If that weren t enough, the Washington-based Advisory Board Company and their focused Cardiovascular Roundtable organization suggested, in a recent publication entitled Cardiac Services Survival, Competitive Imperatives for Future Prosperity in a Pressurized Market, that there was, A Gathering Storm. Yet we know from daily first-hand experience that the storm is not gathering; it is here and has been for a while. Many of us feel that there is no safe port in which to ride out this storm but rather, as the title of the Alliance of Cardiovascular Professionals (ACVP) conference suggested, we need to learn how to navigate in these turbulent seas. Part of the navigation process involves the expansion of facilities in almost every market. Even here in Kansas City, which is about as far away from the seas as you can get, there is turbulence as cardiovascular programs expand by constructing new facilities, updating existing programs or planning for future buildings. In Kansas City, we have two dedicated heart centers, each either well under construction or in the final stages of planning. Other hospitals and healthcare systems in Kansas City are now planning to remodel or planning new construction. Almost certainly this construction will include facilities for their cardiovascular program. According to Corazon Consulting, 78% of cardiac programs surveyed in the U.S. are planning futures in a similar fashion to the Kansas City model. The challenge that all of us face is how to plan, build or expand in this uncertain environment. Never before have we had to consider so much potential financial risk as we embark on expansion plans. This is further complicated by the enormous changes in technology that loom on the horizon, including, but not limited to, endovascular procedures, expansion of electrophysiology programs and the challenges of specialized equipment, new diagnostic modalities such as ultrafast CT, and the future of new drugs. We also have to include the challenge of information technology imperatives. Not to be overlooked in the planning process are also physician elements, including the competition for and from cardiologists, free-standing, specialized hospitals, the establishment of new cardiovascular (CV) programs in hospitals, new unprotected angioplasty programs and the emergence of Chest Pain Centers. Add to this the efforts that will have to take place not only to secure business from the baby boomers but to successfully plan facilities that will support and attract the other generational groups. For some of us that have been involved in this business for a while, it is a little hard to believe that Generation Xers are now becoming CV managers, bringing exciting new skills, talents and perspectives to our business. Puzzled, discouraged, and frustrated about how to proceed and contribute to the building and expansion process in your facility? Don t be, as this may be the adventure of a lifetime, and indeed, you may never have an opportunity like this again. How to proceed and in which direction should you go? The answer may be a long way away from the seas in Kansas, in a small town called Liberal. Liberal was the site of the famous fictional storm, or a tornado in this case, which whisked Dorothy away to the Land of Oz. There are some interesting lessons you can learn from the movie The Wizard of Oz. These lessons may help you ride out the whirlwind we find ourselves in today. Lesson 1: Imagination can take you anywhere, even over the rainbow, and sometimes you have to leave home to find it. Think big and outside the box as you look at expansion. Research what is going on around you, not only in your market but over the rainbow. Many of us in Kansas City traveled to various hospitals in Indianapolis to understand what was happening in that community when four heart hospitals recently opened. Some of these facilities tout a paperless environment, the all-digital hospital, and universal patient rooms. Talk about over the rainbow! Lesson 2: Follow the Yellow Brick Road, but always be ready for a detour. Be flexible in your planning and be ready to change course. Will you have to convert one of the new cath labs into an endovascular suite that might be used by a variety of specialists in addition to the cardiologists? Where will you put an ultrafast CT scanner? Who will read the studies and will that change the number of catheterization labs you are planning? Have you planned for enough electrophysiology labs, and are they configured to support additional equipment that may become the standard in future EP labs? Planning is an art, and faith, hope and perhaps even a little love can work wonders, but ruby slippers can t hurt either. Lesson 3: When friends stick together, they can work miracles. Don t be afraid to ask for help. Call some of the people in your network of contacts and find out what they are doing. They may have been there and done that already. Participate in the list-serve e-mail product offered by the ACVP and try your best to attend the annual management conference where CV leaders freely share their plans, experiences, perspectives and successes. What are friends for, after all? Lesson 4: Having the courage to ask for what you want is half the battle. All you need is right there inside of you. Don t be afraid to be bold in your planning. If you don t ask for more space, it is likely that you will not get it. Following some of the lessons above, you will have the answers or know where you can get them. And perhaps, most importantly… Lesson 5: When you go out into the world, remember, stand up for yourself, but always be kind to the little guys. Design a process that will empower everyone, even the little guys, and they will own the process and the facility along with you. Lastly, design a facility that will support the patient and the family along with the caregivers. Think about how much the new facility will support your community, because after all, There is no place like home.