Purpose: Over the past decade, the Heart Institute at Cincinnati Children's Hospital Medical Center (CCHMC) has grown its ambulatory presence significantly in Ohio, Kentucky, and Indiana. These efforts have aligned with regional strategic plans from an organizational and institutional level to expand access closer to home for pediatric cardiac and adult congenital heart disease services for patients and families. Ambulatory growth has required collaboration from many groups internal and external to CCHMC in order to optimize access to these services. The approach to care delivery within these initiatives can vary, so a “one-size-fits-all approach” does not work for robust and adaptable growth within the model established by the Heart Institute.  As such, a roadmap to document best practices, learnings, and key considerations for organizations to utilize when pursuing ambulatory strategic growth and development will help enhance success. This must be done through a lens of collaboration and ongoing learning. 

Project Design: A roadmap outlining steps, timeline, dependencies, and key questions was created with feedback and buy-in from administrative and clinical departments at CCHMC and from external partners. Four specific milestones were identified. The first milestone was the assessment of the opportunity through market analysis, understanding current referral patterns and consideration of potential partners in the region. The second milestone was the determination of the care delivery model. Options may include telehealth, a physical footprint in a leased location, use of a mobile health bus or a hybrid model. The third and fourth milestones included pre-launch and post-launch operational efforts respectively. Sub steps and considerations were identified for further clarity. Specific partners within the organization and necessities, such as communication and connectivity, are highlighted to illustrate the breadth of collaboration and transparency needed to accomplish growth.

Results: Due to the creation of this roadmap, the Heart Institute was able to effectively and expeditiously launch new ambulatory clinics, develop new relationships with area health systems, and increase market share in key strategic regions. Additionally, learnings and resource assessment could be captured and acted upon for faster problem solving. Since 2008, the Heart Institute has added 22 outreach locations across Ohio, Kentucky, and Indiana, providing access to care close to home for patients and families. As a result, between FY09 and FY22 Q3, clinic volume has grown by 56% and an increase in surgical volume of 34%. Specific examples of increased presence in various markets include the launch of clinics in Northern Kentucky for pediatric cardiology visits, partnering with local adult healthcare systems to provide services, and meeting patients at locations convenient to them via the mobile unit. 

Conclusion: The Heart Institute at CCHMC highlighted best practices and core questions to consider when pursuing strategic growth. Key examples of success were used to outline steps and included market assessments, care delivery pathways and models, stakeholders needed for operational efforts, and an ongoing process of optimization after implementation. Through this effort, a streamlined approach for ambulatory growth enhanced access to care for patients and families and can be used for future expansion opportunities.