Redesigning ambulatory care for what’s next

As ambulatory care continues to take center stage in healthcare transformation, health systems are reimagining patient throughput, delivery models and leadership structures. One of the voices leading this charge is Jeff Butler, COO of UCLA Health’s Community Clinic Network.

For Butler, solving healthcare’s toughest problems starts with one fundamental focus: making care accessible.

“Access is my No. 1 priority — without it, nothing else we do matters,” he says. “If patients can’t get in, the rest of the system doesn’t work.”

That clarity of purpose has shaped how UCLA Health is redesigning its ambulatory infrastructure — not just by adding new clinics or services, but by radically rethinking how care is delivered, optimized and scaled. With 288 sites and growing, the organization is investing in a mix of data-backed planning, operational rigor and embedded innovation, from specialty urgent care models and mall-based retail clinics to virtual triage and real-time space utilization teams.

Butler’s leadership also has helped bring cohesion to a complex enterprise, aligning governance structures, reinforcing cultural standards, and creating tools that empower frontline managers and improve staff retention.

In this Q&A, he discusses how UCLA Health is tackling access, why regional strategy matters more than ever, and how clarity, consistency and culture are critical to building the future of ambulatory care.

How did your career path lead to ambulatory leadership?

I didn’t start in healthcare. I actually considered Wall Street early on, drawn to the high-energy and pressure. But I realized I wanted a career grounded in human connection. That led me to the Institute for Healthcare Improvement, where I started by answering phones on the 1-800 line and directly interacting with people. From there, I moved into project roles working with health systems, which set me on a clear trajectory. I went back to school at the University of Michigan for my Master of Health Administration degree, then joined UCLA Health as an administrative fellow. Over the years, I’ve worked across nearly every part of the system — hospitals, service lines, call centers, strategy and ambulatory clinic operations. That diversity gave me a deep understanding of what it takes to lead ambulatory operations at scale.

With ambulatory revenue projected to surpass 50% of total health systems revenue over the next decade, how is UCLA making strides in access to care?

Access isn't a single-department issue: It's a systemwide effort that requires alignment from every corner of the organization. We’ve taken a multi-pronged approach. We’re expanding our physical footprint — opening new clinics, hiring more providers and increasing urgent care and access sites. We’re also optimizing what we already have. We launched an exam room utilization dashboard that tracks use hour by hour across more than 3,000 rooms. A dedicated operational SWOT team visits clinics to improve space usage, scheduling and workflows.

We’ve also gone deeper into urgent care access. We now have 12 urgent care sites and are launching 24/7 telehealth urgent care shortly so patients can talk with a provider within 15 minutes from the comfort of their home or workplace. Beyond that, we’ve created specialty urgent care models — same-day walk-ins for ophthalmology, oncology and orthopedics — to prevent downstream bottlenecks. We’re also in discussions to extend this to dermatology and neurology, among many others. The goal is to resolve urgent needs quickly, reduce ED visits and prevent the creation of unnecessary follow-up visits.

How do you evaluate geographic growth and positioning?

Every market is different. Like most others, we evaluate payer mix, competition, referral patterns and population demand. In Los Angeles, patients generally won’t drive more than 10–15 minutes for primary care, so we need localized sites. For specialty care or imaging, they may go further, like 30–40 minutes. Our strategy blends local hubs with regional spokes — and we use region-specific market share goals to guide our expansion.

Because we serve more than 10 million people in Los Angeles County alone, demand is high across the board. But capital is limited, so we’ve had to prioritize. We’ve taken a region-by-region approach, building out full-service networks that can serve entire patient populations.

What’s unique about your governance and leadership structure?

We’re still evolving, like many AMCs. One of my goals as COO has been to integrate ambulatory and hospital operations wherever possible — especially in shared services like HR, real estate and general services, things like security, materials, clinical engineering, and emergency preparedness. That said, ambulatory needs its own governance structure for things like policies, SOPs and daily operational workflows. We've created tiered escalation huddles specific to ambulatory and set up distinct committees that ultimately report to the same system-level governance. It’s a hybrid — we act like one system where it makes sense and maintain separation where necessary.

How is UCLA Health using digital and virtual tools to expand care?

