Ambulatory care is the engine room of U.S. healthcare, delivering critical services to millions outside of traditional hospital walls. In an era defined by workforce shortages, shifting reimbursement models, and unrelenting pressure on margins, few areas are more vital—or more misunderstood—than ambulatory operations. This is precisely why the latest episode of The American Journal of Healthcare Strategy podcast with Abby Berkes, MBA, Administrator of Ambulatory Operations at Lehigh Valley Health Network, matters.
Abby’s story is not only about managing a portfolio of outpatient services; it’s about what operational excellence looks like on the ground, how leaders can bridge clinical and business divides, and what it really takes to keep ambulatory services both efficient and humane. From workforce development to the nuts and bolts of process management, Abby offers practical insights for anyone serious about the future of outpatient care. If you’re leading teams, building a career in healthcare administration, or simply trying to decode what makes high-functioning ambulatory networks tick, her perspective is essential reading.
Ambulatory operations refer to all healthcare services provided outside of a hospital’s inpatient setting—essentially, outpatient care. These include everything from imaging and rehab to sleep labs and occupational medicine. As Abby explains, “Ambulatory operations is really your outpatient setting, so it’s any service that isn’t taking place on the inpatient side. You don’t have to be admitted to the hospital for it.” In U.S. healthcare, where cost pressures and patient preferences are driving a steady migration from inpatient to outpatient care, mastering ambulatory operations isn’t optional—it’s strategic.
Within Lehigh Valley Health Network, Abby’s portfolio is broad:
Occupational medicine programs and workers compensation
Sleep lab departments
Endocrinology testing centers
Durable medical equipment
Imaging, breast health, home health, and more
Why does this matter? Because these services form the connective tissue of health systems, supporting both acute care and population health. Efficient ambulatory operations can:
Reduce unnecessary hospitalizations
Enhance patient experience and access
Support revenue diversification for health systems
Enable more nimble responses to market and regulatory changes
“There’s a lot of variation there, but it’s really the outpatient departments that are supporting the larger hospital system,” Abby notes, underlining just how integrated ambulatory care is to a system’s overall health.
If you’re wondering what it takes to lead in this space, Abby’s path is instructive. She didn’t start in healthcare—she started in manufacturing and employer-side operations. As she puts it: “I started out actually on the employer side… in employer production and manufacturing. When I finished that training program, I had the opportunity to move to the clinical side.”
Key steps in Abby’s career progression:
General Operations Training: Gained management skills in process and people management.
Transition to Clinical Space: Moved into clinic operations at Concentra, learning how “operations is operations”—regardless of sector.
Hands-On Leadership: Took every project, no matter how outside her comfort zone. “I was never the person that said nope, don’t have time for that. I always took on every opportunity and my team and my mentors always knew I needed to be challenged.”
Continuous Education: Didn’t complete her MBA until later in her career, after feeling a disconnect in high-level meetings: “I felt the disconnect from a dialogue, from a process, and a thinking standpoint. I said now is the time…I felt the need where I had to [get my MBA] in order to continue to progress in my career.”
Growth through Mergers: Integrated departments during the acquisition of Coordinated Health by Lehigh Valley, managing the complexity of scaling from small to large teams during COVID-19.
The lesson for future leaders? Be relentlessly curious, say yes to new opportunities, and be willing to cross-train—clinical knowledge can be learned, but operational agility and a bias toward action are irreplaceable.
Abby’s day-to-day is a masterclass in managing complexity and change. She answers the question directly: “It’s different every day… My schedule as of 5:13 on March 5th for tomorrow, as it stands, will likely change by 8 a.m. tomorrow. As operations leaders, we have to be okay with that.”
A typical week for Abby might include:
Back-to-back internal and external meetings
Direct check-ins with teams to identify and address challenges
Reviewing volume and financial data
Client meetings, including employer occupational health site tours
Vendor meetings to evaluate new equipment or services
Collaborating across departments on integration or process improvement
Being visible on the front lines—“I have always made it a point to be front and center with those teams, knowing them by name, who they are, what they do every day and understanding that challenge.”
Why is frontline visibility so important? Abby’s approach is hands-on: “Anytime I’ve ever taken on a new role, I found it very important to sit with every member of the team… sit at the front desk for about a week, then with the billing team, then the sales team. The only way we’ll ever be able to evaluate a process… is to understand what the team is talking about.”
Key takeaways for leaders:
Stay adaptable—expect plans to change, sometimes hourly.
Build trust through presence, not just policies.
“Walk the process” yourself, not just once, but continuously.
One of the most common struggles for healthcare administrators without clinical backgrounds is building credibility with physicians and nurses. Abby is candid: “That’s some of the biggest challenges that I’ve encountered being non-clinical in the clinical space. I get very honest with the doctors that I work with—I say, ‘I’m not a doctor, I need you to explain this to me as if I’m a patient.’”
