April 19, 2021

Being a Leader during a Crisis, with Dr. Shereef Elnahal

Dana Bernardino

1Huddle Podcast Episode #13

On this Bring It In podcast episode, 1Huddle’s CEO and Founder Sam Caucci sat down with Dr. Shereef Elnahal, the President and CEO of University Hospital right here in Newark. Dr. Elnahal has been leading New Jersey’s only publicly-owned hospital during the pandemic, which has given him a unique perspective on how to conduct yourself as a leader during times of crisis while successfully adapting and working through all the challenges our frontline workers and healthcare professionals have had to overcome during COVID-19. 

Before he became University Hospital’s CEO, Dr. Elnahal served as New Jersey’s 21st Commissioner of Health in the administration of Governor Phil Murphy and was appointed by President Barack Obama as a White House Fellow to the U.S. Department of Veterans Affairs. Dr. Elnahal holds a Bachelor’s degree in Biophysics from Johns Hopkins and a Doctor of Medicine from Harvard Medical School.

On this episode of Bring It In season one, Shereef and 1Huddle’s CEO and Founder Sam Caucci talked about everything from what it truly means to be a leader during a crisis.

Audio available on Apple Podcasts, Spotify, and Google Podcasts. 


Below are some of the insights Shereef shared during our chat, edited for length and clarity. You can find more Bring It In podcast episodes here.

  • “The best way to conduct yourself as a leader is to continuously learn, adapt, change, and approach your job in a time of crisis with humility.”
  • “Leadership can’t hide in a time of crisis. If leadership is hiding, they’re not doing the job.”
  • “The combination of approaching your job as a leader with humility, but also taking quick action to fix things that weren’t working and communicating incessantly throughout the process has really helped us get through this.”
  •  “Being honest and being transparent gets you the trust you need to come together and take action effectively.”
  • “The effectiveness of a team really depends on trust within that team.”


Sam: I can’t imagine being a healthcare CEO during a global pandemic — especially at a hospital where you have a ton of work you’re doing to move things forward. What have you seen as a leader, and what has been something that you’ve learned during the experience in the last few months? 

Shereef: Sam, it’s really been one of the most difficult times you can imagine in healthcare. We’ve seen things over the last several months that we never thought we would have to see in healthcare. The idea of a pandemic was very much a conceptual one. The pandemic plans that governments and jurisdictions had were old if they existed at all. Certainly, at the institutional level at hospitals and other institutions that take care of patients, we just weren’t prepared. You also really can’t find anybody who’s alive who has gone through a pandemic successfully, and that’s a really important point to make. It’s been a century since this has happened. Anybody who claims to have the right answer at any given juncture is either misleading or sort of not understanding the moment they’re in. To make mistakes is part of the process of never having gone through something before and the best way to conduct yourself as a leader is to continuously learn and adapt and change and approach your job in a time of crisis with humility. To paint the picture of what we were seeing, I was walking around the hospital at all shifts during the worst of this surge. We saw things that we had never seen before in healthcare patients. Multiple patients on a ventilator at any one time, the fact that we had to retrofit parts of the hospital and use the same staff because we didn’t have enough staff otherwise to treat these very sick patients. For example, in our mother-baby unit, we had nurses who were used to caring for women who had just given birth. Now, they’re being asked to care for someone with severe shortness of breath on oxygen, on the cusp of needing a ventilator. I’ll never forget a conversation I had with one of the baby nurses when she basically just looked at me and said “I have 10 patients with the disease that I’ve never cared for before and with a severe condition that I’ve never had to address before.” The sort of desperate way in which she told me that will always be etched in my memory. The best thing we could do as leaders was to be present and literally bring boxes of PPE to the bedside to make sure that our communication was swift and strong. We were soliciting feedback every step of the way and that when we found that something wasn’t working, being humble enough and insightful enough to change it rapidly and try something new. The combination of approaching your job as a leader with humility, but also taking quick action to fix things that weren’t working and communicating incessantly throughout the process really helped us get through this.

Sam: I think about so many companies that have struggled to keep their workforce connected during COVID. So many businesses have been working from home, and that is obviously not the case at University Hospital. From your seat as a leader, how did you keep everybody connected and together over the last few months? 

