+ DESIGNING A SURGERY CENTER: A STEP-BY-STEP GUIDE
Opening a new Ambulatory Surgery Center (ASC) is a complex process that requires careful planning, strategic decision-making, and a deep understanding of regulatory requirements. At Cotton Architecture + Design, we specialize in guiding physicians and healthcare organizations through this process, ensuring that their vision is realized efficiently and successfully.
+ Selecting the Right Site
The first step in developing a new surgery center is choosing the right location. Ideally, ASCs should be built on pad-ready sites—locations that already have utilities in place and are prepared for construction. Key factors to consider include:
Site size and constraints – Ensuring there’s enough space for the building footprint, parking, and future growth.
Parking requirements – ASCs typically have high parking demands due to the volume of patients and staff.
Traffic flow and accessibility – Easy patient drop-off and pickup areas, emergency access, and efficient vehicular movement.
Cotton Architecture can assist in assessing potential sites by creating preliminary site plans that address these factors before any major financial commitments are made.
+ Space Planning & Design
Once a site is secured, the next step is to develop a functional layout tailored to the specific needs of the ASC. No two ASCs are exactly alike, and different specialties require different design considerations.
To guide this process, we use an in-depth questionnaire—a structured list of over 80 questions that help determine:
The number and type of operating rooms (ORs).
The required sterilization workflow—whether a single-room or two-room sterilization setup is preferred.
The number of pre-op and PACU bays, based on anticipated patient volume.
Specific equipment and infrastructure needs, which can impact room sizes, mechanical systems, and electrical requirements.
The goal of this phase is to create a schematic block plan—a high-level spatial arrangement of rooms and workflows—before moving into detailed architectural drawings.
+ Navigating the Design Process
The formal design process consists of three primary phases:
Schematic Design (SD) – Establishes the overall layout, patient flow, and core spaces within the ASC.
Design Development (DD) – Introduces more technical elements, such as mechanical, plumbing, and electrical systems.
Construction Documents (CD) – Produces final, detailed drawings that contractors use to build the facility.
Each phase requires collaboration with doctors, administrators, and consultants to ensure the space aligns with clinical workflows, accreditation standards, and financial goals.
+ Understanding Regulatory Approvals
ASCs must comply with a range of state and local regulations, which vary based on whether the project is a tenant improvement (TI) or a ground-up construction.
Tenant Improvements (TIs) typically take two to three months to obtain city approvals.
Ground-Up ASCs often require site entitlements, environmental reviews, and extended permitting processes, which can take eight months or more.
At Cotton Architecture, we help clients navigate these processes by managing documentation, coordinating with city officials, and ensuring compliance with all applicable codes.
+ Construction & Project Execution
Once permits are secured, construction begins. Timelines vary based on project size and complexity:
Tenant Improvement ASCs – Typically six to eight months for completion.
Ground-Up ASCs – Generally 12+ months, depending on permitting and construction complexity.
A major challenge in today’s construction environment is supply chain delays, particularly for electrical panels and medical equipment. Identifying long-lead items early and integrating them into the construction schedule is critical to avoiding project delays.
During this phase, Cotton Architecture remains actively involved, providing construction administration services, coordinating with contractors, and ensuring quality control to bring the project to a successful completion.
+ Licensing & Final Approvals
Before an ASC can officially open, it must obtain final state licensure and meet accreditation requirements. In Arizona, for example:
The architect must submit a compliance package verifying that the ASC meets state standards.
The owner applies for an operating license, which can take one to two months for approval.
Additional accreditation (AAAHC, Joint Commission, etc.) follows, depending on the owner’s preferences.
At this stage, meticulous documentation and collaboration with regulatory bodies ensure a smooth approval process and timely facility opening.
+ Key Takeaways for ASC Owners
If you're planning to open an ASC, here are three key takeaways to keep in mind:
Start early – Site selection, permitting, and regulatory approvals take longer than expected. Plan ahead.
Engage the right team – Working with experienced architects, contractors, and consultants helps avoid costly mistakes.
Challenge the status quo – ASCs don’t have to be cookie-cutter facilities. Thoughtful design can enhance efficiency, patient experience, and long-term profitability.
At Cotton Architecture + Design, we’re passionate about designing healthcare spaces that optimize workflow, enhance patient care, and support physician-led innovation. If you’re considering a new ASC project, we’d love to help bring your vision to life.