18 minute read
Good People
5questions Cheryl Hays
Walking into the Covid pandemic as president of Marshall Medical Centers
Story and photo by David Moore
In the best of times it would be a challenge to take the administrative reins of a healthcare system with two hospitals, nine outpatient locations, 1,569 employees, 220 skilled physicians, 26 specialties, a $165 million budget and the pressure of maintaining the standards required to keep its Joint Commission designation as a “Top Quality Performer” among America’s hospitals.
Those are the reins Cheryl Hays accepted at the end of April 2020, when Marshall Medical Center President Gary Gore retired after some 30 years of leading Marshall Medical Center North and South. She took those reins as the entire world stood at the gaping threshold of the dark unknowns of the Covid-19 pandemic.
Cheryl had 31 years in nursing and hospital management – 21 of them in administration at MMCN – when board representatives began asking her in late 2019 about taking Gary’s place. Covid was unheard of; her reluctance was mostly because of Gary’s substantial shadow.
“I kept saying no,” says Cheryl, who at the time had been MMCN’s administrator for 17 years. “I felt our jobs were very different. Gary was such a visionary. I felt I was the boots on the ground making things happen. It would be big shoes to fill.”
In January 2020, Mike Alred, chairman of the Marshall County Healthcare Authority, came to Cheryl’s office as a show of confidence in her.
“I understand why you keep saying no,” she recalls Mike saying. “But I want you to know the board would be very supportive of you doing this.”
“I told him I would consider it and needed to pray about it,” she replied. She agreed about the time the first U.S. Covid case was reported, before anyone knew the coronavirus would cause the greatest healthcare crisis ever, escalating to 242 million cases worldwide – and counting.
“Gary told me the new job was just more of what I had been doing. But we didn’t recognize the Covid factor,” Cheryl says. “It’s been nothing like what we’d been doing.”
Covid or not, while growing up in Oneonta, Cheryl never pictured herself running hospitals
“As I recall,” she says, “I never really gave a lot of thought to what I would be.”
The main career avenues open to women then were teaching and nursing. The former was Cheryl’s early interest.
“I lined up dolls with a chalkboard and taught them,” she laughs. As a teen, her mother told her she was smart and should be a nurse.
“I looked into it and decided it’d be interesting,” Cheryl says.
After graduating in 1976 from Oneonta, her boyfriend opposed her going off to a four-year nursing school, so she undertook a two-year medical assistant program at UAB – and enjoyed it.
That summer, Cheryl worked for a Cullman doctor. Summer’s end also saw boyfriend’s end, but Cheryl’s desire to earn a nursing degree remained.
“I asked my dad if he would be willing to support that goal, and he said absolutely. So I finished at Jacksonville State with a BSN degree – and a husband.”
He husband, Tim Hays, is now a retired teacher who wrote an original musical The Whole Backstage produced in 2021. Featured in GLM’s spring 2020 issue, Tim related his version of how he “reeled in” Cheryl, saying he “happened” to be sitting on the hood of his Camaro, shirtless with gold-tanned jack-hammer muscles, playing a guitar and singing “Love Me Tender,” all to impress her. After that, she was in hot pursuit.
Tim did make an impression, Cheryl laughs. “But he would tell you I stalked him, and there’s not a shred of truth to that.”
He soon asked her out, but she had an upcoming chemistry test and declined. “He assured me that chemistry was one of his best subjects and he could help me study. I fell for it – but I soon found out that he knew no more about chemistry than I did.
“However,” Cheryl continues, “he was really funny and a quick thinker, so maybe I was pretty easily reeled in – but I never pursued him. I was raised to believe that the guy always had to make the first move. You never acted interested – and yet we dated steadily. So maybe I reeled him in…”
Either way, they married in January 1981. She graduated that spring, they settled in Oneonta, and she became a nurse, working nights in Birmingham at Montclair Medical Center’s postpartum GYN unit for $7.35 per hour. St. Vincent’s East later hired her for its ICU.
