Report Highlights
What We Found
The county implemented two recommendations, is in the process of implementing another four recommendations, and did not implement one recommendation.
What the Statuses Mean
- Implemented – Auditee has fully implemented the recommendation, or auditee has resolved the issue to meet the recommendation’s intent.
- In Process – Auditee has started implementation on the recommendation.
- Not Implemented – Auditee has not implemented, or does not intend to implement, the recommendation.
Why We Did This Evaluation
The Auditor’s Office follows up on audit recommendations to support county government’s accountability. This evaluation focused on recommendations with the following deadlines:
- October 1, 2022
- January 1, 2023
- July 1, 2023
Additional Context
The Auditor’s Office is following up on programs that operated during the COVID-19 global pandemic. The COVID-19 contact tracing and wraparound service programs no longer exist. When following up, we considered what happened while the programs were still operating. We also considered actions that were taken after the programs ended but could improve contract monitoring and emergency readiness moving forward.
Status of Recommendations
Implemented
Recommendation #3: We recommend that the Health Department work with the Department of County Human Services to develop a plan to evaluate the efficacy and timeliness of wraparound services and assess the current data collection and information sharing system under that lens by January 1, 2023.
Auditor’s note: The Program Design and Evaluation Unit, an inter-agency unit that serves the Multnomah County Health Department and the Oregon Health Authority, conducted an evaluation of wraparound services. The Health Department provided us with a copy of the evaluation report.
Recommendation #7: We recommend that the Chief Operating Officer work with department leadership, including the Health Department Director, Human Resources, Risk Management, and Emergency Management to evaluate and revise or add to general county trainings to ensure they set expectations for working during emergencies and can be available on demand by July 1, 2023.
Auditor’s note: A county team developed a training guide for county employees working in disaster resource centers, with trainings available on demand. However, that is just one way that county employees may work outside of their usual duties during emergencies. County leadership has also added information about working during emergencies to the new employee orientation, which all new employees are expected to take.
In Process
Recommendation #1: We recommend that the Health Department work with the Department of County Human Services to provide education and technical support to partner organizations around county contracts, reporting requirements, and county expectations around data collection, monitoring, and service provision by October 1, 2022.
Auditor’s note: The Health Department has taken several steps to provide education and technical support to partners. The Public Health Division provided us with notes from meetings with partner organizations that sometimes included topics related to contracting and funding. One meeting, in November 2023, specifically focused on data. Additionally, the Health Department, in collaboration with Central Finance, hosted a workshop in May 2023 for prospective partner organizations on the topic of county purchasing.
However, these actions appear ad hoc. Additionally, actions could be better targeted to the issues identified in the audit, such as unclear and uncoordinated data collection and monitoring. Therefore, we are considering this recommendation in process and encourage the Health Department to further develop processes to proactively and routinely offer targeted support to partner organizations moving forward.
Recommendation #4: We recommend that the Health Department work with the Department of County Human Services to document lessons-learned and incorporate into planning documents, including lessons-learned identified in this report by January 1, 2023.
Auditor’s note: The Health Department participated in the development of an After Action Report that was led by Emergency Management. The report has not yet been released. Therefore, we are considering this recommendation in process.
Recommendation #5: We recommend that the Health Department, including Community Partnerships and Capacity Building in Public Health, work with county Organization Learning to create a mechanism, such as a community of practice, for staff across the county who work with community partners and community-based organizations to network, collaborate, and develop professionally by July 1, 2023.
Auditor’s note: A new community of practice is in the early stages of development, with a kick off meeting held in September 2023.
Recommendation #6: We recommend that the Chief Operating Officer work with department leadership, including the Health Department Director, Human Resources, Risk Management, and Emergency Management to identify barriers and establish processes for redeploying county experts to programs in need during emergencies by July 1, 2023.
This could include exploring changes to labor contract language or a county policy for all employees to be disaster workers, and identifying a strategic range of cross-county participants, like Health and HR, to include in emergency preparedness activities.
Auditor’s note: The county has taken several steps to improve readiness for county workers to be reassigned during disasters. Human Resources has added language to job descriptions stating that employees may be reassigned during emergencies. County staff added information to the county’s intranet site about working in a disaster resource center (for example, working in a shelter during severe weather).
The county also piloted a program to offer a 20% pay premium to encourage workers to volunteer for shelter shifts in severe weather. A human resources manager led an evaluation of that program. They identified barriers to staffing severe weather shelters in the evaluation report. The Chief Operating Officer told us that the recommendations from that evaluation report will be incorporated into future labor contracts.
However, the intent of the recommendation was focused more on reassigning county administrative experts - such as human resources, contracting, and finance professionals - than on general staffing for severe weather shelters. In our audit we found that Health Department human resources staff were overworked during the pandemic and the county lacked processes to reassign county experts across departments. The Chief Operating Officer shared information with us about process changes for experts to voluntarily fill emergency shifts. However, we are concerned about how this will apply in a long-term emergency.
We acknowledge the significant work that has been done to improve disaster response. However, some steps, such as negotiating new labor agreements, are still in process and additional work may be needed to address the issues in the audit. Therefore we have determined that this recommendation is still in process.
Not Implemented
Recommendation #2: We recommend that the Health Department work with the Department of County Human Services to monitor whether contracted partners adhere to monthly reporting requirements and create a plan of action for when they do not by October 1, 2022.
Auditor’s note: Public Health has developed a spreadsheet to help track contract reporting moving forward. However, we did not receive evidence that additional monitoring or action planning occurred with contracted partners for COVID-19 services or has started yet with new contracts.
Objectives, Scope, & Methodology
The objectives of this evaluation were to determine the status of recommendations from Pandemic Response Audit: Contact Tracing that had the following due dates:
- October 1, 2022
- January 1, 2023
- July 1, 2023
Auditors evaluated the status of recommendations based on interviews, documentation, and other available evidence.
Updating the Status of a Recommendation
During each audit our office conducts, we develop recommendations intended to improve government operations, particularly with regard to effectiveness, transparency, accountability, and equity. Our goal for evaluating the status of recommendations is to help ensure management implements these recommendations for improvement.
We recognize that after we publish an evaluation on the status of recommendations, management may fully implement a recommendation that we reported was in process or not implemented. Management can then provide evidence to the Auditor demonstrating why the recommendation’s status should be changed in the Auditor’s future reporting. The final decision on whether to change any recommendation’s status rests with the Auditor.
Staff
Caroline Zavitkovski, CIA, MPA, Audit Director
