Buy Capacity Back Without Hiring

Why This Deep Dive Exists

A lot of operations advice in healthcare has two problems. It’s either too generic to apply, or it recommends fixes that quietly require more headcount, more software, or more meetings. This piece does the opposite: it uses United Airlines as a case study to extract what actually drives margin in a high fixed-cost system, then translates those mechanics into a simple playbook a multi-site outpatient group or home health org can run in 30 days.

You won’t get vague advice, abstract frameworks, or “culture transformation” sermons. You’ll get a way to reframe the problem, diagnose where capacity’s leaking, and execute a sprint to recover capacity and protect margin without hiring.

The Trigger Story: What United Is Signaling

United’s message is simple: “We’re positioned to drive strong profits in 2026 by leaning into higher-value demand, growing loyalty revenue, and keeping the operation stable enough to hold margin even when conditions get messy.” They reported about $1.04B in Q4 net profit and absorbed a roughly $250M pre-tax hit tied to a government shutdown while staying profitable, with premium and loyalty trends moving in the right direction.

That’s the signal. United isn’t relying on “more volume.” It’s relying on a profit engine built on mix, repeatability, and fewer failures that trigger expensive recovery work.

Why an Airline Story Matters for Outpatient Operations

Airlines and outpatient care run on the same math: high fixed costs, hard capacity limits, and small failures that cascade into system-wide disruption. Airlines call it irregular operations. Outpatient groups live it daily as incomplete referrals, eligibility surprises, prior authorization delays, reschedules and no-shows, documentation defects, and denials. The shared lesson is simple: margin doesn’t disappear because demand’s weak, it disappears because operations leak.

The Core Reframe: You’re Not Understaffed, You’re Leaking Capacity

When teams are overworked, the default answer is “we need more people.” Sometimes that’s true, but most of the time the immediate issue is a meaningful percentage of your labor is trapped in rework loops that shouldn’t exist. You can have a team working nonstop but output slows to a crawl if work keeps bouncing back for corrections.

Examples you already know:

• Referrals arrive missing information, then bounce back and forth

• Patients get scheduled before coverage’s verified

• Authorizations sit because no one owns the queue

• Notes get kicked back, corrected, then kicked back again

• Claims deny for the same reasons every month

That work consumes time, burns staff, delays care, and reduces throughput. It also makes you feel understaffed even when you’re not. Capacity recovery starts by treating rework as a measurable cost, not a normal part of the job. If you want a deeper breakdown of how rework quietly manufactures backlog, I wrote a dedicated article on the rework tax and a one-week rework audit that helps you pinpoint the two loops stealing the most capacity.

The Three Lenses to Steal From United

United’s profit story can sound like finance talk, but it’s really an operating model story. They’re protecting margin by being deliberate about what demand they prioritize, how they keep customers coming back, and how they absorb disruption without the system falling apart. Those are the same levers outpatient operators have, just in different clothing.

Lens 1: Mix

United’s profit push isn’t coming from doing more of the same flights. It’s coming from shifting more of their limited seats toward the bookings that pay more. Premium and long-haul travelers bring in more revenue per seat, so United’s tuning the system to serve more of that demand.

In an outpatient clinic, “mix” means deciding what earns a slot, because your schedules are your inventory. If you fill them with work that cancels, denies, no-shows, or takes three rounds of admin cleanup, you’ll look busy while margin slips. That usually looks like:

• Protecting prime slots for low-rework visits, and routing high-friction payers into a pre-clearance lane

• Protecting follow-up capacity with follow-up-only slots, then releasing any remaining slots by noon the day before to avoid stranded capacity

• Tightening referral intake so your schedule doesn’t fill with incomplete, high-churn cases

• Limiting high-friction work to controlled blocks until the process is stable

This is NOT about excluding people. It’s about refusing to let the hardest-to-run work set the pace for the entire clinic.

Lens 2: Loyalty

United’s loyalty engine matters because it turns one-time buyers into repeat buyers. When customers keep choosing you, you spend less effort and money “re-winning” demand every cycle. Loyalty smooths volatility and gives the business a steadier base to plan against.

