1. From a planning perspective how was this heart center plan generated? was it market-driven or in a non-market-driven perspective?

1. If the donor gets his wish, and it is generous, what are the related issues for the hospital (the issues, of course, all dollars are fungible and thus additional resources not included in the gift will have to be redirected from other areas of the hospital to support this initiative? That was not in the hospitals plan.

The Unexpected Donation It was a typical, busy Friday night at Podomoro Jackson Hospital when the ambulance pulled into the turnaround in front of the emergen- cy department entrance. Within minutes, a man was triaged and an electrocardiogram was performed. The clinicians quickly identified a serious blockage of blood flow. The man was brought into the surgical suite, where a cardiac catheterization was performed that involved threading a flexible tube into the heart from a blood vessel in the wrist or groin to open the blocked artery. This procedure was done through the person's groin to open the blockage of the blood flow. Following the procedure, the person remained in the hospital for monitoring for two days before his discharge. The next week, he met with his cardiologist. Upon further review and testing, the physician referred him to the major heart center in the nearby metropolitan area to discuss whether further intervention was needed and the best future course of action that might be warranted. Podomoro Jackson Hospital and its marketplace Podomoro Jackson Hospital is a 275-bed community hospital that is on the outer ring of a major metropolitan area. In recent years, it has seen an increase in its service area's population as a larger number of younger families have moved out into the community because of more affordable housing. Additionally, there is an increase of Baby Boomers who are on the verge of retiring or have retired who like the less hectic feel, the smaller towns that populate the area, and some of the housing that is available around the county's lakes. The hospital has a good range of services from cancer care (although it is not a comprehensive cancer center), cardiology, emergency care, endoscopy, hospitalists, dialysis and kidney care, lab services, maternity, neurology, pain management, psychiatry, pulmonary care, radiology, rehabilitation, sports medicine, stroke care, surgery, trauma care, travel medicine, urgent care, and urology. Historically for major tertiary services, the hospital has referred into the metropolitan center where there are three tertiary hospitals; one of these is an academic institution. Across these three institutions, there is a major heart center, comprehensive cancer center, a separate children's hospital, and other tertiary dedicated specialty centers. Historically, Podomoro Jackson and other smaller community hospitals that existed on the outer ring of the metropolitan area have referred to these facilities as needed; however, for many years, most people preferred the local community hospital since the distance to downtown was thirty to fifty miles depending on where someone lived. Over the past twenty-five years, highway construction has made the travel easier to some extent except for the increase in conges- tion. In recent years, each of these downtown hospitals has begun aggressive expansion plans of establishing satellite clinics further out around the outer metropolitan ring. This strategy was to capture patients in the outer reaches of the service areas like where Podomoro Jackson is located so that patients do not have to travel as far for primary care or specialty doctor visits. There has also been a rumor that one of the hospitals is planning to build a new hospital somewhere outside of the downtown metropolitan area. No good deed goes unpunished Two months after the incident of the man who was treated at the hospital on a Friday night at Podomoro, the director of development called the hospital CEO. "I have some amazing news," she said. "You may not know it, but a couple of months ago, we treated a patient through the ER, a man who came in by ambulance with a heart attack. Ultimately, he was quickly diagnosed. It was pretty routine, and all went well." "Okay, great to hear," said the CEO. "So why the call?" "I just got a call from the man and his spouse telling me they moved here only recently. The man is a retired CEO from one of the larg- est companies in the state. They are so appreciative of all that was done for his care. They believe this hospital should have a heart center. They want to meet with you and are committed to donating at least five million dollars, more if necessary, to a heart center here. I guess the man ultimately had a stent done downtown. He thinks the community's heart care needs should be taken care of here at Podomoro Jackson. If it should take a little more money for a dedicated heart center, he is willing to listen. His father and his wife's mother died from heart problems. They want this to happen now and want to meet with you." As the CEO hung up the call with the development director, he realized this had to be one of the