“I loved it,” Cheryl says, “but I did not love the commute.”
When her hometown hospital offered her an ICU position, she accepted. That led to a position as director of education/ infection preventionist.
Cheryl later started the master’s program at UAB but was disappointed with its focus on theory and not clinical nursing, so she changed to hospital administration.
“I knew immediately I was in the right spot,” she says. “It combined my interest in business with that of clinical care.”
Though happy in her studies, swapping a salary for tuition payments, commuting and raising their toddler son Adam on Tim’s teaching pay was a squeeze.
“By the time I finished my master’s, we had about $4 in the bank, a loan from my dad, some canned vegetables from Grandma, and baby Lindsey on the way,” she says. “But we made it!”
SNAPSHOT: Cheryl Hays
Early life: Born Sept 30, 1958, in Cullman, second child of Emily and the late
J.O. Marcum; grew up in Oneonta.
Siblings: Debbie, Lance and Linc. Education: graduated Oneonta High, 1976;
Jacksonville State University, BS degree in nursing, 1981; MS in Health Administration, the University of Alabama in Birmingham, 1988. Family: 1981, married Tim Hays; son Adam died in 1999; daughter, Lindsey Ruggles (Alex) of Florence, grandson James Adam, 4. Career: RN, Montclair Medical Center, Birmingham, 1981-82; ICU nurse, St. Vincent’s East, 198283; ICU nurse, director of education,
Blount Memorial Hospital, Oneonta, 1983-85; VP of Clinical Services,
Cullman Regional Medical
Center, 1988-95; president,
Lawrence Baptist Medical
Center, Moulton, 1995-99; chief operating officer,
Marshall Medical Center
North, 1999-2002; administrator, MMCN, 2002-18; COO, Marshall
Medical Centers 20182020, president, Marshall
Medical Centers, 2020-present. Fellow in the American College of
Healthcare Executives.
Cheryl was “over-the-moon happy” when Cullman Regional Medical Center hired her as Assistant Administrator. CRMC was managed by Baptist Medical Centers, which seven years later took over Lawrence County Hospital in Moulton. BMC sent Cheryl there as administrator. Those were four tough years. “The medical staff was very opposed to Baptist taking over and made their objections loud and clear,” she says.
Hearing Gary Gore needed an assistant administrator at MMCN, she hopefully applied. Four months later, she was interviewed, hired and moved temporarily into a Guntersville apartment. Tim remained in Moulton with the kids to finish his teaching year and sell the house.
Then disaster struck.
Cheryl had been at MMCN about two months when Adam, then 14 with a congenital heart defect, became critically ill. He spent 30 days at UAB awaiting a new heart. Only hours before a heart became available, he suffered cardiac arrest. His kidneys shut down. Doctors put him on bypass, proceeded with the transplant, but Adam never recovered.
Work was a struggle, to say the least.
“It was the darkest period of my life, and several years before I felt like I was back on my game,” Cheryl says. “I’ll always be grateful to Gary. He was enormously patient.”
For 21 years at Marshall North, Cheryl loved working in operations, first as COO and later as administrator, the position she took in 2002 when Gary left MMCN to head Marshall Medical Centers.
In her early years, she gave little thought to being one of the few females in hospital administration.
“I always focused on the role I was in, doing the best I could,” Cheryl says.
Gary, the visionary, set goals for Marshall North and Marshall South. Cheryl, the operations pro, the boots on the ground, ensured the hospitals achieved those goals. “As a team,” she says, “I think we worked very well.”
To ensure Gary’s vision of keeping MMC financially strong at a time when many local hospitals were forced to close their doors, he helped bring about an integration agreement with Huntsville Hospital Health System in October 2018. The two entities committed to investing $110 million over 10 years to expand MMC services to meet local needs.
That agreement was a key factor in late 2020 when the healthcare authority began to consider Gary’s pending retirement.
