by Beth Derby
My very first surgery center was 1978, when nobody knew what an ambulatory surgery center was, including me. I was brought in long after the design had been completed. The construction had already begun, and I was asked to outfit the place, to go buy things. I suppose if that facility had failed, I would have gone back to running the Yale Recovery Room and would’ve never had a career in ASCs.
It was Temple Surgical Center in New Haven, CT. We started with 4 ORs and eventually grew to 6. The flow was awkward and the rooms were small, but even then, space was used to maximize patient flow. People walked into the OR. Actually walked in!
What we didn’t know in 1978 could’ve filled 500 books. We learned with each project and then applied the experience to each of our future centers. That original company in Connecticut went on to build 6 more centers in every major city in Connecticut. The model for the facility grew over time. And since then, the model has become even more sophisticated.
ASC Development Requires Hyper Specialization and Forward Focus
In the beginning, I had to learn about the basics like electric receptacles, because I had to buy equipment that had to plug into it. Now we have people that have formal mock-ups of every wall in every room in every facility. There are experts in floorplan to maximize clinical flow; in engineering to meet airflow and pressure needs; in equipment for purchasing according to a specific project’s needs. That expertise allows Compass to look ahead at the clinical needs associated with a center based on the physicians who will work there. Working with architects, construction teams, and engineers we develop a physical space that can adequately meet current demands with an eye toward growth and future trends in surgery.
We’re now building physical plants laid out in an incredibly efficient manner, in an atmosphere that is, 1) conducive to performing at the highest level of clinical standards, while 2) addressing the psychosocial needs of patients, surgeons, and staff, and visitors.
Of course, a hyper-specialized development team is an additional cost upfront, but there are incredible cost savings at the end of the project from fewer change orders, less overhead cost, and the ability to hit timelines.
Knowing How to Stay on Track is Table Stakes. Cross Communication is What Makes Us Good.
There are a handful of major tasks or milestones in facility development.
- Identifying physicians and/or hospital partnerships and their goals
- Approving facility design
- Tracking time and spend
- Equipping the center
- Hiring the right people as staff and leadership
- Completing Regulatory Inspections
- Opening the center in a timely manner
Any development company worth its salt can do these things. We’ve learned the differentiation comes in proactive and thoughtful communication.
An ASC is an idea before it becomes a concrete building. That idea is developed by surgeons and health systems. Sometimes when that idea is communicated to design and construction experts, the partnership’s image of their center gets lost in translation. Our role is to deal with design and construction experts who have spent years optimizing ASC design and building and combining it with the partnership’s wish list
An adept information assessor and transmitter, a mediator between the stakeholders that understands construction needs as well as clinical needs, can facilitate the development process, making sure all sides have the information they need to be successful and satisfied. Compass provides guidance and facilitates cross-communication, which shrinks project timelines and moves the project from an idea to the partners’ dream ASC, while meeting all necessary construction and regulatory requirements.
Case Migration Brings a New Set of Problems to Solve
As high acuity cases migrate to ASCs, there are new questions and problems to solve. One is facility size. To state the obvious, the ASC financial model only works if you build out only as much square footage as you need to do the type and number of cases available. We’ve found alternative ways to meet the clinical needs of a program without building to excess, and if you reduce the facility overall by 500-1000 square feet at $550/sq foot, you’ve just saved a lot of money.
That said, for joints and spine, ORs need to be bigger than they have been, but they don’t need to be as big as many might think. New hospital ORs are being built bigger than ASC ORs need to be, but in an ASC, you can do any case in a 450-500 square foot OR.
I will say, the biggest change in ASC design in the last 5 years is in sterilization processing departments (SPD). To meet the needs for a fully integrated Orthopedic surgical practice, there are more instrument trays with larger equipment and equipment that needs specialized knowledge about processing. You need larger sterilizers, often more sterilizers, and ultrasonic machines or lo-temp units to handle a broad variety of procedural equipment, as well as an SPD team that knows how to manage flow.
A lot has changed over the last 40 years in ASC development, and we’ve learned a lot about what to do, and what not to do. We’ve learned to hire the right vendors to reduce time, control costs, and maximize space. They have amazing expertise that helps us deliver on the goals set by partnerships. We’ve learned one huge part of our job is communication (read: translation/mediation). And we’ve learned to make tweaks here and there to always be optimizing the development process and product.