Virtual care is far more than video visits, though we still do about 10–12% of our visits that way. It’s about how we manage inbox messages, deploy e-consults, triage patients and schedule efficiently. We’ve added self-triage tools and are using telehealth to fill urgent needs quickly. Getting as many of these tools in the hands of patients lets us scale care, preserve in-person slots for those who need them and give patients more choice.

How do you ensure brand consistency and experience across 288 sites?

That’s one of the hardest parts of my job. We’ve are currently building what I call our UCLA Health ambulatory operating system — a standardized playbook for how clinics run, even those that are 200 miles away from our main campus. It includes everything from SOPs and workflows to space standards and training. We’ve also created hands-on support teams — patient experience, space utilization and operational implementation — to help execute at the clinic level. I like to compare it to Starbucks: You know what to expect from the brand, and that consistency comes from well-defined processes and training, not just signage.

What are the key performance indicators for your network?

We focus on three high-level metrics:

1. New patient growth: Our goal is 5% year-over-year. More new patients equal better access.
2. Patient experience: Specifically, likeliness to recommend. We are just starting to use AI tools to aggregate feedback into one clear score for local teams to help focus on key areas.
3. Safety event reduction: We aim to reduce safety incidents (e.g., wrong medication, patient falls) by 2% annually.

These are part of every clinic’s scorecard, which we review monthly. We’ve intentionally kept the metrics simple and focused as too much data can become noise.

How would you describe your organizational culture and leadership approach?

Our culture is built around passion for patient care and talent development. We’ve created centralized recruitment and robust onboarding. I’m especially proud of our clinic coaches who we’ve certified to help develop managers. Each one rotates between 20-25 clinics to implement best practices for holding meetings, having difficult conversations and building morale. We’ve seen a 24% improvement in our staff turnover this past year. My leadership style is hands off unless needed. My aim is to provide tools, remove barriers and trust my team to thrive by empowering them. That’s how we build culture — by investing in people.

How are you using data and technology to support staff and patients?

On the workforce side, we’ve built a people development scorecard that tracks turnover and highlights areas for improvement. For operations, we’ve created centralized dashboards around access, call center performance and clinical workflows. But we’re very careful not to overload our teams — we focus on a few meaningful metrics and use the rest as deep-dive tools.

What excites you about your role at UCLA Health?

I love working with smart people to solve hard problems. Healthcare is incredibly complex, and it’s filled with brilliant, passionate people — that combination motivates me. Every problem we tackle is rooted in doing what’s best for patients, and that mission gives the work meaning. I’ve stayed at UCLA Health for 17 years because I believe in the people here. Whether I’ve been leading a call center or expanding a behavioral health program, it’s the challenge and the team that have kept me going.

On my first day as a manager, a seasoned nurse came to me in tears, asking for help with a difficult colleague. I didn’t know what to say — I was fresh out of school. But I listened, stayed present and we found a resolution together. That moment cemented for me that leadership is about people. Supporting them and listening to them — that’s the job.

Any innovative practices you’re especially proud of?

As I’ve briefly mentioned, these three stand out as they help us provide improved access and care for our patients:

• Mall-based clinics: We’ve opened three, with extended hours and weekend appointments. They’re located where people already go, making care convenient and accessible and giving patients as many options as possible.
• Space utilization SWOT teams: They assess exam room usage in real time and recommend workflow changes to maximize our clinical space. This helps us grow without costly new constructions.
• Behavioral Health Associates model: We embedded therapists and psychiatrists into primary care for short-term mental health needs. It’s a co-managed model with the primary care physicians covered by insurance that allows us to intervene early and prevent downstream crises. Patients love it, and it’s been a big win for increasing access to behavioral health needs.

What advice would you give leaders looking to grow ambulatory services?

Don’t chase volume or margin alone. Use data to identify genuine needs in your community and resist the urge to expand specialty services in isolation. You need comprehensive services — primary care, labs, specialty care and imaging — to build a sustainable, trusted footprint. Think regionally, and plan for what it takes to support each service.

What’s your greatest professional accomplishment?

Honestly, it’s staying at UCLA Health for nearly two decades and still making an impact. Watching ideas become real — programs, clinics and policies — and seeing them improve patient care is deeply fulfilling. It’s not one moment; it’s the accumulation.

I tell people that it’s important to do something that inspires them. If you’re not excited about your work, you won’t do your best — and you won’t be proud of the result. Find meaning in your role, and it’ll show in your outcomes.