“We were still new in the integration agreement with Huntsville Hospital, and everyone felt that it wasn’t a good time to bring in a new leader,” Cheryl says. “No one could have foreseen that a pandemic would hit as Gary handed off the baton to me. I’m sure he would have rather left when everything was going well.”
Don’t think she’s looking for sympathy because of Covid’s timing.
“In leadership, you feel a heavy weight of responsibility to ensure we have the resources, staff and protocols needed to deal with any crisis,” Cheryl says. “But I don’t want anyone to think, ‘poor baby.’ I’m in offices all day. It’s our front-line people who are most burdened – they’re the ones dealing firsthand with the suffering.” 1. What sort of impact has Covid-19 had on Marshall Medical Centers?
The emotional impact on everyone cannot be adequately described.
The virus is devastating to families, and to have that anxiety level multiplied by the visitation restrictions required to contain the virus – that impact is hard to describe. Masking made it harder for patients and staff to communicate.
To have such an influx of critically ill patients over an extended length of time – many of whom would not make it – drains the front-line staff, including physicians and nurses. To bond with patients, and be a part of the final hours between patients and families are emotional events that cannot be put away when staff leaves the hospital. It takes a heavy toll.
In addition to the emotional drain of caring, staff constantly fear unknowing exposure and carrying it home to their children, spouses, elderly parents. Many undressed in their carports and showered before interacting with family.
All of this might have been taken in stride had it lasted a month or two – but we’re in month 21 and counting.
When the pandemic began, an almost immediate nationwide shortage of personal protective equipment developed. We didn’t know if we would have enough PPE and ventilators. We met daily to discuss inventory levels of gloves, gowns, masks, disinfectants and other necessities.
Sometimes asymptomatic patients exposed others before anyone knew they were positive. Testing supplies had to be limited to those most likely to be positive. PPE had to be changed between patients, and visitors also needed PPE.
We often got down to the last ventilator, then found one to borrow, buy or rent. Being in a system, we could also move vents as needed between North, South and Huntsville.
Extra staff had to be here to screen people entering the facility and ensure that everyone was masked. ER traffic had to be re-routed with screening outside, requiring extra nurses. Initially we opened a daycare center because the public ones closed, leaving many staff unable to work because of childcare obligations.
Our already shorthanded staff was emotionally and mentally exhausted with the extra patients. And because we couldn’t allow visitors, they had to make and take dozens of patient calls daily. Everyone understood – it was just difficult to meet the extra expectations on top of all the precautions.
At a time in history when we most needed to spend more time with isolated and scared patients, we had the least staff available to do so. Most family members understood. Some took out frustrations on staff or even hospital property. And not being able to care for patients the way the staff wanted to, is further emotionally and mentally draining – and the patients suffer the same loss of connection.
Policies regarding visitors, deliveries, equipment salesmen, pharmaceutical reps – everyone – had to be evaluated. Policies changed almost daily as new information came in constantly.
Rapidly changing information and policies, along with status updates, had to be disseminated to staff, physicians, board members, the public and Huntsville Hospital.
All meetings were replaced with conference calls, Zoom. Office workers were advised to stay in their own departments. With constant social
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distancing, not eating together or gathering to celebrate small victories, a total shutdown of the camaraderie that makes work meaningful, so much suffering … it’s been very isolating for everyone. 2. What has enabled MMC to deal with the pandemic?
Much of it is disaster training. We’ve always had disaster plans ready for different scenarios and drill on them throughout the year. We work with community agencies to get comfortable with what resources they have and how we can best work together.
When Covid hit, we already had the structure in place to manage it and communicate. We updated the surge plan based on the disaster being a pandemic.
Possibly more important than preparedness is teamwork. We have a very resourceful and dedicated team led by incident commanders Audra Ford and Renee Jordan. I don’t want to go further with names because so many people played key leadership roles.
