Quick Intro: Who Are You in the OR?

• Which best describes your role in relation to surgical site decisions? Options: Orthopedic surgeon, Ophthalmologist, Gastroenterologist, Anesthesiologist, ASC administrator/manager, Hospital OR director, Payer/network manager, Employer benefits manager, Patient or patient representative, Other
• Tell us about your practice setting and scale (brief): Options: Independent practice (1-5 surgeons), Group practice (6-20 surgeons), Large multispecialty group (>20), Hospital-employed, Managed care/payer team, Employer HR/benefits, Other
• Typical weekly elective surgical volume you or your group schedule (estimate): Options: 0–5 cases, 6–15 cases, 16–30 cases, 31–60 cases, 60+ cases
• Which procedure types make up the majority of your elective cases? Options: Orthopedics (e.g., arthroscopy, small joint), Spine (outpatient-candidate), Ophthalmology (cataract, retina), GI (endoscopy, polypectomy), Pain interventions/injectables, Plastic/reconstructive, Mixed/other
• How would you describe your top priority when choosing an outpatient surgical site? Options: Patient safety and outcomes, Predictable scheduling/blocks, Fast turnover and throughput, Lower cost per case, Available specialized equipment/implants, Ease of credentialing, Payer contracting/network access, Other
• What's one sentence that captures why you're exploring alternate ambulatory sites right now?

What’s the One Thing Driving You Crazy?

• If you could eliminate one recurring problem that costs you time, money, or peace of mind in your surgical workflow, what would it be?
• How frequently does that problem occur? Options: Multiple times per week, Once a week, A few times a month, Monthly or less, Rarely
• In concrete terms, what impact does it have when that problem happens (choose all that apply)? Options: Case delays/late finishes, Increased cancellations, Staff overtime costs, Worse patient experience, Lost revenue, Clinical risk/near-miss, Other
• Describe the last time this issue directly affected a case—what happened and how did it end?
• When you try to fix this, what solutions have you tested and what stopped them from sticking?
• How does this frustration make you feel about scheduling more cases—or bringing new surgeons into your workflow? Options: Confident to expand, Cautious but open, Reluctant to change, Actively looking for alternatives

Who Really Holds the Keys?

• Who ultimately signs off on shifting cases to a new outpatient site—and do they fully understand the trade-offs? Options: Surgeon(s), Group practice leadership, Hospital administration, Payer/network contracting, Employer/benefits, Shared decision-making, Other
• Which stakeholders must be convinced for a move to happen? (Select all who matter in your context) Options: Surgeons, Anesthesia leadership, Nursing leadership, Hospital credentialing, Payer relations, Employer/benefits, Patients, Legal/compliance
• What is each stakeholder most worried about—be specific (e.g., ‘payers want cost per case; surgeons want OR time certainty’):
• How long does it typically take to satisfy credentialing, contracting, or internal approvals before you can begin cases at a new site? Options: <1 month, 1–3 months, 3–6 months, 6–12 months, 12+ months
• Which of these influences the decision most often in your experience? Options: Clinical safety data, Turnover time and throughput, Reimbursement rates, Contracting/network status, Ability to handle comorbid patients, Logistics/transport
• Who would you want us to meet first to move discussions forward (name or role)?

Are You Comfortable Pushing Sicker Patients to an ASC?

• How would you define your current clinical threshold for ASC candidacy (ASA status, comorbidities, procedure complexity)? Options: ASA I–II only, Select ASA III with optimization, Routine ASA III and some IV, Many ASA III–IV with anesthesia support, No formal threshold
• Which comorbid conditions make you hesitate to perform outpatient—select all that commonly appear in your schedule: Options: Obstructive sleep apnea, Morbid obesity (BMI>35), Significant cardiac disease, Insulin-dependent diabetes, Chronic pulmonary disease, Anticoagulation therapy, Other
• What anesthesia capabilities do you require on-site to feel safe (choose top 3)? Options: CRNA with physician oversight, Dedicated anesthesiologist, Regional anesthesia expertise, Ability to manage difficult airway, Post-op extended recovery monitoring, ICU/hospital transfer readiness
• How often in the last 12 months have you needed to transfer a patient from ASC to hospital care? Options: Never, 1–2 times, 3–5 times, 6–10 times, 10+ times
• Describe a near-miss or transfer case: what triggered it, how long the transfer took, and what you wished had been different?
• What monitoring, staffing ratios, or post-op protocols would change your mind about accepting higher-risk cases?

