Chris Keeley and his chief of staff, Sarah Liston, reflect on their experiences in NYC Test & Trace Corps, the organisation created in 2020 by New York City to respond to COVID-19.
Sarah: New York’s first COVID-19 case was identified on 1 March 2020. By 29 March, over 30,000 cases had been confirmed and by 6 April New York City had nearly 25% of the total deaths from COVID-19 in the U.S. Healthcare workers were trying to keep up with the endless demand that this new virus inflicted on our hospitals and on their own physical and mental health. What were you doing during this time?
Chris: I was an operational leader at NYC Health & Hospitals, which is the largest municipal healthcare system in the United States. In early March 2020 I was asked to help build a telephone hotline that would allow hundreds of medical providers to support New Yorkers concerned about, exposed to, or infected by COVID. The hotline fielded tens of thousands of calls and helped relieve some of the pressure on the already overflowing emergency departments. By later in the month, the ICUs and hospitals remained strained and we needed additional staff capacity. I worked with partners in other New York City agencies, with the U.S. Department of Defense, and countless volunteer and staffing agencies to cultivate a clinical workforce that could come into the ICUs at our 11 hospitals. It quickly became clear that the pre- existing volunteer structure and provider credentialing process was not built for a system-level, region-wide crush, such as we experienced in the first wave of COVID in NYC.
Sarah: I remember how so many healthcare workers from all around the country were coming to New York at that time. Did they all have to go through that provider credentialing process?
Chris: Any medical providers working at any of our 11 hospitals went through that process, yes. We needed to know they were qualified medical providers before allowing them to care for patients. We built an entirely new process and an online tool that would take our 6–9 month credentialing process down to 96 hours. We very quickly streamlined the process even further and got it down to within 24 hours. That meant we could tell a volunteer doctor in California to get on the plane that day and that we’d have them cleared to serve patients the next day.
Sarah: What was the day-to-day team leading experience like during that time?
Chris: We’d need to work with a large team of internal and external partners to get it right. Each day I would share with my immediate team the number of staff and number of staff hours that we directly made available on the frontlines of the COVID fight based on the previous day’s work. For example, I’d tell them we’d cleared 250 providers the day before and each provider will work 12-hour shifts for the next 7 days. That meant our work that one day made possible 21,000 clinic hours in the ICU that week and that we’d need to do the same today and the next day and the day after that. I’d ask someone from the team to spend a few minutes to informally model how many patients those providers might serve during those 21,000 hours so that they could share that impact with the team the next day. The team stayed motivated, focused, and effective despite needing to work 16–20 hour days every day for well over a month.
Sarah: What is one of the things you are most proud of about that effort?
Chris: I was most pleased to see that when I needed to transition into Test & Trace to help build out the contact tracing and COVID testing infrastructure that I could step back from the surge staffing work with confidence that the process and team could—and did—sustain it without me. It’s two years later and that same process is still effectively used today for our testing sites and elsewhere.
Sarah: In his Chief of Staff piece from January 2022, Rob Dickins writes ‘the initial and most common question has often been “What does a chief of staff do?”’ Before you started your first chief of staff position, did you know what a chief of staff did?
Chris: Like a lot of people my age and older, you think of a chief of staff and you see Leo and Josh from the West Wing. You know… the walk-and-talk, making million- or billion-dollar decisions with limited information, intense loyalty to the mission, and keeping the principal from getting bogged down in the interpersonal nonsense that can be unavoidable in a large organisation. And being quick witted seemed to be a requirement, at least in those Sorkin versions of the role.
Sarah: After you had been in the position for a while, how did your expectations match up with the reality of the role?
Chris: For me, one of the biggest differences was coming to recognise that it’s all about communications among the team and managing without authority. You can manage on behalf of the principal and say ‘do this because the boss said so and I’m here to make sure you don’t mess it up’ or you can say ‘let’s figure this out together’. I’ve found that collaborative approach to be the more effective 100% of the time. Keith Ferrazzi’s recent book Leading Without Authority articulated this idea well. He articulates it with lots more dimension than that so I don’t want to sell it short, but I imagine his idea of co-elevation as someone intentionally putting on blinders to the table of organisation. That you work with who you need to, and find a way to make it happen, regardless of title or ‘small p’ politics.
