Image by StockSnap from PixabayFrom standalone centers to hybrid models, patient-centered design, and the integration of new technology, ambulatory surgery center (ASC) design is transforming the way health care is delivered.
Ambulatory Surgery Center News connected with Camilla Moretti, principal at architecture firm HKS, which has designed over 5,800 large-scale health care projects across the globe, to talk about the forces shaping the future of ASC design and how operators can plan for scalability and growth.
Highlights of that conversation can be found below, edited for length and clarity.
ASC News: How does your firm work with ASCs, in particular? How active is that space for you? And have you seen any growth in that space recently?
Moretti: We have a lot of clients moving into that arena. Obviously, the drivers are volume, efficiency and payer dynamics. A lot of that growth has been driven by the shift in procedures, as payers dictate what kinds of procedures are covered in each setting. That’s why we’ve seen a big shift and growth in ASCs – certain specific surgeries are not allowed in hospitals unless there’s a clinical reason, such as comorbidities, to justify that level of care. Without those reasons, systems won’t get reimbursed at the hospital level.
That’s what has driven the growth of ASCs. They’re not required to meet the same design guidelines or levels of occupancy as hospitals, but they still meet the same sterility and quality standards. Construction for ASCs can often be simpler and faster, allowing systems to establish a presence in a community without the cost of building a full-blown hospital. That’s the biggest change we’ve seen – just the sheer number of ASCs popping up left and right.
Is your focus more on standalone construction, or do you often see hospitals adding ASCs as outpatient wings to their facilities?
It varies. What we see most often is either standalone ASCs or combo buildings – meaning an ASC paired with other services like clinics. For example, we’ve worked with a client who built a four-story building with an ASC and a freestanding emergency department on the first floor and clinics above. It was a one-stop shop. Often, this approach allows health systems to establish a presence in new markets or compete with other growing providers.
We’ve also done some ASCs on hospital campuses to alleviate congestion, but standalone facilities are often more convenient for patients. Parking is easier, and patients don’t have to navigate complex hospital layouts. The chances of procedures being delayed are also much lower at ASCs. Scheduling stays on track, room turnover is faster, and everything runs more efficiently, which benefits both patients and physicians.
I’ve heard similar feedback anecdotally from operators. This leads me to another question: How have patient expectations influenced the design of ASCs?
Patient expectations are always a priority. At HKS, we focus on both patient and staff experience because happy staff lead to better outcomes. We look for ways to improve patient experience, like providing access to natural daylight. For instance, we recently finished designing a cardiac ASC with a recovery area offering views of a ravine. This enhances the experience for both patients and their families, something that’s often harder to achieve in a large hospital setting. These considerations can make a big difference in how the space feels overall.
Higher-acuity procedures are moving into outpatient settings. How does that influence ASC design and development?
The main thing is designing ORs to provide the same level of care as a hospital, even if the building doesn’t have the structural requirements of an institutional setting. While ASCs can handle higher-acuity procedures like joint replacements or cath lab cases, the key is ensuring there’s a plan for complications. For example, Michigan recently allowed cath labs in ASCs, but there are strict guidelines on what procedures can be done, how ASCs are staffed and how to handle emergencies.
It’s an operational question – can the ASC handle higher-acuity cases if something goes wrong? For procedures like knee replacements or small joint surgeries, ASCs need larger rooms and appropriate equipment, but the overall design approach remains focused on efficiency and safety.
You also mentioned staff spaces earlier. Have there been any trends or changes in designing staff areas for ASCs?
Providing natural light in staff spaces is a big win. Happy staff deliver better care, so we prioritize improving workflows to make their jobs easier. We use tools like design diagnostics to observe and optimize how staff work in existing facilities. It’s about efficiency – making sure everything staff need is within reach to reduce unnecessary movement and prevent workarounds. For ASCs, this translates to faster room turnover, smoother procedures and better patient recovery processes.
What advice would you give to ASC operators designing facilities that can scale for future growth?
That’s always something we need to think about: How do you grow? You do not want to put anything that is a major barrier in the path of growth. So you always need to understand, what’s my direction of growth, and make sure that you can grow all these things together. You need to be able to grow your prep and recovery, your ORs and your SPD.
You also need to have the ability to clean all of those things. So, sterile processing has to grow in the same direction and in the same way. We either oversize it to begin with – which is never good because you don’t want to buy something you’re not going to be using – or you just make sure that the department can grow over time. Those three things, those three key elements, need to grow together. You can’t grow one without the other.
Lastly, is there anything else worth noting about ASC design and development trends?
We’re seeing a lot more of [technology and robots] in ASCs as well. You might not know exactly the type of integration, or if there is going to be a robot, but if there’s any reason to think there might be, you want to size your OR larger. You don’t want to keep moving the robot in and out. That’s a really expensive piece of equipment, so you keep it in the room, and you push it all off to the side.
You [should] have flexible spaces within the footprint that could accommodate that future growth as well or the addition of technology. Because tech’s changing really fast, and you need to be prepped for it, even if you don’t know what that tech is yet.
