Nisha Jacob Savanhu, MD, MBA
Ten years ago, many ASC conversations started with “What do we need to open a new center?” Today, more start with “What do we need to renovate or expand?”
In a 2015 trade-show note, one ambulatory surgery center was described simply: “New facility this fall/early spring 2016.” The need was clear: a facility was being created and equipment would be required to make it operational.
A decade later, the language sounds different. A 2025 ASC lead reads: “Currently 4 OR bays… wants to replace all.” Another recent note describes a center with “very old stretchers and equipment” while evaluating new seating and stretcher options across a larger network.
Those comments capture an important evolution in ambulatory surgery. The ASC story is no longer only about adding sites and expanding access. A growing part of the story is what happens after an ASC has been operating for years: equipment ages, case mix changes, staff expectations evolve, technology improves, and the workflow itself becomes something leaders deliberately redesign.
Growth Is Increasingly Happening Inside Existing ASCs
A validated longitudinal Voice-of-the-Customer analysis of 446 ASC and outpatient-surgical trade-show interactions shows both sides of the ASC growth story. Earlier records contain many straightforward expansion signals: new construction, new centers, additional procedure rooms, and first-time equipment purchases. Those conversations have not disappeared. Recent notes still describe new centers, added service lines, and organizations building multiple sites.
What has changed is the prominence of lifecycle replacement. In the validated all-show cohort, explicit replacement or aging language appeared in 21.8% of 2015–2018 notes and 35.1% of 2022–2025 notes. The specific comments are revealing:
- “25 yrs old competitor X units.”
- “Need 5 stretchers because… they are too old to buy parts for.”
- “They have many surgery centers and have very old stretchers and equipment.”
For manufacturers and ASC leaders, this is an important signal. It means the ambulatory surgery infrastructure created during earlier waves of growth is reaching a period in which replacement can also become redesign. A center does not have to replace an old stretcher with the same workflow it had 15 or 20 years ago. Replacement creates an opportunity to ask whether the work itself can be performed differently.
The Conversation Is Moving from Products to Workflow
One of the clearest patterns in the VOC is that customers often name a product while describing a workflow problem. A chair, stretcher, headrest, recliner, or fluoroscopy unit is the visible request. Underneath it is usually a capability: movement, access, positioning, recovery, reduced handling, or faster turnover.
A 2017 ASC note stated that the facility wanted to move patients to chairs “to improve turn time.” A 2018 lead wanted to “keep patients in them vs transferring.” A recent ASC described an even more explicit goal: “do the full 1-2-3 steps from pre to OR to post.”
These are not merely product preferences. They are attempts to redesign the patient journey. In an ASC, where space, staffing, room utilization, and turnover are tightly linked, mobile equipment can function as part of the workflow architecture.
Modernization Is Also a Workforce Strategy
A second positive trend is the way staff experience increasingly appears inside equipment conversations. The notes are often brief, but they capture the physical reality of repetitive work.
- “She is worn out from cranking and pumping. She wants power.”
- “Powered eye stretchers for aging staff.”
- “Wants a chair that goes higher… because doctor stands.”
The implication is larger than convenience. Equipment design influences how often staff bend, pump, crank, push, reposition, transfer, and compensate for limitations in the device. As ASCs compete for experienced clinical staff, reducing unnecessary physical effort can be considered alongside throughput, safety, and patient experience.
Replacement Is Becoming a Reconsideration Point
Competitor or conversion language appeared in 14.5% of the earlier notes and 27.3% of the 2022–2025 group. That matters because replacement is not automatically a like-for-like event. Recent notes include facilities considering a switch because existing equipment is old, difficult to service, delayed, or no longer supported with readily available parts or technical assistance.
- “Currently use Company X. Does not like. And want to change to chair.”
- “Can’t get pendants for old Company Y chairs.” And “Has Company Y but issues.”
- “Currently using three units. Need a U.S.-based option because of technical support and parts availability.”
A mature replacement market creates an opportunity for innovation. The question is no longer just, “What should replace this unit?” It can become, “What should the next version of this workflow look like?”