Shereef: Well, it really gets to the necessity of making sure that communication is clear, frequent, redundant, and is happening at levels that you’ve never had to use before. I was doing town hall week, and giving updates on the pandemic and the number of patients. We had the projections on the number of patients we were going to get, our status with PPE going line by line — every type of PPE — so that folks understood and weren’t surprised when we asked them. For example, to begin submitting their N95 masks for sterilization because we were running low on certain types of masks. We had to get ahead of that bad news because if you don’t, then you show up to work thinking that you’re going to have a certain type of PPE, especially when you’re dealing with a disease that’s so deadly, and to find that out at the moment is very demoralizing. Even though we still had folks that were getting messages here and there, I’m proud to say that we were staying ahead of updates and making sure people were informed. By doing that, there was a forum where we brought people together very deliberately every week with these town halls where folks were able to ask their questions even if the question was very much one that caught us off guard or highlighted a vulnerability in terms of our response, we welcome that. We made sure that people were comfortable in expressing those issues because otherwise, we wouldn’t be able to address problems. Having facilitated communication, making sure that huddles were happening at the unit level, on a regular basis, and reliably — those things really helped us stay together. As a level one trauma center and as a hospital that’s gone through tragedies and crises in the past — September 11th, Superstorm Sandy, the Ebola issue…We had one patient with Ebola who had traveled and was suspected of possible Ebola exposure; that person was here. We’ve been through crises before and are used to operating in times of emergency. Not every hospital is the same way, so it’s important to understand that. Not taking our robust experience with emergency management for granted and really emphasizing communication has really helped us come together.

Sam: Do you think that tough times have exposed leadership?

Shereef: I think absolutely. Leadership can’t hide in a time of crisis. If leadership is hiding, they’re not doing the job. The anxiety that people have — especially when they’re putting themselves on the line just by virtue of coming to work — people look to the leader for guidance, for comfort, for a sense of competence. I had to be here, I had to be present. I had to be in front of issues, even when I didn’t know the answer. I had to be humble enough to admit that. Exposing your own vulnerability as a leader can be one of the most important things you do in a time of crisis because nobody realistically expects you to be ahead of everything and get everything right. By definition, people’s expectations are lowered during a time of crisis because it’s a time of uncertainty for everybody; but being honest and being transparent gets you the trust you need to come together and take action effectively. We did that, and I’m happy to say that I think it had good results. It can feel nerve-wracking to expose vulnerability as a leader and to say that you don’t know something or that there isn’t a clear plan, but folks tend to know the answer to that anyway. Coming forward with the truth and with an accurate and clear picture of what’s happening is the first step. I’ll also say that crises are a time — especially during this pandemic — where a lot of folks are experiencing grief. We had over 10 people in our workforce die of COVID-19 and every time that happened, we didn’t try to hide the news. We didn’t try to sweep it under the rug. We announced it every week and we came together in a moment of silence to recognize their service. It’s reasonable and correct, but it’s certainly rationale for leadership and for organizations to want to protect information when things aren’t going well. And by definition, things aren’t going well during a crisis. But to have done that I think would have been really demoralizing for the organization, especially when it came to deaths and illnesses. With the permission of the family, we grieved together, we celebrated folks who came off of ventilators and came back to work and recovered. We talked about the good and the bad during the crisis, and I think that’s really helped bring us together even more. To your previous question, it is helping us manage the problems that have lingered. We have a lot of staff who have post-traumatic stress. The symptoms of PTSD related to fears of another surge happening or a second wave, all of that is very real. Instead of trying to hide those issues, we’ve been very upfront about encouraging people to reach out for help because if people are not addressing those issues upfront that is putting themselves at risk and it’s putting the organization at risk because we assume that we have a fully compensated staff ready to come to work and meet the next challenge. If that’s not the case, we need to be there to support everybody in our organization. A lot is involved here with addressing the spiritual and emotional and mental health and well-being of our staff, and it’s something we’ve had to stay ahead of or continue to stay ahead of. 

Sam: I can’t imagine that in your environment. It makes me think about some of the other companies and leaders we’ve had that we’ve talked to who are fighting in a similar way to keep their employees motivated and connected together while at home. But it’s just a totally different scenario on the frontline with what you’re describing. When trying to talk about the future of work, what have you learned about the community through the pandemic? What have you learned about being a business in a community? And I bring that up beyond just healthcare, but there’s so many companies that are moving back to the urban core or trying to connect from a responsible manner with their community and having hopes of doing so. With all the work happening at the University Hospital, what have you learned about the role that we can play in connecting with communities as businesses and leaders?

