 2015). As such, restaurants play an important role in providing nutritious and healthy food to the public (Almanza, Ghiselli, & Khan, 2014) with restaurant inspections essential to that process of providing healthy food (Reske, Jenkins, Fernandez, VanAmber, & Hedberg, 2007).
The Food and Drug Administration (FDA) publishes the Food Code to help guide restaurant inspection efforts. The Food Code is revised every 4 years with amendments every 2 years. FDA's newest release of the 2013 Food Code marks the 20th anniversary of the Food Code (U.S. Department of Health and Human Services [HHS], 2015) and reflects collaboration efforts among FDA, the U.S. Department of Agriculture's Food Safety and Inspection Service, and the Centers for Disease Control and Prevention, as well as the Conference for Food Protection (CFP). In fact, the 2013 edition directly incorporated the input of consumers and regulatory, industry, and academia stakeholders who participated in the 2012 meeting of the CFP (HHS, 2015).
The purposes of the Food Code are to "assist food control jurisdictions at all levels of government by providing them with a scientifically sound technical and legal basis for regulating the retail segment of the food industry," "reduce the risk of foodborne illnesses within food establishments," provide "uniform standards for retail food safety that reduce complexity and better ensure compliance," "eliminate redundant processes for establishing food safety criteria," and "establish a more standardized approach to inspections and audits of food establishments" (HHS, 2015).
The 2013 Food Code carried over many changes from the 2009 Food Code, including the revised designation system for code violations (HHS, 2009, 2015). This designation system changed "critical" and "noncritical" violations to violations categorized as a "priority" item, "priority foundation" item, or "core" item to better "link the provision to hazards associated with foodborne illness or injury" (HHS, 2015). In other words, the three-tier classification is expected to more closely associate the appropriate amount of risk with violations because its division of violations into three categories might be expected to offer better discrimination among risk levels. In support of this revision, it has been suggested that one advantage to the new designation system is that the "use of critical, priority, and priority foundation is a basis for the risk-based inspection strategy for food safety" (Indiana State Department of Health Food Protection Program, 2015).
While FDA provides the Food Code to guide restaurant inspections, states and other jurisdictions make decisions whether to implement the code in its entirety or in part (HHS, 2015). In other words, different inspection formats may be used in different parts of the county. Currently, many states still use the critical/noncritical inspection system (Food and Drug Administration, 2015).
Although narrative inspection systems such as the critical/noncritical inspection system provide detailed descriptions of violations that take into consideration repeated violations and provide in-depth information, there is no defined passing or failing score. Passing or failing is based on the experience and professional judgment of the health inspector, so that the interpretation of severity or risk may be less clear to restaurant managers and consumers (Almanza et al., 2014). The newly proposed three-tier system faces the same problem. Additionally, "the new terms introduced into the 2009 FDA Food Code are not food safety-related terms that are relevant to educating the public, the regulated industry, and regulatory officials"--resulting in concerns over the feasibility of the new system as it might 1) require "a re-education process that does not emphasize food safety or food-borne illness prevention," as the new system demands changes to "naming convention" and "established culture of food safety" and 2) be "difficult for regulators to articulate and difficult for the regulated industry to understand" (Conference for Food Protection, 2012).
Moreover, research has shown that individual inspector, as well as inspection format, can influence inspection results (Almanza, Ismail, & Mills, 2002; Almanza, Nelson, & Lee, 2003; Lee, 2006; Lee, Nelson, & Almanza, 2010). To complicate the problem, individual inspector risk perception, which may directly impact inspection results, can be influenced by the narrative used to describe violations (Choi & Almanza, 2012). With these factors in mind, before making a decision about whether to adopt the new Food Code, some states may be concerned that changing...