--- title: The Hidden Risk Inside High-Performing Surgery Centers description: Margaret Curtin, Curi Advisory Risk Consulting, shares how new ambulatory surgery center patient safety culture data reveals emerging risks as centers grow. Learn why ASC risk assessments and stronger systems are essential for patient safety. image: https://blog.curi.com/hubfs/GettyImages-1275071476.jpg --- [Skip to content](https://blog.curi.com/hidden-risks-ambulatory-surgical-centers#main-content) [![Curi](https://blog.curi.com/hs-fs/hubfs/Curi-logo-horizontal-positive-2.png?width=1443&height=479&name=Curi-logo-horizontal-positive-2.png "Curi")](https://curi.com/) Mobile Menu Icon - [Home](https://blog.curi.com) - [Request Topic](https://share.hsforms.com/1a9ssFAKcTDWA-LBmRgaeowcuu4r) - Topics Show submenu for Topics - [Claims](https://blog.curi.com/tag/claims) - [Clinical Care](https://blog.curi.com/tag/clinical-care) - [Health Policy](https://blog.curi.com/tag/health-policy) - [Litigation Education](https://blog.curi.com/tag/litigation-education) - [Market Commentary](https://blog.curi.com/tag/market-commentary) - [MPL Insurance](https://blog.curi.com/tag/mpl-insurance) - [Practice Management](https://blog.curi.com/tag/practice-management) - [Risk Management](https://blog.curi.com/tag/risk-management) - [Wealth Management](https://blog.curi.com/tag/wealth-management) - [Well-Being](https://blog.curi.com/tag/well-being) - [Subscribe](https://share.hsforms.com/1couqp4WFRrS7xtWs6x0y-Qcuu4r) - [Home](https://blog.curi.com) - [Request Topic](https://share.hsforms.com/1a9ssFAKcTDWA-LBmRgaeowcuu4r) - Topics Show submenu for Topics - [Claims](https://blog.curi.com/tag/claims) - [Clinical Care](https://blog.curi.com/tag/clinical-care) - [Health Policy](https://blog.curi.com/tag/health-policy) - [Litigation Education](https://blog.curi.com/tag/litigation-education) - [Market Commentary](https://blog.curi.com/tag/market-commentary) - [MPL Insurance](https://blog.curi.com/tag/mpl-insurance) - [Practice Management](https://blog.curi.com/tag/practice-management) - [Risk Management](https://blog.curi.com/tag/risk-management) - [Wealth Management](https://blog.curi.com/tag/wealth-management) - [Well-Being](https://blog.curi.com/tag/well-being) - [Subscribe](https://share.hsforms.com/1couqp4WFRrS7xtWs6x0y-Qcuu4r) # The Hidden Risk Inside High-Performing Surgery Centers [Margaret Curtin MPA, HCA, DFASHRM, CPHRM, CPCU](https://blog.curi.com/author/margaret-curtin-mpa-hca-dfashrm-cphrm-cpcu) Mar 25, 2026 [Risk Management](https://blog.curi.com/tag/risk-management) ![Hidden Risk Inside High-Performing Surgery Centers](https://blog.curi.com/hs-fs/hubfs/GettyImages-1275071476.jpg?width=960&name=GettyImages-1275071476.jpg) Recent Ambulatory Surgical Center patient safety culture data reveals emerging risks. Curi Advisory's Margaret Curtin discusses the findings and why risk assessments matter more than ever. Ambulatory Surgical Centers (ASCs) are one of the fastest-growing care delivery models in the United States. Procedures once limited to hospitals are now routinely performed in outpatient settings. I’ve worked with ASC leaders across the country and consistently see the same strengths. They’re efficient, patient-centered, and increasingly complex in the care they deliver. But here’s the parallel reality that I am sharing with the leadership teams we’re advising: **efficiency and safety do not automatically scale together.** The newest national patient safety culture data provides an important signal—not that ASCs are unsafe, but that they are entering a new phase of risk. ## Key Takeaways:  - High performance can mask emerging risk for ASCs. Strong safety culture scores don’t eliminate exposure when growth, complexity, and pace start to outstrip operational safeguards. - Systems, not individuals, drive most claims. Malpractice events in ASCs (and other healthcare organizations) typically stem from process gaps, communication breakdowns, and workflow weaknesses rather than clinical competence. - Proactive risk assessments prevent reactive crisis management. Evaluating how care is delivered under real-world pressure helps organizations address vulnerabilities before harm, complaints, or claims arise. ## What National Data Shows About Ambulatory Surgery Centers The Agency for Healthcare Research and Quality’s (AHRQ) 2025 national ASC safety culture database included: - 292 ambulatory surgery centers - 7,845 staff respondents - 57% response rate Across all participating centers, **85% of responses were positive for patient safety culture overall.