Integrating Health System Clinics: Aligning Ambulatory Care Clinical Services to Enhance Patient Experience, Increase Efficiency, Improve Clinical Outcomes, and Elevate Team Engagement

An integrated health system aims to organize clinical services across the continuum of care for patients. This patient-focused model enhances experience, clinical outcomes, and operational efficiency. A large urban academic medical center with over 100 clinics has a divided ambulatory care oversight model consisting of academic department vs. health system ambulatory care clinics. The health system can better connect and manage the entire ambulatory care portfolio to drive performance improvements and increase staff engagement and role satisfaction while reducing the cost of care.
In May 2024, a multidisciplinary work group consisting of health system nursing and operational executives and project managers began the journey to integration. The aim of this substantial project was to achieve alignment, optimization, and cost reduction while increasing support, streamlining resources, and improving staff and faculty engagement for internal medicine service line ambulatory care clinics.
With a five-month runway to integration, the work group performed strategic assessments of staffing, clinical operations, provider productivity, and team engagement. Understanding and validating the scope of work was a key first step in the process. Initial assessments revealed the clinical teams were receptive to integration; however, the workgroup understood the importance of enhanced communication and increased clinical collaboration between health system leadership and key stakeholders within the academic departments.
The health system provided strengthened infrastructure to support next steps for integration. A roadmap, initiatives, and projects focused on optimizing clinical workflows and performance excellence were developed to reduce both clinical and operational variation while increasing patient access, efficiency, and safety. Also, there was a renewed focus on engagement and overall role satisfaction.
As a result of the assessments, staffing ratios were redistributed, ensuring the clinical team was working at top of license and scope. Development and implementation of standing medical orders (SMOs) helped to streamline and optimize clinical workflows, allowing for reduced clinic waiting times and increased satisfaction for patients. Clear provider productivity expectations increased appointment access and accountability for performance.
Early post-implementation data and feedback reveal the aim of integration was achieved and process improvements are ongoing. The team’s report improved staffing support, more efficient workflows, greater resource allocation, increased patient satisfaction, and stronger team morale. Longer-term outcomes to be measured are improved clinical outcomes and overall reductions in the cost of care. With continued positive feedback and outcomes, health system integration will be expanded to additional ambulatory care clinics.