Ambulatory surgery centers (ASCs) run on precision. Case schedules, room turnover, documentation, supplies, anesthesia coordination, and patient communication all have to move in the same direction. When that coordination works, the center can feel efficient and focused. When it breaks down, pressure often lands first on the clinical and administrative teams expected to keep the day moving.
Tina DiMarino, DNP, MBA, RN, CNOR, CASC, FACHE, from Custom Surgical Partners, emphasizes that provider wellness in surgical centers is closely tied to leadership habits. In compact outpatient surgery environments, leaders influence more than morale. Their decisions shape communication, role clarity, survey readiness, staffing expectations, and the way teams respond when the schedule becomes difficult.
Healthcare organizations are increasingly treating burnout and professional well-being as organizational issues, not only individual ones. The National Academies has called for a systems approach to clinician burnout, and NIOSH identifies long hours, high stress, hazardous conditions, and organizational pressures as risk factors for healthcare worker burnout [1], [2]. For surgical center leaders, the lesson is practical: healthier teams are usually built through consistent management behavior, not isolated wellness messaging.
Leaders set the tone before problems become visible
In a surgical center, culture is often visible in small moments before it appears in formal metrics.
It shows up in whether staff feel comfortable raising a concern before a case begins. It appears in how leaders respond to a turnover delay, a missing instrument, a surgeon preference issue, or a documentation gap. It can be heard in the way managers speak to new employees when the day is running behind.
These moments matter because teams watch how leaders behave under pressure. A calm, specific response can keep a problem contained. A vague or reactive response can make the same problem feel larger than it is.
The most effective leadership habits are often ordinary. Leaders make expectations clear. They follow through on repeated issues. They distinguish between a one-time mistake and a process problem. They avoid treating the most dependable employees as the default solution for every operational gap.
That last point is important in ASCs because teams are often lean by design. The same experienced nurse, scheduler, technician, or administrator may become the person who knows how to fix everything. That can help the center in the short term, but it can also create hidden strain. When too much informal responsibility collects around a few people, the organization becomes less resilient.
Leaders can reduce that risk by noticing patterns early. If the same person is always staying late, if the same handoff repeatedly confuses, or if the same documentation problem appears before every survey cycle, the issue is no longer isolated. It is part of the management system.
Research has linked healthcare leadership quality with clinician well-being. A Mayo Clinic Proceedings study found that physicians’ ratings of their immediate supervisors’ leadership qualities were associated with burnout and satisfaction [3]. ASCs are different from large hospital systems, but the broader principle still applies: leadership behavior helps define the working climate.
Why communication matters during high-volume surgical days
High-volume surgical days test a center’s communication habits. The schedule may be carefully planned, but the day can still shift quickly. A patient may arrive late. A case may run long. A supply may be missing. A surgeon may request a change that affects the next room.
In those moments, communication becomes part of how the center operates.
Strong communication helps staff understand what is changing, who owns the next step, and what information must move with the patient. Weak communication forces employees to guess. Guessing creates rework, delay, and frustration, especially when staff are already managing clinical duties and regulatory documentation. These communication workflows have become increasingly important as digital healthcare tools continue to reshape care coordination and operational efficiency.
For surgical center leaders, the goal is not constant meetings or excessive messaging. The goal is reliable communication at the points where confusion is most expensive. That may include morning huddles, room-turnover expectations, escalation rules, preference-card updates, post-case debriefs, or a clear process for identifying missing information before the patient reaches the procedure room.
Communication also affects how staff experience compliance. Medicare-certified ASCs must meet federal Conditions for Coverage, including requirements related to governing body oversight, surgical services, quality assessment and performance improvement, and infection control. CMS regulations require ASCs to maintain an ongoing, data-driven quality assessment and performance improvement program [4]. When these expectations are translated clearly into daily routines, they become part of how the center works. When they are addressed only before inspections, they can feel like sudden pressure added to an already full workload.
Leaders can make compliance less stressful by communicating it as routine operational discipline. That means staff should know where policies live, how education is tracked, who owns credentialing follow-up, how quality items are documented, and what to do when a gap is identified.
This approach does not remove the seriousness of survey readiness. It makes readiness more predictable. For a clinical team, predictability can reduce the mental load of the workday.
How mentoring can help new ASC managers avoid isolation
Many ASC managers are promoted because they are strong clinicians or reliable operators. That experience matters, but it does not automatically prepare someone for every leadership responsibility inside an outpatient surgery center.
