Inside the Advanced Surgical Institute: Janet Carlson on Patient Care and Innovation

When Janet Carlson, MSN, BSN, RN, NE-BC, FACHE, first stepped into an ambulatory surgery center (ASC), it wasn’t as an executive or a nurse, it was as a patient. As the nurse started her IV, she casually asked what she did for a living. When Janet shared that she was a nurse at the hospital next door, the response was immediate: “Would you like a job?”

Three weeks later, Janet was back at the ASC, this time as an employee. Since then, her path has taken her through nearly every role in the ASC space, from nurse to director of nursing to CEO.

Today, as the Vice President of Ambulatory Surgical Centers for Commonwealth Pain & Spine, Janet is leading the launch of new centers in Evansville, New Albany, and Elizabethtown.

In this conversation, Janet shares what makes ASCs different, how affordability and patient experience go hand in hand, and why this growing model of care is reshaping the future of surgery.

You’ve built a long career in healthcare leadership. What has kept you committed to the ASC space?

Janet: From the very beginning, I was drawn to the ASC model because of its pace, its teamwork, and its ability to get patients home safely the same day. I’ve worked in multi-specialty centers, learned every role, and gained a deep appreciation for how each piece fits together.

I also like staying clinically relevant. I still keep up my nursing skills so I can jump in when needed. That connection to patient care keeps me grounded, even as I’ve taken on leadership roles.

For patients who may not be familiar, how would you describe an ASC? How is it different from a hospital?

Janet: Think of an ASC as a smaller, freestanding surgical center designed for elective procedures. Patients don’t have to navigate a giant hospital or parking garage - they park right out front and walk in. The experience is more personal, efficient, and cost-effective.

Costs are lower because we’re leaner, but quality never suffers. Infection rates are very low, outcomes are excellent, and patients go home the same day. ASCs are meant for generally healthy people having elective surgery, so we can optimize them beforehand and ensure a smooth recovery.

How do technology and safety show up in the ASC experience?

Janet: Safety is our top priority. From check-in through discharge, we confirm the patient’s identity, allergies, procedure, and surgeon. It may feel repetitive, but it’s essential.

Technology helps us keep patients informed, apps and communication tools remind them when to stop eating, which medications to take or hold, and when to arrive. We also require a driver and a support person for the first 24 hours post-op. After surgery, we survey patients about their experience and use that feedback to improve care.

Affordability is another big part of the ASC story. How do you keep costs down without sacrificing quality?

Janet: We negotiate with vendors and use lean processes. For example, we have pre-packed room turnover kits so staff aren’t scrambling for supplies after a case. It saves time, energy, and money.

Because ASCs are flat organizations, we can quickly adopt good ideas. If someone has a way to streamline or save, we try it. And we track the average cost per case, so we always know where we stand financially.

Commonwealth Pain & Spine recently partnered with ASI. How did that shape the vision for the Evansville Center?

Janet: Commonwealth Pain & Spine has long been a leader in pain management. As our network grew, with more physicians, surgeons, and advanced practice providers, we needed our own surgical space. Until now, our surgeons worked in hospitals or other ASCs.

Opening our own centers was the natural next step. Some procedures require anesthesia support or higher monitoring, and an ASC is the right environment for that. Evansville was the perfect place to start - it’s one of our busiest regions - and it sets the stage for New Albany and Elizabethtown.

Beyond the clinical side, how do you help patients feel cared for?

Janet: Communication. Our nurses call patients ahead of surgery to review instructions and answer questions. On the day of surgery, we update family members at every step, when their loved one goes in, when the procedure starts, and when they’re in recovery.

We want patients and families to feel informed and reassured. Our guiding principle is simple: treat every patient the way we’d want our own loved ones to be treated.

Looking back, what career moments make you most proud?

Janet: I’ve been fortunate to be part of many “firsts” in the ASC space. What makes me proud is the culture we’ve built, a team willing to take on challenges and embrace new technology.

At Commonwealth, it truly takes a village. From nurse administrators to marketing, everyone has helped shape the Advanced Surgical Institute brand. One highlight is our OR design. We intentionally built operating rooms at least 500 square feet - big enough for orthopedics, spine, or any specialty. I like to call them “non-denominational ORs.” That foresight means we’re ready for growth and can easily welcome outside surgeons.

What’s your vision for Evansville and the other ASIs - five years from now?

Janet: The migration of procedures from hospitals to ASCs is accelerating. For independent physicians, ASCs are essential, they provide freedom to practice outside hospital systems while giving patients affordable, high-quality care.

In five years, I see our centers at full capacity. Total joints, complex spine, cardiovascular and vascular cases - all are moving into the ASC space. Our job is to be ready for that demand and continue offering patients a concierge-level experience with outstanding outcomes.

What advice would you give young healthcare professionals interested in leadership?

Janet: Healthcare is dynamic, and ASCs are only going to grow. My advice is to talk to people already in the space and learn from them.

I like ASC leaders to have nursing backgrounds. They can step in when needed, which happens often in a center where everyone wears multiple hats. There’s also plenty of opportunity for non-clinicians: supply chain, billing, coding, process improvement. It depends on your interests, but the opportunities are there.

Is there anything we haven’t touched on that’s important for people to know?

Janet: Two things. First, we’re new to the market but built to grow. We welcome like-minded surgeons looking for OR time. Our centers were intentionally designed to handle more cases and higher acuity safely.

Second, we now have space to care for workers’ comp and personal injury patients. In the past, getting those surgeries scheduled was frustrating, with frequent cancellations. Having our own ASCs removes that barrier and gives our physicians the control they need.

At the end of the day, ASCs decompress hospitals by taking lower-acuity cases out of the big ORs. That leaves hospitals to focus on the sickest patients, while we provide safe, efficient care in a setting patients prefer.