Increasingly, immediate patient service--whether scheduling an appointment or seeing a physician--is a realistic expectation. Smoothing patient access and hitting service targets takes sophisticated planning and a true scientific approach. The department of medicine at Boston's Children's Hospital has taken a new approach to visit management, using a model that could be applied to any practice in any setting. Staff have set up categories of care and guidelines for scheduling, realigning tasks in order to make better use of provider resources and expertise and restructuring associated supporting operations.