By ANN DONAHUE
In a single year, Cedars-Sinai Medical Center sees more than 130,000 patients 60,000 of those emergency-room visits. The 24-acre campus is made up of eight main buildings, totaling more than 1.5 million square feet, which includes separate wings for outpatient surgeries, mental health and pediatric research.
There are a total of 6,600 employees, 1,800 physicians and 2,000 volunteers.
It's one of the world's most hectic and challenging hospitals, a place that tries the most dutiful of doctors and the most accepting of patients.
At the center of it all is Dr. Arthur Johnson.
Johnson is chief of staff at Cedars-Sinai. As such, he is the ambassador between the hospital's doctors and the administration the man who describes changes in regulations to his physician colleagues and acts as their advocate on policy issues to the guys who wear suits instead of scrubs. He's the one who has to control the chaos by lending an understanding ear to doctors but by making sure petty politics doesn't get in the way of patients.
To do this, Johnson is trying to make Cedars a more open place, a hospital where doctors can speak up to the administration and act as advocates for patient care. He has instituted a policy of free communication, in which doctors are encouraged to voice their opinions in forums that he arranges.
"If you didn't have doctors and you didn't have patients, you wouldn't have a hospital," Johnson said. "So you better listen to us."
As a result, Johnson finds himself holding meetings. Lots and lots of meetings. He darts back and forth between the administration and the doctors, and every now and then finds time to do what he went to school to learn how to do: deliver babies.
Apart from his administrative duties, he sees dozens of patients each week as an OB/GYN. "The most important thing I do at work is patient care," Johnson said. "There are no meetings I'm in that can't be interrupted."
Juggling the two sides of his workday requires an almost fanatical devotion to organization. Johnson's laptop computer with his schedule travels with him everywhere except the operating room.
At times, he admits it can get overwhelming.
"There are always so many problems," he said.
There's the upcoming accreditation process that Cedars is required to go through Johnson describes it as the mother of all final exams. There's legislation working its way through the state legislature that could change the cap on jury malpractice awards. There's the recent vote by the American Medical Association and doctors employed by Los Angeles County to unionize.
And then there are the things that impact day-to-day operations. Johnson just signed a policy change that requires those operating x-ray machines to obtain specific licenses. If it's a mandate from above, and it has to do with doctors, it has to go through Johnson first.
"They send it to me and it's usually written in legalese," he said. "I rewrite it so it sounds like me, sign it and send it on."
Johnson knows that all the things he authorizes won't be popular with the medical staff, no matter how open he keeps the lines of communication.
"I have my 30-second rule," he said. "You can complain for 30 seconds, and then that's it. Move on to something productive."
Colleagues find Johnson's leadership style almost paternal. He's firm when the occasion calls for it but it's always apparent that he's looking for the best solution. "OB/GYNs have a different outlook on life," said Dr. Paul B. Hackmeyer, vice chief of staff. "It's a kinder, gentler leadership."
At 11:30 a.m. on a recent Tuesday, it's time for one of Johnson's innovations to get doctors to talk about what's on their minds.
This is his "Fifth Tuesday" group, a gathering of the physicians he considers to be the opinion leaders of the hospital, in Cedars-Sinai's main conference room.
"I borrowed this theme from Ed Koch," Johnson said. "When Ed Koch was mayor of New York, he used to yell 'How am I doing?' This meeting is for me to yell, 'How are we doing?' "
Lunch is served for the 40 physicians that attend, but Johnson has no time for the pasta and Caesar salad. He hooks up his trusty laptop to an overhead projector and launches into a PowerPoint presentation on "competent and compassionate" care.
"You want to go beyond just responding to the problem, you want to solve it," he said. "Sometimes you have a really narrow window of time to accomplish things. But I'll say this this is the one place you can dream and then see it happen."
What are Johnson's dreams for Cedars-Sinai?
He wants to see more togetherness on the staff so he's arranging social events at the Los Angeles County Museum of Art and the Hollywood Bowl. He wants new doctors to feel at home "Cedars is a big place, people can get lost in the shuffle here" so he is going to start an orientation for the new physicians on board. He wants more doctors to step forward and talk about the concerns they have about the future of medicine under the managed care system.
"It's very important to develop future leaders," he said. "With the changes that have occurred in medicine, there's not much time to get involved in the political arena. The thing doctors have always done to survive is to practice medicine and not take time out to do administrative work. But rules, legislation, government these things can make them more effective as patient advocates."
An hour and a half later, Johnson heads to his medical office located in the east tower. It's 1 p.m., and after no less than four meetings, his administrative duties are done for the day. Now he has 11 patients lined up.
"It's kind of nice to come to your office," he says, sitting in the waiting room, finally eating his lunch and using his laptop as a tray. "It's sort of like a refuge."
As he looks through several pages of messages, he muses about his dual roles.
"The most difficult thing about being chief of staff is balancing administrative work with clinical practice so you don't shortchange either," he said. "The doctors trust me because they know I would never do anything to harm patients."
Johnson's consultation room has the typical physician's accoutrements a mammoth-sized medical degree on the wall and various plastic models of parts of the body you'd rather not know about as well as pictures of family and friends on almost every available flat surface.
"See that picture of those two twin girls there?" he asks, motioning to a black-and-white photograph of two women hugging. "They're in their mid-30s now. I've treated them since they were 14 and they've grown up under my care. They send me Father's Day cards. Being an OB/GYN allows me to develop rich relationships with people I don't think other internists have the same opportunity."
Johnson chose OB/GYN as his specialty because he respects the dedication women have to preventative health care. "It's an opportunity to really treat the whole patient," he said. "In this country, 70 percent of the women use their gynecologist as their primary care physician."
Are his patients impressed that their doctor also serves as chief of staff?
"They're impressed as long as they can still get an appointment," he laughs.
As the day winds down, Johnson treats a very pregnant patient named Brynn (she didn't want to give her last name), who is scheduled to undergo a Caesarian section the next day at noon.
Johnson explains the last-minute details Brynn can't eat after midnight, she should arrive at the hospital at about 10 a.m. and will be given epidural anesthesia around noon. The entire operation will take between two and three minutes after the incision is made, Johnson says.
Brynn is obviously nervous. This will be her second child Johnson delivered her first baby several years ago in an unplanned C-section after 22 hours of labor.
As she gets ready to leave, Johnson gives Brynn a bear hug and smiles.
"Between my first child and now, I've had some not-so-good pregnancies," Brynn said. "Arthur has always been so kind. He would let me come down and listen to the heartbeat of this baby anytime I wanted to. At some points, I was down here once a week. I live in Calabasas and I wouldn't come to Cedars if it weren't for Arthur Johnson."
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