The Nassau County Department of Health (DOH) has 240 employees and serves more than 1.3 million residents on Long Island, New York. Nassau County is the immediate Eastern neighbor of New York City, a suburban community with significant health and socioeconomic disparities. This area was an immediate epicenter of the COVID-19 epidemic, which demanded an immediate, all-encompassing enhanced disease control response by employees across all units. This also presented an unprecedented workforce management challenge: The immediate goal was to accurately track employee work hours so that a uniform, credible, searchable, and adaptable tool could support our emergency response efforts. The administration team developed a new, iterative system of tracking tools, built using advanced Excel functions, that allowed the department to manage and track employee schedules and work functions as well as complex absences (paid and unpaid); this was especially challenging because none of the existing timekeeping and scheduling tools had the capacity to capture nuanced data.

The pandemic was a fluid situation from the beginning. A State of Emergency was declared by the County Executive on March 13; on March 22, a New York State Executive Order mandated that all non-essential businesses be closed in an attempt to “flatten the curve” as the state was experiencing more than 4,800 cases a day. Nearly all regular work ceased, and resources were redirected to COVID-19: case investigations, contact tracing, isolation and quarantine home checks, delivering urgently needed PPE to front-line workers, and providing wrap-around services (including food deliveries and household essentials) to residents. By March 21, DOH was impacted by COVID-19 as well, with employees becoming ill and others requiring quarantine. In addition, county guidelines allowed certain classes of employees to remain at home with pay, including individuals with pre-existing health conditions and those over 60 years of age. Others had their work temporarily discontinued. The department shifted to a 7-day schedule, with some employees assigned to work weekends in response to skyrocketing caseloads.

In partnership with the fiscal unit, DOH administration built an iterative, complex, and highly adaptable master tracking system that combined team schedules provided by bureau directors, paper employee COVID-19 timesheets (which alone has nearly 110,000 lines of data to date), and absence  information collected by HR staff. This master tracking system can be sorted by date, employee, unit, cost center, etc., and details the COVID-related work in regular and overtime hours and dollars. Tremendous partnership and collaboration with individual employees and bureau directors have resulted in a master tracking system that the entire department can be proud of: With the evidence-based information gleaned from this system, DOH has demonstrated that a portion of the $2.3 million incurred in personnel expenses through the third quarter of 2020 is eligible for funds through the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Without this relief funding, DOH’s budget would have been decimated, and the department would not have the resources to provide its regular services at the same level of excellence to the Nassau County public.

As a suburban county immediately to the east of New York City, Nassau County has been severely impacted by COVID-19 and was part of the nation’s initial hotspots. To date, Nassau County has had more than 92,000 cases and 2,400 deaths. DOH has provided an exemplary response to the pandemic, deploying a staff of 240 toward a focused, enhanced disease control response. However, a concurrent management and administrative challenge immediately arose alongside the emergency itself: How to effectively and accurately manage and track staff work hours (and absences) as the pandemic spiraled, and the department was working in ways it had never had before.

 Thus, the practice goal was to develop and implement an iterative, adaptable master workforce tracking system that would be maintained separately by DOH staff but dovetail with data from the existing county timekeeping system; work hours devoted to the pandemic as well as the unprecedented types of absences had to be accurately captured. This tool was built within weeks by administration in close partnership with the fiscal unit using advanced Excel functions (including pivot tables and VL lookups); this has been continually used and improved for 43 weeks as of this writing—and will be until the emergency is over. The tracking system has already been used to support the work of the Nassau County Office of Management and Budget as it seeks to apply for reimbursement from FEMA and other state and federal emergency agencies.

 The DOH COVID-19 response began on Super Bowl Sunday, February 2, 2020; a traveler had landed at John F. Kennedy International Airport from China, and her final destination was in Nassau County. The emergent situation has continued since then: The county had its first positive case on March 5; the Nassau County Executive declared a State of Emergency on March 13, and the New York State PAUSE Executive Order was mandated on March 22, closing all non-essential businesses. Along with the Nassau County Police and the Office of Emergency Management, DOH was among the only county agencies that still operated full time and on site. Staff were dedicated to:

Enhanced Disease Control. The Disease Control unit was conducting case investigations and contact tracing seven days a week. This included providing wraparound services for those in isolation and quarantine (securing and delivering food items, personal hygiene essentials and/or linking individuals for the provision of these services).

COVID-19 Testing Oversight. This portfolio has included reporting and analyzing epidemiologic data, oversight of large contact and cluster investigations, and providing guidance to both public and private schools in Nassau County. In turn, other school-related activities—such as custodial services, busing, and food services—are often impacted, and recommendations must be made by DOH staff.

