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Quarterly: Fall 2020 - Lise Valentine

Tales from the COVID Front: Coming Together While Staying 6 Feet Apart

By Lise Valentine

As auditors, we’re accustomed to evaluating programs. But operating them in a crisis? Not so much. I recently returned from a nearly three-month assignment as a facility manager for Chicago’s COVID response, and would like to share some lessons learned.

Accepting the Mission

In late March 2020, the Mayor’s Office requested volunteers to assist in Chicago’s COVID response by operating quarantine and isolation facilities temporarily set up in hotels. The Office of Inspector General (OIG) answered this call, contributing staff to assist in a variety of COVID-response missions. My day job is leading the audit side of OIG. It was a privilege for me to serve on the COVID mission; I’m deeply grateful to our amazing staff and excellent supervisors, Darwyn Jones and Cameron Lagrone, who kept the audit work going strong in my absence.

City Hall assigned several OIG colleagues the role of managing a quarantine and isolation facility in downtown Chicago. We reported for duty at a boutique hotel next to Millennium Park, temporarily reserved as a place for people with mild cases of COVID to recuperate if they could not safely isolate from others at home. We operated the facility from April 3 until June 20.

Coming Together

I’m proud of what we accomplished during our 11 unexpected weeks in the medical/hospitality business. Foremost for me was the opportunity to dispense with our usual, often adversarial, “teams”—auditors vs. auditees and investigators vs. subjects. OIG is scary for many city employees; they’re not eager to see our names in their email inboxes. In the context of the COVID response, however, we came together across departments to create something novel for the public and new to each of us, sharing the mission of operating a safe quarantine and isolation facility.

For the first few weeks a police commander took the lead, to the bemusement of those familiar with OIG’s role in police oversight. But we had an excellent relationship with the commander and were sorry to see him called back to full-time law enforcement duties in late April. At that point, I took over the lead role, alongside a new crop of additional hardworking, dedicated managers who normally supervise the city’s vehicle ticketing and booting operations. We also worked shoulder-to-shoulder (to be precise, six feet apart) with city personnel from the police, fire, fleet, IT, and public health departments, as well as representatives from the Mayor’s Office, a temporary nursing staff, and a team provided by the hotel. Hopefully, the experience helped our city colleagues come to see OIG as not quite so scary.

It was also gratifying for me to work so closely with OIG staff from outside the audit division. Our team included people from the investigations, legal, data analytics, and operations sections; we’d never spent so much time together before. Oddly, during this period of physical separation from the rest of our colleagues (who were working from home), our cross-sectional team worked on a joint project for the first time.

Finally, it was a challenging, but rewarding, professional stretch for the OIG COVID crew to work and communicate with each other across 12-hour shifts—endless thanks to our heroes who volunteered to work nights!—given that our normal work is not shift-based.

Staying Apart

While I’m proud we helped provide a safe isolation location for over 150 people, our facility had the capacity to serve many more. The underutilization of the resource was a source of constant frustration. We were never able to discern the extent to which this was due to the city’s poor advertising of the facility and/or a true lack of demand, but it was clear that the city’s effort to publicize the operation, especially with non-English speaking communities and communities of color, was insufficient. It was shocking to hear how difficult it was for some of our guests to find out about the services we offered, and how their medical care providers didn’t know about the isolation facility and/or encountered great difficulty referring their patients to us.

Further, although city personnel from various departments largely succeeded in coming together to support a joint mission, we still encountered the typical problems of information silos, poor communication, and a vague command structure above us that inhibited prompt decision-making and problem-solving in a situation where the need for such operational nimbleness was particularly acute. I’d hoped that in a crisis, calcified government structures would be dissolved and reconstituted into lean, swift operations—but that was wishful thinking.