largest single donations to a hospital of his size. In the same regard, as he thought through this generous gift, there was a lingering concern about whether this was the way he should go with moving to establish a heart center. The Unexpected Donation It was a typical, busy Friday night at Podomoro Jackson Hospital when the ambulance pulled into the turnaround in front of the emergen- cy department entrance. Within minutes, a man was triaged and an electrocardiogram was performed. The clinicians quickly identified a serious blockage of blood flow. The man was brought into the surgical suite, where a cardiac catheterization was performed that involved threading a flexible tube into the heart from a blood vessel in the wrist or groin to open the blocked artery. This procedure was done through the person's groin to open the blockage of the blood flow. Following the procedure, the person remained in the hospital for monitoring for two days before his discharge. The next week, he met with his cardiologist. Upon further review and testing, the physician referred him to the major heart center in the nearby metropolitan area to discuss whether further intervention was needed and the best future course of action that might be warranted. Podomoro Jackson Hospital and its marketplace Podomoro Jackson Hospital is a 275-bed community hospital that is on the outer ring of a major metropolitan area. In recent years, it has seen an increase in its service area's population as a larger number of younger families have moved out into the community because of more affordable housing. Additionally, there is an increase of Baby Boomers who are on the verge of retiring or have retired who like the less hectic feel, the smaller towns that populate the area, and some of the housing that is available around the county's lakes. The hospital has a good range of services from cancer care (although it is not a comprehensive cancer center), cardiology, emergency care, endoscopy, hospitalists, dialysis and kidney care, lab services, maternity, neurology, pain management, psychiatry, pulmonary care, radiology, rehabilitation, sports medicine, stroke care, surgery, trauma care, travel medicine, urgent care, and urology. Historically for major tertiary services, the hospital has referred into the metropolitan center where there are three tertiary hospitals; one of these is an academic institution. Across these three institutions, there is a major heart center, comprehensive cancer center, a separate children's hospital, and other tertiary dedicated specialty centers. Historically, Podomoro Jackson and other smaller community hospitals that existed on the outer ring of the metropolitan area have referred to these facilities as needed; however, for many years, most people preferred the local community hospital since the distance to downtown was thirty to fifty miles depending on where someone lived. Over the past twenty-five years, highway construction has made the travel easier to some extent except for the increase in conges- tion. In recent years, each of these downtown hospitals has begun aggressive expansion plans of establishing satellite clinics further out around the outer metropolitan ring. This strategy was to capture patients in the outer reaches of the service areas like where Podomoro Jackson is located so that patients do not have to travel as far for primary care or specialty doctor visits. There has also been a rumor that one of the hospitals is planning to build a new hospital somewhere outside of the downtown metropolitan area. No good deed goes unpunished Two months after the incident of the man who was treated at the hospital on a Friday night at Podomoro, the director of development called the hospital CEO. "I have some amazing news," she said. "You may not know it, but a couple of months ago, we treated a patient through the ER, a man who came in by ambulance with a heart attack. Ultimately, he was quickly diagnosed. It was pretty routine, and all went well." "Okay, great to hear," said the CEO. "So why the call?" "I just got a call from the man and his spouse telling me they moved here only recently. The man is a retired CEO from one of the larg- est companies in the state. They are so appreciative of all that was done for his care. They believe this hospital should have a heart center. They want to meet with you and are committed to donating at least five million dollars, more if necessary, to a heart center here. I guess the man ultimately had a stent done downtown. He thinks the community's heart care needs should be taken care of here at Podomoro Jackson. If it should take a little more money for a dedicated heart center, he is willing to listen. His father and his wife's mother died from heart problems. They want this to happen now and want to meet with you." As the CEO hung up the call with the development director, he realized this had to be one of the largest single donations to a hospital of his size. In the same regard, as he thought through this generous gift, there was a lingering concern about whether this was the way he should go with moving to establish a heart center