Her approach:
Acknowledge the expertise of clinical colleagues—don’t pretend to know what you don’t.
Position yourself as a practice enabler: “They need you to help run their practice so they can do the best care that they possibly can.”
Focus on operational and process challenges, not clinical decisions.
This humility builds trust and ensures operational improvements are aligned with clinical realities, not imposed from above.
Planning horizons in ambulatory care need to span from weeks to years. Abby is clear: “We always continue to look, you know, three, six, nine months, five years ahead… Healthcare is changing, it’s no secret, but we can take a look at the trends.”
Business planning involves:
Reviewing payer policy changes (especially Medicare/Medicaid) and projecting downstream effects
Preparing for acquisitions, mergers, and integration
Opening new service lines or sites based on forecasted need
Building flexibility into plans to allow for quick pivots
Abby credits her leadership team with enabling strategic foresight: “Because of those decisions, we were able to open new hospitals during COVID while other systems were shutting down. We absolutely look as far ahead as reasonably possible.”
The actionable insight: Data-driven forecasting, scenario planning, and alignment between executive and frontline teams are essential. Leaders who plan only for today’s problems are already behind.
Mentorship, Abby emphasizes, is not a luxury—it’s foundational. “I’ve been blessed with some really great mentors… Some people are naturally great at [strategic thinking], but when you have people that challenge you—and being okay with people challenging your thinking—that’s when you really become a great strategic thinker.”
How do you find the right mentors?
Interview your potential leaders as much as they interview you. Abby notes, “I think it’s very important to also interview the people that are interviewing you… You need to have a leader you can connect with, that is going to help drive you to be a better leader yourself.”
Seek out mentors who challenge, not just support, your ideas.
Don’t limit your circle to people who think like you—look for those who share your goals, but not necessarily your background.
Abby’s own network—from Mike Ryan at Concentra to Amy Nyberg at Lehigh Valley—has shaped her ability to think analytically and lead through uncertainty.
When asked about the biggest problem facing ambulatory care, Abby doesn’t hesitate: “It’s the same challenge that every other health system in the country is facing—and it’s a staffing shortage.” She references projections that the U.S. will be short 120,000 primary care physicians by 2030—a crisis not solved overnight.
How is Lehigh Valley Health Network responding?
Partnering with other health systems and clinical teams to develop creative staffing solutions
Focusing on workforce development and pipeline strategies (engaging younger generations, offering resources, and career events)
Emphasizing the mission-driven impact of healthcare careers to retain and inspire staff
“There’s a patient and their family at the center of everything that we do… We have an obligation as community leaders to do what’s right and try to engage people to want to enter the health system,” Abby asserts.
Action items for executives:
Invest in staff well-being and retention.
Collaborate across organizations for workforce solutions.
Frame healthcare careers as meaningful, resilient, and impactful—because they are.
Abby’s journey and perspective offer practical takeaways for leaders across the spectrum:
Prioritize process and people equally: Effective ambulatory operations depend on both clear systems and empowered teams.
Lead from the front lines: Make yourself visible and available to staff; walk the process, ask questions, and learn directly from frontline experiences.
Adopt a flexible, data-driven approach: Forecast for multiple horizons and maintain agility to respond to changing market, regulatory, and workforce dynamics.
Seek and nurture mentorship: Proactively build relationships with leaders who challenge and inspire you—and return the favor as you advance.
Champion the mission: In the face of shortages and burnout, reconnect teams to the broader purpose and impact of their work.
“Ambulatory operations is really your outpatient setting, so it’s any service that isn’t taking place on the inpatient side. You don’t have to be admitted to the hospital for it.”
“I was never the person that said nope, don’t have time for that. I always took on every opportunity and my team and my mentors always knew I needed to be challenged.”
“I have always made it a point to be front and center with those teams, knowing them by name, who they are, what they do every day and understanding that challenge.”
“It’s the same challenge that every other health system in the country is facing—and it’s a staffing shortage.”
The real story behind ambulatory operations is one of constant evolution—where leaders like Abby Berkes, MBA, blend process excellence, adaptability, and human-centered leadership to deliver care that’s both efficient and deeply personal. For executives and future healthcare leaders, the call is clear: build your operational toolkit, nurture mentor relationships, and never lose sight of the people at the center of your work—both staff and patients. As Abby reminds us, “There’s a patient and their family at the center of everything that we do… We have an obligation as community leaders to do what’s right and try to engage people to want to enter the health system.”
Ambulatory care is changing. The leaders who will succeed are those willing to adapt, collaborate, and put people first—today, and for the long term.
