From implementing AI to staffing shortage workarounds, here’s how ASC leaders and physicians are improving their practice’s workflow and efficiency.
The more than 19 leaders featured below are speaking at Becker’s 31th Annual: The Business and Operations of ASCs, Oct. 16-18, 2025, at the Swissotel in Chicago.
If you would like to join the event as a speaker, please contact Francesca Mathewes at fmathewes@beckershealthcare.com
As part of an ongoing series, Becker’s is connecting with healthcare leaders who will speak at the event to get their insight on thought-provoking questions within the industry.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What process improvements have had the greatest impact on your ASC’s performance in the last 12 months
Jennilee Caffey. Regional Administrator at Baylor Scott & White Sports Surgery Center at The Star (Frisco, Texas). For our facility, it is the automation of our patient communication prior, during and after procedure.
Heather Colón. CEO of Orthopedic Surgery Center of Palm Beach County (Boynton Beach, Fla.): We’ve improved several processes over the last 12 months. One of the most impactful changes was streamlining our case scheduling and pre-admission workflows. By improving communication between the business office, clinical team and physician offices, we reduced last-minute cancellations and ensured patients were better prepared for surgery.
Additionally, we implemented a focused effort on supply chain optimization in collaboration with our amazing materials manager. This included standardizing implants and supplies, which not only reduced costs but also improved operational efficiency in OR turnover.
We also prioritized cross-training among team members, which enhanced staffing flexibility and strengthened our team’s collaboration. This was particularly effective when facing scrub tech and OR circulator shortages. Collectively, these initiatives led to improvements in patient satisfaction, case volume growth, operational efficiency, increased EBITDA and larger partnership distributions.
Janet Carlson, RN. Executive Director of ASCs of Commonwealth Pain & Spine (Louisville, Ky.): One process improvement that we have implemented is the use of an inventory platform to track our medical supply spend per case. This is achieved by tying a surgeon’s preference card to the surgical case to monitor our spend and allows us to accurately track costs. Since medical supply spend has such a significant impact on your [profit and loss] statement, it is worth building and monitoring this cost center at each of our ASCs. I can have meaningful conversations with my surgeons to reduce unnecessary spending when I have accurate data to share with them because I am monitoring this, we call it case costing. It helps me identify opportunities, inefficiencies and ultimately cost savings resulting in better financial performance. I am also better informed using this platform to facilitate having conversations with my vendors to achieve better pricing for our medical supplies.
Edward Dixon. Sterile Processing Manager of Surgery Center Mountain View (Calif.): Over the past year, the development of our ASC toolkits has been one of the most impactful process improvements as we prepare for the upcoming launches of two major Sutter campuses — Emeryville and Santa Clara West. These toolkits are going to be instrumental in ensuring these new ASCs open on time and are fully aligned with Sutter Health’s Destination 2030 vision to expand access, improve quality and deliver a connected, clinician-friendly care experience. The ASC Toolkits focus on meeting critical deadlines and ensuring operational readiness. They emphasize early hiring, detailed project timelines and proactive engagement with physicians to understand their surgical needs well before the first case. This enables us to design operating rooms that reflect the workflows and specialties of the surgical teams we’re onboarding — setting the foundation for a smooth go-live and long-term efficiency. The Emeryville expansion will include an acute care hospital, surgery center, urgent care and multiple specialty clinics — enhancing access to comprehensive, patient-centered care across the East Bay. Similarly, the Santa Clara West project, part of Sutter’s 1 million-square-foot Silicon Valley development, will offer integrated ambulatory services, including primary and specialty care, diagnostics, imaging and surgical services.
By using these toolkits to guide our planning, we are creating repeatable, scalable processes that ensure we stay ahead of schedule, build strong clinical partnerships, and set up each ASC for long-term success. These efforts are key to delivering on our strategic priorities — expanding care access, strengthening clinical integration and supporting whole-person health throughout our communities.
Sean Gipson. CEO and Division President of ASCs for Remedy Surgery Center (Hurst, Texas): Over the past year, ASCs have implemented several process improvements that have significantly enhanced their performance. Some of these improvements that my center has implemented include integration of advanced technology, digital care management, optimized operational efficiency and service line expansion. Many ASCs have adopted cutting-edge technologies to streamline operations and improve patient outcomes. For example, we initiated sharing and enhancing clinical integration. Our system allows surgeons to access comprehensive patient records, leading to more coordinated and efficient care.
