Image by sungmin cho from PixabayA growing number of ambulatory surgery centers (ASCs) are being built to meet demand for efficiency, patient convenience and higher-acuity capabilities, but designing them requires more than adding ORs and new technology.
In a recent ASC News webinar, three leaders from across the industry shared what they are seeing in the field and how forward-looking operators can avoid design and development missteps.
The panel featured Michael McClain, managing partner at LeftCoast Healthcare Advisors; Camilla Moretti, studio practice leader for health at HKS; and Lanie Dschaak, director of ambulatory surgery operations at Harborview Medical Center.
Their conversation touched on construction trends, workflow planning and the importance of designing with staff in mind.
General building activity
In 2025, ASC development remains active, but more cautious, particularly among health systems evaluating capital investments under reimbursement pressure, McClain said during the webinar.
McClain’s firm, LeftCoast Healthcare Advisors, provides health care consulting for ambulatory surgery centers and other health care organizations.
“At the first part of the year, I think we had a little bit of a pause,” McClain said. “People were taking in … what’s going to happen with interest rates, what’s going to happen with the cost of capital and the cost of building.”
Two types of projects are still moving forward, McClain said. One is smaller, single-specialty ASCs for independent groups, and the other is larger, more complex centers led by health systems or big physician practices.
“All old things are new again,” McClain said, noting similarities to the early 2000s when physician demand also drove development.
From her perspective at HKS, Moretti said that while standalone ASC builds are common, she is also seeing more hybrid projects.
“We have the ASC that’s part of a larger building, maybe it’s a MOB (medical office building), so you have clinics for the physicians that are going to be in the ASC, and then the ASC space proper is a joint venture between the hospital and the docs,” Moretti said.
From her experience at Harborview, Dschaak said physicians want predictability and efficiency. Seattle-based Harborview is a part of the UW Medicine health network.
“They want to come in, do their 10, 12 cataracts pretty much uninterrupted,” she said. “Predictable is what physicians are looking for.”
Patients are seeking the same convenience, Dschaak said.
“They want to come in, not be walking through the halls of a large hospital trying to find a spot to get their carpal tunnel taken care of,” Dschaak said.
Designing spaces for staff
The panelists agreed that designing for staff experience is no longer optional.
“One of the benefits of an ASC is that you have a little bit more flexibility on locating those types of spaces for staff engagement,” Moretti said.
That includes break rooms with natural light, shorter travel distances and thoughtful circulation, she said.
“Happy staff provide better care,” Moretti said.
At Harborview’s new ASC, even the addition of windows has excited employees, Dschaak said.
“I had a comment from one of the inpatient OR staff: ‘Oh my gosh, I heard you have windows over there,’” Dschaak said.
McClain said staff-centered design can directly affect retention.
“[Give] them lounge space, recovery space and eating space that isn’t just a concrete pad as afterthought. … That builds long-term alignment with your staff,” McClain said.
Flexibility within the OR is equally important, Dschaak said.
“You’re not having to restage the entire room when you’re moving from left to right side of the body,” Dschaak said, recommending anesthesia drops at both the head and foot of the bed.
Sterile processing must also be planned early, Dschaak said.
“You need to have enough instruments, enough trays, and decide whether you’re going to have a full sterile processing department on site or outsource,” Dschaak said.
McClain said ASC leaders should project surgical volume realistically to avoid costly inefficiencies.
“Building a facility that’s too large can end up creating situations where you have too much staff, and it’s very difficult to manage from a lean operation standpoint,” McClain said.
Hospitals and health systems investing in ASCs
More health systems are leading ASC development through joint ventures or in-house projects, often to shift higher-acuity procedures into lower-cost settings, Moretti said.
She said some systems are now setting internal facility design standards to accelerate development timelines.
“We are going to be seeing a lot more automation in design and construction – and standardization of spaces so that systems can bring these online a lot faster,” Moretti said.
These ASCs are often built to handle more complex procedures like total joints or cardiovascular interventions, which require additional considerations, Dschaak said.
“There are some requirements when you want to do a total joint in a standalone ASC around the square footage of the actual OR,” she said.
Storage for equipment like Hana tables and proper SPD space must also be factored in from the start, Dschaak said.
“Starting with your state regulatory requirements is key,” Dschaak said.
And support space must scale along with surgical complexity, Moretti added.
“Trying to do ortho cases where the SPD was not appropriately sized becomes very difficult,” Moretti said.
Technology is also a consideration, especially as robotics, AI and analytics enter the picture, McClain said.
“The single most important part of the work when it comes to technology is projecting reimbursement and operating costs long term,” McClain said.
He cautioned that AI must be evaluated carefully.
“Is it really speeding up your service, or is it just simply replacing decision-making that should be left at the hands of nurses and physicians?” he said.
The panel also discussed block scheduling, which Dschaak said is critical before expanding OR capacity.
“You have to optimize that block as much as possible so that you don’t lose [surgeons],” she said.
Strong governance and peer-to-peer accountability can help align surgeon behavior with center efficiency, Dschaak said.
Looking five years out, Dschaak said she hopes operators will find the sweet spot in facility size and bring clinicians into planning early.
“Just because you designed it and opened four walls, it doesn’t necessarily mean everybody’s coming,” Dschaak said.
McClain said operators should avoid leading with real estate and instead start with a solid business case.
“What are you trying to accomplish with your ambulatory surgery plan?” he said. “Then build the bricks and mortar around it.”