Public Health Information Network. DOH staff has worked daily with the County Executive’s team to develop a multimedia campaign to educate residents. These activities include: holding daily televised briefings as well as interviews with print and radio media; responding to media FOIL requests; posting information on social media; holding virtual town hall meetings; and developing a dedicated COVID-19 website, which is continuously maintained and updated. DOH staff have also been operating a COVID-19 Call Center seven days a week since March 5. Nearly 70 DOH employees have been staffing the Call Center on a rotating basis, responding to more than 60,000 inquiries from the public.

Enforcement. DOH staff have been enforcing New York State Executive Orders at, but not limited to, the following facilities: food service establishments, children’s day camps, hotels, motels, pools, beaches, body art studios, gyms and other facilities that have DOH permits. Enforcement activities include contact tracing, site visits, complaint response and other enforcement actions (closure directives, violation notices, issuance of hearing notices and fines).

Technical Assistance to Local Authorities. This assistance has served local legislative members and senior County Executive staff as well as with Town and City officials, managers and supervisors, Village mayors, and various agencies such as the Police Department (County, Town, City and Village), Office of Emergency Management, local Homeland Security, virtually every County agency commissioner and  School District superintendents, local hospital administration, faith leaders, and local liaisons to New York State officials. In addition, DOH staff are now providing technical assistance and working with local authorities in establishing and executing COVID-19 vaccination points of dispensing (PODs).

Legal. DOH staff have been drafting, preparing and serving DOH Commissioner’s isolation/quarantine orders, and release from isolation/quarantine letters; answering voluminous, case-specific calls from the public regarding isolation, quarantine and release requirements and metrics; providing recommendations and guidance across a wide spectrum of industry, schools, and health care organizations regarding isolation, quarantine and return-to-work protocols; and collaborating across all levels of governmental agencies to ensure adherence to evolving federal, state and local laws, rules and guidelines with respect to isolation, quarantine, and release from isolation/quarantine.

Administration. DOH staff have been extensively scheduling, coordinating, and managing the staff required to effectively execute all the above activities and functions while also keeping employees as safe as possible. This has including establishing and maintaining rotating work schedules, seeking and establishing alternative work sites (including setting up VPN connections so that employees could work from home as well as identifying and setting up auxiliary work sites in other County buildings).

The range of these round-the-clock activities meant that the normal “swiping in” and “swiping out” at time clocks was no longer credible sole source for tracking employee work hours or types of absences. An innovative workforce tracking system was developed, launched, and maintained with continuous quality improvement; together with data that was then exported in from regular county timekeeping and payroll systems, the tool can be readily sorted by employee, time (day/work week/month), unit, and cost center to provide reports for internal financial management, institutional grant management, and county budgeting needs.

From the beginning, the success of the master workforce tracking system relied on the full partnership and collaboration of the Health Commissioner, members of the executive staff, as well as individual employees. Additional partnership and collaboration have been helpfully provided by other Nassau County agencies, especially the Office of Management and Budget, which provided monthly department-wide data pulls that included employee names, titles, units, rank/steps, cost centers, and salaries. This monthly data pull provides the back-end framework to the entire tracking system—because even during the pandemic, there have been new hires, retirements, promotions, and other variances to the employees’ status and pay, all which impact payroll costs.

The data input provided by DOH staff includes:

Weekly Scheduling Templates. Each week beginning in mid-March, a scheduling template was created for each unit, for a total of 13 (12 regular units plus the Call Center, which continues to be populated by eight teams of approximately 10 employees each across units). The Excel template was pre-populated with the days of the work week across the columns and employee names in the rows; when the supervisor clicked on the blank cell, a pull-down menu appeared, so a choice could be selected for each employee on every day: worked on site, worked from home, vacation, sick, personal, comp, off (for the two days during the seven-day work week that the employee did not work and was not paid), authorized day off (to designate the additional paid third day off that some on-site employees were given to provide relief during the exceptionally intense periods in March and April), and not working. The “not working” category was later built out by the human resources department to indicate the reasons why employees were not working during the pandemic beyond the usual leave requests. These categories included: isolation due to COVID; quarantine due to DOH exposure; quarantine due to non-DOH exposure, at home-underlying health condition, at home-age over 60, and bereavement leave (COVID-related deaths of family members). These templates were distributed weekly; once completed by supervisors, the data was rolled-up into the master tracking document. (Behind the scenes, each date/employee name had a unique numerical code that was generated so the tool could be checked for duplicative entries.) Because the response to the pandemic required such fluid adaption of staffing, employees were re-assigned from one unit to another week by week: environmental health employees were assigned to disease control for case investigations, lab employees were assigned to administration to help handle the incessant stream of phone calls from the public, and early intervention and WIC employees were assigned to the Call Center, etc. It was a constant adaptation to the evolving pandemic and departmental needs, requiring open communication among units, collaboration among supervisors and teams, and everyone remaining focused on what, for many weeks, was DOH’s primary goals: lowering the death rate and reducing the community spread of the disease. Beginning in August, the weekly scheduling template was simplified so that supervisors only had to fill in the names of employees “not working” so administration could track the COVID-related absences (which by then included the 14-day quarantine that was required for those traveling outside of New York State, New Jersey, and Connecticut).

