Q&A: Hospital Chief Reflects On Lessons Learned During The Pandemic Year

Robert Chaloner, chief administrative officer of Stony Brook Southampton Hospital, spoke last week via Zoom one year after the official start of the tumultuous pandemic year.

Q: I’m curious about the lessons that you’ve learned from the last year, the ones that you think will help the hospital move forward and maybe help the hospital deal with future outbreaks, too.

If I had to say in one sentence the biggest lesson I’ve learned, it is: Never overlook the little stuff.

We think about the medicine. We think about the nursing care, the physicians. We don’t often think about plastic gowns and masks and the minor supplies that we just assume are going to be like water flowing through the taps, and it’ll just always be there.

I liken it almost to … I remember, during Hurricane Sandy, thinking, “Oh, so we’ll lose power a little bit. It’s not going to be a big deal.” And then my house, I lost power for two weeks. And it wasn’t the loss of power — the candles were kind of cool, we got a little heater in the house, a kerosene heater, and we were able to get food and all of that. But the fact that my well ran on electricity and I had to find places to take a shower. Or I had haul in water to flush the toilets.

And that was really the sort of unanticipated little things. You just assume the water will always be there. And I think that was the lesson that many of us learned with something like this.

And I think the country’s still learning that. It’s not even the tough stuff. Sometimes it’s the delivery chain. And it’s the small supply items that need to get manufactured. And making sure you’ve got adequate stocks of those things, because that was when we really had some very concerning moments, I would say, just when we were close to running out of PPE for our staff early in the pandemic.

And, since then, it’s always been things like Plexiglas. Where do we get the Plexiglas from to put up all over the hospital? Do we have the Purell dispensers? Are we able to stock the Purell? Now, as we’re doing vaccination clinics and things, do we have tables and chairs? The vaccine’s flowing, but you can’t vaccinate people sitting on the floor. Where are you going to get those things from? And when the whole country is rushing for those supplies all at once, it creates an issue.

And I know, myself, I’m going to adjust in the future, when we do disaster planning, just think a lot more about those little, tiny, seemingly unimportant items that you just expect always to be there. Like the water always coming out of the taps.

Q: A crisis really kind of highlights that stuff. The medical equivalent would be: Until you break an arm, you don’t realize just how much you need that arm to do little things every day.

That’s a great way of putting it. It really is. And I think that’s how difficult it is — to put a shirt on with a broken arm — with some of those struggles. … It’s just exposed a lot of vulnerabilities that we have, and I hope we learn the lessons going forward. That we do a better job with that.

Q: You’re looking ahead sometime in the next decade or so to the construction of a new hospital. Was there anything that you learned during this time that’s going to inform that? And how you design the space?

Oh, yeah. That’s a great question, because we were actively beginning the planning for the new hospital during this time period. And so there’s lots of things we learned.

One is, we’ve learned the value of private rooms. Which we always knew we wanted the new facility to be all private rooms. But it becomes very challenging when you’ve got a lot of semi-private rooms, which we do currently, to try and juggle and make sure that patients are cohorted appropriately, so they’re not infecting each other.

In the past, we used to design, like, ER bays with curtains separating them, thinking it gave a lot of flexibility to move patients in and out. Well, curtains aren’t so easy to clean, and curtains don’t provide privacy. And, frankly, those ER bays, if they had permanent walls around them — which some of ours do, but not all of them — could function as overflow rooms.

That was one area that I have to say my engineering team was brilliant at fixing, but it was a challenge for us. So, with airborne diseases, and most of them are, we worry about isolation. We worry about the patient who is contagious not spreading into other parts of the hospital. And then we also worry about the immunocompromised patients not contracting it.

And so, traditionally, hospitals were built with a few, what we call, negative pressure rooms, where the air only flows in, it doesn’t flow out. So we would put an infectious patient in that room. And the air is only going in and then exhausted up through the roof. So it’s not being recirculated back into the hospital. And we had a few of those rooms, but we didn’t have enough.

So that’s where my engineering department was brilliant, because they found all of these ways of creating negative pressure rooms. And that was one of the biggest challenges we had, turning rooms into negative pressure. And, at the same time, we had some immunocompromised patients who were still coming into the hospital, and we had to protect them — and they had to be in positive pressure rooms.

So one of the big lessons that we’ve learned is that in the new facility that we build, we want the rooms, and there’s technology available to do this, where, with the flip of the switch, we can make the room go from neutral pressure to negative or positive pressure, depending on the type of patient that’s in there.

So that’s a big lesson. That’s going to be an expensive add-on in the new facility, but we think it’s a step that’s going to be worth taking.

We learned that just putting sanitation stations throughout the hospital, Purell and hand-washing stations — many of the older hospitals like ours were built in the days when there might be one hallway sink. But you need those sanitation areas in front of every single room.

We’re looking at how we design our waiting areas in flow. Ideally, we’d like to minimize flow. And an interesting thing that happened in the ER: We didn’t want the ER waiting room filling up with patients, so we pushed the triage to the very front. If you remember, we created that tent out front, and we stopped people before they stepped foot in the building, and we’re checking them and doing an initial triage.

