‘How could we make Hackensack Meridian more efficient?’

New Jersey has been one of the states hardest hit by COVID-19. At Hackensack Meridian Health, system leaders have embarked on a process to act on lessons learned as they

Robert Garrett gird for a second wave. CEO says they’ve also started to rethink how the system should be structured once the pandemic ends. Garrett spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.

MH: New Jersey was hit hard in the pandemic’s early stages. Where do things stand now for Hackensack Meridian?

Garrett: We were the early epicenter of this pandemic. We’ve treated about 10,000 COVID patients in our network, which is an incredible, astonishing number. At the peak, which was April 13 for our health network, we were at about 3,000 COVID-19 patients. (As of two weeks ago), we’re under 70 patients through 17 hospitals and over 10 or 11 long-term care facilities.

A lot of credit goes to our healthcare workers, to our team members, but also to the state of New Jersey as well in terms of how they’ve managed this. People have been social distancing. They’ve been masking. We’ve been outspoken about those issues as public advocates.

MH:

You touched on masking. It has become so politicized. How did you talk about it with your community?

Garrett: I did an op-ed about the benefits of masking. And I said it shouldn’t be political. There should be no question—it not only has been proven to prevent the spread of the virus, but actually even when particles of the virus have gotten through the mask, the cases we’ve seen have been less (severe) because it blocks many of the particles. So people aren’t getting as sick as they would have gotten if it wasn’t for the mask.

We’ve also been on the airwaves. We’ve done public service announcements. We’ve been educating our team members. We have weekly virtual town hall meetings. We’ve had webinars and we try to bring evidence-based data to the table, but there’s no question that masking has been a really effective tool. Hackensack Meridian was the first health network in the entire region to require universal masking for our team members, for our physicians, as well as our patients. And even after visitors returned, they were masked from the very beginning.

MH: Talk about the playbook you’re developing for COVID 2.0. What is it?

Garrett: What we’ve done is document a lot of lessons learned. We have over 30 chapters that have been completed. And those are things such as emergency preparedness, how to increase capacity on very short notice. During the height of the COVID crisis our flagship hospital, Hackensack University Medical Center, within a just a couple of days, had to take its entire cafeteria space and convert it into a 72-bed COVID unit in days. So capacity was a lesson learned in terms of what needed to be done. And so we’re putting plans in to be prepared for COVID 2.0.

Also staffing was a big issue. If you’re going to increase capacity, we need to source staffing. And … certainly supplies and (personal protective equipment)—a lot of lessons learned there, what worked, what didn’t work. We literally had to source PPE around the globe, and what we’re learning now is No. 1, we’re able to stockpile for a potential 2.0. We have close to 90 days worth of PPE. We’re trying to build that up to 180 days by the fall. We’re trying to form new partnerships to be sure that we can get domestic sources of PPE in the future.

We also have a chapter about testing and how to ramp up our capacity. We’re entering into a privatepublic partnership with the state of New Jersey. There are some federal funds each state has received to expand testing. And in New Jersey, they felt the way to go was to partner with hospitals and health systems because we have laboratory facilities. And if we can put additional equipment in to be able to ramp up testing, it’s probably going to be an effective way to be able to treat COVID if there is another surge.

MH: Have you had problems with reagents and being able to get some of that into your facilities?

Garrett: It has been a problem on and off. But we have partnerships with some of the commercial laboratories; we’ve also developed our own internal tests, which really proved to be a game-changer early in the pandemic. It’s a rapid test developed by our Center for Discovery and Innovation. It took the best of two worlds—the best of the (Centers for Disease Control and Prevention) tests and the best of the World Health Organization tests and put it together. In the early days of the pandemic, there wasn’t much testing capacity at all from the commercial laboratories. We were able to test patients and get results back within hours.

MH: With PPE, physician practices and others say they’re still struggling with supplies. How do you balance your need to be ready for a second wave versus shortages for other providers?

Garrett: We were the recipient of ventilators and PPE early on in the crisis from other parts of the nation. We are reciprocating as well … our colleagues out there, particularly with some of the newer hot spot states that need our help.

MH: Hackensack is not unique in this situation, but there have been concerns from front-line staff that they aren’t getting the protection they need, especially staff who contracted the virus. How do you address that in the playbook you are developing?

Garrett: The biggest difference going forward is that I don’t believe there’ll be as many changes in terms of the CDC guidelines. Literally, as we were in the midst of this crisis, sometimes those guidelines would change two, three, four times a day. It was very difficult in terms of what (PPE) was appropriate to reuse, what was not appropriate to use. The guidelines have become more standardized now and there’s a growing consensus as to how PPE should be used.

I can’t say enough about our front-line caregivers. I (attended two events on Aug. 20), which is Remembrance Day at Hackensack Meridian Health. Sadly, we lost 21 team members to COVID-19 during this pandemic.

We haven’t had an opportunity to really grieve because we’re still in the midst of this pandemic. We thought it was important to celebrate the lives of those that we lost, and to make sure that we never forget their contributions. But I have to tell you, there isn’t a meeting that goes by, there’s not a day that goes by that we’re not concerned with and putting our team members first in terms of their protection. And of course our patients’ protection too.

We’ll have a much more balanced and steady state going forward, as far as the guidance on PPE. And also, with somewhat of a lull that we’re seeing now, it gives us a chance to catch our breath and to do that stockpiling so that we won’t have to scramble and literally wait for a shipment of face masks to come in from China or somewhere else overseas.

MH: One setting that continues to be challenging is nursing homes. Can you talk a little bit about what you’re doing there? You made some additional hires, right?

Garrett: One of the things that we did was convert our nursing homes into community hospitals, if you will. We beefed up the staff significantly. We had many more clinicians. We had infection control specialists who were rounding. We separated patients wherever possible. We started testing our residents and our staff. If you’re nonsymptomatic, you are tested once a week, whether you’re a team member, a physician or a resident of the long-term care facility. And of course, if you are symptomatic, you are quarantined and tested repeatedly.

MH: Pivoting to the financial impact COVID has had on the industry, how are you recalibrating not just for the end of 2020, but going into 2021?

Garrett: In terms of financial recovery, our strategy has been threefold. No. 1, we’ve focused on the CARES Act and the monies that were approved by Congress to be sure that we would get our fair share, because we were hit very hard.

The second piece is the fact that we wanted to assure the public that it was safe to come back to our hospitals, to our various facilities. We went through extraordinary measures. We did terminal cleaning. We had it certified by outside agencies. We did a lot of infection control, procedural upgrades. We started taking temperatures at the door. We tested our 36,000 team members. We tested physicians. We test every patient who comes in. We did PSAs about that it was safe to come back and I’m happy to say, we’re getting there. We’re not all the way back, but that was certainly a major strategy.

The third piece was an internal review. I would call it “Let’s Reimagine Hackensack Meridian Health” in a post COVID environment. We formed a senior-level steering committee, and we also formed a new board committee that is overseeing the process. The steering committee identified 10 major work streams to improve revenue in this new COVID world— What do we think is going to expand? What types of services and programs should we be investing in? But also how could we make Hackensack Meridian more efficient?

We also are looking at our portfolio. Do we need to change some things? Do we need to own everything we own today? Can we still achieve our mission and maybe have some sort of different relationship with some of the providers?

We’re really looking at everything and I’m happy to say that those 10 work streams have produced 300 specific initiatives that we

● are now enacting.

“Sadly, we lost 21 team members to COVID-19 during this pandemic. We haven’t had an opportunity to really grieve because we’re still in the midst of this pandemic.”