The economics of critical access hospitals are distinctive. Sixty percent of CAH revenue typically comes from government payers like Medicare and Medicaid, according to the American Hospital Association. Patient volume is a fraction of what it is in urban facilities. And while urban hospitals may have several hundred people on staff at any given time, a rural hospital may only have a handful of people on the clock between sunset and sunrise. In rural Minnesota, many of our 79 critical access hospitals do not have the option to simply replace their facilities when improvements are needed. This reality has been exacerbated by the recent recession. In response, rural health care leaders often opt for large additions and remodels of existing facilities, to upgrade and expand services. In these cases, a well-planned phased building project can be an excellent approach. However, phased addition and remodel projects are significantly more complicated—both in planning and execution—than new building projects. In these cases, it’s essential that CAH leaders understand the characteristics of successful phasing and, even more importantly, hire a project team who does, too. It’s here that CAH culture plays a role.