Sarah: You have worked as a chief of staff in many capacities, which, having never held that position until working for you now, I am glad I didn’t know until very recently because I would have been super intimidated.
Chris: I thought you crushed it as chief of staff for the City’s contact tracing programme. From what I saw, it helped in your role that you had been with the programme from the start and had served as a frontline contact tracer. Is that accurate?
Sarah: My experience on the front lines as a contact tracer profoundly shaped my work as chief of staff. It’s been said you don’t have to know how to hold a broom to tell if the floor is clean. But I say, it sure doesn’t hurt. Knowing first-hand how contact tracers executed their mission and the challenges they faced, was invaluable to my work addressing bigger-picture issues as chief of staff. Also, as a contact tracer, I saw the positive impact of Trace’s work call-by-call in real-time. That kept me energised and passionate when I had the opportunity to serve our mission at a higher level.
Above all, speaking with thousands of fellow New Yorkers who either had COVID or had been exposed to it is about as real as it gets when it comes to learning, practising, and honing two skills that I think are indispensable in any leadership role, especially for a chief of staff: empathy and active listening. In addition to contact tracing and offering crucial resources like free at-home meal delivery and the option to stay at one of our quarantine hotels at no cost, many of those calls evolved from their initial purpose into conversations about fear, loneliness, and uncertainty about what to do next. Learning to, metaphorically-speaking, meet the person where they are, listen and understand what they are saying—both explicitly and implicitly — and to provide genuine support and reassurance with referrals and actions made for the most successful calls. I found myself constantly drawing on that experience in my role as chief of staff because so much of the role is about communicating, listening, connecting, collaborating, and supporting.
Chris: What were some of the challenges of stepping into a chief of staff role for the first time?
Sarah: The biggest challenge was simply my own self-doubt. I had never served as a chief of staff before and I thought that would be a real obstacle. My resume did not have all the bells and whistles, whether educational or in terms of work experience, that one might expect to see in a traditional candidate’s background. But as I quickly learned, much to my surprise and relief, many of the seemingly unrelated things that I have done in my career provided skills and experience that set me up well for the job. My background—which runs the gamut from spokesperson for a District Attorney to owner of a vintage clothing boutique to event planning and producing cabaret shows—was a great fit. Each of those things involved skills that are integral to the role of chief of staff: managing lots of moving parts, juggling competing urgencies, working with various personalities, keeping an eye on the whole while tending to the fine details, thinking strategically, staying agile and being ready to quickly pivot to plan B (or C), making stuff happen, and (my personal favourite) navigating ambiguity—which would be a fun topic to explore with you in a future conversation.
In his article, Dickins discusses three potential ‘orientations’ of a chief of staff: orienting your focus towards the principal, orienting it towards the leadership team, and orienting it towards the organisation often like a COO would. Which of those orientations appealed to you the most and why?
Chris: The three orientations Dickins laid out rung pretty true to me. In my prior roles I oriented myself toward the leadership team and the organisation, with less emphasis on the principal. I see the value in the principal orientation, but I don’t think it’s what makes me happy or where I excel. In this organisation, I’m actually the COO, but I still found myself constantly acting like a chief of staff. I’ve been responsible for building out and managing our community and school testing programmes, mass vaccination, and at-home vaccine programmes, supply chain and logistics, administration, and at times our outreach teams and more. I’m realising now as I have time to reflect on it more intentionally, that while those teams all reported to me, I think I managed them as though they didn’t. I managed them, I think—though we’d need to ask them if this is true—as though they were independent teams and I was helping those team leaders craft their own way in collaboration with their individual teams. There were definitely moments where I had to make an executive decision and move us forward, but largely I was keeping a safe but watchful distance and supporting them to manage their own teams. I think I was acting in some ways less like a chief operating officer and more like a chief of staff that was coaching and supporting a manager that reported up elsewhere.
