‘We don’t have a crystal ball, so we have to pivot on a dime’

Rollout of COVID-19 vaccinations has been spotty across the nation with some healthcare organizations running into challenges getting staff to either agree to get their shots or, in some cases, not having enough doses to go around. At the University of Iowa Hospitals & Suresh Gunasekaran, Clinics, 90% of staff have gotten their first shot. CEO of the Iowa City-based system, spoke with Modern Healthcare Managing Editor Matthew Weinstock about the vaccination efforts. The following is an edited transcript.

MH: Are there any particular things you’ve done to get to a 90% vaccination rate? We’re not seeing that rate across the industry.

Gunasekaran: Starting early was really important. It began before the official emergency use authorization. We were fortunate to be one of the clinical trial sites for the Pfizer vaccine. So our staff began to understand months ago that this vaccine was under evaluation and that Iowans in our town were participating in the trial. When we looked at the safety and efficacy data, there was a little bit of Iowa in that data and that helped convince a lot of the staff.

We had a lot of our leaders—both in the research enterprise and the clinical enterprise—who were able to give thoughtful reviews of the data. Finally, probably the most important thing, was that we started vaccinating so quickly. We did so much preparation that hundreds and thousands of our staff members were vaccinated just in the first week or two, which created a lot of momentum. Everyone seemed to have a friend, colleague or coworker they trusted who was able to get vaccinated and I think that was another critical part of it.

MH: You ran out of the Pfizer vaccine in early December, right?

Gunasekaran: We did. Multiple different times we ran out of the Pfizer or Moderna (vaccines) based on not only national shipments into Iowa, but shipments within Iowa … but we were able to keep going. When we ran out of Pfizer it was only a week and then Moderna was there. Then later in the month we really benefited from our relationships across the state and had a much higher Pfizer allocation come forward. It’s been fits and starts, but in the end, it’s all been good.

MH: Is there a challenge operationally of keeping track of the two vaccines?

Gunasekaran: One of the things we’ve done to make sure it doesn’t overwhelm us is to really evolve our normal, safe clinical operations.

All of our employees are scheduled through the same process that we would use for our entire employee health program. Everyone is surveyed, everyone’s information is collected in that way. We are using barcode scanning and other things that we would do for any other immunization to get down to not only which vaccine but which lot number and on what day so that all of those same safety mechanisms that everyone’s come to rely on at UI Health Care are being used in this process, all the way up to follow-up appointments, reminders, etc.

MH: How are you connecting with that 10% of staff that hasn’t been vaccinated yet?

Gunasekaran: We continue to disseminate information on side effects. I think that a lot of the folks who are unwilling to get the vaccine are really taking the attitude of, “Let me wait and see how the first set of folks do. What’s going on between the first and second doses and how safe this ultimately turns out to be.”

We’re learning more about it, but for right now, it seems like the side-effect information is what most people are interested in.

MH: Did you talk about mandating the vaccine?

Gunasekaran: That came up. Ultimately, we still respect that it’s a personal choice to do it and that ultimately the community will have to still stick with all of our safety standards until we feel as though we’ve got a care environment that is safe not only for our staff but also for our patients and the community as a whole. A successful vaccination program will accelerate that return normal. And that’s what we try to talk about with the staff—the importance of doing this for the community and for our operations. But it’s a little bit early right now; we were not inclined to make it mandatory.

MH: The board of regents is in the middle of contentious contract negotiations with one of the unions, especially around pay. SEIU asked for a 5% pay hike but the regents recently came back with a 1% offer. How does that impact relationships with staff?

Gunasekaran: I wouldn’t call it contentious. I would say that this is a very constructive conversation and I’ve actually found SEIU to be very easy to work with and they have very much been committed to the safety of our staff just as much as we have throughout this entire process. They’ve shown a lot of different flexibility and even within their proposal they had some good ideas. We’re obviously going to have to figure out what is financially appropriate during this contract negotiation.

When it comes to safety, when it comes to staffing, when it comes to a commitment to our community and to our patients, I think we’re on the same page. The tough part is how are we going to figure out the finances with so much uncertainty swirling around the system. But I think that one of the good things here at UI Health Care is that both the union staff and the nonunion staff have been on the same page about our commitment to the community and our commitment to say safe.

MH: You increased ICU beds throughout the peak of the pandemic. How do you look at the ebb and flow of what you need going forward?

Gunasekaran: It’s tough. The issue is we don’t have a crystal ball, so we have to pivot on a dime. We run about 850 beds, but 70% to 80% of those beds are always for people who are not from our county. So for us, we are a major referral center for this state. As circumstances change on the ground in Davenport or Cedar Rapids or Burlington … we need to pivot to make sure that we can handle that capacity.

The good news … is that so many of our hospital and physician partners in those communities have been able to handle it. But when we see these high peaks, that’s when we need to step up and provide additional capacity.

We feel a little bit better now that our staff is vaccinated because the double whammy before was our staff might be out during an infection peak in the state. But the bottom line—and this is the reality every time we fail at social distancing and we fail at controlling (the pandemic)—it affects non-COVID care. When we’re surging our ICUs, it means cardiac care and neuro intensive care and other clinical services are affected. That’s why we constantly worry that increasing the hospitalization rate, even if it doesn’t overwhelm our beds, displaces a lot of really important care and affects the health of so many Iowans. ●

“The tough part is how are we going to figure out the finances with so much uncertainty swirling around the system.”