Leading a hospital during a pandemic

March 3, 2021
Adapting to rapid changes is key to leading during a crisis

In what could have been his last wish, a critically ill COVID-19 patient asked for a Sprite just before intubation, when hospital staff inserted a tube in his trachea to facilitate his breathing. Fortunately, the man survived and eventually was discharged from Del Sol Medical Center, a 350-bed, acute care hospital in El Paso, Texas.

Moments like this stand out for Del Sol Medical Center CEO David Shimp, ’01, amidst the blur of high-stakes decision-making and unrelenting pressure that defined hospital leadership during the past year.

“El Paso was not in the first big COVID-19 wave in the U.S.,” he said. “We had the benefit of learning how other cities responded to the pandemic.”

Shimp used that knowledge when Del Sol Medical Center experienced its first peak of COVID-19 patients in July and its second, considerably larger peak in November. From Sept. 6 to Nov. 17, the hospital’s COVID-19-positive daily census increased tenfold, leading administrators to implement surge plans.

“The biggest leadership challenge we faced was managing the rate of change as El Paso essentially became ground zero for COVID-19,” the CEO said. The hospital had to respond to rapid changes in both its COVID-19 patient load and treatment protocols.

During COVID-19 peaks, one refrain echoed above the rest: Where will the next 10 patients go?

“We put surgeries, such as knee replacements, spine surgeries, and screening colonoscopies, on hold to be sure we could handle the influx of COVID patients,” Shimp said. “Then we re-purposed spaces normally used to support surgical procedures to support COVID patients instead.

“At the beginning of the pandemic, clinical best practice supported early intubation of patients. Later, based on emerging evidence, the practice moved away from early intubation to treating patients with high-flow oxygenation, a non-invasive therapy that delivers large amounts of oxygen.”

Hospital teams labored at an intense pace during the pandemic.

“During a 12-week period, we worked seven-day weeks,” he said. “It was a daily cadence starting at 7:30 a.m., addressing staffing needs, bed capacity, oxygen supplies, and communications with our staff and physicians—everything we needed to cover to best support our community.”

The University of Richmond alumnus, who majored in leadership studies and minored in biology, said he relied on three guiding principles in leading Del Sol during this crisis. He upheld the hospital’s mission statement of being committed to the care and improvement of human life, prioritized the safety of staff so they could continue to care for patients, and ensured compassionate treatment of patients.

“If my mother were a patient, how would I want her treated?” he asked. “We created virtual visitation mechanisms as well as end-of-life exceptions to allow a family member to say good-bye to their loved one. We served our patients with compassion at every stage of treatment.”

Administrators of Del Sol Medical Center, part of the HCA Healthcare system, collaborated with El Paso’s other hospital systems to determine how to respond on behalf of the community.

“We were in this fight together,” Shimp said. “We wanted to be consistent across hospitals in things like our ethical standards of care, how we handle PPE [personal protective equipment], and hospital visitation.”

When necessary, he summoned the experts. He recalled a day when, due to unprecedented demand for oxygen, ice began forming on the equipment that converts liquid oxygen into gas. The freezing of oxygen supplies necessitated the transfer of some patients to a sister hospital.

“We immediately reached out to HCA’s corporate facilities and engineering team to ensure the sustainability of the hospital’s oxygen supplies going forward,” Shimp said.

“At the Jepson School of Leadership Studies, I learned the critical thinking skills needed to manage such a crisis. I also learned the value of humility. You don’t need to nor can you know everything—you just need to recognize what you don’t know and who the subject-matter experts are.”