How about you? Do you see your role at Test & Trace reflected in one of those three orientations?
Sarah: I do. It’s a hybrid between serving the leadership team and the organisation and seems to be in line with what you said your focus has been in your prior roles. I suspect that, like you, I find more joy in orienting myself toward the collective rather than the principal. I have not yet been a chief of staff in a principal-oriented setting, and perhaps I would like it. But I have so enjoyed the coming together and ‘worlds collide’ collective that exists at Test & Trace that I can’t imagine giving up that bird’s eye view and the ability to move across departments connecting the dots. Kind of feels like a super power – not in the traditional sense of being ‘powerful’, but finally being able to fly freely in a professional sense rather than being anchored down or boxed in.
Test & Trace had a number of chiefs of staff in different areas of the organisation. How do those roles fit into the organisational structure?
Chris: We’ve been a chief of staff rich environment, haven’t we? We had one for the Deputy Executive Director, one for the Director of Trace, I was a former chief of staff, and our former deputy executive director and one of our primary partners from City Hall were both former chiefs of staff at major agencies in the federal government. In addition to that, some of our major programmes reporting to me, like the school testing programme and our data and analytics vertical, have their own chiefs of staff. Considering we had probably 7,000 employees and a very sizable budget, it makes sense we needed more than one! I think each of those people that served as chiefs of staff in Test & Trace, along with those who were former chiefs of staff, were each effective in their own way, but they all shared those core chief of staff instincts—to overcommunicate, to identify gaps that we’d need to manage toward or work around, and to place a heavy emphasis on team morale.
Sarah: When you spoke earlier about leading the effort to quickly get much-needed healthcare workers on the frontlines in NYC’s COVID response, you talked about using data to quantify success. Dickins has written about the challenges of measuring the success of a chief of staff because the nature of the role doesn’t allow for the same concrete, ‘metrics-oriented’ goal posts. How do you quantify the success of a chief of staff?
Chris: I think there’s two metrics. First, whether the team as a whole is accomplishing the goals they’re assigned to accomplish. Second, whether they’re positioning the team to fight the next fight. In a sports setting, the chief of staff would be the field captain. I’d look to see if the team is executing on the field the way they need to, making smart adjustments as the game develops.
And then I’d look at feeling of the team between gamedays, between scrums. The chief of staff needs to keep the comradery and the morale high. They need to make sure everyone has the opportunity to voice their concerns and have them addressed. They also need to address toxins head-on in a way that keeps them from infecting the team. My metrics for a chief of staff are measured by whether the team is advancing strategically and team-building as they do it.
Your data question reminds me of one of our colleagues who was a former chief of staff. She managed inter-agency work around the vaccine rollout in New York and she would hold standing meetings to review detailed data to be sure were we getting vaccine out to New Yorkers throughout the City and to manage the team, but she also consistently used the venue to do intentional team-building. She’d have someone from the Health Department do ‘vaccine trivia’ once a week to educate everyone about vaccines and vaccine hesitancy over the centuries. It was super interesting and a great way to have everyone contextualise their day- to-day work beyond COVID. And then she’d end every meeting with what became the mantra ‘Vaccines are joyful’, which I always loved. On stressful days it would sometimes become ‘vaccines are [bleeping] joyful’ which would reflect the team’s frustrations in a given moment, while keeping the drumbeat going. It was a great reminder that no matter how hard the moment was, we were doing something that was saving lives, that would get our city through the pandemic, and that while the tactical work can be hard, in the grand scheme it was and it should be downright joyful. That type of on-the-field, real-time morale boosting and team building, to me, is what a good leader and a good chief of staff does.
You mentioned you were glad you didn’t know I’d been a chief of staff before. What was it like being chief of staff for someone that had been one themselves? And being chief of staff in such an emergency-type setting?
