LOUISVILLE, Ky. — One morning last month, a health clinic next to a scruffy strip mall here had an unlikely visitor: a man in a suit and tie, seeking to bring a dose of M.B.A. order to the operation.
A dozen clinic employees, who spend intense, chaotic days treating an unending stream of Louisville's poor and uninsured, stared stonily at handouts he had brought as he made his pitch.
The visitor was Danny DuBosque, a "coach" hired to help the nonprofit clinic adapt to the demands of the federal health care overhaul. He had come to discuss a new appointment system, one that will let patients see a doctor or nurse within a few days of calling, instead of weeks or months.
"It's a huge satisfier," he declared — management-speak that fell flat with Dr. Michelle Elisburg, a pediatrician who was scheduled to see 26 patients that day.
"It puts me on edge," said Dr. Elisburg, who has spent her career treating the poor. "Under this model, it's first come first served, whoever calls fastest. But that's not necessarily the patient who really needs to be seen."