Individual Employee COVID Timesheets. Employees have been asked to submit paper COVID timesheets indicating their hours worked on the pandemic. Those working in units solely devoted to COVID (including in disease control and at the Call Center) sign in and out on group timesheets. All this data has been manually entered by administration staff members into COVID excel worksheets, which in turn are rolled-up into the master tracking document. This raw data has constituted the main bulk of the tool and currently has more than 110,000 lines—and is growing daily.

Timekeeping Data. On a monthly basis, human resources employees generated reports from the Nassau County timekeeping systems, including hours worked, overtime hours, wages, etc. These reports are complex, and it takes considerable time and effort for the fiscal unit to align this data so that it can be used to cross-check against the individual employee COVID timesheets to ensure as much accuracy as possible.

With all these complex data inputs, the master workforce tracking system actually has easy-to-use front-facing dashboards. For example, the dashboards can be sorted by unit, employee, date, cost center, etc., showing on any given day how many employees were working (either from home or on site) or how many employees were at home (due to underlying health conditions or were quarantined due to COVID exposure, either at the workplace). The number of worker hours devoted to the pandemic by this single local health department is already in excess of 48,000. This evidence-based portrait of the department’s work during the pandemic is at once awe-inspiring and deeply moving, showing how the agency’s employees rallied to confront the ravages of the disease on our neighborhoods and communities while also struggling with its own illnesses and heartbreaking family losses.

The master workforce tracking system has been continually adapted and creatively maintained to implement the concepts of quality improvement during the 43 weeks (as of this writing) that it has been in operation.

Scheduling. The tool was originally rolled out in mid-March in response to the intense scheduling needs of the department. DOH had switched to a 7-day work week, which meant that some employees were now working on weekends to serve the Nassau County pandemic as cases mounted and the state locked down. Supervisors from each unit were submitting schedules in varied formats—some provided lists in the email text, and others handed in schedules on Word or Excel documents. The weekly scheduling template was designed by staff in administration and the fiscal units to provide a uniform mode of collecting this information. This was quickly adapted to allow supervisors to indicate whether employees were working on site or from home and whether they were permitted to take an additional authorized day off with pay (which was permitted during March and April to provide additional relief to employees who were not only working around the clock but also taken out of their comfort zones).

Human Resources Absence Management. Toward the end of March into April, the department itself experienced impacts of the pandemic as employees became ill and had to isolate, others had to quarantine, and still others were taking bereavement leave due to the deaths of family members. The workforce tracking system was expanded to include ways to capture the reasons why employees were not at work in ways never before encountered in the workplace. In addition, state guidance was often changing daily, as were rules around whether employees had to use their own time if they were ordered to quarantine or if they had to care for children who were suddenly doing their classwork remotely; the tracking system was adjusted to allow for the evolving types of circumstances that employees were in.

Civil Service and Union Rules. As the weeks went on, it became apparent that assumptions had to be questioned and the tool continuously improved so that both the data captured as well as the calculations behind the curtain were as accurate as possible. For example, union employees (which constitute all but four of DOH employees) are paid for a 45-minute lunch, but non-union employees have a 60-minute lunch; union employees who work overtime on a day that normally would be off get four hours of overtime pay, even if they have worked less. Countless such variances surfaced over the months, which required constant tweaking of calculations and formats.

The workforce tracking system has proved invaluable in helping to determine the number of hours that some employees worked on COVID that could not be billed to various core grants (e.g. WIC) as well as in assisting the Office of Management and Budget prepare for emergency fund reimbursements.

The primary lessons learned in developing and improving the tool are that constant communication is key to garnering cooperation from staff at every level. The system is only as good as the data collected and how it is analyzed. The framework of this system can be easily adapted for future uses as they may arise, whether for a short-term emergency response or one that is more sustained. While this tool is just about as far from the public eye as any management system can be, it has functioned steadfastly due to the commitment and dedication of many DOH employees who believe deeply in supporting the work of the department as it serves the residents of Nassau County.

With the evidence-based information gleaned from this system, DOH has demonstrated that a portion of the $2.3 million incurred in personnel expenses through the third quarter of 2020 is eligible for funds through the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Without this relief funding, DOH’s budget would have been decimated, and the department would not have the resources to provide its regular services at the same level of excellence to the Nassau County public.

Residents are served best by an agency that is operating effectively and efficiently throughout a long and uncertain game, and this workforce tracking system has played its own vital role in ensuring that this practice is thoughtfully and carefully executed each day. In addition, it is an evidence-based portrait of the tireless dedication and sheer herculean effort that these public servants have dedicated to the well-being of Nassau County residents in the face of an ongoing public health crisis.