The Journey to a Modern ASC

The road to a fully functioning surgery center is paved with unexpected challenges and tough decisions.

What the public sees are the glamorous professional ribbon-cutting photos from the groundbreaking event or the glowing press releases and news stories about the sprawling new surgery center with the latest, greatest equipment and technology.

What they don’t see are the countless hours that went into planning the project, the potential catastrophes that were averted in the eleventh hour and the blood, sweat and tears that go into every surgical construction project. As anyone who has ever taken part in an ASC build or renovation can attest, there’s nothing glamorous about the endless unseen and unheralded work that goes into making it all happen.

Contractors control all

From capital equipment planning to solving the inherent staffing puzzles to utilizing local resources, solid leadership from core stakeholders is an absolute necessity for every project.

After all, your stakeholders are the ones who ultimately decide which partners to trust with such a complex, high-stakes proposition. First, you need an architect who has healthcare experience and is up to date on all of the state and local building codes and CMS’ Life Safety Code, says Beverly Kirchner, RN, BSN, CNOR, CASC, chief nursing officer of SurgeryDirect, an ASC development firm based in Dallas. But architects aren’t the only ones who need this knowledge. “The key to success as a leader in your center is to know these regulations yourself so you can question the plans with your architect,” says Ms. Kirchner. “Question the electrical and mechanical engineer the architect will work with for the project.”

When it comes to the work itself, however, few partnerships are more important than the one you forge with your contractor. “The partner needs to be chosen carefully,” says Ms. Kirchner. “The contractor controls the building or remodel.”

There’s a Grand Canyon-sized gap between a contractor and the right contractor. The latter can make all the difference in the world when it comes to navigating the labyrinth of red tape that stands between the start of a project and the finish line. Ms. Kirchner advises leaders to make sure your contractor and the subcontractors are experienced in healthcare construction and how to comply with all the relevant building codes for your project. “Ensure that once the construction drawings are completed you bring the contractor’s representative, the subs’ representative and the vendors providing your installed equipment to a meeting where the vendors review with you, the contractor and subs to ensure the drawings are accurate for the equipment.”

This, Ms. Kirchner says, is when you want to ask those questions about whether the electrical is correct and in the correct location, if the plumbing is right, and all the other major and minor details that could come back to haunt you if it’s not addressed properly early on. “I get the subs, the contractor and vendor to sign off on the drawings before construction starts,” she says. “The signature says all responsible parties agree the construction drawings are accurate and I, as the client, will not be charged for a change order if it happens when installation starts. This was a lesson I learned the hard way with one of my projects.”

Jamie Heater, RN, CNOR, vice president of facility development for Blue Cloud Pediatric Surgery Centers in The Woodlands, Texas, agrees with Ms. Kirchner’s assessment of the contractor relationship. She adds that stakeholders must act strategically but decisively when launching projects in today’s surging market. “Great ASC spaces that become available are not going to last for long,” says Ms. Heater. “We’ve seen ASCs being built and acquired more often than ever before. The development and executive team must be motivated to remove the roadblocks that cause some ASC development teams to lose out on great locations.”

To evaluate new locations, Ms. Heater is bullish on the role technology can play.

“Deploying the use of 3D physical building scans and drone evaluation for building spaces that are otherwise hard to reach has been a game changer,” she says. “We can identify troublesome existing conditions that may have otherwise been discovered well into renovation or construction. I’m getting better with the drone but needed to learn a few tips from my 15-year-old.”

Contractors control all

Designing the facility or renovation is only part of the equation; outfitting it with all the appropriate capital equipment and devices is the other Heruclean task. That’s why Ms. Kirchner reminds leaders to view their equipment sales representatives as vital strategic partners throughout the ASC journey.

“The contractor controls the building or remodel.”
Beverly Kirchner, RN, BSN, CNOR, CASC

“Reach out early in the process,” she says. “Identify equipment that must be installed in your new project and request specification documents and help from the company to work with the architects and engineers to ensure you have the right information and can install new equipment without any change orders.” This is where the equipment sales representative and their install team really shine, and facilities that fail to keep them in the loop throughout the entire process do so at their own peril. Change orders, says Ms. Kirchner, are costly and will quickly take over your budget. To prevent the costly change-order pitfall so many leaders end up suffering, she encourages stakeholders to do their work up front to understand the drawings, workflow of team members and location of equipment before construction starts.

“Make sure you review every electrical outlet placement, every monitor for vital signs, dispenser, paper towel holder, trash can — in other words, everything you need and use every day,” says Ms. Kirchner. “Take the time to walk the place room by room. It will save you time, money and headaches when the project is finished.”

While every surgical construction project takes unexpected turns, there are some guarantees: You’ll invest tons of time, spend heart rate-boosting sums of money and go through more Advil than usual. Plan accordingly. OSM

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