University Hospital CEO Shereef Elnahal, MD shares his takeaways from a recent U.S. Senate Committee hearing about the national supply chain, University Hospital's pandemic response, and the Newark-based hospital's efforts to get its Black and Brown communities vaccinated.
The COVID-19 pandemic presented the provider sector with a plethora of challenges and learning opportunities, including the importance of maintaining a robust supply chain. Hospitals and health systems faced shortages of critical supplies while trying to navigate caring for patients who had contracted the novel coronavirus.
In mid-May, the U.S. Senate Committee on Homeland Security and Governmental Affairs held a hearing to address the medical supply chain and what changes are needed to successfully operate during the next pandemic or health crisis.
Among those who testified before members of the Committee was Shereef Elnahal, MD, CEO of University Hospital, New Jersey's only public hospital. In his testimony, Elnahal described what the Newark-based hospital experienced during the COVID-19 pandemic, including facing shortages of critical supplies such as PPE and medication.
"As the number of COVID cases in our emergency rooms and intensive care units doubled, tripled, and quadrupled, we found ourselves at risk of running out of supplies for which we have never seen shortages before," Elnahal said during the hearing. "This includes protective equipment for our staff and ventilators for the patients with the most severe cases of COVID-19."
Shereef Elnahal, MD, CEO, University Hospital. Photo courtesy of University Hospital.
Prior to his role at University Hospital, Elnahal served as Commissioner of the New Jersey Department of Health and as a White House Fellow to the Secretary of Veterans Affairs during the Obama administration. Following the hearing, Elnahal spoke with HealthLeaders about his takeaways from the hearing, University Hospital's pandemic response, and the hospital's efforts to get its Black and Brown communities vaccinated.
This transcript has been edited for clarity and brevity.
HealthLeaders: What are your biggest takeaways from the hearing?
Shereef Elnahal: [The hearing] was a productive bipartisan inquiry into what we can do to better shore up the supply chain in the event of a pandemic. It's a bright spot in the overall environment in Washington right now, the fact that leaders from both parties in Congress want to come to solutions on this issue because nobody wants a repeat of what we saw last year.
To not have the essential supplies and medications to care for patients in the most desperate of times in the richest country on Earth is a problem that we just cannot ignore. There was agreement on that and a broad consensus that we need to find solutions.
I learned a lot about how the domestic manufacturing capacity for PPE was not adequate, to begin with, and over time, there has been offshoring of too many of these assets and productive capacity. I had the front-line view of that last year when we were on the phone with suppliers, mostly abroad, who were telling us “No" because they had nationalized their supply chain for their own pandemic response.
To boot, we received shipments from suppliers from abroad that were defective equipment, and essentially examples of fraud. We did the best that we could in real-time to vet some of the suppliers, and even after all our exhaustive efforts, some shipments slipped through the cracks that were simply not acceptable for patient care.
HL: What steps are required to ensure the supply chain is ready for the next pandemic?
Elnahal: Making sure that the Defense Production Act is ready to deploy in the event of a public health crisis. The Biden administration is making significant strides in that.
[There are] representatives from the textile industry who are reorienting their operations at the request of the federal government, who are saying that they're happy to help in this, but we need to make sure that textile manufacturers are protected in this country.
[Implementing] incentives for domestic manufacturing of critical drugs. We were days away from running out of some critical medications that we've never seen depleted before, including basic drugs like fentanyl and propofol that keep people sedated on a ventilator. It's an unacceptable outcome to have people wake up while they have a breathing tube down their throat.
Finally, having more of these suppliers domestically will improve oversight and add another layer of protection against fraud, not to mention the benefits on American jobs, and building the productive capacity of the future.
All the policies to achieve those ends will be determined by folks who are experts on these issues. I was [at the hearing] to highlight our experience as an end-user and purchaser of these critical items on behalf of our patients and our community, and I was grateful to provide our perspective.
