At most ASCs, anesthesia and OR leadership operate in parallel that involves coordinating on clinical matters but rarely sitting down together to make operational decisions.
With scheduling operating in a silo, oftentimes ASCs end up running three separate optimization processes where one would do.
Megan Friedman, DO, chair and medical director at Pacific Coast Anesthesia Consultants in Los Angeles, told Becker’s closing that gap has been the single biggest lever her organization has pulled to strengthen outcomes.
“One of the biggest shifts has been improving perioperative alignment between anesthesia, OR leadership and scheduling,” Dr. Friedman said. “Operational decisions are now more data driven and coordinated in partnership.”
The shift sounds straightforward. In practice, it requires dismantling a workflow assumption that anesthesia optimizes for clinical safety, OR leadership optimizes for throughput and scheduling optimizes for volume, and that these three goals are naturally compatible. However, ASC leaders say they often aren’t.
When those functions operate in silos, the friction can show up in metrics like lagging on-time starts, underperforming room utilization and rising same-day cancellations. And because no single department owns the number, so no single department fixes it. SCA Health’s group vice president of operational strategy and innovation, Lindsey Lowder, told Becker’s the company now uses Tableau dashboards to monitor anesthesia-linked performance measures specifically to get ahead of that dynamic, including first-case on-time starts, PACU length of stay, OR utilization, medication use and cancellations, broken down by cause, physician and service lines.
“This data-driven approach helps us proactively address scheduling inefficiencies and reduce the risk of same-day cancellations,” she said.
Dr. Friedman said her center now measures success across all of those dimensions together, including turnover times, first case on-time starts, same-day cancellations, room utilization, overtime utilization, surgeon satisfaction and cost per case, rather than tracking them in departmental isolation.
That last metric, cost per case, is where the alignment argument becomes hardest to ignore for ASC administrators watching margins compress. Scott Kulstad, CEO of St. Paul, Minn.-based St. Paul Eye Clinic, told Becker’s that ASC leaders are often “busy chasing volume but financially blind — doing more cases, adding higher-acuity procedures, or accepting more payer mix shifts without knowing true cost-per-case.”
The fix, he said, is treating time like inventory.
“Standard work, visible readiness metrics, surgeon-level feedback loops and clear rules for releasing and backfilling time,” he said.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.