Structuring for Success: A Framework for Building a Cardiovascular Center of Excellence.

Cardiovascular programs are often high-cost, high-volume service lines plagued by fragmentation and inconsistent governance. This article presents a structured framework for developing a cardiovascular center of excellence (CVCOE) to enhance care quality and strategic integration. A CVCOE is a purpose-built program defined by three interdependent layers-foundational infrastructure, clinical pillars, and governance-unified through a physician-led clinical model that drives the business and operating models. Drawing on implementation experience across diverse hospital settings, the framework provides a roadmap for aligning structural investments with evidence-based care delivery and organizational capacity. It introduces a two-stage lifecycle: an initial implementation stage to achieve clinical and financial viability, followed by a maintenance stage focused on iterative quality improvement and potential scope expansion. By embedding leadership and quality systems at the structural level, this model offers hospitals and health systems a replicable approach to optimizing cardiovascular services and creating the conditions needed for better outcomes.