When Time Matters: Throughput and Turnover

• If you could eliminate the single biggest bottleneck that steals OR time every day, what would it be?
• What is your target room turnover time for routine elective cases (minutes)? Options: <15, 15–25, 26–35, 36–50, 50+
• Which parts of the turnover cycle cause the most delay—choose all that apply: Options: Cleaning/terminal cleaning, Case set-up and equipment prep, Implant/supply retrieval, Staff changeover and briefings, Patient transport and recovery handoff, Sterilization backlog
• How predictable is your daily schedule (how often do cases run on time)? Options: Almost always, Most days, About half the time, Rarely, Almost never
• What staffing model do you currently use and where do you see gaps (nursing mix, techs, float staff)?
• What would a realistic improvement in throughput look like for your team in the first 90 days (quantify if possible)?

If Things Go Sideways, Who’s Responsible?

• Imagine a case requires emergency transfer—are roles, timelines, and responsibilities documented and rehearsed? Options: Fully documented and rehearsed, Documented but not rehearsed, Informal verbal plan, No clear plan
• What transfer capabilities does your preferred receiving hospital offer (select all that apply): Options: Dedicated transfer hotline/ED pathway, Surgical admit directly to floor/OR, 24/7 critical care availability, Rapid ground ambulance, Air transport within region, None/limited
• How long is an acceptable transfer time in your area before it becomes clinically risky? Options: <15 minutes, 15–30 minutes, 31–60 minutes, 61–120 minutes, No nearby hospital
• Who signs and owns the transfer agreement in your organization (role or department)?
• Which legal, documentation, or insurance concerns typically slow transfer agreement sign-off? Options: Liability allocation, Payment responsibilities, Credentialing alignment, Operational SLA details, Patient consent language, Other
• Describe one change to transfer planning that would make you more confident operating at an ASC.

What Will Make You Say ‘Yes’ (and By When)?

• What one measurable outcome would convince you to move a block of cases to our ASC tomorrow? Options: Turnover time reduction (minutes), Lower per-case cost (%), Reduced cancellations (%), Improved patient satisfaction (NPS), Faster OR start times, Improved staff satisfaction
• Which pilot case types would you be comfortable starting with (select up to three)? Options: Cataract/lens, Small joint arthroscopy, Simple GI endoscopy, Minor plastic/ENT, Pain injections, Select spine injections
• What timeline feels realistic for a pilot from contract to first case? Options: 2–4 weeks, 1–3 months, 3–6 months, 6+ months
• What logistical or training support would you expect during the first 30 days? Options: On-site checklist and run-throughs, Dedicated clinical trainer, Anesthesia shadowing/support, Supply/implant coordination, Daily debrief and corrective actions, Other
• What internal objections or hurdles do you foresee and who would need to be persuaded?
• If you’re open to a next step, what’s the best way to continue—phone call, site visit, pilot proposal, or something else? Provide preferred contact or timing. Options: Phone call, On-site visit, Pilot proposal (written), Credentialing kickoff, Other

• Solution Experience Pre-Read Alignment
• Case-by-Case Clinical Walkthroughs
• Throughput & Staffing Simulation (Operational Proof)
• Emergency Escalation & Transfer Pathways Drill
• Solution Experience Validation & Sign-off

