Case Study: Hospital Moves Outpatient Service Line to Freestanding Ambulatory Care Center

Case Study: Hospital Moves Outpatient Service Line to Freestanding Ambulatory Care Center

Avanza capabilities at work: Strategic Planning, Implementation, Due Diligence


A large academic medical center in the Northeast requested assistance with a two-phase project that included (1) building a freestanding, provider-based orthopedic surgery center for new and existing services, and (2) developing a musculoskeletal ambulatory care center. The hospital wanted both centers located in the same building, and it intended to move its outpatient orthopedic procedures, musculoskeletal physician practices and ancillary services into the new facility. The outcome would be a comprehensive program that could compete with other freestanding orthopedic programs in the area.


Avanza Healthcare Strategies (formerly ASC Strategies) was engaged by the hospital to serve as an "operational general contractor" over the project and to work with the hospital facilities team, outside architect and program administrators to ensure program-integration, efficiency and cost-effectiveness goals were met.


  • Provided guidance on how to develop and operate the new outpatient program most effectively by taking advantage of the single location for services, reducing redundancies in operations and staff and establishing appropriate reporting structures.
  • Made recommendations related to facility design, including equipment selection and location, in order to maximize workflow efficiency.
  • Developed staffing plans that would deploy support staff more effectively, minimize redundancy and reduce costs.
  • Standardized paperwork across disciplines, eliminating the need for patients to fill out multiple forms upon arrival and enabling same-day visits across disciplines.
  • Developed documents, trainings and drills to ensure operational compliance prior to regulatory surveys required for licensing and accreditation. Policies and procedures addressed patient safety, infection control, quality measurement, benchmarking and other operational priorities.
  • Worked with the IT team to customize EPIC to the ambulatory care center's needs and workflow.
  • Advised the hospital's supply chain managers how to ensure just-in-time deliveries to the offsite department.
  • Assisted in the development of communication plans for providers and patients regarding the new location and integrated services.
  • Infused a culture of quality, efficiency and competitiveness by revising operational workflows and procedures, and assisting with staff selection, training and other internal reforms. As the hospital CEO said, "You're here to slap our hand every time we try to turn this into a mini-hospital."


Avanza worked with the hospital project manager from concept through opening of the ambulatory care center, serving as additional bench strength during the critical development process. The facility passed all regulatory surveys with no deficiencies, and the program is now self-managed, profitable, competitive and growing.

A majority of the hospital's orthopedic patients are seen at the center, and with patient wait times under 10 minutes, provider and patient satisfaction is at an all-time high. Moreover, after just 12 months, daily patient encounters are 15 percent higher than the hospital's goal, and the percentage growth in budgeted encounters has doubled.

The center also has emerged as a marketing asset because of its physical and operational appeal. Institutions from around the country tour the facility, and it is being used as a model for other organizations as they develop similar programs.

Avanza is on call to help the institution with a planned expansion and addition of new programs into the facility.

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