An additional step that we took was advanced patient integration. To enhance patient engagement and streamline care coordination, some ASCs, such as ours have adopted digital care management platforms. These platforms provide preoperative education, facilitate postoperative monitoring and enable direct communication between patients and care teams. For instance, we use this technology to deliver personalized educational content and track recovery progress, leading to improved patient outcomes and reduced readmission rates.
Every ASC has to be focused on improving operational workflows to enhance efficiency and reduce costs. Strategies include streamlining patient flow, automating scheduling and appointment reminders, and cross-training staff to perform multiple roles. These measures have led to reduced wait times, increased procedure volumes and improved patient satisfaction.
There has been a notable shift of complex procedures, such as advanced spinal surgeries, from hospital settings to ASCs. This transition is facilitated by technological innovations and regulatory changes that allow a broader range of procedures to be performed safely and cost-effectively in outpatient settings. We have specialists in high-end cases like spinal surgery that have reported higher patient satisfaction due to the specialized care and efficient recovery processes that we provide.
Earl Kilbride, MD. Orthopedic Surgeon of Austin (Texas) Orthopedic Institute: I work in a successful five-room ASC. In terms of process improvements, we do a couple of things. One is, and most important, we know our contracts. We do not pick patients based on these contracts, but we are aware of the margins. Secondly, we do case costing. As a surgeon, many facilities keep us in the dark in terms of our spend on a particular case. At this particular ASC, we are transparent, which ultimately helps the process.
Omar Khokar, MD. Gastroenterologist of Illinois GastroHealth (Bloomington): The process improvement with the greatest impact on performance within the last 12 months is room turnover. Improving room turnover times within the entire ASC has allowed us to utilize less staff numbers for the same volume of cases, as well as increasing block time availability.
Catherine Llavanes. CEO of Sante Health Partners Ambulatory Surgery Center (Los Angeles): One of the most impactful process improvements in our ASC over the last 12 months has been optimizing our OR block scheduling and case coordination. By aligning surgeon availability with procedure types and expected case durations, we significantly reduced turnover time and increased OR utilization. This change alone led to more cases per day without compromising quality or staff well-being.
We also focused heavily on staff cross-training and communication protocols, especially between clinical and administrative teams. This allowed for more flexibility in coverage and faster response to unexpected schedule changes. Not only has this improved operational efficiency, but it’s also helped with team morale and patient satisfaction.
Benjamin Levy, MD. Gastroenterologist at University of Chicago Medicine: We have increased the number of nursing navigators helping patients who are directly scheduled for colonoscopies by their primary care physician. Nursing navigators are important to help patients with their prep, to answer questions and to standardize preoperative care. The goal is to improve prep quality, to help patients on anticoagulation (coordinating with PCPs and subspecialists) and to prepare patients who might be on GLP-1 agonists for weight loss with careful instructions about when to hold their medication. With the surge in weight loss medication usage, such as Ozempic and Wegovy, patients sometimes need additional instructions to prepare for [esophagogastroduodenoscopys] and colonoscopies as GLP-1 agonists can slow down gastric emptying. The nursing navigators are a fantastic resource for patients. We are excited to expedite endoscopies that are ordered directly by primary care physicians and want to make patient experiences with the prep as wonderful as possible. Nursing navigators can identify any barriers to care such as transportation. Nursing navigators have the potential to improve patient satisfaction and to reduce no-shows/cancellations at ASCs and hospitals.
Justin Marburger. Director of Surgical Services of Plastic and Cosmetic Surgery Center of South Texas (San Antonio): The measure of improvement that has led to the greatest impact on our performance has been our hiring and staffing processes. The decision to move our full-time employees to [pro re nata] status has allowed us to combat the fluctuations in quarterly scheduling and allow for a better work/life balance. Furthermore, once we began the transition, we found that our full-time employees equated to a habitual routine, which introduced complacency. The highest performing teams set the highest standards for themselves and enforce those standards daily. The worst thing you can do to a high-performing team is to maintain a low-performing individual. The framework we utilize consists of four categories: Output, outcome, behavior and attitude. Output: Are employees doing enough? Outcome: Does the work produced deliver the desired results? Behavior: Does the employees’ behavior align with our culture? Attitude: Does that employee have a tendency to view and judge things in a certain way, based on emotions and beliefs. The aforementioned can be set into two categories. The employee either does or does not produce the appropriate amount of work and that employee either does or does not contribute to the culture. If this individual does perform exceptional work albeit with a bad attitude or behavior, they are not performing to our standards. On the other hand, if this person has a praiseworthy attitude and behavior but cannot produce the output/outcome set forth, they are also not performing. This allows for simple conversations about whether the employee either does or does not perform at the level of expectations.