• Legal/Relations to update or finalize transfer agreement language and distribution list.
• Operations owner to produce a gap list for equipment, instrumentation, and implants needed per case.
• Clinical lead to document anesthesia risk mitigation steps for comorbid patients and identify need for higher acuity capability.
• Schedule any vendor confirmations or inventory orders required for the pilot cases.
• Baseline Throughput & Metrics Review
• Produce a proven, time-based schedule that demonstrates the projected cases-per-room-per-day.
• Confirm a staffing model (roles and FTE assumptions) that supports the simulated throughput.
• Identify the top 3 operational risks that could prevent achieving the future-state and mitigations.
• Operations to deliver a simulation report with projected throughput, staffing plan, and key assumptions.
• HR/Staffing to map current staff to the proposed model and identify hiring or cross-training needs.
• Ops to draft a pilot day schedule for the inaugural cases reflecting agreed changes.
• Present Current Transfer Protocols
• Agree on clear transfer timelines and the single point-of-contact at the receiving hospital.
• Validate that escalation triggers and response roles are understood by all clinical and operations staff.
• Schedule and commit to a live transfer drill prior to inaugural cases.
• Introductions & Objectives
• Clinical lead to prepare a transfer checklist and one-page escalation guide for OR and PACU staff.
• Ops to schedule the live transfer drill with the receiving hospital and confirm observers.
• Recap Current State, Consequence, Future State
• Customer explicitly validates that the proposed ASC approach achieves the defined future-state for their practice.
• Agree a pilot start date and the handoff plan to Deployment with named owners for remaining risks.
• Document any unresolved items with owners and deadlines to be closed before pilot.
• Finalize pilot schedule and publish the inaugural-case plan to all stakeholders.
• Handoff to Deployment: populate Pre-Deployment Readiness checklist with the validated case items and owners.
• Customer to sign off on the list of remaining risks and assigned mitigations prior to pilot launch.
• Produce and document one clear current-state sentence.
• Quantify the top 2–3 consequences (cost, time, risk) of staying in the current state.
• Agree on a one-sentence future-state outcome to be proven in the experience.
• Select 2–4 real cases and confirm pre-read materials and owners.
• Customer to deliver case charts, typical OR schedules, baseline turnover and complication metrics before the next session.
• Host to prepare a one-page template for current-state, consequence, and future-state to use during case walkthroughs.
• Assign leads for each selected case (clinical owner, operations owner, anesthesia owner).
• Recap Preconditions & Case List
• Validate eligibility rules for the selected real cases and identify any disqualifying factors.
• Confirm anesthesia plan compatibility and note cases requiring higher acuity support.
• Verify equipment/implant availability and any vendor or inventory gaps.
• Produce a short list of exceptions and clear escalation triggers for each case.
• Simulated Day Build
• Map Case-Specific Escalations
• Current State Statement
• Proof Presentation: Case Validations
• Case 1: Clinical Timeline Walkthrough
• Proof Presentation: Throughput Simulation
• Consequence Quantification
• Role-Play Drill
• Run Simulation & Timing Walkthrough
• Case 1: Tie to Consequence & Future State
• Case 1: Forced Validation
• Documentation & Consent Requirements
• Proof Presentation: Escalation Readiness
• Sensitivity Scenarios
• Future-State Definition
• Case Selection & Pre-work Checklist
• Confirm Operational Changes Needed
• Case 2: Clinical Timeline Walkthrough
• Action Plan & Drill Schedule
• Customer Validation & Acceptance
• Logistics & Roles
• Decision & Next Steps
• Exceptions & Escalation Triggers

• Provide Fully Equipped Procedure Rooms
• Rapid Room Turnover Between Cases
• Central Sterile Processing and Instrument Sterilization
• Dedicated Perioperative Nursing and Circulating Staff
• Administer Monitored Anesthesia Care (MAC)
• Provide General Anesthesia with Airway Management
• Intraoperative Imaging (C‑arm/Fluoroscopy) Availability
• Point-of-Care Laboratory Testing (BMP/INR)
• On-site Pharmacy Dispensing Perioperative Medications
• Supply Procedure-Specific Implants and Consumables
• On-site PACU Recovery and Same-Day Discharge
• Postoperative Wound Care and Dressing Changes
• Emergency Stabilization and Hospital Transfer Execution
• Sterile Implant Tracking and Documentation

Provide Fully Equipped Procedure Rooms

• How many fully equipped procedure rooms do you require at launch? Options: 1, 2, 3-4, 5+
• Which specialties will use the procedure rooms (select all that apply)? Options: Orthopedics, Ophthalmology, Gastroenterology, Pain Management, Plastic Surgery, Other
• What specialty-specific equipment must be permanently installed (e.g., arthroscopy towers, phaco machines)?
• Do you require negative pressure, laminar flow, or other specialized room HVAC specifications? Options: None, Negative pressure, Laminar flow/HEPA, Other
• Are rooms expected to support hybrid procedures requiring integrated imaging or robotics? Options: Yes, No
• Who owns and is responsible for maintenance and calibration of installed equipment? Options: ASC/operator, Surgeon/group, Third-party vendor, Shared responsibility (detail in comments)

