Q&A: HHSC Kaua’i Region’s Lance Segawa discusses the importance of transparent organizational culture during a pandemic

With 41 years of leadership experience in health care, Lance Segawa is in the unique position of being the Regional Chief Executive Officer in the Kaua’i Region at Hawai’i Health Systems Corporation (HHSC), which runs two hospitals and five clinics on the rural island of Kaua’i. In this Q&A, Segawa discusses pandemic preparation, the vaccine rollout and the importance of a transparent organizational culture.


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Sydney Kurle: Can you tell me a little about Hawai’i Health Systems Corporation: Kaua’i Region? What is your mission and who do you serve?

Lance Segawa: “Hawai’i Health Systems Corporation is the state of Hawaii’s safety net hospital system. So we are a public entity, we have roughly 13 hospitals throughout the state and on Kaua’i, we have two hospitals Kaua’i Veterans Memorial Hospital and Samuel Mahelona Memorial Hospital. When I talk about safety nets, we serve the entire community, irrespective of someone’s ability to pay. We serve uninsured, we’re there to provide comprehensive health care to the entire community no matter what the situation.”

SK: What issues has your region experienced with the pandemic?

LS: “I would say some of the same things that have impacted communities across the nation. Initially there was a lot of concern regarding our capacity on Kaua’i, to take care of what was expected to be a fairly significant number of infected individuals. So early on, I’d say February or March of 2020, we did a lot of projections on what the worst case scenario might look like. Did the island have enough hospital beds? Did we have enough ICU beds? Did we have enough ventilators to care for these patients? We also examined resource capacity in terms of people. Did we have enough nurses, respiratory therapists, doctors? So we went through that exercise. Once the lockdown began, because in our situation both our hospitals have attached long term care facilities, we had to pay really special attention to making sure that we could keep those long term care residents safe, because they’re the most vulnerable. That meant that we had to close down visitation and isolate these residents. It was really difficult for the residents and their families. We had to implement some pretty restrictive policies around travel for our employees. We had to make sure that our employees remained healthy. And then we began to see issues around PPE supply, being an island state it takes a long time to get supplies from the mainland. Did we have enough masks? Have enough gloves? Just basic personal protective equipment for the employees. 

Access to care was definitely impacted. People couldn’t go and see their doctor like they normally do, so telemedicine became a very important way of connecting with patients. And we definitely saw community members stay away from the ER, and what we’re experiencing now is the people who come to the ER are a lot sicker, because they’ve been waiting, out of fear that if they come to the hospital they could potentially catch COVID. So all of these things have been felt throughout the entire country. I don’t think we’re that much different.”

SK: What programs have your organization created to deal with the emotional stress of the pandemic?

LS: “We have the only inpatient behavioral health unit. So one very important decision that we had to make was to delay the construction of the unit. We have nine beds, if we went forward with the renovation, we would have reduced our capacity to four. Which was part of the plan, we were going to do that, the renovation was going to take about nine months, but because of the pandemic , we decided to delay the renovation. We thought it wasn’t possible for us to manage the potential load of patients needing psychiatric support. As it turns out, that was a good decision. In our nine bed unit, the average census has been around seven or eight. 

So if you think about it, if we had done the renovation as planned, reduced our capacity to four, that would have meant all these patients would have needed to be transferred to Oahu. And that would have been very difficult. That was a decision that was made to support the psychiatric and behavioral health needs of our community. Our primary care doctors have been more attuned to dealing with their patients’ needs in that area of psychological issues, depression, just isolation in general.”

SK: How has your organization been handling the vaccine rollout, especially in such a rural area?

LS: “From the very get-go, we knew that the only way to do it in Kaua’i would be to coordinate our resources with the third hospital on the island, the private hospital, Wilcox Medical Center So we began conversations with Wilcox Hospital and their leadership. We made an agreement early that we would lock hands and work together in vaccinating the community. The major player was the department of health, and so they were part of the team and in many respects, led the effort to coordinate. 

So by doing that, we were able to create consistency in terms of communication for the island community. That meant streamlining the supply chain of vaccines  because that was a statewide effort. By making sure that we have our act together in Kaua’i, we’re able to be much more exact with what we needed on a week-to-week basis of vaccine supplies.

I think that effort puts us in a good position because now we’re pretty much done with the 75 and older group, which is the 1b group. That puts us in a good place to be prepared to do the next group, which is the 1c group  ages 65 to 74 and people with chronic diseases. We’re actually in a pretty good place right now.”

SK: What are some of the challenges of providing care in a rural community?

LS: “One is the access to qualified providers. So physicians, different specialties, pathologists, infectious disease specialists, cardiologists, we struggle to have an adequate supply of that level of provider. Primary care is also challenging. We need more primary care doctors. We also struggle with specialty nurses, so ICU nurses, ER nurses, and it’s just because our pool is smaller. And when we go to try and attract people from other states, there’s always that issue of can they acclimate to the island? Because there can be a cultural difference. There’s always that risk that someone comes to Kaua’i and it’s just not a good fit, and there’s an associated cost with that as well. It costs money to bring someone on to the island. But again I don’t think it’s any different anywhere you go.”

SK: The provider shortage has been exacerbated by the pandemic, you touched on it a bit but how has your organization been dealing with the shortage? And what strategies do you use to lure providers in?

LS: “This is gonna sound almost too simple, but I think it’s such a great way to start in terms of a strategy. In our organization, we really emphasize and encourage having constant communication. Talking about difficult situations, we don’t want employees to ever feel alone. So I think that having that ongoing emphasis on how everyone is doing. Making sure the managers are working with their staff on a regular basis. How is everyone adjusting to this new normal with the virus? I think that has helped. It’s kept everyone connected. No one is feeling isolated. Again it sounds simple but encouraging difficult conversations doesn’t always happen consistently in organizations. Don’t be afraid of asking the tough questions. Don’t be afraid of really addressing issues. So when you think about stress, stress builds up because you’re holding things in, and we encourage people to let it out. Because if you don’t do that, how are you going to be your best when you take care of patients? You have to take care of yourself first. So we spend a lot of time developing managers and encouraging that kind of connection with employees. So I think that’s really an important strategy and it’s part of who we are as an organizational culture. So I think our culture was the right way to go, it was the right thing to have with the pandemic.”