Public health emergencies and disasters bring with them various challenges that demand rapid and effective responses from state and territorial health departments. Often at the forefront of these challenges is the need for surge staffing—immediate reinforcement to boost workforce capacity in the face of high-stakes situations such as mass casualty incidents, large-scale vaccination clinics, or the long-term strain of sustained emergencies. The concurrent demands of acute crises and prolonged emergencies can complicate this staffing need further, underscoring the importance of having a resilient, adaptable, and capable workforce.
Navigating these complexities may seem daunting, but it provides a valuable opportunity for strategic foresight and preparation. Closely examining potential future needs within your jurisdiction and across disciplines can lay the groundwork for a robust surge staffing strategy. Furthermore, partnering with other departments or sectors, and learning from their experiences and lessons, can bring you critical insights and innovative solutions.
By exchanging experiences and learning from one another, state and territorial health departments can transform these staffing challenges into opportunities for enhancement.
Navigating surge staffing during a public health emergency is a complex endeavor. State and territorial health departments often face the dual challenge of swiftly increasing their workforce capacity while effectively integrating contract or temporary staff. The unpredictable nature of health crises adds another layer of complexity, making it difficult to plan and maintain a stable, efficient workforce.
Structural hurdles, such as contractual obligations and restrictive hiring practices, compound these challenges. These can delay workforce augmentation and keep agencies from strategically deploying critical response personnel, including community health workers, contact tracers, and case investigators. As a result, the public health response may not be as effective as needed.
Common contributing factors to these challenges include:
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Contract staff integration: Incorporating contract staff into an existing workforce is not always straightforward. Differences in work practices, organizational culture, and employment expectations can create hurdles that affect the smooth functioning of the team.
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Strategic workforce deployment: Effectively responding to a public health emergency requires agencies to strategically deploy all available resources. However, a lack of planning, coordination, or understanding of the roles and potential contributions of different workforce segments (e.g., community health workers, contact tracers, and case investigators) can lead to missed opportunities and inefficient use of resources.
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Structural barriers: Contractual constraints, restrictive union contracts, and stringent hiring practices can keep agencies from swiftly augmenting their workforces during emergencies. These barriers can result in critical delays and inefficiencies, contributing to workforce shortages during pivotal response times.
This section highlights a successful and innovative solution your peers implemented to address challenges with workforce surge staffing during public health emergencies. This story presents the factors that catalyzed the innovation, the existing policies or funding mechanisms that facilitated action, the potential barriers the agency faced, the collaborations and partnerships the agency leveraged, and tips for implementing and/or scaling the solution.
Strengthening the Frontlines: The Carolina Community Tracing Collaborative's Innovative Approach to COVID-19
Introduction
In April 2020, North Carolina, like many states, was grappling with the burgeoning COVID-19 pandemic. The state's public health agencies quickly understood that they needed to implement extensive contact tracing to curb the spread of the virus. However, they were constrained by staffing limitations and needed a solution that was swift, efficient, and expansive.
To address this pressing issue, the North Carolina Department of Health and Human Services turned to a cooperative approach. It joined forces with Community Care of North Carolina and the North Carolina Area Health Education Centers—organizations with deep-rooted experience in liaising with local health departments and training healthcare personnel. The collaborative sought the expertise of Partners in Health, a global nonprofit with a well-regarded model of contact tracing. This powerful alliance became known as the Carolina Community Tracing Collaborative (CCTC).
CCTC’s primary objective was to bolster the fight against the pandemic by enhancing contact tracing initiatives. Its scope expanded to establishing testing clinics and, eventually, vaccination clinics. Leveraging COVID-19 response resources, CCTC managed to recruit an additional 750 staff members, including a significant number of medical professionals. These augmented staff members were then strategically deployed to areas of the greatest need, working in close coordination with local health departments.
