Gwen MacKenzie took the helm of taxpayer-funded Sarasota Memorial Hospital in 2005, after the Florida legislature had decided to let it open clinics outside Sarasota County (but without using Sarasota tax dollars). The hospital’s plan to build an outpatient clinic in Manatee Memorial’s back yard has stoked controversy about fair competition, and the hospital is also dealing with issues such as uninsured patients, nursing shortages and doctors leaving high-risk specialties. We talked to MacKenzie as she made rounds on the night shift.

What’s different about a public hospital?

Our shareholders are the community. We have a publicly elected board. Our financials are on our Web site [www.smh.com]. Our profits go back into services and projects. It’s more about openness and transparency.

You’ve said your inpatient services lose money, so the hospital wants to increase outpatient dollars. What services are profitable?

Obstetrics, neonatal care, pediatrics, psychiatry and the ER are our mission services, but they are not profitable. We support them with orthopedic surgery, cardiac and our outpatient clinics. [In those clinics] we’re offering services the community needs to access close to home—primary care, walk-in services, home health, imaging. The first three are typically not profitable but imaging is. National chains such as Quest labs and HealthSouth come to the area to provide outpatient services in a niche fashion. We would like to be able to compete.

How many clinics have you opened?

We have 15 outpatient centers in various stages of development. We have three projects this year—the North Port freestanding emergency room, the State Road 64 clinic, over which there has been some controversy, and the main campus energy center that’s being replaced to make room for the replacement patient bed tower. Over the next five years, we’ll have $500 million in projects including the tower.

What’s the biggest threat to the hospital’s bottom line?

Declining reimbursement and increasing numbers of uninsured patients. Our obstetric services are over 50 percent Medicaid.

What’s the biggest threat to quality of care?

Lack of standardization of care. You’d never see a pilot not doing a preflight checklist. We’ve become more like that. We have checklists, audits, hand-off communication. We have a completely electronic medical record system. Less than 3 percent of hospitals have that today because it’s so difficult to get doctors to enter orders electronically. We’ve had it for seven years.

How do you keep patients and staff safe under a hurricane threat?

We’re spending $3.8 million this year to harden the buildings. We have an A team and a B team, and we’ve told them it’s their community responsibility to be here. We even have a shelter for their pets in the parking garage.

Are you in favor of universal health coverage?

I don’t think people understand what it means. It would impact how much healthcare we can receive. In Canada, they don’t rehab stroke victims after a certain age. For those of us who [can] freely choose any healthcare we want, it would be difficult.