** On the surface, that sounds reassuring—and it is. But in my work, safety culture surveys and data are not meant to confirm comfort—they are meant to identify blind spots, much like risk assessments. ## The First Important Insight: ASCs Are Not Small Anymore   The AHRQ report shows a wide distribution of operating room capacity: - 14% have 1–2 ORs - 20% have 3 ORs - 19% have 4 ORs - 18% have 5 ORs - 14% have 6 ORs - 15% have 7+ ORs This matters because many modern ASCs now function operationally closer to micro-hospitals than “small outpatient clinics.” Yet most still operate with hospital-level clinical complexity **without hospital-level risk infrastructure.** This is where exposure begins. ## The Good News: Continuous Improvement Is Strong The highest-scoring safety measure nationally was **Organizational Learning & Continuous Improvement** at **91% positive.** Staff overwhelmingly reported that facilities are actively trying to improve patient safety and prevent problems from recurring. I also find it encouraging that **94% reported patient care information is effectively communicated across areas.** This tells me something important: ASCs are committed to quality. Their teams are engaged. Their clinicians care deeply. But safety failures rarely occur because staff don’t care. In my experience, they **happen when systems fail under pressure.** ## The Real Risk Signal: Staffing Pressure and Workflow Pace Here are the statistics that I believe should immediately get leadership’s attention: **Staffing, work pressure, and pace were the lowest scoring safety domain—72% positive**. Even more concerning, **only 52% of staff reported they do NOT feel rushed while caring for patients**. To me, this is the most important number in the entire report. Because in healthcare risk, “rushed” strongly correlates with: - Wrong-site procedures - Medication errors - Sterilization shortcuts - Communication breakdowns - Documentation failures - Handoff failures - Failure-to-rescue events Notably, 85% of respondents still rated their ASC as “Very Good” or “Excellent” for patient safety, which actually reinforces my concern. Why? Because **organizations often feel safe right before preventable events occur.** The safety incidents that my team assesses rarely originate in obviously unsafe organizations. They originate in busy, confident, and high-performing ones. ### Why This Matters Specifically for ASCs Compared to hospitals, ASCs are uniquely vulnerable because they often have: - Lean staffing models - High case turnover expectations - Surgeon scheduling control - Limited on-site emergency resources - Less formalized risk management programs - Rapid growth and service expansion In other words, **operational efficiency is their greatest strength—and often their primary exposure.** When surgical volume increases but workflow processes don’t evolve, risk accumulates quietly. And most malpractice claims tied to ASCs that my team has reviewed are not caused by clinical incompetence. They are caused by **system design failures.**. ## What a Risk Assessment Actually Does (And What It Is Not) Many administrators assume risk management means policies, incident reporting, credentialing review, and insurance requirements. But those are compliance activities. **A true ASC risk assessment is different. When my team conducts an assessment, we evaluate *how care is actually delivered*,** including: - Pre-operative processes - Surgical time-out reliability - Instrument reprocessing workflow - Handoff communication - Post-anesthesia monitoring - Emergency response capability - Documentation patterns - Workflow pacing and turnover pressure In other words, our risk assessments look at **where the next claim will come from—before it happens.** ## The Gap Most ASCs Don’t Realize Exists The national data shows that ASCs believe they are safe—and largely, they are. But the same data also shows staff feel rushed. In my experience, that gap is exactly where adverse events live. **High safety scores do not prevent claims.