Readers Write: Patient Access Has Evolved. The Operating Model Hasn’t.

Patient Access Has Evolved. The Operating Model Hasn’t.
By Steve Nilson

Steve Nilson is acting director of access and experience with Tegria.

Nearly every health system calls access a strategic priority. Once considered an operational outcome, patient access is now discussed in board meetings, embedded in growth strategies, and linked to financial sustainability and digital transformation. That’s real progress.

But in many organizations, the operating model still reflects an older reality. It’s an all-too-familiar model, one where scheduling, digital tools, workforce planning, and financial accountability are governed separately. We have elevated access to the boardroom. We just haven’t rebuilt the system around it. The result is misaligned leadership and a persistent gap between ambition and execution.

Recognition Isn’t the Problem

In conversations across health systems, leaders describe access as foundational to growth, patient experience, and margin performance. Executive teams review access metrics regularly. Investments have flowed into centralized scheduling, digital front doors, automation tools, and AI-enabled communications.

Yet appointment availability remains constrained. System transparency is lacking. Wait times persist. Workforce shortages strain capacity. Digital tools are layered onto workflows that were never redesigned.

The issue isn’t awareness, it’s integration. Access touches operations, clinical leadership, IT, strategy, and finance. In most organizations, responsibility is shared across these groups. Shared ownership can be healthy, but without clearly defined decision rights and coordinated governance, it often diffuses accountability. If everyone influences access, who owns the outcome?

The Structural Gaps

Three structural gaps appear repeatedly.

• Governance without coordination. Access strategy may be discussed at the executive level, but operational decisions still sit within departmental silos. Template design lives in ambulatory operations. Digital configuration sits with IT. Workforce planning sits elsewhere. Financial oversight operates on its own cadence. When these domains are not aligned around common priorities and shared metrics, execution slows. Decisions are made locally that affect enterprise performance globally.
• Technology before workflow redesign. Many systems have invested heavily in digital tools to enable access, from online scheduling to automated outreach, to AI-driven communications. These capabilities matter. But technology does not correct poorly designed templates, unclear referral pathways, or misaligned incentives. Without disciplined workflow redesign and provider alignment, digital optimization becomes surface-level improvement. The underlying constraints remain.
• Workforce treated as a supply problem. Workforce shortages are real and significant. But many organizations frame the issue solely as a recruitment and retention challenge. Less attention is given to productivity design, top-of-license utilization, and care team restructuring. When capacity constraints are treated only as a hiring issue, operational redesign opportunities are missed. Access transformation requires rethinking how care teams are structured, not just how many FTEs are available.

Finance Must Be in the Room

Another pattern is limited structural involvement of finance in access governance. Access is expected to drive growth and protect margin, yet ROI attribution and capital discipline are not always tightly integrated into strategy development.

That disconnect creates tension. Operational leaders pursue experience and throughput improvements. Finance leaders require near-term, measurable return. Without shared governance and aligned performance metrics, access initiatives can stall in prioritization cycles.

Access cannot be an operational initiative with financial consequences reviewed later. It must be governed as a financial strategy from the start.

What Actually Changes the Trajectory

Organizations that close the execution gap do a few things differently:

• They clearly define what success looks like.
• They establish enterprise-level governance with defined decision rights for access.
• They align operational, clinical, digital, and financial leaders around a shared scorecard.
• They challenge internal policies and requirements that add complexity to processes.
• They redesign workflows before optimizing technology.
• They treat workforce design as a strategic lever, not just a staffing problem.
• They narrow priorities rather than spreading resources across fragmented pilots.
• Most importantly, they recognize that access is not a project, but an enterprise priority.

From Initiative to Operating Model

The next phase of access transformation will not be defined by how many tools are deployed. It will be defined by whether organizations align governance, workforce, finance, and digital infrastructure around a cohesive operating model.

Access has been elevated appropriately. Boards are paying attention. Executives are engaged. Investment continues. But elevation alone doesn’t produce integration. Until access is governed with the same structural rigor as finance, quality, and growth, health systems will continue optimizing components rather than transforming performance.

The opportunity isn’t to declare access strategic. It’s to build the system that makes it executable.