Access and flow: Why a system approach works
Abstract
Patient access and hospital flow remain among the most pressing challenges for health systems today. Emergency department boarding,1 prolonged inpatient stays and delayed speciality appointments create inefficiencies, increase costs and undermine patient experience. Inova Health, a nonprofit system in Northern Virginia, undertook a system-wide transformation to address these challenges by moving from a site-based to a system-based approach. This paper outlines the guiding principles, infrastructure and cultural shifts that enabled Inova to create an integrated ‘access and flow system’. Key enablers included the development of a centralised capacity management team, a system transfer centre, a multispeciality contact centre and digital tools such as self-scheduling, remote monitoring and automated outreach. Organisational change management, including standardisation of processes and a consumer-first mindset, was central to success. The paper discusses the lessons learned in shifting from a holding company model to a true system of care, highlighting the importance of technology enablement, transparency and resilience in leading large-scale change. This experience demonstrates that patient access and flow are not isolated challenges, but system challenges requiring coordinated solutions. The implications for other health systems are clear: meaningful progress requires infrastructure, cultural alignment and leadership commitment. This article is also included in The Business & Management Collection which can be accessed at https://hstalks .com/business/.
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Author's Biography
Marque Macon, FACHE, is vice president and administrator of ambulatory operations and physician/ APP Services at Inova Health, where he leads operations and strategy for more than 175 physician offices, 10 service lines, 2,100 employed providers and over 3.2 million annual patient encounters. He is accountable for financial performance, operational excellence and integration of ambulatory services across the system of care. Mr Macon brings over a decade of leadership experience spanning quality improvement, value-based care, population health, business development and physician practice management. Prior to joining Inova, he served as Assistant Vice President for Atrium Health’s Clinically Integrated Network in Charlotte, NC, supporting more than 2,700 physicians in advancing cost, quality and risk adjustment outcomes. A Fellow of the American College of Healthcare Executives (ACHE) and a Certified Six Sigma Black Belt, he also serves as ACHE Regent for the District of Columbia and Northern Virginia. He holds a BS in industrial engineering from Clemson University and an MBA from Loyola University Chicago.
Michelle Vassallo, MHA, BSN, RN, NE-BC, CEN, is vice president of operations, clinical enterprise at Inova Health, where she directs strategy and execution of patient access and flow across Northern Virginia’s leading nonprofit health system. With nearly two decades of progressive leadership experience, she has advanced from frontline nursing roles in Inova Fairfax Medical Campus’s Adult Emergency Department and Trauma Center to senior executive leadership. In 2020, she served as Administrative Lead for Inova’s COVID Coordination Center, overseeing a team that administered 100,000 vaccinations in 53 days. Ms. Vassallo has been recognised for her leadership and impact with honours, including Washingtonian Magazine’s ‘50 Outstanding Nurses’ (2021), the Healthcare Council of the National Capital Area’s Employee of the Year (2016) and George Mason University’s Alumna of the Year (2022). She holds a BSN from the University of Virginia, an MHA from George Mason University and is board-certified as a Nurse Executive (NE-BC) and Certified Emergency Nurse (CEN).
Citation
Macon, Marque and Vassallo, Michelle (2026, June 1). Access and flow: Why a system approach works. In the Management in Healthcare: A Peer-Reviewed Journal, Volume 10, Issue 4. https://doi.org/10.69554/EGML9819.
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