Five years ago, when HealthSouth hired me to set up the freestanding, multispecialty Exeter Surgery Center in Reading, Pennsylvania, I thought my 26 years of OR nursing experience would see me through the task. Although the fact that we now perform over 5,000 outpatient cases a year attests to our success, I did not know back then if we would make it through those first few months of operation. Starting up an ASC was undoubtedly the greatest challenge of my professional career. Here are some of the most important lessons I learned.