If you think the term "development team" sounds vague, you're right. But it's not intended to confuse you - rather, it's meant to give you the flexibility to assemble the team that's right for the needs of your particular project. Whether it's an army of one or a cadre of industry experts who've made more mistakes than you ever will, the professionals on your development team will be different from those on the surgical construction project the next town over. Let's take a look at how you can figure out who's needed on your team.

The core group
This might sound a bit silly, but it's important to keep in mind: In order to determine the needs of your project, you first need to have a project. That is, you must figure out if there is interest from other physicians in starting a surgical center. Look for physicians who are busy, who are well-respected within the community and who have a reputation among hospital staff for being easy to work with. In the long term, this will result in a staff that wants to work for your facility and good community standing; in the short term, this will make it easier to attract other doctors and investors and make the myriad meetings and decisions easier.

Once you've got a group of prospective physician-owners, you need to sit down and ask yourself some questions regarding the clinical and financial viability and the commitments you're willing to make:

• Are your surgical volumes enough to support a new ASC, and do you expect them to continue to grow?
• Do you want the flexibility to buy your own equipment, hand-pick your staff and schedule your own cases?
• Do you have the ability to make a significant financial investment?
• Would the facility be multi- or single-specialty?
• How much control of the business do you want, and what is your desired financial return? (These go hand-in-hand.)

If you know the answers, you can set about raising more capital and assembling your development team. It's important to have the plan organized to the best of your ability and on paper, so potential members of the team can tell you whether they're a good fit for your project.

The development team
The members of your development team will be the gears that get your surgical construction project done. Choose them according to their experience with ventures like yours and with the duties they'll be tasked with.

• Healthcare consultant. It's my opinion that hiring a healthcare consultant is a good idea. This person can be the go-to for physicians, your lawyer and your architect (in short, everyone involved in the project) or can take on very specific duties, such as fine-tuning the location of small items like switches, alarm panels, hand rub dispensers and cabinets to optimize efficiency. The right consultant can help you decide how many physician-investors would strike the right balance between potential profit dilution and necessary case volume; help you write your pro forma (which is necessary for gaining financing approval) coordinate various inspections, certifications, licensures and accreditations; and create manuals and forms that will be integral to day-to-day facility operations. A consultant can also plan labor and equipment, or you can leave these tasks to a specialist. Obviously, the more you ask your consultant to do, the more you'll be charged (for more on choosing a project manager, see "Suit or Hard Hat?" on page 32).
• Accountant. An accountant can also help you with assessing financial feasibility and writing and analyzing your pro forma. He'll be able to guide you in setting a budget and acquiring capital investors and financing from a bank or healthcare financing company.
• Lawyer. Meeting state and federal guidelines is no easy task. A lawyer, preferably one with healthcare experience, should be the one to guide you through the maze of regulations - certificate of need state laws, Anti-kickback and Stark laws, for example - and help you write your operating agreement. If you can manage it, a lawyer with specific experience in ambulatory surgery projects is even better. And one who's got a feel for your state and local politics can help you navigate those potential roadblocks. If there's a downside to the national healthcare specialists, it's that they might not be entirely aware of all the ins and outs of your state's laws. But if you're in Texas, where there are relatively few laws to navigate and getting a facility up and running is pretty straightforward (well, legally speaking), that's not a problem. Here in Illinois, I'd advise hiring a lawyer intimately familiar with our more regulated system and particularly tough CON laws.
• Management company. Most physicians don't start out with a corporate partner, but you're welcome to go that route, as it would put an awful lot of resources at your fingertips. In many cases, such a company would probably take on the role of healthcare consultant, lawyer and accountant in one, and help you find a design and architect company as well as a builder. The downside is that a corporate partner might not have a feel for the political environment in your area, and it would almost certainly take a large ownership share (see "What Can Corporate Partners Bring to the OR Table?" on page 44).

The auxiliary team
I call this group the auxiliary team not because the duties they perform aren't important, but because they come along later in the process than those in your development group.

• Architect and builder. Only after you've secured financing can you get things moving on the design end. Look for architect and building pros who have ASC - and maybe, if you're lucky, specialty-specific - experience, because they'll be able to spot problems with designs that break healthcare-specific design codes and maybe even be able to tell you if you're overbuilding for your business plan.
• Equipment planner. Beds, OR tables, OR lights, booms, anesthesia machines, C-arms, phacoemulsification machines, smoke evacuators ? it's enough to make your head spin. An equipment planner won't just tell you what you need, but will also help you find the best deal on the potentially millions of dollars' worth of capital equipment necessary to run your facility. Expect to spend in the neighborhood of $350,000 to $400,000 per OR for fixed and movable equipment, $250,000 on instruments and $150,000 on furniture and furnishings. One hint: Don't let the equipment planning firm buy in its name. Otherwise, you won't see rebates you're entitled to.
• IT consultant. Buying and planning for digital imaging, mobile computing, wireless networking, HIPAA security and privacy rules, voice recognition, paperless records and network-enabled medical equipment probably requires an expert. And no, the fact you were able to hook up your home computer to the Internet is not going to cut it (see "Building IT into Your Facility" on page 50).
• Hiring consultant. You're most likely to do the hiring yourself, but if you don't have time or don't feel you have the expertise, there's no rule that says you can't have an agency do it for you.

Embrace the progression
While it's important to be able to organize all the people involved in a surgical construction project into logical groups according to the chronological order in which their tasks need to be performed, try not to think of your venture as a strictly linear progression. If you want to keep the project moving along (so it's on time and more likely to be on budget), there should be quite a bit of overlap among the various members of the development team and the auxiliary members in terms of the hiring and performance of their duties.