A nurse manager may understand the operating room but feel less prepared for budgeting, personnel conversations, survey documentation, benchmarking, or physician-owner dynamics. An administrator may be skilled in healthcare management but still needs time to understand the pace and staffing model of ambulatory surgery. A physician leader may know what safe care looks like clinically while needing support with governance, accountability, and team communication.
This is where mentoring becomes a business issue as much as a leadership issue. Unsupported managers can become bottlenecks. They may delay difficult conversations, absorb too many tasks, avoid delegation, or spend too much time reacting to problems that should be built into a process.
Mentoring gives leaders a place to pressure-test decisions before the stakes rise. It can help a new manager understand which issues require immediate escalation and which require better structure. It can also help leaders separate personal performance problems from workflow problems.
The distinction matters. If a documentation process is unclear, coaching one employee may not fix it. If staff do not know who owns a compliance task, reminding the team to “be more accountable” will likely have a limited effect. Mentoring can help leaders look past the visible symptom and ask whether the center has the right system in place.
Evidence on healthcare workplace interventions supports the need for organizational action. A 2023 systematic review in BMJ Open found that workplace interventions can improve well-being, engagement, and resilience and reduce burnout among healthcare workers, although the authors noted that study design limitations affected many findings [5]. The practical implication is that leadership support should be structured and sustained, not treated as a one-time response after strain becomes obvious.
Building a culture that works under pressure
A healthy surgical center culture is not one where pressure disappears. Surgical care will always involve time sensitivity, clinical responsibility, and unexpected changes. The real test is whether the team has enough structure and trust to manage pressure without turning every disruption into a personal burden.
Culture is shaped by the behaviors leaders permit, reinforce, and measure over time. If rushed handoffs are tolerated, they become normal. If staff concerns disappear after meetings, employees stop raising them. If high performers are constantly asked to compensate for weak systems, the center may preserve short-term productivity while increasing long-term risk.
Building a culture that works under pressure usually starts with practical habits. Leaders can review recurring delays, clarify role ownership, protect time for education, standardize onboarding, and make sure survey preparation is distributed across the right people instead of concentrated in one overwhelmed leader.
They can also measure signals that do not always appear on a financial dashboard. Turnover, absenteeism, overtime, late documentation, repeated incident themes, staff meeting concerns, and exit interview comments can all point to pressure inside the center. These indicators do not tell the whole story, but they can show leaders where to look.
For healthcare business leaders, the broader point is that provider wellness is not only a human resources concern. In surgical centers, it is connected to operational resilience. Teams that communicate clearly, understand their roles, and trust leadership are better positioned to handle high-volume days without relying on constant improvisation.
DiMarino’s work in ASC and office-based surgery consulting, compliance support, operations, education, and leadership mentoring focuses on the practical link between leadership structure and team performance. For centers trying to strengthen their teams, an outside operational review can help identify whether the pressure is coming from workflow, role confusion, survey preparation, leadership isolation, or several issues at once.
Healthier surgical center teams are built through repeated leadership habits, especially when the schedule is full, the day is behind, and the team needs clear direction.
References:
[1] National Academies of Sciences, Engineering, and Medicine. (2019). Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. National Academies Press. https://doi.org/10.17226/25521
[2] Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. (2024, April 23). Risk Factors for Stress and Burnout: Healthcare Workers. CDC. https://www.cdc.gov/niosh/healthcare/risk-factors/stress-burnout.html
[3] Shanafelt, T. D., Gorringe, G., Menaker, R., Storz, K. A., Reeves, D., Buskirk, S. J., Sloan, J. A., & Swensen, S. J. (2015). Impact of organizational leadership on physician burnout and satisfaction. Mayo Clinic Proceedings, 90(4), 432-440. https://doi.org/10.1016/j.mayocp.2015.01.012
[4] Centers for Medicare & Medicaid Services. (n.d.). 42 CFR Part 416 - Ambulatory Surgical Services. Electronic Code of Federal Regulations. Accessed June 15, 2026. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-416
[5] Cohen, C., Pignata, S., Bezak, E., Tie, M., & Childs, J. (2023). Workplace interventions to improve well-being and reduce burnout for nurses, physicians, and allied healthcare professionals: A systematic review. BMJ Open, 13, e071203. https://doi.org/10.1136/bmjopen-2022-071203
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