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:
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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.
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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.
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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:
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292 ambulatory surgery centers
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7,845 staff respondents
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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:
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14% have 1–2 ORs
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20% have 3 ORs
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19% have 4 ORs
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18% have 5 ORs
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14% have 6 ORs
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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:
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Wrong-site procedures
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Medication errors
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Sterilization shortcuts
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Communication breakdowns
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Documentation failures
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Handoff failures
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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:
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Lean staffing models
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High case turnover expectations
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Surgeon scheduling control
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Limited on-site emergency resources
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Less formalized risk management programs
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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:
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Pre-operative processes
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Surgical time-out reliability
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Instrument reprocessing workflow
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Handoff communication
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Post-anesthesia monitoring
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Emergency response capability
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Documentation patterns
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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:
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Workflow reliability
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Human factors risk
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Communication vulnerabilities
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Emergency preparedness
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Documentation exposure
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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 is here to support you and your organization. Contact me at margaret.curtin@curi.com to learn more or get started with an assessment.
References:
- 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 Bottom of Form
The content contained herein was generated by Curi Advisory with the assistance of an AI-based system to augment the effort.
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