ASC Best Practice


Article by Herb Rubenstein, President, Herb Rubenstein Consulting, and
Cher Pascoe, President, Pascoe Professional, Inc.


Ambulatory Care Centers or Ambulatory Surgery Centers (ASC) are often locally owned, independently operated health care organizations. Doctors are often the investors, serve on the board of directors, participate in management of the center, and hire an administrator to carry out their wishes.

This article addresses a key problem with this framework of ownership and operation of ASC's.

Knowledge Sharing Among ASC's

How does the Administrator of one ASC learn on a daily basis what is working or not working in other ASC's? Certainly from publications like Becker's ASC Review. Also, from talking with other ASC's, attending conferences, and reading the trade press. However, proprietary research by Herb Rubenstein Consulting has identified a significant gap in knowledge and information transfer among ASC's. Specifically, Administrators are caught up in the day-to-day operations of ASC's. There are few significant informational networks available to ASC Administrators to let them know about newly discovered or developed best practices, or standard solutions to standard challenges many ASC's face on a daily basis.

This article calls for and documents why a new emphasis on best practices knowledge transfer is important to aid ASC's deal effectively with the challenges they face.

The Enhanced Role of Best Practices and Standard Operating Procedures

The basic structure of the health care industry and the role of ASC's in that industry will quickly begin to change. Today, as stated before, many ASC's are independently owned by a few doctors. They are operated as an island with their own crafted rules and procedures. They learn little on a daily basis from how other ASC's are operated.

However, in industry and in much of modern business practice in the United States, the best knowledge transfer approaches are often between the various stores or outlets of commonly owned chains. ASC's by being independent, often miss out on having the knowledge sharing or best practices sharing that exists and supports other sectors of our economy.

As hospitals are starting to get more and more involved in investing in ASC's, and as consolidation of ASC ownership becomes more and more widespread, there will be more and more ASC's that will not be operating in the future as islands, but rather as part of networks or as the word is used in the general business sector, chains.
Business networks, or chains, are built on standard operating procedures, and best practices that are generated at each site, collected daily by the central office and communicated daily by the central office to all operating units. Today, with wikis, blogs, and many other Web 2.0 communication channels, smart organizations are promoting peer-to-peer, operation-to-operation, communication channels so best practices can be communicated among operating units as soon as they are discovered.

ASC's have not matured to the point where best practices are identified and communicated on a regular basis across ASC operating units. It should be a key component of the job of ASC Administrators to find other ASC's willing to share information on what is working and not working in ASC's. In some industries, these are called communities of practice.

Enhancing the Role of the Administrator to Include Gathering and Disseminating Best Practices Information and Knowledge

It appears from our research that ASC Administrators spend all of their time putting out fires, dealing with scheduling problems, dealing with customer (doctor) complaints, trying to collect their receivables, fighting with insurance companies over the reimbursements they will receive, and dealing with many other day-to-day activities. Administrators have not been encouraged or given the time to create the networks of Administrators who are willing to share information and best practices on a regular basis.

Part of the new role for Administrators and management of ASC's should be for them to learn daily from other ASC's about what is working and what is not working in their industry. Best practices must be shared among ASC's and this information must be sent up to each ASC board and down to each ASC staff member accurately and quickly. With our new communication technologies, setting up these knowledge sharing networks is no longer difficult.


It seems like an easy recommendation to make that Administrators and ASC management should embark on sharing best practice information. This change, like all other changes, will require significant changes in the roles of Administrators, in the relationship among ASC's, and the use of new information technology. The sharing of information across ASC's might run into the argument that each ASC is a competitor of all other ASC's and therefore, they will not share best practice or useful management information. Certainly some ASC's are competitors with other ASC's. However, we believe as the ASC business model and sector of the health care industry matures, many, if not most, ASC Administrators and management would gladly share, on a daily basis, best practice information. We urge every ASC and all associations and trade publications to begin in earnest to substantially increase the sharing of best practice information across the sector. The benefits of this sharing will far exceed the costs given the low cost nature of new information technology.

About the Authors

Herb Rubenstein is the President of Herb Rubenstein Consulting, a consulting firm to businesses and individuals with its headquarters in Denver, Colorado. He is the author of two business books, Breakthrough, Inc.: High Growth Strategies for Entrepreneurial Organizations and Leadership for Lawyers, and over 100 articles on business strategy, entrepreneurship, leadership, and improving how organizations function and deliver value. He can be reached at He can also be reached at (303) 279-1878. The website for the Herb Rubenstein Consulting is .

Cher Pascoe is a Medical Marketing Professional and President of her own strategic consulting firm, Pascoe Professional, Inc. Cher has over twenty-three years specializing in all aspects of medical marketing and serves as Senior Advisor to The White House Health Project, a twelve year project, developing and measuring ROI of employer-based health education, wellness and prevention programs. She can be reached at (303) 232-8161 or .