By Donald Gilpin

James Demetriades

James Demetriades, who became CEO of Penn Medicine Princeton Health (PMPH) on March 1, is leading the growing medical center through the second year of a pandemic and into a future of transformations that he continues to pilot.

In an April 13 phone interview, he noted that he and PMPH learned many lessons over the past year as they confronted the unpredictable onslaught of COVID-19. Demetriades, however, in his 18th year at the hospital, already had plenty of experience in observing and participating in dramatic transformations. His role has grown and changed along with the medical center’s growth and change over the years.

Though he feels some nostalgia for the days of the old Princeton Medical Center on Witherspoon Street, before the move to Route 1 in Plainsboro in 2012, Demetriades emphasized the importance of the growth.

“I loved being in the center of town,” he said. “I certainly miss being able to stroll up Witherspoon Street to Nassau Street. But we’ve built a health campus that spans across an individual’s life cycle, from the Children’s Hospital of Philadelphia specialty office building to the hospital, which is the anchor tenant of our campus. We have sickness and wellness services, independent living, skilled nursing, assisted living and memory care, childhood and adult daycare.”

He continued, “Over the past 10 plus years we’ve created an integrated campus that, once complete, will represent a $1.5 billion asset to the residents of central New Jersey. Add to that our large behavioral health continuum with our 110-bed behavioral health hospital on Herrontown Road and another six outpatient facilities throughout the state.” He pointed out the limitations of the Witherspoon hospital location with demand and technology increasing rapidly and no space for expansion in town.

Early in his career Demetriades started at what was then Princeton Hospital in the finance department doing contract negotiations and running different facets of the organization. “I’ve been so fortunate to be part of this organization from a personal growth perspective,” he said. “I was lucky enough to link up with an executive who saw a spark in me to get into operations and running departments. I’ve steadily progressed up the chain of command.”

Demetriades most recently served as senior vice president and chief operating officer at PMPH before taking the step up to CEO. “The people are what make this organization what it is,” he said, “and that’s why I’ve stayed so long. We have the most committed nurses, doctors, support staff, and other frontline clinicians. It’s a special organization from that perspective. I feel so fortunate, especially in a time when most people spend only a handful of years with an organization and move on.”

Pandemic Response

Demetriades described some of the upheavals at PMPH triggered by the waves of COVID-19. “Wave 1 really hit Princeton, and we were kind of at the vanguard of COVID. We were at the tip of the spear. We saw a very sharp uptick during wave 1 in late March and early April last year. We hit our high water mark with about 90 COVID patients in house. We exceeded the capacity of our critical care unit.

“We set up our recovery room, which is ICU capable, into a satellite critical care unit and we were managing patients in both our normal critical unit and in our recovery room. Medical staff members heeded the call and supported the effort, with our anesthesia team and other medical staff providers trained in critical care medicine supporting our ICU physicians.”

He continued, “It was an all-hands-on-deck mentality. The other heroes in this were the incredible nursing staff and all of our caregivers. We had people redeployed from areas like the operating room and ambulatory care practices — nurses and technicians and care providers — to support the care of COVID patients throughout the hospital.”

Fortunately, wave 2 has been a different story. “It’s no longer the novel coronavirus for us,” Demetriades said. “Therapeutics have evolved. At the beginning we were using hydroxychloroquine and we were moving people to be vented faster, but now we have therapeutics like remdesivir and dexamethasone that are very valuable treatment regimens. We are infusing monoclonal antibodies for particular high-risk populations, and these have been valuable assets for our treatment of patients.”

Noting that the average length of stay in the hospital for COVID patients is now much lower than it was a year ago, Demetriades added, ”The mortality is absolutely much lower and our numbers have been much lower and much more manageable in this second wave that started in November and began to wane in March.” Patient numbers in the second wave at PMPH never rose above the mid-40s.

COVID-19 has taught some valuable lessons, according to Demetriades. “What we’ve learned over the past 13 months has been invaluable, and the whole U.S. health care system has learned an awful lot and will be as prepared as possible for whatever could come at us. It’s been a trying year.”

Telehealth

One major transition during the pandemic has involved an increasing reliance on Telehealth, especially in the area of behavioral health. “In March and April last year we quickly pivoted, both in the primary care and specialty side, to move to a very heavy Telehealth model,” Demetriades said. “One of our most notable areas to transition was our outpatient behavioral health, and because of rules around social distancing and the nature of outpatient behavioral health we have largely stayed on a Telehealth platform throughout this pandemic. We’ve done more than 80,000 outpatient Telehealth visits and group therapy sessions.”

PMPH has also established significant programs in COVID-19 testing and vaccinations. “We’ve served as a major community resource for our private practice physicians to refer their patients for testing, and we’ve administered 20,000 doses of vaccine here, an accomplishment we’re really proud of.”

In battling the pandemic, PMPH has also learned a few lessons about managing inventory and essential supplies. “Hospital organizations around the country really prided themselves on being just-in-time inventory management systems, with very low inventory of products in-house because the sophistication of technology makes it very easy to order supplies and get them when needed,” said Demetriades. “But when you face a pandemic and every item of PPE becomes scarce in a matter of days, we had to spend the time between wave 1 and wave 2 of COVID building our stockpile of PPE to continuously protect our employees and medical staff.”

The greatest transformation initiated by the impact of the pandemic, however, is in the realm of technology, which has changed healthcare and how it is delivered forever, said Demetriades. “We are continuously evolving into a community-centric strategy as opposed to an institution-centric strategy,” he added. “Traditionally people expect to go to a hospital when they need care, but the new demand is for more and more care where people are. That is part of our strategy moving forward.”

Psychological Impact

Demetriades went on to emphasize the psychological effects of the pandemic on the hospital staff. “It took us some time to realize it and a little bit of time to respond to it,” he said. “We are very fortunate to have a very robust religious ministry department here, and we’ve been working with a local crisis counselor to support our staff. We have also been able to take advantage of resources that the broader Penn Medicine community has for provider and employee wellness. That’s been critical for our staff.”

The “outpouring of support from the community,” Demetriades noted, has also been a major factor for the staff. “Seeing that they are so well supported and respected for going to battle every day with COVID has really been critical,” he said.

Expressing his excitement in moving forward into the future with PMPH, Demetriades stated, “We’ve built the foundation or the springboard for our future success.” He went on to describe “four key imperatives” on which that success depends.

Quality of medical care and continuously improving that quality is essential, he said, “to continue to be the undisputed regional leader in quality.”

Growth and access constitute Demetriades’ second imperative in terms of level of services, types of services, geographic reach, and bringing care to where patients are.

His third imperative focuses on the community’s experience with PMPH. “They want the cutting-edge technology and they want the best providers, but they also want to have relationships with their care team and a relationship with the organization,” he noted.

Demetriades’ fourth imperative is a focus on the employees of PMPH. “It includes our ability to continue to recruit the best and brightest throughout the organization, and I want more people to have the opportunities to grow in their careers much as I have in this organization,” he said.