In an outpatient clinic, “loyalty” isn’t points or perks. It’s patients returning for the next visit, referral partners continuing to send you work, and fewer people dropping off because the experience is reliable. Loyalty is operational, since it reduces re-acquisition work and stabilizes demand. That usually looks like:

• Closing the loop at checkout: follow-up needed → appointment booked (or a timed task created with an owner if it can’t be booked on the spot)

• Reducing appointment churn by running a 48-hour readiness check (confirmed, forms complete, eligibility cleared, patient instructions acknowledged) and routing exceptions into one recovery queue

• Protecting referral partner trust with predictable intake, status updates, and a published turnaround time for “first scheduled”

• Fixing the repeat offenders that make patients bail: billing surprises, long waits, missing follow-ups, lost paperwork

• Handling failures with a clear recovery rule (one owner, one escalation trigger, and a same-day callback standard), so one miss doesn’t become a lost patient

This isn’t a marketing play. It’s reliability at scale.

Lens 3: Resilience

United took a major disruption hit and still performed, which tells you their model isn’t built for perfect conditions. It’s built to absorb shocks, recover fast, and keep the profit engine running when something external breaks the plan.

In outpatient care, disruption is normal operations. It’s prior authorization delays, last-minute cancellations, staffing gaps, payer changes, broken interfaces, and documentation requirements that shift overnight. Resilience means your clinic doesn’t rely on heroics to recover. It relies on clear ownership, simple standards, and triggers that surface problems early. That usually looks like:

• Assigning one owner per queue, so work doesn’t stall in handoffs when staffing shifts

• Using escalation triggers (aging, backlog, defect thresholds) so problems turn visible before they explode

• Separating planned work from recovery work by creating a daily “recovery lane” for authorization issues, reschedules, and documentation defects

• Standardizing a definition of ready at intake and pre-visit, so incomplete work doesn’t enter the clinic day and bounce around

• Running a fixed weekly cadence that forces root-cause fixes (one change, one owner, one due date), instead of recurring fire drills

This isn’t about being tough. It’s about being designed to recover.

The Teardown: Where Multi-Site Outpatient Groups Usually Break

United protects margin by reducing the number of failures that trigger expensive recovery work. Outpatient groups lose margin the same way: not from one big catastrophe, but from small breakdowns that create rework, delays, and churn. This teardown walks the chain from intake to cash so you can see where capacity is getting burned. Each section ends with what it costs and what to measure so you can stop guessing and start fixing the right leak.

1) Intake and Referrals

United equivalent: Booking and customer data capture. If the reservation is wrong or incomplete at the start, the work doesn’t disappear. It shows up later as exception handling at check-in, at the gate, or in customer support.

Intake is where capacity starts getting spent before a patient ever shows up. When this step isn’t controlled, downstream teams end up doing detective work, and the referral either stalls or turns into a multi-touch cleanup job.

Symptoms:

• Incomplete intake packets

• Duplicate entry across systems

• Referrals that vanish into inboxes or fax folders

• Patients who never get scheduled

Root causes:

• No single owner of the intake queue

• Too many intake paths with no standard entry rule

• No “definition of ready,” so downstream teams keep discovering missing items

What it costs:

• Longer time-to-first-visit

• More touches per patient

• Higher referral leakage

What to measure:

• Referral-to-scheduled time

• Percent incomplete on arrival

• Touches per referral (a rough count is fine)

2) Scheduling

United equivalent: Network, gate, crew, and aircraft scheduling. When schedules and buffers don’t match reality, the plan looks fine on paper but breaks in motion. The result is missed connections, constant reshuffling, and expensive day-of recovery work.

Scheduling is where your capacity turns into real throughput or wasted inventory. When rules vary by site or live in people’s heads, the calendar looks full but the day still falls apart, and the recovery work quietly becomes someone’s second job.

Symptoms:

• Reschedules all day

• No-shows treated like a law of nature

• Calendars that don’t match reality

• Site-by-site variation in scheduling rules

Root causes:

• Rules live in people’s heads

• No clear priority rules for scarce slots

• Weak feedback loop that turns patterns into fixes

What it costs:

• Empty slots plus overtime

• Patient dissatisfaction

• Staff burnout from constant recovery work

What to measure:

• Fill rate

• No-show rate by reason

• Reschedule count per appointment

3) Prior Auth and Eligibility

United equivalent: Clearance checks that determine whether a passenger can fly, such as ticket validity and travel document requirements. If clearance isn’t handled upstream with clear ownership, the problem surfaces at boarding, when time is most expensive and the entire system is waiting.

