Enhancing Cancer Care Through Ambulatory Care Model Redesign: Impacts on Disease-Based Care and Scheduling Teams in US Specialty Hospitals
David Dennis Price, Amy Elisabeth AltomareObjective:
The Ambulatory Care Model Redesign (ACMR) initiative sought to improve patient-centered, team-based oncology care in a leading US cancer specialty hospital by strengthening care coordination, optimizing care team roles, improving scheduling reliability, and increasing operational efficiency across ambulatory clinics. The initiative sought to address increasing care complexity, workforce strain, and patient throughput challenges by redesigning care delivery through interprofessional collaboration and agile implementation strategies.
Methods:
ACMR was implemented as a quality improvement initiative using Plan-Do-Check-Act methodology, agile project management, and a tri-level governance structure involving executive leaders, operational leaders, and frontline care teams. Key interventions included pooled rooming; top-of-license role optimization for medical assistants, registered nurses, and advanced practice providers; embedded disease-team scheduling; standardized point-of-service scheduling workflows; expanded electronic health record (EHR) checkout functionality; and real-time performance dashboards. Outcomes were monitored using key performance indicators, including order entry, same-day scheduling, EHR in-basket turnaround, checkout completion, and patient experience.
Findings:
ACMR produced measurable improvements in clinic operations, care coordination, and patient experience. Orders placed before checkout increased by 15.4 percentage points (pp), same-day checkout completion rose by 30.0 pp, and appointment scheduling before patient departure improved by nearly 20.0 pp. EHR in-basket optimization reduced scheduling-related messages per provider by 44.0%, with 80.0% addressed within 48 hours. Patient satisfaction improved by 15.3 pp for ease of scheduling and by 11.3 pp for perceived care coordination. Embedding schedulers within disease-specific teams also improved interprofessional collaboration and role clarity. Despite these gains, barriers including physician hesitancy, staffing variability, and dashboard fatigue highlighted the need for sustained leadership engagement, cultural alignment, and adaptive change management.
Conclusion:
Structured ambulatory oncology redesign supported by interprofessional governance, role optimization, EHR-enabled workflows, and real-time data can improve access, coordination, and patient experience. Sustaining gains requires continued leadership engagement, staffing alignment, and iterative performance monitoring.