Recently, Building Design + Construction invited Oculus Inc.’s Healthcare & Government Co-Director, Rob Forney, AIA, LEED Assoc., VA-Space & Equipment Planning System (SEPS) Certified, to contribute to its Annual Healthcare Report alongside other industry leaders. Drawing on decades of experience designing healthcare environments across the country, Rob shared his perspective on the trends shaping outpatient surgery facilities.

Below are Rob’s insights into the design strategies and industry shifts shaping the future of outpatient surgery and helping healthcare providers deliver safer, more efficient, and more adaptable care.

Q. Has the demand for outpatient surgery facilities been increasing or decreasing over the last 12 months?

A. Across industry reporting, financial data, and regulatory developments, the last 12 months show a clear upward trend in demand for outpatient surgery facilities, especially ASCs. Growth is not just forecasted – it is actively occurring through rising case volumes, facility development, and shifts in health‑system strategy.

Q. Is prefabrication more or less prevalent in these building types than in others?

A. Prefabrication is more prevalent in outpatient surgery facilities than in most other commercial building types, but it is far more systems‑based than structural/modular prefabrication. This means higher use of prefab MEP racks, headwalls, booms, ceiling service panels, and corridor utility assemblies than in generic office or retail projects.

Q. Improving these facilities’ workflow seems to be important to healthcare providers. How is that being accomplished?

A. Improving workflow in outpatient surgery facilities (especially ASCs and hospital outpatient departments) is a top operational priority, and it is being accomplished through a combination of facility design strategies, process standardization, and digital technology—all aimed at reducing variability, shortening patient time on site, and increasing daily case throughput.

Q. What is being done to ease pressure on healthcare and medical employees?

A. Healthcare providers, especially those operating outpatient surgery facilities and ASCs, are actively addressing staff pressure and burnout using operational, design, workforce, and technology-based interventions. The focus has shifted from short‑term staffing fixes to systemic workload reduction, improved predictability, and better day‑to‑day working conditions.

To ease pressure on healthcare and medical employees, especially in outpatient surgery, providers are not just adding staff; they are engineering stress out of the system through less manual work, more predictable days, smarter buildings, clearer workflows, and technology that removes friction instead of adding it. Facilities that combine all of these approaches show lower burnout, better retention, and stronger operational performance than those relying on staffing increases alone.

Q. A number of health systems are moving their outpatient surgery services to a 24-hour operating model, some offering same-day surgery. What features are being added or enhanced within the building/complex to meet that challenge?

A. Health systems that are moving outpatient surgery toward a 24‑hour operating model (often meaning extended recovery/23‑hour stay capability rather than “admit like an inpatient unit”) are upgrading both the clinical platform and the support infrastructure so they can safely handle higher-acuity procedures, later operating hours, and overnight observation—without creating inpatient‑level overhead. When outpatient surgery truly runs overnight, the facility evolves into a high-acuity, continuously operating surgical plant with PACU‑level recovery, night‑ready staff infrastructure, and hospital‑grade reliability — but without inpatient beds.

Facilities that only “extend hours” fail. Facilities that redesign for 24‑hour reality succeed.

Q. What resilience and/or sustainability features are must haves for these facilities?

A. Outpatient surgery centers today treat resilience as a patient‑safety requirement, not a premium feature. Core “must‑haves” include:

• Highly reliable electrical power (emergency generators plus UPS for ORs, anesthesia, IT, and PACU)
• Resilient HVAC systems that can maintain pressure, temperature, and humidity during failures
• Dependable medical gas, water, and IT infrastructure.

Current FGI guidance reinforces the need for formal risk, disaster, and vulnerability assessments so facilities can sustain surgery, recovery, and sterilization during utility outages, extreme weather, or other disruptions. Even in freestanding ASCs, continuous access to PACU‑level care, protected IT rooms, and clear separation of life‑safety and critical systems are baseline expectations because even short interruptions can immediately jeopardize patient safety. 

Sustainability priorities increasingly overlap with resilience and operational cost control. Many owners now expect healthcare‑appropriate high‑performance design aligned with ANSI/ASHRAE/ASHE 189.3, including energy‑efficient HVAC, the ability to set back OR air changes when rooms are unoccupied, water‑efficient systems that preserve infection control, and durable, low‑maintenance materials with long life cycles. Electrification‑ready infrastructure, commissioning, and ongoing performance monitoring are becoming standard to control long‑term energy risk while supporting future decarbonization goals without compromising surgical reliability. Together, these strategies reduce operating costs, support staff well‑being, and ensure outpatient surgery centers can remain functional, safe, and competitive under increasingly volatile energy, climate, and workforce conditions.

Q. What regulations is your firm keeping an eye on that might affect your outpatient surgery center projects down the road?

A. For outpatient surgery center projects, owners and designers should closely monitor federal reimbursement and licensure frameworks, particularly CMS rules governing ambulatory surgery centers. While these are operational regulations, they strongly influence building design by defining allowable length of stay, recovery models, staffing expectations, and emergency preparedness requirements. As outpatient care continues to absorb more complex procedures, even subtle shifts in CMS guidance or survey interpretations can affect OR sizing, recovery capacity, and infrastructure resilience. Accreditation standards from organizations such as AAAHC or The Joint Commission also play an outsized role, as their survey expectations frequently drive owner requirements for infection control, medication safety, emergency power, and documentation-ready environments.

Another major area to watch is the evolution of facility design guidelines used by authorities having jurisdiction, most notably the Facility Guidelines Institute (FGI). Updates to outpatient-focused chapters increasingly emphasize risk assessments, resilience, acoustics, flexibility, and staff safety – areas that directly affect space programs and building systems, even when not explicitly codified in state law. Life safety expectations for ambulatory healthcare occupancies, ventilation and pressure requirements for operating and procedure rooms, and emergency preparedness provisions are all trending toward higher consistency with inpatient best practices, particularly as ASCs adopt extended hours and higher-acuity cases.

Finally, firms should track the growing influence of healthcare-specific sustainability and resilience standards, especially those issued by ASHRAE and ASHE. Standards such as ANSI/ASHRAE/ASHE 189.3 are increasingly used as benchmarks for high-performance outpatient facilities, while parallel decarbonization guidance is shaping owner expectations for electrification readiness, energy-efficient HVAC strategies, and enhanced commissioning. At the same time, resilience requirements – backup power, IT continuity, medical gas reliability – are no longer viewed as optional upgrades but as baseline expectations tied to patient safety and operational continuity. Together, these forces are steadily raising the regulatory and technical bar for outpatient surgery centers nationwide.

These responses were originally contributed by Oculus Inc.’s Rob Forney to Building Design + Construction‘s Annual Healthcare Report and are republished here with additional context. You can access the full report here.