United through Access: The Value of an Access Team
I’m no stranger to wearing many hats. Coming from a lean, New York State hospital, I’ve always been asked to juggle roles. During my time as the Medical Director of Primary Care, I took on a plethora of positions – within the leadership of my own division, the Department of Pediatrics, the larger hospital system, and the pediatric residency and medical school training programs.
Despite all these appointments, nothing could’ve prepared me for the world of ambulatory access.
Prior to the pandemic, our department chair had a vision for greatness – one that involved capturing patients from our key catchment areas who so often skipped over us in favor of receiving specialty care in New York City. She vowed to accomplish that by expanding the ambulatory footprint and the scope of our departmental faculty to support the new growth. As a part of her bold plan, she envisioned increased numbers of unique patients seeking primary and specialty care, eventually supporting the building of a children’s hospital.
She used to tell us that “failure is not an option,” and we heard her, loud and clear.
It was at this critical juncture that I got my opportunity to step into the world of access. Among the key appointees for the expansion were: a business partner, a clinical lead nurse, a seasoned appointment scheduler, and me – the Medical Director of Primary Care. As someone who’s worked with healthcare leaders for many years, I thought handling such a group would be little challenge.
That assumption was quickly turned on its head. Our four clashing perspectives each seemed to pull the group in different directions, stretching ourselves so thin that we couldn’t come to an agreement. Our conversations were intense from the get-go, and they weren’t always fun. Rather than rallying around our passion for patients, our competing goals seemed to collide at every juncture.
However, it was the intensity of these early discussions that eventually forged our strong bond. Slowly, the by-product of these impassioned meetings emerged: a new and honest knowledge of each other’s perspectives and priorities. By advocating for ourselves and expressing our goals from the perspective of our previous positions within the health system, we learned fundamental truths about one another.
Finding that we were all dedicated to access, clinical excellence, and patient satisfaction, we began to discuss how to achieve our shared goals. We collectively identified metrics from our available data: volume, provider reimbursement, our error reporting system, and patient experience.
I brought a provider’s perspective to these roundtable discussions, teaching my partners about the priorities and motivations of our career academic clinical physicians. I shared my wealth of knowledge on departmental and hospital priorities, the lessons I’d learned from leading a group of physicians, and the nuances of how academic learners impact the clinical environment. Not lost on my colleagues was the empathy I expressed over our physicians’ feelings of helplessness: that they were sacrificing autonomy and being left without sufficient time to care for patients -- or how their home lives were being impacted by the multitude of in-basket messages, necessitating late nights and weekend hours.
At the same time, I learned a plethora of access topics new to me, like call answering rates, the workflow related to patient scheduling, the nuances of template building, monitoring room utilization, and countless more operational details. Through courage and collaboration, we had assembled our dream team to tackle new access challenges.
However, as history teaches us: the best-laid plans of mice and men oft go awry. Shortly thereafter, the pandemic struck.
Our work turned on its head, and we were suddenly thrown into the turbulent sea of shifting ambulatory access. Overnight, the playbook we had so carefully crafted became obsolete. Clinics shut down, reopened, and shut down again. Schedules were rewritten daily, telemedicine became ubiquitous, and patients needed access more than ever.
In those moments of chaos, it was not a single strategy or an individual’s expertise that carried us through. It was our ability to lean on one another - to draw from our collective knowledge, pivot quickly, and make decisions in real time.
Our differences, once a source of tension, became our greatest strength.
This shared adaptability allowed us to not only survive the uncertainty, but even to strengthen our commitment to access. When policies changed overnight, we adjusted. When providers hesitated to embrace new workflows, we were there to educate and reassure. When patients struggled to navigate virtual care, we found ways to bridge the gap.
In the years since, our work has extended beyond access alone. When I launched an Ambulatory Quality Board, each of us introduced a metric drawn from our respective disciplines, shaping patient care with the same interdisciplinary collaboration that had sustained us through the pandemic.
These efforts have had a lasting impact on our operations, our colleagues, and most importantly, the patients we serve. The team that helped lead the charge began as four fragments, but we emerged as a cohesive unit. We were taught a valuable lesson as we grew to understand one another - that access isn’t about any single perspective; it’s about uniting diverse voices in service of the patient.