Shereef Elnahal has been in the seat as commissioner of the New Jersey Department of Health for just over 15 months, and will stay on until July, before he leaves to take on a new role as the CEO of University Hospital in Newark.
The switch from a public service leader to a hospital executive is a sudden one for Elnahal, who previously spent three years at the U.S. Department of Veterans Affairs, but he said he saw the position as an opportunity to pursue a dream he has always had — to lead a health facility.
In an exclusive interview, his first since being selected CEO for University Hospital, Elnahal spoke with ROI-NJ about his stint at the DOH and what his goals are when he arrives in Newark in late summer.
ROI-NJ: First let’s start with the application for the University Hospital job. Why did you apply with only a year under your belt at the DOH?
Shereef Elnahal: Because I believe the community deserves the best hospital in the state, in Newark. I think that could, I think that’s the right step for my career at this stage. I’ve always wanted to be a hospital leader in addition to a public health leader … and that opportunity was made available and I applied for it.
ROI: Sources told us you were approached for the position. By whom and when?
SE: A board member called me (in February) … and thought that we had done a lot of good work at DOH, because, unfortunately, a lot of the inequity in the health care system existed there in addition to Trenton, Camden and Atlantic City — mostly our urban areas, and they thought someone with a public health lens who was already familiar with the issues at UH, based on what happened last year and this year, could add something to the table. And, so, I was encouraged to apply. I ended up applying. And, after that, it was a competitive process. So, I went through several rounds of interviews with the selection committee. I ended up having dinner with different groups of board members — because certain board members can’t be in the same physical location in public. So, I made my case and I think the field was pretty large and competitive. I’m honored to have received the offer. So, after that initial call, it was going through the motions, recusing myself where I needed to.
ROI: Why were you interested in it?
SE: The real answer is, I see a problem at University Hospital that’s fixable, and to be part of a story where I joined a team that I believe has what it takes to guide the organization in a way that really begins to deliver what the community deserves. … It’s not going to be easy leaving the administration. It will be very bittersweet. I think the organization and its people, its employees, are very talented. It’s hard to accomplish what you want to accomplish without effective leadership. And I’ve heard that (at) every organization that I’ve worked in, I heard it in the VA, I heard it at the department, where folks not only had to push the pause button on work, but, in some situations, because of the political climate, were doing work without telling anybody. You don’t want an organization like that.
ROI: What is one thing you see as an area of innovation?
SE: First of all, it’s situated right next to (New Jersey Institute of Technology) — a team that I’ve loved working with already, which is the New Jersey Innovation Institute. Those folks have already been doing work with UH and there’s a lot of work that can be expanded. I’ve already prioritized and recruited UH into the New Jersey Health Information Network, which will be a very effective care coordination tool, especially for folks who don’t have solid continuous access to care. They have holistic care for transgender care that is connected to other best practice sites like the RWJ Barnabas Health Somerset Proud Clinic, which is referring patients to UH. And, by the way, everybody wants to get into this, because it’s still a very underserved population.
ROI: University Hospital has been a problem for every commissioner for a few administrations now. Why do you think you can fix it and what do you think you can fix?
SE: The organization has problems. It is not a problem. Here are the problems:
Quality, which is foundational and absolutely necessary to improve all other problems. So, if people don’t think they can bring their family member there for safe care, there’s no way that the financial situation will improve. There’s no way the regulatory compliance environment will improve. There’s no way the relationship between management and the unions will improve. And there’s no way, more importantly, that patient care itself to improve. And there are models for this that I intend on implementing from former mentors, one of whom is Peter Pronovost, who directed the Armstrong Institute for Patient Safety and Quality at (Johns) Hopkins, which is where I had my clinical training and quality training.
The second category is finance. Improving creditworthiness will be very central to increasing the reputation of the institution, but also more flexibility with capitalizing the institution. I am baffled by why there hasn’t been an outreach to, at least, the business community of Newark when the mayor has built, made a centerpiece of his agenda, the economic revitalization of that city. Their employees should consider UH a place to send themselves and their kids. They don’t, but it’s right there. It’s right near the business district. It’s in the center of the city. (Improving the hospital) is also going to be tying a strategic plan, which didn’t previously exist, which is astonishing to me, to a financial plan that financially tests the assumptions about where the organization wants to be in five years.
ROI: You got some heat for the department’s handling of the infection spread at University Hospital not too long ago. What insights did you gain from that situation that will help you?
SE: We were made aware of attempts to move the pediatric unit to Newark Beth (Israel Medical Center). In addition to many patient safety and quality issues that we were made aware of, as a department, a lot of that came from staff, who called us. Instead of calling their own management team to say, ‘I see a problem here.’ That is a wakeup call to the management team, or it should be, that we are not necessarily the first people you think of when you see a problem. I am going to spend a lot of time building trust with everyone, from line staff all the way up to senior management and the medical staff, to say that we have to be a cohesive team. We have to buy in and figure out a way to engage and ask thoughtfully and genuinely the front line what we can do to improve care conditions. The nurses, the physicians, they know what need to improve and how to improve it. My question is, have they found the channels to express what they know to be true?
ROI: There is a very strong political faction protecting University Hospital and Newark in general. How are you going to handle that new environment? And are you concerned about being seen as Gov. Phil Murphy’s inside man there, even though he does have support from Essex County?