Prior authorization and eligibility aren’t just administrative tasks, they’re gating steps that decide whether a scheduled visit becomes clean revenue or a delayed, rescheduled mess. When this queue has unclear ownership, the clinic day pays the price in idle time, last-minute scrambling, and lost visits.

Symptoms:

• Patients ready, payer not ready

• Clinicians idle or backfilling with lower-value work

• Constant follow-up and rework

• Visits delayed, then lost

Root causes:

• Unclear queue ownership

• Missing triggers for escalation

• No aging visibility, so urgency becomes emotional

What it costs:

• Idle clinical capacity

• Delayed revenue

• Admin hours that produce no visit

What to measure:

• Authorization lead time

• Authorization aging buckets

• Percent of visits delayed due to auth

The point here isn’t “prior authorization is annoying.” The point is that prior authorization is a queue, and queues need owners, triggers, and standard work.

4) Visit Execution and Documentation

United equivalent: Flight execution plus the required operational sign-offs that close the loop. If standards vary or defects are caught late, crews end up doing after-the-fact cleanup and the operation slows the next day.

Visit execution and documentation is where clinical work either converts cleanly into billable work or gets stuck in rework. When templates, training, and “done” standards vary, defects aren’t discovered until late, and clinicians end up finishing yesterday’s work after hours.

Symptoms:

• Notes returned for corrections

• Missing documentation fields

• Charting after hours

• Coding confusion

Root causes:

• Inconsistent templates across providers and sites

• Variable training

• Defects detected too late

What it costs:

• Clinician burnout

• Reduced throughput

• Billing defects downstream

What to measure:

• Note defect rate

• Hours to close note

• Rework touches per note

5) Billing and Denials

United equivalent: Revenue leakage that shows up after the flight, such as disputes, refunds, and fare rule mismatches. If it stays trapped in a back-office cleanup function, the same upstream defects keep creating new leakage.

Billing and denials are where upstream defects show up as cash problems. If denials are treated as a back-office issue instead of a signal that something broke earlier, rework becomes permanent and margin leakage turns into a recurring monthly surprise.

Symptoms:

• Denials rising

• A/R days creeping

• Rework living permanently in the back office

• “Fix it later” becoming the default

Root causes:

• Upstream defects never feed back into upstream fixes

• Denials treated as revenue cycle problems instead of process defects

What it costs:

• Margin leakage

• Cash delays

• Labor spent on rework

What to measure:

• Denial rate by reason

• Dollars at risk

• Rework hours in billing

The Playbook: A 30-Day “Buy Capacity Back” Sprint

United equivalent: Airlines don’t fix irregular operations with a giant transformation program. They stabilize one part of the operation, measure where the recovery work is coming from, tighten standard work, assign clear ownership, and run a consistent cadence until performance holds.

This sprint is built the same way. It’s designed for an overstretched ops leader who needs results fast, without new tech, consultants, or a transformation office. The point is to stop the bleeding in one slice of the operation, prove you can recover capacity by reducing rework, then scale what works.

Days 1 to 3: Pick the Slice

Pick one service line or one site first, and pick the one with high demand and high pain. The goal is proof of capacity recovery, not an enterprise transformation.

Days 4 to 7: Measure Three Numbers

United equivalent: Airlines track a small set of operational signals during disruption, not 25 metrics. The goal is fast visibility into flow, failure, and recovery load.

Three metrics, no more. Keep them simple and consistent.

• Cycle time: Referral-to-first-visit, or request-to-completed-visit

• Defect rate: Percent of cases requiring rework (missing intake items, auth delays, note corrections, denials, reschedules)

• Rework hours: Estimate weekly rework hours by role (precision can come later)

Days 8 to 12: Map the Work in Plain English

Follow one referral through the system. Write each step. Mark every handoff, every wait, and every “send back” moment. Circle the two biggest rework loops. Two loops are enough to create meaningful capacity in a month.

Days 13 to 18: Fix the Two Loops With Standard Work

United equivalent: Airlines don’t rely on heroics when the operation’s under pressure. They rely on standard work so the “basic plays” run the same way across crews and stations.

