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Ambulatory Care Team Improvement & Optimization (ACTION) Program 


“The impact of transformational leadership in patient outcomes cannot be overstated, as it has the power to inspire healthcare teams to provide the highest level of care and create a culture of excellence that leads to better patient outcomes, staff experiences, and care delivery.”


– Charlene Platon, Director of Ambulatory Nursing

Charlene Platon. profile image (1).png

The culture of transformational leadership has a demonstrated history of innovation, empowerment, and patient-centered care. One of the most recent achievements of this culture is the implementation of the Ambulatory Care Team Improvement and Optimization (ACTION) program’s 2nd cohort, which has had a meaningful impact on nursing practice, patient care, and patient outcomes in the ambulatory care setting. The program’s second cohort comprised of nursing and interdisciplinary team members across eight specialty care clinics.

The ACTION program is a continuation of the work that had started during the 2021 ACTION pilot. From its inception, the ACTION program was designed to improve the efficiency and effectiveness of ambulatory care delivery, with a focus on strengthening communication, streamlining processes and expectations, and enhancing patient-centered care.

Patient Experience Outcomes

  • Overall clinic improvement in patient experience metrics:

  • “How would you rate the nurses on listening carefully to you” – improvement from 86.5% to 87.4% (August 2022 to December 2022)

  • “How well the staff worked together to care for you” – improvement from 82.4% to 87.9% (August 2022 to December 2022)

  • Awaiting updated patient experience data from February 2023

Staff Engagement

“I feel engaged and that I am a productive member of the care team” – an improvement from 86% to 92% of participants.

“Likelihood to recommend the organization to a colleague as a good workplace” – an improvement from 28% to 42% of participants.

Since the launch of the ACTION program, the impact on ambulatory clinical practice has been significant. Post-implementation survey results showed that 92% of ACTION cohort members, including nurses and patient care coordinators, felt productive and engaged, indicating that the program has had a positive impact on staff morale and job satisfaction.


Other improvements were seen in clinic efficiency, patient access, staff productivity, and communication. These results have been attributed to the increased collaboration and alignment among staff regarding clinic workflows and role expectations, as well as the implementation of new tools and processes that have helped streamline workflows and reduce inefficiencies. For example, through this work, PCCs had the ability to elevate their scope of practice, enabling nurses to offload clinic activities that could be performed by PCCs. In turn, nurses were enabled to perform clinic activities at the top of their scope, providing opportunities for physicians and advanced practice providers to manage patient care at their appropriate scope of practice.

Outcomes from Cohort #2 of the ACTION program were presented at Ambulatory Nursing Grand Rounds on February 22, 2023. The presentation was entitled, “Growing ACTION: Expanding Ambulatory Care Optimization in Specialty Care Clinics.”


The presenters included:

  • Julie Tisnado, MSN, RN, CNRN 

  • Brenda Magana, PCC II  

  • Cindy (Wanling) Wu, BSN, RN, CWCN

  • Elizabeth Law, BSN, RN

  • Jodie Mae Shiba, BSN, RN, ONC

  • Josephine Ambrosio, BSN, RN

  • Lily Lam, DNP, RN, FNP-BC

  • Sally Magana, PCC II

  • Verona Lomboy, LVN​

Another example of elevated nursing practice is the implementation of ambulatory nurse-led visits. The ACTION program, in partnership with Revenue Integrity, developed a standardized process for implementing billable ambulatory nurse-led visits. Nurses within ACTION Cohort #2 successfully began offering nurse-led visits as part of their clinical care models, positively impacting both nursing satisfaction and patient satisfaction. Nurse-led visits will continue to be more effectively streamlined, standardized, and implemented to additional clinics in 2023.


When it comes to the patient experience, the ACTION program has had been influential. Cohort #2, for example, improved patient experience scores by up to 5.5% related to nursing care delivery. This indicates that patients are more engaged and involved in their care, which can lead to better outcomes and improved patient satisfaction.

ACTION Program Cohort #2  Service Lines

Advanced Wound Care Center,

Redwood City

•ACTION Ambulatory Workflow alignment increased from 75% to 95%

•Expanded PCC scope to top of their practice

Head & Neck Oncology

Cancer Center Palo Alto

•ACTION Ambulatory Workflow alignment increased from 60.4% to 80.2%

•Improved standard work processes for pre-clinic preparation

•Built in peer-to-peer open encounters on APP template to allow efficient scheduling

Orthopaedic Surgery


•ACTION Ambulatory Workflow alignment increased from 70% to 80%

•Improved overall team engagement and patient satisfaction

Orthopaedic Surgery

Redwood City

•Decrease in inappropriate referrals and improved timely access to appropriate care

•Improvement in scheduling and completion of P2P by PCCs

Cutaneous Oncology,

Cancer Center Palo Alto

•ACTION Ambulatory Workflow alignment increased from 60.4% to 80.2%

•Improved standard work processes for pre-clinic preparation

•Built in peer-to-peer open encounters on APP template to allow efficient scheduling

Neuroscience Headache Clinic

Neuroscience Health Center

•Improved patient experience, improved message management metrics

•Implemented 517 nurse-led visits (December 2021 to January 2023)

•Improvement of ePA process, resulting in 87% of all initial medication PAs approved 

Orthopaedic Surgery


•Elevated clinical team scope of practice

•Improved team communication, In Basket efficiency, and role delineation

Radiation Oncology

Cancer Center Palo Alto

•Enhanced role understanding and scope of practice for PCCs

•Approval for replacement PCCs and additional 1.0 FTE to support ACTION goals

Overall, transformational leadership culture can result in tremendous strides in improving the quality and effectiveness of care in the ambulatory setting. The ACTION program is just one example of an innovative and team-oriented approach that is driving these improvements. Ambulatory Nursing leadership looks forward to continuing to expand the program more broadly across ambulatory care clinics in 2023.

Congratulations to Ambulatory Care for optimizing their practice!

The Ambulatory Nursing leadership team and ACTION core team would like to recognize the valuable contributions made by the nurses, clinicians, interprofessional team members, and ambulatory leaders involved in the ACTION program. Your dedication, commitment, expertise, and support have been instrumental in advancing quality of care and patient outcomes, as well as staff engagement in ambulatory care.


In addition, Ambulatory Nursing leadership would like to thank the following groups for their collaboration and contributions to ACTION Program Cohort #2.

  • Business Operations Team, Patient Care Services

  • Revenue Integrity Team

  • ACTION Steering Committee Members


We truly appreciate your partnership!

Submitted by: Charlene Platon, MS, RN, FNP-BC, Director of Ambulatory Nursing – Nursing Administration

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