And it worked. We were able to direct people appropriately without them first making this waiting room stop. So we’re looking at that step and how we manage that.

Another thing we’re looking at is, the rooms could be acuity adaptable. Maybe not all of them, but a portion of the rooms, in addition to the ICU rooms, could have all the technology built into the wall. So that if we overflow on ICU again, essentially it’s wheeling in monitoring equipment. Not trying to put all of the oxygen flow and all of the other things, so that those are all in place appropriately. And also just having surge space available.

So as we’re looking at the way we, hospitals, tend to compartmentalize their beds. We’ve got certain number of ICU beds. We have a certain number of this type of bed, certain number of that type of bed. Early on, especially last spring, we just needed COVID beds all over the place. And so having spaces that we could quickly turn into surge capacity.

Q: I wonder if, a generation from now, the industry is going to look back on 2020 as sort of a moment when a lot of things were learned and a lot of things changed. So that when you’re designing facilities moving forward, there’ll be some specific things that will be done in a very different way. And this hospital may be one of the first hospitals built with some of that in mind.

I’m hoping, and that’s certainly something we’re going to pitch to our donors and other supporters and stakeholders out here, that, hopefully, we will build from the ground up one of the first community hospitals post-COVID. And so I’m hoping that there’s a learning laboratory opportunity for us that I really want us to take advantage of.

And it’s going to cost some money, because some of these things like that pressure issue or having acuity adaptive rooms. That all takes additional expense. But I think it’s going to be well worth it. And I definitely feel that we can be even better prepared for the future.

I ask myself that question all the time about how the world is going to change in health care. Because I was in Lenox Hill — I had just started my career, and I was at Lenox Hill in 1981, ’82, when the first HIV-positive patient was admitted. And we still didn’t really know what it was. And the patient was very, very sick. And over the next couple of years, as we learned what this was and how it was spread, the industry started to adapt — things like universal protocols, where we treat all body fluids … we take certain protections.

Prior to that, I remember doctors giving us a hard time, and nurses [saying], “I’m not going to wear gloves. I need to be able to feel the patient’s skin. And that’s ridiculous that I should have to wear gloves when I’m drawing blood.” It was a very different world.

… A lot of the isolation rooms and things that we have in place today, especially for immunocompromised patients, are as a result of the AIDS crisis. And this was even more pervasive.

So I think we’re going to see some other changes. That’s interesting, personally. Mask wearing is going to be interesting to see how we respond during flu season in the future. I think this is the first year — and I’m going to knock on wood, because I don’t want to get one now — but I think it’s the first year ever that I haven’t had at least one winter cold. And a lot of people told me that. So we’ll see.

Q: This last year has to have taken a real toll on your staff. Can you talk about it: Have you had losses? I mean, have people left the hospital? How is morale? How is the overall health of your staff after a year of this?

That was my biggest worry when this thing started. One, I was worried about [staff] getting sick and dying, and thank God we haven’t had any of that. And we’ve been able to keep people safe. They’ve been able to keep themselves safe, because they’ve taken everything seriously.

We’ve hired more people during this past year. We’ve needed to hire more. And our staff haven’t left because of COVID. I mean, there’ve been some natural retirements and a few people who’ve got other opportunities, but our turnover rate is … I haven’t calculated it, but I’ll bet it’s certainly no greater than it ever was.

And I actually think there’s a sense of motivation and pride that we haven’t felt in health care in a long time. I mean, everybody who’s in health care likes being in health care. It’s a very rewarding place to be. But even when we’re at our most tired, this thing more than anything makes us realize the importance of what we do.

And I can tell you, there’s just tremendous pride from every sector of the hospital. I’ve heard this from the environmental service workers who are going in the rooms cleaning up after the COVID patients who’ve been sick and just knowing they’re doing the right thing. The nurses, the doctors, right now the vaccination pods and the testing centers, and the staff working at those — they really feel like we’re the soldiers fighting this war. And I think they have a tremendous pride in that.

And nobody has deserted. I haven’t once had to have a talk with anyone about, “You have to do this. This is your job — you’re required to do it.” Everybody’s done it.

I’ve heard fear. A lot of us have been afraid, myself included. When this thing started, I didn’t know what was going to happen. And as I was walking around, and [worrying about] how easily it was going to spread and what would happen to my own health. But particularly for the clinicians who were right in the rooms with the patients.

We’ve had nobody refuse an assignment. We’ve had nobody back out of something. And the only time we’ve seen any kind of higher-than-normal sick calls was when people got their second doses of vaccine and were feeling crappy the next day. And I was one of them, who left half a day early after that.

People have been great. I think most health care workers realize just how important they are. And I couldn’t be prouder to work in this profession, to be honest. And I mean that from the bottom of my heart — these people are amazing.

Q: So in treating the disease, how did the second and subsequent waves of treating the illness itself differ from that first wave? There was a lot of learning as you were treating the first time around, wasn’t there?