Create one-page checklists for the work that keeps breaking:

• Definition of ready for intake

• Scheduling rules and priority logic

• Auth triggers and escalation rules

• Note completion standards by visit type

Put the checklist in the workflow, not in a folder.

Days 19 to 23: Lock Ownership and Decision Rights

Name one owner per queue, then make visibility non-negotiable with triggers that force action before the backlog becomes a crisis.

Name one owner per queue:

• Referral queue owner

• Auth queue owner

• Documentation defect queue owner

• Denial feedback loop owner

Add escalation triggers that force visibility. Decision rights matter, since a red condition that requires a meeting isn’t a trigger, it’s a delay.

Examples:

• Auth pending over 48 hours turns red

• Referral backlog over X volume turns red

• Note open over 24 hours turns red

• Denial rate above threshold triggers root-cause review

Days 24 to 30: Install a Weekly Governance Cadence

United equivalent: When something breaks repeatedly, airlines use a tight operating cadence to review failures, assign owners, and close loops. That cadence is what stops the same disruption from recreating itself next week.

One meeting. 30 minutes. Same agenda weekly. The goal isn’t more meetings, it’s fewer surprises.

• What broke

• Why it broke

• What change we’re making

• Owner and due date

• What we’ll measure next week

Track only the three numbers until stability improves.

Day 30: Re-Measure and Make Hiring a Clean Decision

If rework drops and throughput rises, capacity was recovered. If demand still exceeds capacity after rework drops, hiring becomes rational. Hiring becomes an investment into a clean system, not a tax on a broken one.

What to Document So It Sticks Across Multiple Sites

United equivalent: Airlines don’t stay consistent because everyone “remembers how to do it.” They stay consistent because the work is defined, owned, and repeatable across stations, crews, and shifts. When the playbook’s unclear, performance drifts and the system pays for it in recovery work.

Documentation’s how you prevent drift. Document the checklists, definitions of done, queue owners and escalation triggers, weekly scorecard, onboarding notes for new hires, and a one-page “how we run the day” per site. The goal is repeatability, not bureaucracy.

What Not to Do

United equivalent: When disruptions hit, airlines can’t “hire their way out” mid-day or buy a new system and expect it to fix the operation by next week. The fastest way to make irregular ops worse is to add complexity on top of a broken flow.

Even strong teams accidentally make the situation worse by pulling the most convenient levers first. These are the moves that feel productive in the moment but usually lock in more chaos, more rework, and more burnout.

• Don’t hire into broken intake, scheduling, auth, and documentation

• Don’t buy tools before defining the process

• Don’t track 25 metrics

• Don’t run improvements without an owner and a due date

• Don’t let billing defects stay in billing without upstream fixes

What “Operationally Safe” Looks Like

“Operationally safe” doesn’t mean perfect. It means your operation can absorb normal disruption without collapsing into rework, overtime, and cash surprises. For outpatient and home health, that shows up as fewer failure points, faster recovery, repeatable work, clear governance, and metrics that surface reality early enough to act.

• Fewer failure points (fewer hand-offs, fewer send-back loops)

• Faster recovery (problems escalate early, not after the damage)

• Repeatable work, not heroics (standard work people actually use)

• Clear governance (one owner per queue, known decision rights)

• Clean metrics (cycle time, defects, rework hours, not 25 vanity measures)

United’s story matters because in high fixed-cost systems, discipline isn’t a nice-to-have. Discipline is the margin. In outpatient care, it’s also the difference between stable access and permanent backlog.

Appendix: Templates You Can Copy

If you want to run the 30-day sprint without it turning into a vague improvement project, you need simple tools that keep everyone looking at the same work the same way. United doesn’t stay consistent because people “try harder.” They stay consistent because the work is defined, visible, and reviewed in a steady cadence. The templates below are designed for that. They’re intentionally basic so you can use them in a real ops week, not a theoretical one. Copy them into a doc, use them in your kickoff, and keep them alive in your weekly governance cadence.

1) Value Stream Map Worksheet

Use this when you’re trying to stop guessing where the bottleneck is. The goal isn’t a perfect process map, it’s to see where work waits, where it bounces back, and where hand-offs create rework.