The Buying Journey Is Becoming More Digital — Without Becoming Less Clinical
One of the clearest changes in the historical notes is the emergence of digital evaluation. Virtual, video, or other explicitly digital evaluation language appeared in only 0.9% of 2015–2018 notes, compared with 25.3% of 2022–2025 notes.
Recent customers repeatedly request videos, online literature, virtual demonstrations, and then onsite trials.
- “Wants virtual demo.”
- “Send video, literature and pricing.”
- “Virtual demo and onsite trial.”
This is not a replacement for clinical evaluation. It is a more efficient front end to it. The emerging evaluation path often moves from information and video, to a virtual demonstration, to an onsite trial, and ultimately to a purchase decision. That gives busy ASC teams a way to screen options before committing staff time and clinical space to a physical evaluation.
A Single ASC Conversation May Represent a Network
The data also contains more references to multi-site influence in recent years. Explicit multi-site or network language increased from 1.3% in the earlier period to 7.8% in 2022–2025. Some contacts oversee several facilities; others are part of organizations building or operating many centers.
- “They have many surgery centers.”
- “Have 19 facilities.”
- “Opening 18 surgery centers!”
That changes the meaning of an individual customer interaction. A discussion that begins with one facility may eventually influence standards, equipment choices, or workflows across multiple outpatient sites.
2019 Shows the Transition in Motion
If the early and recent periods show the endpoints, 2019 shows the transition happening in real time.
Restoring the 2019 ASCA file adds an important middle chapter. The notes already show both sides of the market at once: centers replacing older equipment and centers still adding capacity. One surgery center described an “old esc chair” while looking for a new unit that would be easier to transport. Another had an old Hausted 578 and was already thinking about replacement a year ahead. At the same show, another organization was “building new asc” with six OR suites, while another had recliners already budgeted. The year does not sit neatly on one side of the story. It shows the transition from expansion alone toward expansion plus deliberate modernization.
A separate 2019 lead also linked product interest directly to workflow, describing interest in a fluoroscopy unit to reduce transfers to the OR table. That kind of comment strengthens the broader finding that the visible equipment request is often only the surface expression of a movement, staffing, or workflow problem.
What the Next Phase of ASC Growth Looks Like
The historical VOC suggests that the ambulatory surgery market is moving through a healthy maturation cycle. Growth still includes new buildings and new service lines, but it increasingly includes modernization of established centers.
What the Next Phase of ASC Growth Looks Like
The historical VOC suggests that the ambulatory surgery market is moving through a healthy maturation cycle. Growth still includes new buildings and new service lines, but it increasingly includes modernization of established centers.
- Replacing aging equipment before it becomes a workflow constraint.
- Using technology to reduce unnecessary transfers and repetitive staff effort.
- Evaluating equipment around the entire patient journey rather than a single room.
- Using virtual tools to make capital evaluation more efficient.
- Planning replacement in phases rather than waiting for a complete failure.
- Thinking beyond one facility when organizations operate multiple outpatient sites.
The positive story is not that ASCs are simply getting bigger. It is that many appear to be getting more deliberate. The customer language increasingly reflects leaders who are examining how equipment, staff, patient movement, case mix, capital, and facility design interact.
GF has been listening to those conversations along the way. When clinicians described being worn out from cranking and pumping equipment, the need for powered options reflected more than a feature preference; it reflected staff effort and workflow. When customers described wanting to keep patients on one surface through more of the care journey, it reinforced the value of reducing unnecessary transfers. And as customers increasingly asked for videos, virtual demonstrations, onsite trials, technical support, and reliable access to parts, the way equipment is evaluated and supported has evolved as well.
For this analysis, customer notes were screened conservatively: themes were counted only when the original note explicitly supported them. A final source-reconciliation pass recovered missed historical narratives, and the updated primary dataset contains 446 validated ASC or outpatient-surgical interactions through 2025.
Voice of the Customer is most useful when it does more than document what customers asked for. It helps reveal why they asked—and gives manufacturers an opportunity to respond through product design, evaluation, support, and the way we work with customers over time.
Growth has not disappeared. Growth has matured.
Have questions about how Hausted can help identify solutions that fit your facility? Contact Hausted to be connected with a sales representative who can help review your needs.