I made sure that I emphasized that the safety net institutions in this country who care for the most vulnerable and tended to care for higher proportions of minority residents, were the ones that were worst off. Whether it was us here in Newark, or critical access hospitals that treat Native Americans and other groups across the country, we were facing the worst situation when it came to the supply chain because we just don't have the purchasing power to exert leverage on suppliers in times of crisis unless their supplies are shored up with effective policy.
All those dynamics point to the worst situation for standalone hospitals and safety-net hospitals when it comes to this issue around the supply chain. Making sure that the strategic national stockpile is enhanced and produces what's needed for standalone and safety institutions as a first stopgap, and also reforms that make these supplies more available, will help us make sure we have the critical items we need in the next crisis.
HL: During the hearing, you spoke about how University Hospital handled 83,122 emergency department visitors, 15,572 inpatient admissions, and 199,804 outpatient clinic visits. Can you further describe what the pandemic looked like at University Hospital?
Elnahal: Within days in early March of last year, we saw the number of patients with COVID-19 increase exponentially in our hospital. By the time April rolled around, we were getting between 20 and 30 admissions per night almost exclusively for COVID-19. We had patients with a disease that we knew little about.
This is not an academic issue for us; this is a lived experience of what it's like to proceed through a crisis like this. You couldn't help but notice that in our hospital almost every patient in our rooms was a person of color. It's not just the public health emergency, it's the glaring health equity issues that stem from generations of systemic racism that have created disparities and chronic disease, which make folks in this community more susceptible to COVID-19.
These reforms, if they're enacted at the federal level, will help us meet better equity goals and care for Black and Brown communities more effectively.
HL: How has the pandemic affected your leadership style?
Elnahal: Crisis leadership became my entire agenda last year. That involves excessive communication. You can never under-communicate during a crisis, and you can never under-communicate the truth during a crisis.
We had town halls every week with staff where I would tell them the good and bad news about our supplies and imparted everything we were doing to try to fix that issue. We also had daily e-mails updating folks of things and we had [smaller] forums of people when needed to address issues.
Finally, to not explicitly recognize and mourn for folks who died during this pandemic on our workforce would have been a giant mistake, and I recognized that from the beginning. So, we didn't hide the fact that folks were dying from COVID-19 in our hospital. We were transparent about that and mourned collectively with their colleagues on the frontline. That brought us together in solidarity.
HL: How has University Hospital worked to get over 20,000 people in the community vaccinated, including those who are underserved or who are hesitant?
Elnahal: We vaccinated the first person in New Jersey outside of a clinical trial. We also conducted a Moderna vaccine trial here on our campus and was one of the few hospitals across the country serving a community predominantly of color.
Enrolling people of color in the trials was essential. There's a lot of hesitancy that's well-rooted in the history of systemic racism and racism at the hands of the medical establishment, and also concerns around the current experiences of folks who experience implicit bias at the point of care. We knew there were going to be hurdles and a long way to go to earn the trust of the community, but we approached the community humbly starting around the time that we launched the trial, and that prepared us to get going the vaccination.
As a hospital, we've vaccinated more people than any other hospital in Newark, and we are rerouting our vaccination strategy to move away from our campus and more into the community. [We're] not only doing town halls, talking about the vaccine and why folks should try to accept it but also addressing the most critical barrier now which is access. We now have three mobile vans that we plan to deploy here and elsewhere, to get closer to where people are. We're also conducting walk-in clinics to reduce the barriers upfront to folks who are ready to be vaccinated. Making it as easy as possible is a public health imperative, and we've taken that seriously.
“To not have the essential supplies and medications to care for patients in the most desperate of times in the richest country on Earth is a problem that we just cannot ignore.”
— Shereef Elnahal, MD, CEO, University Hospital
Melanie Blackman is the strategy editor at HealthLeaders, an HCPro brand.
Photo credit: Newark, New Jersey skyline