SE: I think there are a lot of very passionate people in different positions of service to that community. At the county level, the state Legislature and the city, I found a common thread among all of them. They deeply care about University Hospital improving and they want to see the organization succeed. There are different opinions about how to get there, and I have to land there first to understand and come to my own conclusion about the best path. It would be both inadvisable and against the mission to not listen to all those stakeholders very carefully. But, I think the decisions on where the hospital needs to go should be the board and the management team at University working with its employees, and that has to be a work in progress when I get there. If I have to make a decision that I know one of those stakeholders won’t like, or there’s a high probability in my assessment that they won’t like, I’ll let them know in advance before it becomes public, explain my rationale, be honest, transparent and forthright — that formula has worked so far, and I hope it will continue to work when I’m there for them.
ROI: What would you say to those who say your sudden move is reflective of a stereotypical millennial mentality?
SE: I would say it was never my intention to leave this soon, because I didn’t know how much progress we would make at the department. But I also didn’t know that this opportunity would be available, to go to a city that I loved working with and work at a hospital that has tremendous public importance, and opportunities arise when they arise. And having a boss that is able to understand beyond his own immediate sphere what folks on his team might want to pursue in their career — all of that aligned. I wasn’t certain in the beginning, it was a long process to come to the decision, but, ultimately, I think it will prove to be a good decision.
ROI: What is one thing you feel is unfinished or a concern as you leave the Department of Health?
SE: I think the biggest risk the department faces is around the way that we are responding to the needs of the regulated community. Particularly on licensing and surveys. The teams in both of those branches are incredible. They’re dedicated professionals, and we’ve managed to hire more of them, which is what they’ve needed. But the rate of retirement, and without the need to think outside the box, the status quo in terms of the trends would have been bad. And, so, I think we’ve made some changes to turn the page on that. I don’t think the community is seeing them yet because we have to still cross the finish line on a number of them. So, the electronic licensing system, for example, will speed up the time to licensing. We just onboarded several people into the licensing team that will double the productivity of mental health and substance use licensing.
ROI: Speaking of the rate of retirement: There are some who feel that, because you have a large number of employees retiring shortly, or an older workforce in general, the department is in jeopardy of being understaffed, and that it contributed to your decision to leave. Is there any truth to that?
SE: I, in fact, believe that the folks that have been here for the longest time have the most to add to the organization. The more concerning thing is the rate of retirement — the fact that we’re losing those folks just by virtue of them reaching a point where they’d like to retire, which is natural and what people do. So, my response to that has been to set up a foundation where we could bring people across the spectrum into the department as an attractive job. That means partnering with universities to hopefully get folks during training or shortly after training to fill those positions — even if it’s only a couple of years’ stint so that they learn and come back to the private sector. That transit of folks with experience from both sides, I think, would only strengthen the department. And, so, the health systems branch has been trying to implement more work in that area. I think we’ve set up a foundation for all of that to improve. And by improve, I mean the department would be staffed better.
ROI: What are you proudest of from your time at the DOH?
SE: What I’m proudest of first and foremost is building, I think, the best team in state government. I really believe this team is incredible and part of that made me feel like it was OK to leave after a year and a half. The folks that report directly to me are extremely skilled, knowledgeable, have bought into the vision that I’ve tried to set, which is very reflective of course of the governor’s overall vision for health care as a social justice issue. I think regardless of whoever takes my seat, they will find themselves with a team that is extremely skilled, incredibly diverse and is carrying a large swath of initiatives that have incredible momentum.
ROI: What about the actual initiatives. Where did you succeed?
SE: I think we’ve set the foundation for a targeted, intellectually robust approach to the opioid epidemic. We’ve built the foundation for better data sharing. We’re doing a lot of good work with the hospital association and reducing prescriptions of opioids. We’ve connected that to the Health Information Network, which now has 6,000 physicians and going to have, soon, all acute care hospitals. Really, every silo of care, or previous silo of care, are going to be connected. We are doing a lot of good work with syringe access and harm reduction — building upon that foundation that was already set. I think we’re really beginning to reduce all of the adverse outcomes we’ve seen over the last several years.
ROI: Then there’s also the medical marijuana and infant and maternal mortality in communities of color, right?
SE: We’ve overseen the biggest expansion of (the medical marijuana) program and its history. Not only that, we’ve improved the patient experience. It used to take several months for folks to become certified and get the therapy. Now it takes two weeks to get certified. So, these were targeted internal efforts to improve our effectiveness, our service, but externally what we’ve been doing to promote the program. The fact that we’ve extended the number of conditions to things that have always made sense but were unnecessarily suppressed — all of that is something I’m tremendously proud of. You mentioned the work on maternal and infant health. The first lady has just an incredible vision that focuses on the disparities in the inequities, front and center, which is exactly what the problem needs. We have a low infant mortality rate overall, but the disparities are inexcusable.
ROI: How long will the fixes take to play out?
SE: We’ve already made progress in building the anatomy for getting into communities of color in ways that we hadn’t before. It’s the impact model that’s been studied and proven out of the University of Pennsylvania. We’re taking that statewide. I’m very confident the state’s going to see actual reductions in infant and maternal mortality. We’ve made progress and I’m proud of that progress, but these aren’t issues you can solve in two years, even four years. To reduce infant mortality in New Jersey is a decade’s worth of work to reduce maternal mortality, based on one case study that was successful, is at least five years’ worth of work. And that is focused just on quality improvement in hospitals, let alone closing disparities, which is its own challenge.