Sarah: I can totally see how your chief of staff experiences have heavily influenced the way you lead. As you described your leadership style earlier—stepping back to allow the space for team leaders to craft their own way—that explains why you never once said to me, ‘When I was a chief of staff, I did it this way.’ Looking back, I really appreciate that because I feel it gave me a safe space to grow and learn on my own instead of constantly thinking ‘how did Chris do this or that when he was a chief of staff?’ I think the invisible hand has so much more positive power than the heavy hand. And the role of chief of staff always makes me think of an invisible hand – and Josh and Leo from West Wing too!
In terms of being a chief of staff in a public health emergency setting, I found it exhilarating to be able to act and give back during what often felt like such a helpless time. I have always been drawn to public service, but I have never felt such a sense of purpose and accomplishment in a professional setting as I did as Trace Chief of Staff. One of the many reasons that I felt such a sense of purpose and accomplishment is because you fostered a such collaborative work environment. The culture at Test & Trace welcomed new connections and encouraged everyone to voice their ideas, thoughts, and opinions —including in group forums with senior leadership. That surprised me a bit when I first started and really buoyed my sense of belonging to (what will go down in the books as) an historic, life-saving mission.
Chris Keeley is Chief Operating Officer, Deputy Executive Director, and Acting Director of Contact Tracing
Sarah Liston is Chief of Staff to Chris in his role as Acting Director of Trace. She started as a contact tracer in July 2020 before transitioning to serve as a chief of staff for the first time in September 2021.
NYC Test & Trace Corps is a partnership between NYC Health + Hospitals, NYC Department of Health and Mental Hygiene, other city agencies, and community-based organisations. As of May 2022, NYC Test & Trace Corps performed over 11 million tests, engaged more than 2 million New Yorkers in contact tracing, administered 1 million vaccines, and provided critical support services such as home food delivery and quarantine hotel services. All of its services have been made available to all New Yorkers regardless of income, gender identity, immigration status, insurance status or ability to pay.
References
- Coronavirus in N.Y.: Manhattan Woman Is First Confirmed Case in State. Goldstein, Joseph; McKinley, Jesse (March 1, 2020). The New York Times. p. A24. ISSN 0362-4331. https://www.nytimes.com/2020/03/01/ nyregion/new-york-coronvirus-confirmed.html
- Rapid Spread of COVID-19 in New York and the Response of the Community. Taro Kariya.
- Glob Health Med. 2020 Apr 30; 2(2): 123-126. doi: 10.35772/ghm.2020.01032. Epub 2020 Apr 30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731099/
- No Time to Be Lax: Cuomo Extends New York Shutdown, NJ Deaths Top 1,000. NBC. April 6, 2020. Archived from the original on June 4, 2020. Retrieved April 12, 2020. https://www.nbcnewyork.com/news/local/our-9-11- moment-new-york-braces-as-nations-top-doctor-warns-saddest-week-ahead/2361336/
- A Phone Call Away: New York’s Hotline And Public Health In The Rapidly Changing COVID-19 Pandemic. Ross Kristal, Madden Rowell, Marielle Kress, Chris Keeley, Hannah Jackson, Katherine Piwnica-Worms, Lisa Hendricks, Theodore G Long, Andrew B Wallach Health Aff (Millwood). 2020 Aug;39(8):1431-1436. doi: 10.1377/ hlthaff.2020.00902. Epub 2020 Jun 11.
- Staffing Up For The Surge: Expanding The New York City Public Hospital Workforce During The COVID-19 Pandemic. Health Aff (Millwood). 2020 Aug;39(8):1426-1430. doi: 10.1377/hlthaff.2020.00904. Epub 2020 Jun 11.
- Rob Dickins, Vice President & Chief of Staff to the CEO of Autodesk, explores different methods for assessing the value of a chief of staff. January 5, 2022. The Chief of Staff. www.csa.org/journal/measuring-the-value-of-a- chief-of-staff.