Table of Contents
Strategic Rationale
Inova recognized that improving access was not just an operational challenge — it was a cultural one. Despite incremental investments in digital tools, staffing, and service-line expansion, patient wait times and internal friction persisted. Leadership realized the root issue wasn’t insufficient resources but inconsistent expectations and processes across sites. To create sustainable access, Inova needed to operate as a unified system — shifting from localized autonomy toward shared accountability and standardization.
“There is a huge culture of access that needs to be shifted. And because of that, I think you need to have the appetite for change and the courage to do hard things. You need executives that are bought in and supporting and you have to be able to show your wins, your efficiency, your data, you have to be able to tell that story. You have to be able to take the feedback from the practices of what's not working. You have to have a responsive process to make those changes in real time. Same thing with the care sites. You have to be willing to listen. You have to be willing to make changes. You also have to be willing to be transparent with what you need on the other side.”
– VP, Operations, Clinical Enterprise
Overview
Beginning in late 2020, Inova launched a multi-year effort to standardize core operational and clinical processes, focusing on provider scheduling templates, visit-type definitions, and hoteling standards. The initiative sought to uncover hidden capacity by aligning enterprise and clinical leaders on what access really means: not adding more staff or clinics but using existing resources more consistently. The cultural side of the work was just as intensive. Leaders engaged in deliberate, systemwide conversations with clinical chairs, medical directors, and operations managers to define new expectations for scheduling, template utilization, and accountability.
Time Frame
Major standardization pilots began in late 2023
Pilot Scale
Began with select ambulatory service lines (e.g., primary care, specialty practices) and expanded to include enterprise-level scheduling and provider template standardization across the system.
Hoteling and workspace standards implemented across multiple administrative and clinical sites to enable shared physical and operational capacity.
Goals and Competitive Advantage
Establish enterprise-wide access standards that enable a consistent, predictable experience for patients and staff.
Create measurable capacity gains without new capital or staffing positioning Inova to meet rising demand sustainably.
Build a culture of shared accountability where access is viewed as a systemwide responsibility, not a local burden.
Strengthen Inova’s reputation as a high-reliability organization — one that manages variation, measures throughput, and operationalizes “systemness.”
Results
Increased scheduling efficiency and visibility into provider availability, allowing for more balanced patient loads across clinics.
Improved internal confidence in data and access metrics, shifting conversations from “we feel full” to “here’s where our capacity actually is.”
Tangible cultural change reflected in provider participation and acceptance of standardized workflows.
Level of Investment
The early portion of the pilot was relatively inexpensive, focusing existing team members on addressing different priorities throughout the organization to enable different levers of access. Some examples include:
The strategy team not only assessed market demand but developed ambulatory operating standards with expectations for clinic room utilization.
The EMR team focused on building more self-service capabilities while modernizing our foundation system
The analytics teams developed dashboards and KPIs to monitor our progress.
However, the continuing work is a heavy and ongoing lift, as it was distributed across many teams, systems, and leadership structures. This remains a system priority, as mindsets and outputs need to evolve as quickly as both consumer sentiments and technologies change.
Lessons Learned
Standards before sophistication. Inova learned that without agreed-upon operational and clinical standards, even the best technology won’t help access. They had to agree upon a set of standards, otherwise “it’s legitimately a software puzzle — the pieces won’t fit together.” Accordingly, shared logic had to precede advanced initiatives.
To help wait times, work backwards before adding providers. Inova leaders began with desired outcomes and traced backward through process variation to locate the root causes. For instance, after identifying they could not get patients in for four weeks, they identified it wasn’t a physician headcount problem but an appointment standardization problem.
Clean up legacy variation to unlock hidden capacity. Many of Inova’s access barriers were homegrown. Over time, acquired practices, outdated EMR builds, and uneven scheduling norms had created invisible inefficiencies. Aligning those systems and resetting expectations across sites revealed that capacity already existed.
Trusted, cross-functional leadership creates sustainable change. Instead of setting expectations from the top down, Inova brought together respected physician, nursing, and operational leaders to define what “standard” should look like for each specialty. By grounding targets in both RVU performance and contact-hour realities, those leaders ensured standards were realistic and defensible—avoiding the distrust that arises when metrics feel disconnected from clinical practice.