Facing New Challenges

Running a startup public health enterprise in a hotel during a pandemic, when I had experience in neither the medical nor hospitality industries—I thought MA meant Master of Arts, but turns out it also means Medical Assistant—gave me renewed respect for the myriad operational challenges auditees face. Here are a few of the issues we encountered:

  • On opening day, we had no processes established, no access to a shared computer network or printer, and no idea how to organize the medical staff or develop their procedures for client care. The first week was a blur of creating and re-creating processes, procedures, and forms. We didn’t stabilize our processes until at least six weeks into the mission.
  •  Clients and medical staff occasionally squabbled over routine things like removing garbage and delivering meals. While we tried to establish clear and easy processes, these operations were new to most of us and the situation itself was stressful for everyone.
  • When clients’ conditions worsened, we had to call 911 for emergency services, often in the middle of the night. We read about four clients dying in a similar facility in New York City and were determined not to let that happen on our watch.
  • Some clients left the hotel, against medical advice, before their isolation period was over. There was nothing we could do in these situations, despite knowing they were abandoning quarantine while still contagious.
  • One client left his room unnoticed and in violation of policy. He went for a walk, then surprised us by reentering through the front lobby. We scrambled to get him safely back to his room. He soon left against medical advice upon learning his mother had died; he was determined to attend her funeral.
  • A small fire in the kitchen set off the smoke alarm, knocking the elevators out of service, and halting all client intake and discharge.
  • A client put something inappropriate in a toilet, causing a plumbing backup and leakage into our operations center.
  • One of our team members fell ill, raising the fear we would all need to quarantine (leaving no one with experience to manage the facility). After a tense time awaiting their COVID test result, we learned to our great relief that it was negative.
  • In the civil unrest following George Floyd’s killing, our transport vans were destroyed (windows broken, tires slashed, and graffitied), stores next to the hotel were smashed and looted, and a nearby business was burned. The police officers who normally escorted our medical staff to their cars at night made the strategic decision not to do so, because protestors were targeting law enforcement and it may have put our staff more at risk to be seen in their company. Fearing that our facility would be looted or firebombed, I developed an emergency evacuation plan with the hotel engineer. I wound up staying on the job for three days and nights, sleeping in my clothes. Ultimately, no harm came to us. But downtown Chicago was cordoned off, a curfew was set, and public transit shut down, making it extremely difficult for our medical and management staff to get to the facility. We had to supply “papers” showing that our personnel had permission to work at the hotel. But even with these extreme measures, some were denied entry at police checkpoints. 

Appreciating the Differences Between Audits and Operations

Handling minor issues (e.g., timecard disputes) and major ones (e.g., nearby looting) renewed my respect for the challenges of providing direct public services. Effective operations often require immediate action—making the best decisions you can based on the information at hand, without the hindsight available in an audit.

It was gratifying to have the authority to take decisive action within the sphere of operations I could control, but intensely frustrating to be at the mercy of the many broader problems outside my control—for example, the need to publicize the program more effectively, to improve communication with hospitals, and to streamline the intake process. I could envision an eventual audit (which I can’t participate in, because my independence is impaired), published a year or two from now, noting what the city should have done to bring more clients to our facility. Such an audit will take time and cost money. But there I was, in the moment—not the typical vantage point for an auditor accustomed to post hoc analysis—lacking the power to take corrective action. Addressing problems and inefficiencies as they arose would have been so much more effective than waiting for an audit to point them out and offer recommendations for future operations.

Keeping A Healthy Perspective During an Unhealthy Time

As auditors, we are trained to empathize with our auditees and put ourselves in their shoes. This enables us to write achievable recommendations and provide persuasive calls to action. But running a direct service operation during a crisis—actually stepping into the shoes of a front-line worker—made it real for me. Participating in Chicago’s COVID response mission by helping manage an isolation facility disqualified me from participating in a future audit of the service. That sacrifice, though, was well worth the perspective I gained, and the individuals we helped in a time of crisis.

About the Author

Lise Valentine has been Deputy Inspector General for Audit and Program Review at the City of Chicago Office of Inspector General since 2011. Although she holds a Ph.D. in Communication Studies, Dr. Valentine has no medical experience.