** **Strong systems do.** Healthcare liability cases almost never arise from one catastrophic mistake. They emerge from a sequence of small process weaknesses that no one noticed—until a patient outcome forces attention. ## How Our Risk Consulting Team Can Help  At Curi Advisory, our Risk Consulting team (powered by ERC Risk) performs ASC-specific operational risk assessments that function like a clinical safety audit—not regulatory surveys. We evaluate: - Workflow reliability - Human factors risk - Communication vulnerabilities - Emergency preparedness - Documentation exposure - High-risk service lines (GI, Ortho, Pain, Plastics, ENT) Our goal is simple: **Identify preventable patient harm and liability exposure before an incident, complaint, or claim forces intervention.** Because once a serious event occurs, the organization is no longer managing risk. It is managing consequences. If your ASC has grown, added service lines, increased case volume, or experienced staffing strain, it may be time to evaluate not just how safely you operate, but how safely your systems function under stress. That is where risk lives. And that is where prevention begins. [Curi Advisory Risk Consulting](https://go.curi.com/risk-consulting-intro) is here to support you and your organization. Contact me at [margaret.curtin@curi.com](mailto:margaret.curtin@curi.org) to learn more or get started with an assessment. #### References: 1.  SOPS Ambulatory Surgery Center Database. Content last reviewed December 2025. Agency for Healthcare Research and Quality, Rockville, MD. [https://www.ahrq.gov/sops/databases/asc/index.html](https://www.ahrq.gov/sops/databases/asc/index.html) *The content contained herein was generated by Curi Advisory with the assistance of an AI-based system to augment the effort. * SHARE THIS POST [![Share on facebook](https://7528309.fs1.hubspotusercontent-na1.net/hub/7528309/hubfs/raw_assets/public/mV0_d-web-default-modules_hubspot/img/facebook-color.png?width=24&name=facebook-color.png)](https://www.facebook.com/share.php?u=https%3A%2F%2Fblog.curi.com%2Fhidden-risks-ambulatory-surgical-centers%3Futm_medium%3Dsocial%26utm_source%3Dfacebook) [![Share on linkedin](https://7528302.fs1.hubspotusercontent-na1.net/hub/7528302/hubfs/raw_assets/public/mV0_d-web-default-modules_hubspot/img/linkedin-color.png?width=24&name=linkedin-color.png)](https://www.linkedin.com/shareArticle?mini=true&url=https%3A%2F%2Fblog.curi.com%2Fhidden-risks-ambulatory-surgical-centers%3Futm_medium%3Dsocial%26utm_source%3Dlinkedin) [![Share on email](https://7528311.fs1.hubspotusercontent-na1.net/hub/7528311/hubfs/raw_assets/public/mV0_d-web-default-modules_hubspot/img/email-color.png?width=24&name=email-color.png)](mailto:?subject=Check+out+https%3A%2F%2Fblog.curi.com%2Fhidden-risks-ambulatory-surgical-centers%3Futm_medium%3Dsocial%26utm_source%3Demail&body=Check+out+https%3A%2F%2Fblog.curi.com%2Fhidden-risks-ambulatory-surgical-centers%3Futm_medium%3Dsocial%26utm_source%3Demail)   ### About the Author ![](https://blog.curi.com/hubfs/Margaret%20Curtain.png) [Margaret Curtin MPA, HCA, DFASHRM, CPHRM, CPCU](https://blog.curi.com/author/margaret-curtin-mpa-hca-dfashrm-cphrm-cpcu) Margaret Curtin joined the Curi Advisory team in 2023, as Program Director for its risk consulting arm offering clinical risk assessments, claim management, practice management and education support services to hospitals, healthcare organizations and physician groups. With over 30 years of experience in risk management and patient safety, Margaret is a well-known leader in the field. In addition to the medical professional liability insurance industry, she has first-hand healthcare experience, having worked in acute, managed, and ambulatory care settings. Throughout her career, Margaret has also held positions in provider relations, contracting, business development, marketing, education, and underwriting. She is a published author and frequently speaks at industry events and conferences. Margaret is a certified coach and Five Behaviors Certified Practitioner with Wiley in association with Patrick Lencioni. Focusing her coaching practice on leadership and unlocking the power of teamwork for aspiring professionals in the healthcare and the insurance industries. 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