• Trigger: referral arrives or patient calls

• Step list: owner, time to do, time waiting

• Mark: hand-offs, waits, send-backs

• Circle: the top two rework loops

2) Outpatient Defect List

Use this to make “rework” measurable. If you can’t count defects, you’ll keep treating them as normal.

Count as defects:

• Missing referral info

• Insurance not verified before scheduling

• Authorization pending past threshold

• Patient rescheduled due to admin issue

• No-show

• Note returned or corrected

• Claim denied

• Claim corrected manually before resubmission

3) Rework Hours Estimator

Use this to quantify how much capacity is trapped in non-productive work. You don’t need perfect time studies. A reasonable weekly estimate is enough to expose the size of the leak.

Estimate weekly rework hours:

• Intake

• Scheduling recovery

• Auth follow-up

• Documentation corrections

• Denials rework

Sum it. That’s your hidden capacity baseline.

4) Weekly Governance Agenda

Use this to prevent drift. Improvements die when there’s no recurring moment where the team reviews what broke, assigns ownership, and closes loops.

• Metrics: cycle time, defect rate, rework hours

• Top two defects

• Root cause in one sentence each

• One fix per defect: owner and due date

• Re-measure next week

5) Escalation Triggers

Use these to force visibility before the backlog becomes a crisis. Triggers are how you stop relying on memory and heroics.

• Referral backlog above threshold

• Auth aging above threshold

• Notes open above threshold

• Denial rate above threshold

6) 30-Day Sprint Checklist

Use this as your sprint control sheet so the work doesn’t sprawl.

• Pick slice

• Baseline three metrics

• Map work

• Identify top two loops

• Write two checklists

• Assign queue owners

• Set escalation triggers

• Start weekly cadence

• Re-measure

• Decide on hiring only after rework drops

Conclusion

United’s story is useful here for one reason: they protect margin by reducing the number of small failures that trigger expensive recovery work. That’s the whole game in high fixed-cost systems.

Multi-site outpatient groups are playing the same game, just with different nouns. When intake is messy, scheduling rules drift, authorization work has no owner, documentation defects show up late, and denials get “handled” instead of prevented, the clinic starts paying a compounding tax in rework. The day feels full, yet throughput, cash, and staff sanity still slip.

The good news is that this isn’t a mystery problem. It’s a visibility and control problem. Pick one slice, measure the three numbers, circle the two loops, standardize the fix, assign ownership, install a cadence, and re-measure. Do that for 30 days and you’ll know, with evidence, whether you actually need to hire or whether you just needed to stop subsidizing preventable failure.

Want Help Getting This Implemented Without It Becoming Another Initiative?

You don’t need a healthcare “guru” to run this sprint. You need someone who can make the work visible fast, reduce rework at the source, and install a cadence that holds when the week gets ugly.

Here’s what I’m good at:

• Making the real work visible, fast: I’ve worked in environments where “busy” was masking broken flow. The fix wasn’t motivation. The fix was turning invisible queues into shared queues, naming owners, and making the bottleneck impossible to ignore.

• Converting chaos into standard work that actually sticks: That means defining what “done” looks like, building one-page standards people actually use, and running a tight weekly control cadence that closes loops instead of recycling the same fires.

If you hire me, this is what I’ll do with your team:

• Week 1: Map reality across intake → scheduling → authorization → documentation → billing, then pick the one slice where rework is stealing the most capacity (not the one that’s loudest)

• Weeks 2 to 3: Build the minimum set of artifacts to stop the top two loops: definition of ready, one-page standards, queue ownership, escalation triggers, and a simple scorecard your team can run without me hovering

• Week 4: Install the cadence, train to minimum viable competence, and make sure the improvements survive a normal ugly week, not a perfect week

What you’ll walk away with:

• Fewer handoffs and send-backs

• Less rework hiding in side channels

• More capacity without adding headcount

• Cleaner throughput and fewer surprises in cash flow

• A clinic day that runs on designed recovery, not heroics

Reading a playbook is easy. Implementing it while your inbox is on fire is not. If you want help turning this into real change, that’s what I do. I come in, make the work visible, reduce rework at the source, and leave you with standard work, ownership, and a cadence your team can run without heroics.