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The workload of the Communicable Disease and Epidemiology (CD-Epi) program of Public Health’s Prevention Division varies as disease events occur and subside. However, the increasing frequency and complexity of disease events and response needs from 2014 to 2017—such as Zika, mumps, and infections acquired at hospitals—has strained CD-Epi staff and reduced time available for services that protect public health. Division leaders have not updated the strategic direction on work priorities for staff to reflect this higher workload, contributing to declining staff morale. CD-Epi has brought on temporary staff help using various staffing strategies, but inefficient hiring and training processes have reduced the impact of these efforts. We make recommendations to improve workload prioritization, staffing, and onboarding processes.

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CD-Epi plays a critical role in protecting public health at the community level. Its staff work to prevent and control the spread of communicable diseases through investigations, analysis, immunizations, and education and outreach for the public and private entities. CD-Epi is funded by the Public Health Fund, which could experience a shortfall in the 2019-2020 budget. With budget challenges and potential consequences of uncontrolled disease outbreaks, it is important that CD-Epi find ways to manage and prioritize its work during outbreak events.

The Communicable Disease and Epidemiology (CD-Epi) program of Public Health’s Prevention Division experienced an increase in disease response needs from 2014 to 2017, which affected the agency’s ability to complete its workload. In particular, staff, managers, and leaders have set aside prevention and supervisory activities to prioritize controlling the spread of diseases. Division leaders have started strategic planning, but their efforts may not include an assessment of priority activities in light of recent disease response increases. The lack of updated direction from management may contribute to unrealistic workload expectations, which negatively affect morale. Additionally, a lack of clear communication about overtime policies and expectations by division management may have led to unreported staff hours and inefficient use of overtime, creating legal risk for the county.

CD-Epi relies on temporary staff and volunteers when disease response needs exceed available resources. However, its staffing options do not consistently provide the readily available and effective temporary workforce needed for rapid disease response work, which can delay tasks and add to existing staff’s workload. The program has not analyzed its staff resources and options for bringing on temporary staff to find the most efficient strategy to handle periods of heavy workload.

To better align the Prevention Division’s workload with its resources and address impacts to its staff, we recommend the division review workload priorities and collect better information about staff time and disease response cost. We also recommend updating and clarifying overtime authorization and reporting procedures. Lastly, we recommend improvements to several of the division’s current staffing and onboarding processes to enhance the ability of new employees and volunteers to start disease response work more quickly.

Reports related to this audit

Follow up work is in progress. A report will be available as soon as it is complete.


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November 5, 1996
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Audit team

Elise Garvey, Laina Poon, Kayvon Zadeh, and Brooke Leary conducted this audit. If you have any questions or would like more information, please call the King County Auditor's Office at 206-477-1033 or contact us by email