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are responsible for having an employee health policy (16).
Although written health policies have been linked to effective
mitigation of foodborne illness in retail food establishments
(22), the formal development and implementation of
employee health policies may be inconsistent. A study by
Liggans et al. (16) found that 56.0% of fast-food restaurants
and 70.7% of full-service restaurants had no employee health
policies; however, there is limited research in this area and
the research that does exist is primarily from restaurant
operations, as in the Liggans et al. (16) study. Our study
surveyed retail food operations including restaurants, grocery
stores, and convenience stores (C-stores).
Despite having policies, employees may still come to
work when they are ill. Carpenter et al. (4) found that
approximately 60% of the employees who participated
in their study responded that they had worked while
ill. Another study suggested that 64.1% of managerial
professionals were aware of employees' presenteeism (25)
(presenteeism is a term used when workers come to work
unnecessarily while sick) (2, 15, 27); however, only a few
studies have been conducted on reducing sick employees'
presenteeism (23). Managing foodservice employees'
presenteeism is essential to ensuring food safety because the
transmission of microorganisms through sick employees can
pose a significant threat to public health (35). In addition,
the presenteeism issue is closely related to sustainable human
resource management and employee well-being (15, 28),
eventually damaging the overall productivity of foodservice
organizations (30). To address this matter, this study
investigated the presence and contents of employee health
policies in retail food operations, specifically restaurants,
grocery stores, and C-stores.
Health
Concerns regarding employee health have a long history.
Traditionally, employers considered employees' absence
from work problematic and costly (30); thus, any form of
absenteeism, including sick leave, has been monitored and
controlled throughout all industries (12, 30).
Still, many foodservice entities impose punitive
attendance policies on employees to prevent their taking
sick leave or have no employee health policy (12, 16, 25,
30). Consequently, employees may risk termination if they
have excessive absenteeism. Even if there are health policies,
previous literature argued that there are obstacles that
individuals face to taking leave. One major hurdle is financial
concerns (4, 25). Once the employees are absent from
work beyond their paid sick leave, their income is reduced;
therefore, they may have no other choice but to come to
work (29). Especially in the United States, where restaurant
tipping is common, reduced shift hours for tipped employees
can be an additional source of stress and deter employees
from calling in sick (19). According to surveys and interviews
conducted by multiple researchers, sick employees feel
guilty about leaving the workplaces short staffed and often
link presenteeism to a good work ethic (25). To address this
matter, some suggest that paid sick leave may help alongside a
strong food safety culture (2, 16, 27).
Hygiene: handwashing
Assuring safe food is the most important principle for the
survival of food businesses and public health protection;
thus, proper and frequent handwashing, elimination of
bare hand contact with ready-to-eat (RTE) food, and food
safety training programs have been implemented (10, 14,
22). Although the aforementioned practices play a critical
role in preventing pathogen transmission, the exclusion
of ill employees also has a significant effect on food safety
protection (9, 10, 22). Other personal hygiene practices such
as handwashing frequency and the elimination of bare hand
contact with RTE food are important, but a primary route
of food contamination remains the direct contact with the
pathogens transmitted by ill or infectious employees (13, 22).
Considering the potential negative economic impact that
foodborne illness outbreaks cause, managers are challenged
with prioritizing costs related to food safety practices and
revenue generation for the operation. Encouraging employees
to use proper utensils to prevent bare hand contact with RTE
food and to take enough time for proper handwashing, in
addition to restricting sick employees from working, may be
viewed as an additional expense to the operation. Negligence
in food safety at the organizational level makes operations
vulnerable in the long term to incur a higher occurrence of
food safety issues (11, 35). One reason for failing to establish
and maintain a food safety culture may be due to a conflict
between food safety and cost reduction (11).
Food safety culture: attitude, values, and beliefs
To facilitate a food safety culture, managers may need to
use their skills to urge employees to change their beliefs and
behaviors (36). Common attitudes, values, and beliefs about
food safety behaviors accepted in retail food organizations
are known as food safety culture (11), and managers' food
safety knowledge, attitudes, and commitment affect food
safety culture in establishments (5, 13). In the food-handling
environment, standards for safety should be higher than
that of other industries and it is not sufficient to be content
with solely fulfilling regulatory requirements (11, 26).
Thus, the purpose of this research was to identify current
practices concerning the development and implementation
of food safety management systems (FSMSs) used in food
establishments to minimize foodborne illness risk factors.
MATERIALS AND METHODS
The focus of this survey was employee health policies. To
gather data, we created an online questionnaire and a pilot
was tested. The questionnaire consisted of both open- and
close-ended questions. After pilot testing and revision, the
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