A Day in the Life: Managing for Emergencies: Chief of Emergency Medicine for Jackson Memorial Hospital in Miami Balances Budget Realities and Patient Needs
Romano, Catherine, Management Review
A first impression of Jackson Memorial Hospital in Miami is that it's not a medical center at all, but a 67-acre park. The grounds feature manicured lawns, a tree-lined drive and colorful flags snapping in the Florida breeze. Off to the left is the Alamo, a small pink Spanish-style structure that served as the hospital's first building in 1916.
But the Alamo belies the evolution that has since taken place at Jackson Memorial Hospital, now a modern complex with state-of-the-art buildings rising high above that introductory facade. Inside, the urban hospital has its share of sleep-deprived doctors, patients without insurance and too much to do with too little money. That's the world of Dr. Kathleen Schrank, chief of emergency medicine for Jackson. By almost any measure, Jackson is one of the largest and busiest hospitals in the country - 1,567 beds, 52,298 admissions and a budget exceeding $500 million.
Schrank's office is tucked away from the fracas, between triage and billing; and when she starts work at 7:10 a.m., the emergency room is quiet. Quiet, however, is relative. To get to her office this particular morning, visitors must sidestep a young man on a stretcher having his blood pressure taken.
But on this Wednesday, Schrank will not spend much time loitering in her office. It's the first day of a month-long stint in which she will work "on the wards," supervising a team of residents, interns and students. Schrank also serves as an associate professor of clinical medicine for her alma mater, the University of Miami Medical School, a position that requires her to spend two months a year providing patient services. During March she will have spent 25 to 30 hours a week as an internist.
"It's not fun in terms of the overall time required, but I enjoy working as an internist," says Schrank. To make it work, she'll come in earlier, work later and take more work home. "I love the first two weeks, start to get tired the third week, and the fourth week is really long. Then I take a vacation," explains the 44-year-old doctor.
Of Schrank's three years of internal medicine training, she most enjoyed the seven-month stint in the emergency department and the six months in the critical care units at Jackson. After training, she took a one-year position as chief resident and then joined the emergency department staff in 1983. "The hospital couldn't understand why I jumped at the chance [to work in this department]," explains Schrank. Because of the chaos and the generally unpleasant physical surroundings, most physicians don't choose emergency medicine.
By 7:20, she has been awake for nearly an hour and is ready to start her workday. She is already on her second Diet Pepsi. The first was part of her "autopilot" morning routine: Feed the cats, maybe grab a Diet Pepsi and go. "As a medical student, days and nights didn't make a difference, so starting the day with cold caffeine is just fine," explains Schrank.
Today, like most days, there was little traffic during the 20-minute drive from her house in Key Biscayne. Her husband of 23 years, a public defender with whom she shares some of the same clients, was still sleeping peacefully.
Soda in hand, Schrank is briefed by Gloria McSwain, director of nursing for the Emergency Care Center. A delegation of legislators will be visiting the emergency department sometime that morning. Schrank won't be available because she'll be seeing patients. But since none of the names ring any bells to Schrank, she just chalks it up as one of the many tours the department gives each year.
All the same, she informs her staff of the visit as she checks in at each of the center's four divisions. The attending physicians give her a status report before they go home for the day. Her first stop is the Medical Treatment department, her home base.
Although calm at this hour, Medical Treatment is the area that the public generally associates with an ER - doctors, nurses and staff frantically racing around in their color-coded scrubs and ubiquitous white jackets, making life-and-death decisions as patients are continually wheeled in. …