Shereef: What this crisis has shown is that you really live or die by those relationships with community leaders. I’ll just give a few examples; I spent my first year here really trying to build trust and build relationships in the City of Newark and that started with making sure that I met the mayor and his team and that we are in lock step with priorities that we had for this hospital. This is an anchor for the city of New York and for us to be on a similar wavelength is really important to me. He’s been nothing but open arms. In fact, he has a seat on our board now, and that helps us remain accountable to people who live here, the residents. It’s also a very useful sounding board for initiatives that we want to undertake, and it really spearheaded from there. All the elected officials: Senator Weiss, Senator Rice — the whole complement of leaders here in the City of Newark, city council, and incredible leaders here who want this hospital to succeed and have deep and meaningful connections with the faith-based community and with community organizations. We’re invested in those relationships, and as a result, we were able to spread the messages we needed to during the worst of this crisis about staying home, being responsible, and wearing masks, and heading all the public health advice that we needed in order to not have to reach a point of needing to ration care. We came close though, and it just goes to show the precipice that New Jersey hospitals are facing at such a desperate time. Those community connections allowed us, through channels of trust, to influence the right behavior and convince folks that they needed to follow these directives. As a result, everybody who needed care — the most vulnerable who couldn’t prevent themselves from getting COVID — were able to receive top-notch care here regardless of race or ethnicity. We know that this disease has disproportionately hit cities like Newark and minority communities and Black and Brown residents, but as soon as they came through our doors, we’re proud to say that we had similar outcomes across race and ethnicity. That didn’t happen by accident. Now, these connections and relationships will be even more important during the next step, as we’re going to be asking people on a prolonged basis to continue following these directives. But also to eventually adopt a vaccine that goes through rigorous clinical studies and is ultimately approved by the FDA. We know the data is showing that confidence in vaccines is at an all-time low — especially for COVID-19 and particularly low for Black and Brown residents. We need to understand that a vaccine will be one of the most important tools we have for getting back to anything that resembles a normal life pre-COVID. We’re going to have to amplify the messages once an FDA-approved legitimately safe and effective vaccine is available for us to leverage those connections. Making those relationships when times are good is the hallmark of leadership responsibility because at a time of crisis, you do not want to be getting to know the community for the first time. 

Sam: How do you think COVID is going to impact work in general in the future, even beyond a vaccine?

Shereef: I think this will permanently impact work in a lot of ways. Even in healthcare, a lot of folks are realizing that work from home is not only possible — it’s effective. People can do their work well and even better sometimes. Clinically, the way we deliver care is moving more toward telehealth, which has its actual advantages in many ways. A primary care doctor or a mental health professional being able to see the living conditions of someone or their family dynamics, all these things are important and give you that extra level of insight into a patient’s experience. Of course, there are times when folks have to come in for various things like test studies and getting a physical exam, but it’s amazing how much we’ve discovered and realize that we can do at scale on a virtual basis. Virtual work and understanding that people can be productive at home, as tough as it is for them knowing that a lot of folks have children and home can be a distracting environment for a lot of reasons. Even within healthcare, I do think that work from home and virtual care is going to persist. One of the silver linings of this is really forcing everyone to get on the same page with technology. The healthcare industry has been embarrassingly behind with utilizing technology for things that are very intuitive.

Sam: It makes me think about the reality of work. The mindset of employees matters when they show up. I think so much about how in the pandemic, the best leaders have been forced to really consider what’s happening in the mind of their employees, regardless of where they are. I have one final question for you before we wrap up: What’s your hope for the future of work? 

Shereef: My hope for the future of work is that however it evolves — in terms of formats and expectations and the degree to which people work from home — is that we don’t lose the human connection behind work. The effectiveness of a team really depends on trust within that team. I’d hate to see the evolving formats of work negatively impact how people define teams and how people experience teams because I really think that innovation is built on relationships made at work and fostered and cultivated. I don’t think that’s insurmountable with work from home, but we do need innovations that prioritize that. We know how loneliness and mental health and depression can negatively impact productivity. Isolation at home may be a precipitant for those things getting worse. More importantly, the comradery that folks normally are able to establish with in-person work needs to be replicated somehow with the way we evolve. I just say that from personal experience in our hospital, where we had a peer-to-peer support program that helped people get through post-traumatic stress. We had psychosocial support services that our own mental health department was giving to our own employees. We had virtual chaplaincy services because a lot of our employees are people who ascribe to a particular faith and many interfaith sessions. These things were facilitated and prioritized because a lot of people still had to come to work. What I hope is that across industries people prioritize connecting — which doesn’t have to be in person — but making the time and space and format for people to continue to be able to connect and work together. If we don’t do that, then I think we’ll see a lot of negative outcomes.

Topics Discussed: Leadership, Future Of Work, Leadership during Adversity, Healthcare Industry, Community, DEI, COVID, Culture, Relationship Building

Dana Bernardino, Manager of Digital Marketing at 1Huddle

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