Yeah, there sure was. I think that when I look back, and when we first started learning about the disease and the first patient started showing up, there was not clear guidance. There were protocols in place for patients who needed to go on the ventilators. There were protocols for patients with severe respiratory diseases. And some of them were working, and some of the things they were trying weren’t.

If you remember, there was a lot of national press about certain medications. And “try this,” and “try that,” and a lot of it was ineffective. So there was a lot of, just, “let’s throw whatever we think we’ve got at the wall and see if it sticks.”

Little by little, they started learning about this disease and what treatments really would be effective.

Like — and, again, I’m not a clinician, so I want to tread very carefully here — but I’ve heard the doctors talking about the fact that these patients become much more susceptible to blood clotting. That there’s something that goes on in the vascular system, so they become more susceptible to blood clots. And as a result of that, we need to do things to make sure that they don’t develop these blood clots.

… So, little by little, those facts started to emerge and the protocols have now been pretty well standardized. Plus additional drugs have come on the market, so we can treat people even on an ambulatory basis.

Early on, you could see it in the faces of the doctors and the nurses, the sense of: “We just don’t know what’s going to work.” And the stress that created for them. And just trying to manage the patients on a minute-by-minute basis to keep them alive.

Now, I think they have — I don’t think, I know they have — protocols that we have and we can follow. And are much more confident that when we see a patient present this, these are the steps you should take.

And even though we saw a surge again in January, they jumped on it and implemented those protocols. Our overall survival rates have actually been very, very good here at this hospital. But I think that the second time around it’s just gotten better and better. We’re seeing more improved outcomes.

Q: Do you know if the hospital and Stony Brook in general contributed back to the pool of knowledge about how to treat this disease?

Oh, yeah. Stony Brook, we had some minor here, but Stony Brook’s got a number of major trials going on … they’ve been doing a lot of work around this. They have a really good infectious disease team, the whole research group up there. … And they’ve been able to use some of our data, and we’ve participated in some of their trials. So we’re happy to help out.

Q: That’s my point — you benefited from the knowledge that was being gained with the first go-round, but you were also contributing to that knowledge as well at the local level.

Yeah. Absolutely immeasurably we’ve benefited. … I never once felt like we were out here on our own. I always felt that, clinically, we had their support and guidance, and we were able to tap into them at a moment’s notice. And we supported each other, in many ways. When beds started to fill up, we would take some of their patients, or we would help out [Eastern Long Island Hospital in Greenport], and vice versa. It would have been a lot worse for us if we had been on our own.

Q: I’ve asked you this before, but it bears repeating: The Stony Brook merger a few years back was something that was debated. What role do you think it played in the local response, being a part of the Stony Brook system, being able to respond effectively to this pandemic?

I think it played a vital role for us to be able to respond. They were able to coordinate with regional resources and the state and help us get supplies when we needed it. They were able to get us medical knowledge when we needed it. They were able to, when we had a tough case, we could call them immediately and get help as this crisis unfolded. And we functioned as, in our minds, we’re one hospital, and we really did function as one hospital and one organization.

And just moral support, too: We’re all in this together. And we all compared notes every single day. And I think it would have been a very lonely place to be if we weren’t together with them.

Q: Looking ahead a year, what do you expect? I’m wondering if we’re going to go back to largely looking at a future that we can foresee, or does this change the way we plan moving forward, especially large institutions? When you look back at a year ago today, at how different the world was and how much it can change in such a short period of time, I’m wondering how that affects your planning moving forward as an institution?

Well, there are a lot of plans that we have. I mean, clearly, our new facility is one of them. And some of it, I guess, if I had to guess today where we’re going to be a year from now, I think a lot about our plans that we’ve always been working on — the fundamentals of what we’ve been trying to do as an organization. Which is, number one, continue to drive our quality up as high as possible. Number two, provide the greatest amount of access that we can to health care. I mean, that’s been our mantra even prior to joining Stony Brook, is to get more access to people in these communities out here.

And that means more doctors. That means more facilities. That means access to Stony Brook and their specialists. And I think that continued improvement of operations generally in customer service. …

I also think all the hospitals are going to be in a little bit of a catch-up [mode], because a lot of our plans we’ve sort of shelved. This was the year we were going to be doing a lot more. We probably lost a year of planning on the new facility. …

And I think one of the things we’re going to have to really think about is … everybody keeps asking me the question: “When’s this going to be over?” I don’t know, honestly. I’m an optimist, and every time I say it, I end up being three months or six months too soon.

I kind of feel fairly confident that, by the fall, we’re going to be much more back to normal than we are. I don’t think we’re going to have a normal Hamptons summer season. But I do think that things could change. We don’t totally know what’s going to go on with these variants, if something’s going to emerge, and we’re going to just have to be extremely flexible and adaptable and receptive to change, I think, over the next year.

I can tell you where I hope to be — and that’s celebrating with everybody. I miss the vibe and the seeing people. I hate sitting in my office and meeting with people on the computer. I like the small talk that goes around small in-person meetings.

And I’m hoping we’re all celebrating together and valuing how much we’ve missed seeing each other. And don’t go back to like some bad habits either. I’m hoping society can learn a little bit from this.