Brett Maxfield, CRNA. Director of Anesthesia and Surgical Services of Teton Valley HealthCare (Driggs, Idaho): The process improvement we have implemented that has had the largest impact on our success has been a retooling of our scheduling process. Originally, surgeons were allowed to schedule based on estimated surgical times and using a standard block format. We reviewed actual surgical block usage and actual case time based on historical data, and were able to go through and more accurately schedule case times, more accurately and completely use the block time. That enabled us to reduce overall staffing and anesthesia costs while maximizing revenue during those productive periods. This has led to a significant net gain in revenue and productivity and has also had a pleasant side effect of a decreased staff burnout and an increase in available surgical time for additional surgeons to begin operating with us.
Pradnya Mitroo, MD. President of Fresno (Calif.) Digestive Health: The greatest impact on improving revenue in our [endoscopy] center has been getting the schedules completely backfilled when physicians are on vacation. I have created a process where the managers of both of our divisions review [the] three month schedule for all providers for vacations. It is then offered to each of the physicians in both divisions to fill. Then, three weeks prior, anything that is not filled by then goes back to the physicians to fill up, sometimes their schedules may have changed. This has improved our block utilization significantly and improved revenue.
Amol Soin, MD. Medical Director of Ohio Pain Clinic (Centerville): Integrating artificial intelligence has been quite helpful in streamlining operations. From documentation to a chat bot on the website to help answer and direct basic questions to the appropriate staff member, AI has been critical to enhancing the patient experience in ways I didn’t realize was possible.
Vijay Sudheendra, MD. President of Narragansett Bay Anesthesia (Providence, R.I.): ASCs have implemented several impactful process improvements over the past 12 months, targeting operational efficiency, financial sustainability, and patient outcomes. Below are the key initiatives that have had the most significant impact:
1. Technology integration: EHRs have been increasingly implemented to enhance data management, reduce paperwork, and improve productivity. These systems also provide actionable insights into patient care trends and operational bottlenecks
2. Data-driven decision making: ASCs leverage analytics to monitor key performance indicators such as OR turnover times, claim denial rates, and days in accounts receivable. These insights help identify inefficiencies and guide targeted strategies for improvement. Benchmarking clinical outcome metrics against industry standards has helped centers track progress and improve patient safety.
3. Workflow optimization in operating rooms: A comprehensive process analysis has been conducted to identify bottlenecks in OR operations. This includes process mapping and time-motion studies to improve scheduling efficiency and patient flow.
Standardizing protocols for pre-operative preparation, surgical procedures, and post-operative care has reduced variability and improved resource utilization.
4. Expansion of high-acuity procedures: ASCs have shifted focus toward higher-acuity procedures such as orthopedics and cardiology, driven by technological advancements and payer incentives. This transition has increased case volumes while maintaining cost-effective care.
5. Outsourcing key functions: Outsourcing services like revenue cycle management, anesthesia, housekeeping and sterile processing has allowed ASCs to reduce staffing burdens while maintaining high-quality service delivery. Over the past year, these initiatives demonstrated operational excellence, financial sustainability and superior patient care in the ASC industry.
Elaina Turner, MSN, RN. Administrator of Advanced Surgical Institute New Albany (N.Y.): I would say that the biggest impact on our surgery center lately is the implementation of an electronic medical record. The implementation has taken time and was a significant investment. But we believe it will be worth it for many reasons. This EMR allows the nursing staff to chart by exception and get through the documentation quickly. This allows for more time for patient care and gets the nurses away from the computer and back to the bedside. Additionally, this EMR works with the patients ahead of time to collect data and establish communication leading to less time spent documenting for the nurses and potentially fewer cancellations.
Alan Wagner, MD. Ophthalmologist of Wagner Kapoor Institute (Virginia Beach, Va.): Combining Lean Six Sigma and AI to further streamline our clinical preferred practice patterns for each type of patient interaction/visit.
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