Designing for Success: How Adaptable Architecture is Reshaping Ambulatory Surgery Centers
Ambulatory Surgery Centers (ASCs) are rapidly becoming a cornerstone of modern healthcare, offering a cost-effective and patient-focused alternative to traditional hospital settings. However, realizing the full potential of these centers requires more than just medical expertise – it demands a sophisticated understanding of architectural design principles that address the complex needs of all stakeholders.
In the evolving landscape of healthcare, ASCs are carving out a significant niche. But beneath their promise lies a labyrinth of challenges: balancing the diverging needs of stakeholders, navigating regulatory hurdles, and planning for uncertain market conditions. Crafting successful ASCs demands a deep understanding of healthcare dynamics and a collaborative approach to design.
Balancing Stakeholder Priorities: A Delicate Equation
The success of any ASC hinges on effectively balancing the often-competing priorities of physicians, patients, and investors. Physicians, as primary users, prioritize efficiency, seeking streamlined workflows that maximize patient throughput. Conversely, patients place a premium on comfort, privacy, and dignity within the care environment. Investors, naturally, focus on the bottom line, demanding a balance between initial investment and long-term returns.
One example illustrates this challenge vividly. A community health system initially designed an ASC prioritizing square footage efficiency by omitting dedicated toilet rooms in prep/recovery areas. However, after patient feedback indicated a strong preference for spacious recovery rooms with private bathrooms, the design team recognized the potential to enhance both patient and staff satisfaction, and ultimately, attract more patients. This adjustment powerfully reinforced the importance of incorporating natural lighting and comfortable recovery areas to prioritize patient well-being while maintaining efficient staff workflows.
“This balance reduced turnaround times and enhanced patient satisfaction,” noted a healthcare design expert, underscoring the importance of stakeholder alignment at every phase of the design process. A holistic approach extends to staff well-being, integrating features like views of nature, access to outdoor space, green roofs, and ample natural light.
Operational Strategies: Bridging the Gap Between Goals
Beyond stakeholder alignment, effective operational strategies serve as a crucial bridge between diverging goals. For instance, a project focused on physician efficiency adopted a standard, universal operating room (OR) design for all case types. This was further supported by the implementation of a “waterfall” model, allowing surgeons to seamlessly alternate between two operating rooms without delay.
Traditionally, physicians alternating between two ORs to maintain desired throughput can create tension between provider satisfaction and owner priorities, reducing the number of cases handled daily and increasing space requirements. The waterfall scheduling model resolves this conflict by enabling providers to rotate between any available OR, as all rooms are universal and care teams are cross-trained for any case type.
This operational emphasis also extended to nursing team workflows. By streamlining pathways between surgical areas and recovery rooms, the design dramatically reduced non-value-added time for staff, while hospitality-inspired interiors created a welcoming atmosphere for patients. These complementary strategies demonstrate how practical and patient-centered approaches can coexist, transforming an ASC into a destination center for care.
Navigating Ownership Structures and Planning for Growth
Ownership structures significantly influence design considerations. Hospital-led ASCs often prioritize branding and quality, potentially increasing costs, while joint ventures introduce competing priorities between clinical goals and financial imperatives. However, modular designs that are easily expandable offer a compelling solution, keeping initial building size and costs low while allowing for rapid expansion as volumes and market share increase.
For example, a new market facility’s initial four operating rooms could be adapted to different configurations, supporting immediate operational needs and future growth. This flexibility is particularly valuable for ownership groups focused on scaling operations quickly. Projects prioritizing adaptive layouts allow for rapid reconfigurations, helping facilities remain competitive in dynamic markets.
Planning for future growth requires carefully balancing overbuilding and underbuilding. In high-growth markets, ASCs often incorporate shell spaces – unfinished areas reserved for expansion – to adapt to increasing demand. One physician-owned ASC leveraged data analytics to project future growth, aligning facility design with anticipated recruitment goals and surgeon case types. Shell space intended for future ORs was initially used for supplementary support spaces until surgical capacity was needed.
Overcoming Regulatory Constraints and Embracing Innovation
Regulatory constraints, particularly in Certificate of Need (CON) states, add another layer of complexity, imposing strict limitations on facility size and scope. Early engagement with regulatory authorities is crucial to ensure compliance without sacrificing design flexibility.
One health system demonstrated a strategic approach by aligning outpatient services with hospital-based departments. This allowed outpatient ORs to be billed as HOPD environments initially, with the ability to easily convert to ASC billing rates when advantageous or required by payors. Another health system, built as a joint venture, thoughtfully segregated provider-based and non-provider-based ORs, allowing each platform to operate independently while sharing support spaces. These projects demonstrate how thoughtful design can address constraints while fostering innovation.
A Future-Proof Philosophy for ASC Design
Successful ASCs balance operational efficiency with patient experience through stakeholder alignment, data-driven decision-making, and future-proof modular designs. Project teams must focus on creating adaptable, efficient spaces that support evolving healthcare demands while fostering environments that promote healing and trust.
Designing ASCs is both an art and a science, requiring teams to navigate a web of competing priorities while delivering spaces that advance healthcare strategies. By weaving together diverse motivations – from patient satisfaction to physician efficiency and investor goals – project teams can create facilities that meet today’s demands and anticipate tomorrow’s needs.
Key Insight for ASC Success:
- Stakeholder Alignment: Engage all stakeholders early to reconcile diverging priorities and establish a unified vision.
- Operational Efficiency: Explore strategies like standardized room designs and flexible workflows to enhance productivity.
- Adaptability: Use modular and shell space planning to future-proof facilities for growth and market changes.
- Regulatory Navigation: Collaborate with authorities to ensure compliance while maintaining design flexibility over time.
- Patient-Centered Design: Prioritize comfort and privacy to enhance the patient experience and attract higher-payer demographics.
Paul Widlarz, AIA, principal at HGA, combines a background in medical planning and project management to direct programming, planning, and design processes. Attuned to current research on Lean clinical operations, he works closely with clients and user groups to develop design solutions that optimize healthcare delivery. Andrew Zimmer, LEED AP, principal at HGA, has extensive experience leading Lean planning engagements at all scales, regionally and nationally. He has spoken about Lean process and planning at the Catalysis Lean Healthcare Transformation Summit in the US and at the Lean Led Hospital Design Seminar for the Lean Association of Finland.
