ASCA 2025: Flexibility, foresight prevent costly ASC design mistakes

Editor's Note

A thoughtful, operations-driven approach to ambulatory surgery center (ASC) facility design can prevent major delays, costly change orders, and inefficient workflows down the line, according to a May 2 presentation from Akshay Tavkar, MBA, CMPE, CASC, principal and managing director of Skyline Healthcare Solutions, LLC, at the Ambulatory Surgery Center Association (ASCA) Conference & Expo. “You will lose money before you ever get money,” Tavkar warned about starting an ASC, emphasizing the importance of foresight and flexibility in the earliest stages of planning.

“Build it and they will come” is not a sound approach, Tavkar continued. Rather, design should begin only after thorough evaluation of volume projections, staffing plans, equipment needs, and more. Speaking to a packed conference room on the last morning of the event, hosted at the Gaylord Rockies Resort & Convention Center in Denver, Colorado, he offered a number of specific insights and pieces of advice for up-and-coming ASCs. Examples include: 

• Foundational design principles must be tightly aligned with how the ASC will actually function. This includes right-sizing spaces, minimizing patient and staff transit distances, and building for workflow efficiency. Tavkar repeatedly stressed designing with future adaptability in mind: “What are we doing today? What are we going to be doing tomorrow?” Facilities should support scalability through modular or flexible layouts and infrastructure designed to accommodate future power, HVAC, and data demands.
• Operational flow and patient experience must both drive spatial planning. That includes designing intuitive transitions from check-in to PACU and ensuring privacy and comfort in preop and recovery areas. 
• Storage and support spaces should not be treated as afterthoughts. Sterile processing space in particular is frequently shortchanged during design, leading to long-term bottlenecks. Proper sizing of washers, sterilizers, and case carts must be planned for based on procedure mix, volume, and the specific sets required. 
• Involving stakeholders—especially SPD staff, nurses, and surgeons—early in the process is critical. Design elements like OR layout, equipment placement, and even locker room space should reflect the input of those who use them.
• Future-proofing was a recurring theme throughout the talk, especially with regard to technology. Facilities should account for anticipated adoption of robotic platforms, integrated imaging systems, asset-tracking software, lasers, and more. That includes appropriate conduit, ceiling infrastructure, and HVAC design.  
• Involving a life safety expert early is imperative, particularly with varying local and state codes. Design missteps—such as door hardware that fails inspection or incorrectly placed fire dampers—can delay or even derail opening. 
• Patient experience begins at the front door. Considerations like parking, lighting, private consult rooms, Wi-Fi, and device charging stations were all cited as patient-friendly features. 
• Different specialties have different needs for space. For example, orthopedic and joint replacement programs may require extra space for vendor trays, dedicated joint preparation areas, or patient mobility assessment zones.  
• Enlisting the right expertise is critical. Common pitfalls include selecting architects without healthcare experience, failing to identify equipment requirements early, ignoring state-specific regulations, and undervaluing storage and utility infrastructure.