Policies and Funding
CCTC was largely funded by COVID-19 response resources from the federal government. These funds were critical to setting up this pioneering partnership and supplementing the staffing requirements of health departments across North Carolina.
Challenges and Barriers
The initiative wasn't without its challenges. One of the primary hurdles was related to staffing—specifically, recruiting medical personnel for vaccinations and retaining a consistent workforce across counties and regions. A lack of staffing continuity led to frequent on-site disruptions due to travel, equipment needs, proper onboarding, and ensuring fair compensation for all involved.
Further complexities included raising awareness of the initiative among local health departments and coordinating the demobilization of the North Carolina National Guard. The North Carolina National Guard, the North Carolina Department of Health and Human Services, and the North Carolina Office of Emergency Medical Services provided valuable assistance to overcome these challenges.
Collaborations and Partnerships
CCTC’s collaborative spirit extended beyond the foundational partners. Emergency operation partners also played a crucial role in managing, vetting, and tracking requests from local health departments. Open communication, facilitation, and coordination were key to this successful collaboration.
The willingness and flexibility of all parties involved, including Community Care of North Carolina’s ability to provide support across the state, were instrumental in mitigating the threat of COVID-19. This approach proved particularly beneficial in rural areas, which faced unique challenges, such as inequitable healthcare delivery systems and broadband needed for public health communications and education.
Tips for Implementing and Scaling
CCTC’s work has provided invaluable lessons that can guide other states in similar situations, including:
- Identify sources for surge staffing in advance: Emergencies can require a rapid surge in staffing. Identifying potential sources, such as partnerships with local organizations or networks, in advance can expedite this process.
- Establish agreements between partners: Proactive discussions about roles, responsibilities, and agreements can ensure smoother collaboration during an actual emergency.
- Forge connections with local health departments and community organizations: Building relationships with local health departments and community organizations can help facilitate faster coordination in a crisis. This can also help agencies identify potential gaps and opportunities for improvement.
- Increase public awareness of available resources: Engage in public awareness campaigns about the resources available to communities. This can help instill trust and facilitate more effective crisis response.
- Plan for adaptability: Each region may face unique challenges. Planning for adaptability and ensuring strategies can be tailored to specific needs is crucial.
- Learn from success stories: Other states' experiences, such as North Carolina's, can provide practical insights and a foundation upon which to build strategies and processes.
APPLYING THIS KNOWLEDGE TO INFECTIOUS DISEASE
Developing robust tracing programs: CCTC's experience can guide the development of robust contact tracing programs, vital for controlling the spread of infectious diseases.
- Streamlining resource allocation: Lessons learned about strategically deploying resources where they are most needed can lead to more efficient responses to infectious disease outbreaks.
- Fostering collaborative partnerships: The successful collaboration among different organizations during the CCTC project underscores the importance of partnerships in infectious disease practice. This could encourage more partnerships between health departments, nonprofits, and other relevant organizations.
- Enhancing public awareness: CCTC’s success in improving public awareness and acceptance of tracing and testing efforts could be used to guide communication strategies in other infectious disease contexts.
- Improving staffing strategies: Lessons learned about hiring and retaining staff, including using emergency operation partners, could improve staffing strategies during infectious disease outbreaks.
- Scaling effective practices: CCTC’s strategies and practices could be scaled and adapted for use in other states and contexts, helping to improve overall infectious disease practice.
- Planning for future crises: Insights from CCTC’s experience can help health departments better plan for future infectious disease outbreaks, improving their ability to respond effectively.
- Prioritizing flexibility: CCTC’s ability to adapt to challenges, especially in rural areas, underscores the importance of flexibility in infectious disease practice. This could lead to more adaptable strategies and protocols in the future.
This section encompasses a collection of pertinent tools and resources curated from ASTHO's Public Health Innovations Catalog and various other sources to help you navigate and comprehend the intricacies of this subject area. Garner insights and experiences from your peers, enabling you to start building solutions tailored to your health department.
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