Balancing the Load: A Smarter Approach to Ambulatory Access

By Elizabeth Woodcock, DrPH, MBA, FACMPE, CPC - Executive Director, Patient Access Collaborative

Monday mornings can feel overwhelming in any ambulatory practice. Patients with urgent needs flood the phone lines and messaging portals, competing for attention with those who have long-scheduled appointments. This pressure is especially intense in a specialty like orthopaedics, but it affects nearly every clinic. Healthcare is a seven-day-a-week reality, yet outpatient operations typically run only five days, creating predictable Monday chaos. Efficiency and experience suffer, and it’s not uncommon to hear comments like: “We can’t see patients Friday afternoon because we’re getting ready for Monday!”

High-performing health systems are turning to their access teams to solve this problem through load balancing. Also called level loading, these terms—borrowed from computing and manufacturing—describe redistributing existing resources to improve overall system performance. By spreading workload evenly, health systems increase reliability and scalability while reducing bottlenecks. Surges in demand don’t overwhelm the system, and gains in efficiency and experience are possible.

With a system-wide view of supply and demand, access leaders are stepping up to improve ambulatory operations by identifying opportunities to load balance the ambulatory enterprise. High-performing leaders may:

1. Analyze demand patterns. Provide data by month, day, and hour, broken down by service line, specialty, clinician, and diagnosis. These assessments reveal patterns, including seasonal trends (demand) and unused time (supply) to help predict future needs.
2. Facilitate the alignment of staffing and scheduling. Adjust clinician and staff schedules based on demand data. This approach informs more accurate strategic workforce and space planning than the educated guesses of the past.
3. Redirect patients strategically. Guide patients to clinics with lower volumes, emphasizing that care is available faster at alternative locations. Viewing operations at the system level is a game changer, with near-immediate gains for imaging, primary care, and other practices that have myriad geographically disparate locations offering redundant or similar services. While not all patients may be interested in alternative sites, many are happy to travel for timely access to care.  
4. Provide insight into clinic hours. Use data to decide whether to open clinics outside typical business hours, temporarily (for example, “new patient Saturday clinics in September”) or permanently.
5. Optimize scheduling templates. Add same-day appointment slots during predictable surges. Intentionally integrate new patient visits to meet surgical or procedural goals, especially when space or equipment is limited.
6. Balance patient mix. Analyze new vs. established patient demand to better design scheduling templates -- and plan for care teams, space, equipment, and linked services.
7. Leverage automation. Use tools like automated waitlists to fill unused slots.
8. Integrate clinician administrative time into scheduling strategy. Distributing administrative blocks across the week (rather than clustering on Fridays or Mondays), creating capacity balance for patient demand while ensuring clinicians maintain protected time for management, communication, and other administrative responsibilities.
9. Incorporate clinical dependencies into template design. Aligning appointment slots with requirements such as infusion schedules, lab draw timing, and medication-related visit windows to ensure safe, efficient, and patient-centered care delivery as well as efficient level loading.

By embracing load balancing, access leaders can help to create a smoother, more reliable ambulatory operation—one that benefits both patients and the health system.

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