Rapid Room Turnover Between Cases

• What is your target room turnover time (patient-out to patient-in) for standard cases? Options: <15 minutes, 15-30 minutes, 31-45 minutes, >45 minutes
• Which turnover tasks must the ASC perform vs. the surgeon team (e.g., instrument setup, sterile field prep)?
• Do you require a dedicated turnover team or float staff trained for rapid turnovers? Options: Yes, No
• Which supplies and consumables should be pre-staged to support rapid turnover? Options: Basic disposables, Procedure-specific tray sets, Implant kits, All of the above
• Do you want the ASC to track and report turnover metrics (e.g., average minutes, delays by cause)? Options: Yes, No
• Describe any case-mix or schedule patterns that affect turnover needs (e.g., back-to-back short cases, long cases followed by minor procedures).

Central Sterile Processing and Instrument Sterilization

• Will you require a full onsite central sterile processing (CSP) department? Options: Yes, full CSP, Partial onsite + vendor support, Outsource CSP offsite
• How many instrument sets per specialty/procedure should be available to support your schedule?
• What maximum turnaround time do you require for tray reprocessing between cases? Options: <20 minutes, 20-45 minutes, 45-90 minutes, >90 minutes
• Which sterilization methods and validations are required (e.g., steam autoclave, low-temp hydrogen peroxide, AAMI standards)? Options: Steam autoclave, Low-temp sterilization (H2O2), EO gas, Other/unsure
• Who is responsible for instrument maintenance, sharpening, and replacement? Options: ASC/operator, Surgeon/group, Vendor service contracts, Shared
• Do you need instrument tracking (barcodes/RFID) and sterilization cycle documentation integrated with patient records? Options: Yes, No

Dedicated Perioperative Nursing and Circulating Staff

• What perioperative nursing model do you require (e.g., dedicated circulating RN per room, float pool, shared resources)? Options: Dedicated RN per room, Float pool, Shared/variable, Other
• What nurse-to-patient ratios are acceptable in OR and PACU for your case mix? Options: 1:1, 1:2, 1:3+, Varies by acuity
• Are there credentialing, competency, or specialty certifications required for perioperative staff (e.g., CNOR, specialty training)? Options: Yes, No
• Do you require the ASC to provide orientation and procedure-specific competency validation for circulating staff? Options: Yes, No
• Should the ASC support extended hours or weekend staffing for high-volume schedules? Options: Yes, No
• Who handles perioperative scheduling, staff assignments, and on-call coverage for unexpected case changes? Options: ASC operations, Surgeon/group admin, Shared/coordination required

Administer Monitored Anesthesia Care (MAC)

• Will MAC be the primary anesthesia modality for your cases at this ASC? Options: Yes, No, Mixed (case-dependent)
• Which anesthesia providers will be used for MAC (select all that apply)? Options: Anesthesiologist, CRNA, Sedation nurse under protocol, Other
• What monitoring and sedation reversal capabilities are required (e.g., capnography, bispectral index, naloxone/flumazenil availability)?
• Do you require written MAC protocols for patients with specific comorbidities (e.g., OSA, COPD, severe obesity)? Options: Yes, No
• What patient ASA classification threshold do you want the ASC to accept for MAC (e.g., ASA I-II, I-III)? Options: ASA I-II, ASA I-III with restrictions, ASA I-IV with approval, No limit specified
• Should MAC staffing be dedicated (anesthesia provider per room) or pooled across rooms? Options: Dedicated per room, Pooled/roving, Case-dependent

Provide General Anesthesia with Airway Management

• Will you perform cases requiring endotracheal intubation and general anesthesia at this ASC? Options: Yes, routinely, Occasionally, No
• Which airway management equipment must be present (e.g., video laryngoscope, difficult airway cart, supraglottic devices)?
• Do you require facilities for short-term mechanical ventilation or invasive monitoring post-op prior to transfer? Options: Yes, No
• What are the acceptable ASA classifications and comorbidity limits for GA cases at your site? Options: ASA I-II, ASA I-III with criteria, ASA I-IV with prep/approval
• Who is responsible for airway emergency drills, and how often should simulations occur? Options: ASC clinical leadership, Surgeon/anesthesia groups, Joint responsibility
• Detail expected documentation and handoffs required for GA cases (e.g., timeouts, anesthesia record, post-op airway checklist).

