The Big Picture: Wrapping Up the Dream of a New ASC

Crossing the finish line for a successful center requires a special type of architect-stakeholder collaboration.

There are plenty of characteristics stakeholders should look for in the architect they select to design their new surgery center and ensure the vision remains intact throughout the challenges inherent in every new build. Ego isn’t one of them.

“I view the architect’s role as one of service,” says John Gresko, executive architect for DISC parent company TriasMD, a physician-first management company dedicated to creating a network of spine and musculoskeletal ASCs throughout the U.S. “Good design isn’t about personal preferences — it’s about function, flow, and meeting code requirements, because at the end of the day, people’s lives are at stake.”

Flow like an infield

Mr. Gresko brings over two decades of healthcare design experience and has overseen the five most recent DISC Surgery Center projects and renovations. He approaches every project with the understanding that function and flow are non-negotiable for long-term success. “You can meet the budget, you can build quickly — but if the flow is off, the staff will struggle every day,” he says. “Poor flow compromises efficiency, patient privacy, and ultimately, the quality of care.”

Flow is a concept Mr. Gresko likes to explain using baseball terms, stressing how pre-op and recovery rooms, the nurse’s station, the mechanical systems, and the sterile processing department are each inextricably intertwined and must be designed with purpose and efficiency for the center to function properly. “I think of it like an infield,” says Mr. Gresko. “It’s like running the bases — you go from first to second to third to home. In the same way, you move from pre-op to the OR to recovery to discharge, with support spaces like SPD woven in. The flow has to be intentional and sequential.” Mr. Gresko credits Dr. Robert Bray with instilling this understanding early in their collaboration. “Dr. Bray taught me surgical centers aren’t just buildings — they’re living systems,” Mr. Gresko says. “Learning to see the flow through a surgeon’s eyes helped me understand what really matters: supporting patient safety, surgical efficiency and clinical harmony.”

Stakeholders and physician owners need to have a clear understanding of what they are designing the space to accomplish. “I don’t think you can think of ‘surgery center’ as a general term; you need to design specifically for what your center will be,” says Robert S. Bray, Jr., MD, FAANS, founding director of DISC Sports & Spine Center and TriasMD. Dr. Bray, who is recognized globally as a pioneer in minimally invasive outpatient spine, began working with Mr. Gresko in 2020, enlisting him for DISC’s state-of-the-art Marina del Rey ASC.

“Are you building a general-purpose surgery center for hernias and GI procedures, an orthopedic ASC for general ortho cases or are you designing for high-acuity spine and total joint surgeries? A low-volume, high-acuity facility is very different than a high-volume, general-purpose surgery center,” says Dr. Bray, whose expertise is in the low-volume, high-acuity arena. He knows exactly what’s needed to design, build and grow his centers for success. Whereas a general-purpose facility may realistically require 10 or 12 rooms, Dr. Bray says a high-acuity center really only needs two or at a maximum three rooms to succeed. While expansion is always on the minds of eager stakeholders who only see growth potential, overbuilding can be a recipe for disaster. “What you don’t want to do is go way over the amount of space you need,” cautions Dr. Bray. “It’s critical to identify what you are building, why you are building it and then design appropriately.”

Sponsored Content courtesy of ZIMMER

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A Partnership Built on Expertise and Scale

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Zimmer Biomet complements CBRE’s capabilities with its industry-leading orthopedic solutions and flexible financing options. Together, they provide a streamlined, programmatic approach to accelerate time-to-market for new and retrofitted ASCs. Whether you’re breaking ground on a new facility or optimizing an existing one, this partnership delivers a first-class experience tailored to your vision.

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• Turnkey Development: From land acquisition to design and construction, CBRE manages every detail, delivering a fully operational ASC with minimal disruption to your practice.
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ZBX is more than a service, it’s a solution to building your unique orthopedic ASC. By combining Zimmer Biomet’s cutting-edge medical technology with CBRE’s real estate expertise, this partnership minimizes traditional barriers to ASC development. Surgeons can gain access to cost-effective, high-quality solutions that prioritize their goals.

Take the Next Step

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This collaboration empowers you to create a state-of-the-art facility that reflects your practice’s unique needs. Discover how ZBX can transform your ASC vision into reality – contact Zimmer Biomet today — zimmerbiomet.com/asc

References:

Advisory & Transaction Services | Commercial Lease & Sublease Professionals | CBRE. cbre.com. (2025a). cbre.com/services/plan-lease-and-occupy/transaction-services

ZBX^TM Zimmer Biomet ASC Solutions. (n.d.). zimmerbiomet.com/en/products-and-solutions/asc-solutions.html

Architects’ multipart role

This hyper-emphasis on understanding just what a new surgery center (or renovation project) will ultimately become and anticipating most of the obstacles that stand in its way prior to opening are major reasons why stakeholders need an architect partner with ample real-word experience in the ambulatory surgery center space. Mr. Gresko notes, “I’ve learned that the best results come when architects truly listen to the clinical team and understand their workflows. It’s not our job to direct doctors—it’s our job to support them.” Mr. Gresko firmly believes a little bit of humility from an architect is crucial to the overall success of the project. “Architects herd a lot of cats, and we need to get a lot of decisions from all different stakeholders,” he says. “We really shepherd it from the beginning to end. When ego gets in the way, architects can miss the importance of timely decisions. Staying humble helps keep the project moving.”

Drawings and construction documents. First, your architect must provide a very good set of drawings and construction documents for review. As we mentioned earlier, this is where the flow and function of the facility — and the timing to make it happen comes into play. Throughout the course of his two decades in healthcare design, Mr. Gresko has seen avoidable mistakes — from not choosing medical equipment early enough in the process to opting for aesthetically striking features that look great but aren’t able to withstand the heavy, constant abuse of terminal cleaning. “I’ve seen how something as small as the placement of a changing room can unintentionally compromise patient privacy — often because the layout looked fine on paper but didn’t reflect real-world use.”

Design defense. Next, architects must be able to defend the design and possess the ability to argue with city planners and officials over what the intent of the code is — and win those arguments. “An architect who understands the process and knows how to make a compelling case will be more effective at winning those arguments and securing permits faster,” says Mr. Gresko.

Construction administration. The final critical role is construction administration—supporting the owner during construction and ensuring the project is built as designed. A key part of this is helping select a general contractor with the right experience for healthcare work. “This phase is about partnership and oversight,” says Mr. Gresko. “Our job is to protect the owner’s interests by making sure the design intent is followed, and that any proposed substitutions or changes are evaluated carefully to avoid unintended impacts on function, compliance, or patient experience.”

Driving force

When an architect understands their role, it frees up your stakeholders and/or your surgeons to do what they do best: Provide the top-quality outpatient care in a much more efficient manner than a hospital ever could. Dr. Bray has been performing minimally invasive neurological spine cases on an outpatient basis long before the concept took hold in this country, and to date, he’s performed more than 14,500 successful surgeries on patients of all types, including professional athletes and celebrities.

With no signs of slowing down any time soon, Dr. Bray continues to grow his practice and bring his MIS approach to DISC Surgery Centers throughout California as well as a location under construction in Florida. “We are upping the quality,” he says. “We beat every national benchmark on every parameter across the board, from hospital admittance to infection to falls — everything. What drives me to continue is seeing every day that this model is working. We are preserving something I very much believe in personally — position autonomy in private practice.” OSM

Note: This three-part article series is supported by Zimmer Biomet.