Q&A with Robert Garrett of Hackensack Meridian Health: ‘I look at our approach as a transformation of medical education’

How are staffing issues affecting Hackensack Meridian Health?

We are impacted by the current staffing crisis, like most health systems around the country. Certainly COVID-19 exacerbated that. There were some shortages in key areas like nursing, some of the support functions and patient-care technicians. The various waves of COVID exacerbated the situation. At the peak of the omicron variant, which was in January, we had to employ upwards of 1,200 agency-based nurses to supplement the existing staff. Having said all that, it has calmed down quite a bit. We’ve seen nurses returning to work who might have been out sick with COVID, but also those who have let their contracts expire with agencies. There is still a fundamental shortage, and we’re trying to be creative to address it, like doubling down on our partnerships with schools and universities to be sure that we have an ample supply of personnel going forward. It’s certainly not as bad as it was maybe a few months back, but it’s definitely a problem that I think will be with us for some time.

How are you addressing this on the front end as you try to ensure there is a diverse mix of people interested in the medical field?

We created the Hackensack Meridian School of Medicine about five years ago based on what we saw was going to be a significant physician shortage. The idea of the school was to retain talent within New Jersey and recruit talent from beyond New Jersey into our state. We saw COVID really exacerbate that issue.

One of the core curriculum items for the school is what we call the Human Dimension Program, which is based on community immersion. Medical students pair up with individuals and families, mostly from underserved communities. And they follow those families for their three or four years of medical education. Some other medical schools might have an elective class that’s dedicated to that type of approach. But in our case we require it, not just for a class, not just for a semester, but for their entire medical education. Those students will follow two families during the course of their tenure as students to learn firsthand some of the challenges those families are having, particularly in underserved communities dealing with social determinants of health, such as insecure finances or housing, food insecurities, transportation barriers, mental illness and addiction. Those are issues that are keeping these individuals and families from accessing healthcare and staying healthy, maybe preventing them from even going to a physician’s office on a regular basis. We believe teaching medical students early on about some of these issues is a core piece of providing equal access to care.

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How does this differ from traditional approaches to medical school curricula?

I look at our approach as a transformation of medical education. Traditional medical education really focuses on clinical skills, and our school does that as well. We have found that social determinants barriers play a big part in one’s health. Through community partnerships, we’re able to identify people who are at high risk for one or more of the social determinants, and then make referrals to various community centers. Of course they’re under the supervision of faculty who are trained physicians. They can hook up people who have diabetes, for example, with nutrition specialists. And in one case, there was an individual who lost 14 pounds in a really short period of time who needed less diabetic medication. They’ve helped people quit smoking; they’ve found better and more affordable housing; they were able to teach seniors how to use their iPads so they could engage in telehealth and really connect with their providers. You wouldn’t have seen that in a traditional medical school curriculum. We’re really proud of it. It’s received some national attention national recognition. We think it’s going to be the wave of the future.

How are you gauging the success of these programs?

As part of the accreditation process, we have to do a student survey where they talk about what’s working in their medical education and maybe what’s not working. And by big numbers, this program stands out as one that is really working. They find it valuable, they’re learning about the social determinants and the inequities in healthcare access and outcomes. The other piece is in the admissions process. The community immersion program is by far the biggest differentiator for our medical school.

How has the pandemic shaped the workforce? Has it affected interest in the medical field?

I think it has hastened some retirements; we saw quite a bit of burnout. We’ve had to institute many wellness programs for our team members as a result of what they’ve been through being on the front lines now for over two years since the start of the pandemic. On the front end, though, we’re seeing great interest in medical schools, and even in some of the nursing schools that we’re affiliated with. We’ve deployed some of our medical students during the pandemic to help our vaccination centers. Whether it’s through teaching seniors how to how to use telehealth or getting people vaccinated, it seems to be motivating a lot of younger people to come into the field.

What other initiatives are underway at Hackensack Meridian to try to address health inequity?

There’s a moral and strategic imperative to address health equity 
from the perspective of access to care and also from the perspective of disparities and outcomes. From our board all the way through our workforce, we educate and are focused on reducing some of the inequities that are out there.

People of color were three times as likely than their white counterparts to get COVID and twice as likely, sadly, to die from it. Life expectancy is a big disparity now. I think it’s 3.5 years between the white population and people of color. We have a screening tool—it’s a digital platform called NowPow. We have screened 300,000 people who have come into contact with our health network. Of those 300,000 people who are screened to be at high risk for one of those social determinants of health, we have now assisted 70,000 of them by making referrals to their communities. We’ve also partnered with New Jersey’s largest insurance company, Horizon Blue Cross and Blue Shield. They’ve been able to help us identify people who are at high risk based on their ZIP code. We’ve been able to refer 8,000 of those people. It’s called Horizons, Neighbors and Health. Those are just a couple of examples where we are getting at both access in terms of equity and also trying to change the narrative in terms of outcomes.