Intraoperative Imaging (C‑arm/Fluoroscopy) Availability

• How many C‑arm/fluoroscopy units must be available, and are dedicated or shared units preferred? Options: 1 dedicated, 1 shared, 2+ dedicated, Other
• Which c-arm features are required (e.g., mobile high-definition, mini c-arm, digital storage, DICOM export)?
• Who is responsible for radiation safety (lead aprons, badges, exposure monitoring) and what reporting cadence is required? Options: ASC radiation officer, Contracted service, Surgeon/group
• Do procedures require on-site radiology technologist support or will trained OR staff operate the c-arm? Options: Radiology tech required, Trained OR staff OK, Depends on procedure
• Is integration with PACS/EHR/DICOM required for intraop image storage and post-op review? Options: Yes, No
• What maintenance, calibration, and service-level expectations exist for imaging equipment?

Point-of-Care Laboratory Testing (BMP/INR)

• Which POC tests must be available onsite (select all that apply)? Options: BMP/basic metabolic panel, INR/PT, Glucose, Hemoglobin/Hct, Type and screen, Other
• What maximum turnaround time do you require for POC results prior to proceeding with cases? Options: <5 minutes, <15 minutes, <30 minutes, Varies by test
• Does the ASC need CLIA-waived devices and QA/QC documentation integrated with patient records? Options: Yes, No
• Who will operate and maintain POC devices and manage QC logs? Options: ASC clinical staff, Laboratory vendor, Surgeon/group staff
• Are there specific thresholds or result triggers that require case delay, additional workup, or transfer? Options: Yes, No
• Do you require electronic interfacing of POC results with the EHR/LIS? Options: Yes, No

On-site Pharmacy Dispensing Perioperative Medications

• Should the ASC have an on-site pharmacy or automated dispensing cabinets (ADCs) for perioperative meds? Options: Full on-site pharmacy, ADCs only, No on-site dispensing (surgeon brings meds)
• Which medication classes must be stocked (select all that apply)? Options: Anesthetics/sedatives, Narcotics/controlled substances, Reversal agents, Vasopressors/fluids, Antibiotics, Other
• What hours of pharmacist or qualified medication oversight are required (e.g., 24/7, clinic hours)? Options: 24/7, Business hours with on-call, Business hours only
• Who manages controlled substance inventory, reconciliation, and DEA compliance? Options: ASC pharmacy, Surgeon/group, Third-party vendor
• Do you require sterile compounding capability (e.g., TPN, infusion prep) or emergency drug kits? Options: Yes, No
• Should medication dispensing integrate with eMAR/EHR for dose documentation and audit trails? Options: Yes, No

Supply Procedure-Specific Implants and Consumables

• Will implants/consumables be consigned, purchased by ASC, or provided by surgeon/vendor? Options: Consignment, ASC-purchased, Surgeon/vendor-supplied, Mixed
• List the implant types, sizes, and vendor brands that must be available at go-live.
• What inventory levels and reorder points do you expect for high-use implants and disposables? Options: Min/max defined, Just-in-time with vendor, Surgeon-managed
• Do you require on-site sterile storage, temperature control, and expiration monitoring for implants? Options: Yes, No
• Who handles implant warranty, vendor consignment contracts, and billing reconciliation? Options: ASC operations, Surgeon/group, Finance/vendor
• Should supply usage be tracked per case and integrated into charge capture and inventory systems? Options: Yes, No