Pharmacists trying to secure treatments and vaccine. Clinical staff and physicians working far more shifts and much longer hours. Lab management securing reagents and Covid testing options when both were scarce. Nursing leadership, supply directors, human resources, marketing and communication, etc. We have many heroes; many people working long, intense hours behind the scenes to help us deal with the outbreak in addition to the many heroes at the bedside and in the clinical areas.
We have relied on every single employee. Each played a vital role.
During 2 of the 3 primary surges last winter, this past summer and fall, we had to shut down our ORs, cancel elective cases and convert our post anesthesia care units to overflow ICUs.
Day surgery at North and ER at South became sites of monoclonal antibody infusion treatments. Unfortunately, during a surge – there are no beds available to transfer critical patients. Huntsville took patients when they could – although they were also full. With no ability to transfer, having the new dialysis service at South for the last surge was certainly a blessing.
Throughout the pandemic, a major factor in keeping up morale has been the community outpouring of support. It began with the people hand-sewing and donating masks. Businesses donated PPE. Churches did drive-in prayer meetings and prayer bracelets. Food was frequently dropped off for staff. Notes were written by community citizens to the staff, showing appreciation and support.
These expressions of gratitude were critical to keeping morale up. Knowing that their effort was acknowledged and appreciated gave them the strength to keep going.
MMC employees will also tell you that the positive part has been that they pulled together as a team and, in many ways, developed closer bonds.
Everyone learned they can work under extreme pressure for an extended period of time, making critical decisions and changes as required. It has given us greater confidence as an organization.
We are hard pressed on every side, but not crushed; Perplexed, but not in despair; Persecuted, but not abandoned; Struck down, but not destroyed. – 2 Corinthians 4:8-9 3. It sounds as if Covid demands most, if not all, of MMC’s resources and efforts. What projects/upgrades at the two hospitals were on the books but got delayed because of the pandemic?
We’ve repeatedly discussed the need for a detox center, but just can’t find time to fully evaluate. And with the pressure on staffing and beds, we cannot take on an additional inpatient service.
Even as we speak, South has a big project going to increase critical care beds by 50 percent – from 12 to 18 beds. But it’s faced construction delays, state review board delays and shipping delays. Meanwhile, steel, plywood and concrete have more than doubled in price.
We were expanding and coordinating our off-site labs, but that got hindered by workforce shortages and overwhelming time required for Covid testing, reporting and resource needs. We have increased the volume of work we send to the Huntsville Hospital lab.
Telemedicine … when the pandemic hit, we were exploring how we could use that to connect patients with specialists, or with their own physicians outside of rounds. That got interrupted. 4. At some point in the future, when MMC has the time and resources to think of anything other than Covid – and after you address delayed projects – what needs and improvements would you and the board like to address?
We need to upgrade our information system and evaluate online scheduling for outpatient procedures. We want outpatient procedures to be as convenient and “sleek” as possible.
Despite Covid, we had a great year recruiting physicians, adding six doctors, five of them specialists.
This year we have just recruited an additional orthopedic surgeon, and hope to add a neurologist, urologist, gastroenterologist, anesthesiologist and an otolaryngologist (ear-nose-throat). We plan to open an additional operating room at each hospital. Once we have those in place – and our OR cases continue to grow – we may want to look at an ambulatory surgery center.
Prior to pandemic, our hospitals gave about 15 IV infusions daily, most commonly antibiotics, osteoporosis or lung treatments, blood products and IV fluids. Those resources had to be devoted to Regeneron infusions during the pandemic, but we’d like to look at centralizing those treatments at an infusion center.
We need additional critical care beds at North, where we only have eight. We had way too many days when we had to hold patients in ER because beds were unavailable. 5. What’s something most people don’t know about Cheryl Hays?
I’ll have to dig deep for that. I’m pretty open. I think most people see me as being very in control of my emotions – very even-tempered.
But they don’t know that I suffer from road rage. I stay calm in just about any circumstance all day – but put me behind a left-lane driver – and I can barely hold myself together.
And there may still be someone who does not know that I am retiring by the first of March. Though, considering my road rage, I may not plan many road trips.