• Statement of Work (SOW)
• Commercial Terms & Fee Schedule
• Scheduling Rights & Block Time Agreement
• Payer Contracting Expectations
• Credentialing & Provider Enrollment Plan
• Transfer & Emergency Escalation Agreement
• Equipment, Implant & Supply Agreement
• Staffing, Roles & Clinical Responsibility Matrix
• Data Sharing & Quality Reporting Agreement
• Patient Consent & Financial Authorization Templates
• Training, Onboarding & Readiness Timeline
• Gainshare / Value‑Based Arrangement Addendum
• Termination, Renewal & Dispute Resolution Terms

• Executive Success Review (Stakeholder Alignment)
• Clinical Outcomes & Safety Deep-Dive
• Operational Performance & Throughput Review
• Patient Experience, Billing & Payer Outcomes Review
• Continuous Improvement Forum & Shared Channel Kickoff

• Agree on communication updates to patients and payers to prevent recurrence.
• Current State: Operational KPIs
• Identify the primary operational constraints preventing target throughput and quantify their impact.
• Agree on a set of prioritized pilots or process changes with owners and clear success metrics.
• Ensure supply chain and equipment gaps are assigned and resourced to prevent repeat delays.
• Launch a 30-day pilot for the highest-impact throughput change and define daily measurement reporting.
• Place urgent purchase or reallocation orders for any critical equipment or implant deficits.
• Document updated staffing schedules and communicate changes to affected teams.
• Summary: Patient Satisfaction & Complaints
• Ensure patient satisfaction meets the agreed acceptance threshold or define remediation steps.
• Reduce payer denial rate and quantify expected recovery value from appeals or process fixes.
• Welcome & Objectives
• Initiate appeals for high-value denied claims and assign a billing lead for each case.
• Revise the pre-op financial counseling script and patient education materials to address common confusion points.
• Implement a weekly denial-tracking report with dollar exposure and remediation status.
• Purpose & Rules of Engagement for Shared Channel
• Establish a persistent, governed channel for ongoing issues and enhancements with clear SLAs.
• Create and prioritize an actionable backlog tied to business impact and assign owners.
• Set recurring meeting cadences and an escalation matrix to keep momentum and accountability.
• Create the shared channel (platform link), invite required stakeholders, and publish rules of engagement.
• Populate the learning log with initial deployment retrospectives and the prioritized backlog.
• Schedule the recurring operational sync and the first backlog grooming session within one week.
• Confirm whether the deployment met the agreed success signals and quantify any shortfalls.
• Make an executive decision to continue, expand, or trigger remediation with clear criteria.
• Assign owners and timelines for corrective actions and agree the date for the next executive review.
• Distribute the consolidated outcomes report and data appendix to all stakeholders within 48 hours.
• Document executive decision (continue/scale/remediate) and publish required conditions for scaling.
• Assign remediation owners with 30/60/90 day milestones and schedule the next executive checkpoint.
• Meeting Context & Safety Thresholds
• Validate that clinical safety performance meets the acceptance criteria or identify specific gaps.
• Agree concrete corrective actions (protocol updates, training, staffing changes) for each identified root cause.
• Establish an ongoing clinical monitoring plan with triggers for immediate escalation.
• Create and circulate a redacted incident log with root-cause summaries and assigned owners.
• Update relevant clinical protocols and run targeted training sessions for impacted staff within two weeks.
• Implement a daily/weekly safety dashboard feed and set automated alerts for threshold breaches.
• Documentation Standards & Learning Log
• Financial Outcomes & Payer Metrics
• Recap: Agreed Success Signals & Baselines
• Case-Level Event Review
• Bottleneck Analysis
• Outcomes Summary vs Targets
• Backlog Review & Prioritization Framework
• Equipment & Implant Availability Review
• Root Causes for Denials or Patient Dissatisfaction
• Root Cause Analysis & Consequence Assessment
• Key Deviations, Consequences & Risks
• Protocol & Escalation Pathway Validation
• Cadence, Roles & Escalation Matrix
• Corrective Actions: Billing, Authorization, and Patient Communication
• Improvement Proposals & Pilot Design
• Next Steps & Channel Activation
• Decision Discussion: Continue, Expand, or Remediate
• Operational Owners & Measurement Plan
• Clinical Remediation & Monitoring Plan
• Measurement & Escalation for Financial Risk
• Owners, Timelines & Next Review