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“Would you tell me, please, which way I ought to go from here?”

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“That depends a good deal on where you want to get to,” said the Cat.

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“I don't much care where…” said Alice.

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“Then it doesn't matter which way you go,” said the Cat.

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“…so long as I get SOMEWHERE,” Alice added as an explanation.

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“Oh, you're sure to do that,” said the Cat, “if you only walk long enough.”

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Lewis Carroll, Alice's Adventures in Wonderland, Chapter 61

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“The most important questions in life are simultaneously those asked least often.”

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Danish Philosopher Søren Kierkegaard2

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An unexpected (or postponed) pain, concern, fear, accident, or other perceived life (threatening) disruption causes patients to seek care in the emergency department (ED). Those patients take for granted that they are going to the right place to be cared for by people with the necessary skills and training to address their urgent needs. They assume that they will be treated skillfully and expeditiously by a team dedicated to providing the best care and caring.

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Tacitly if not explicitly, patients, community members, physicians, hospital administrators all assume that the ED leaders and staff have responded to the trust placed in them by carefully considering and organizing their approach to emergency care. But have they asked and answered these fundamental questions:

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  • Why does the ED exist? Why are we here? The Vision
  • What is the ED attempting to do? What do we do? The Mission
  • Which core and fundamental beliefs guide the ED? Do we all believe in what we are doing? The Values
  • What differentiates this ED from other EDs? Are we making the right choices? The Strategies
  • How will success be accomplished and measured? Have we chosen the right methods to accomplish our strategies? The Tactics

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These questions correspond to time-tested and valuable tools, which should guide all successful healthcare organizations and their EDs (Figure 2-1).

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Figure 2-1.
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Vision, mission, strategy, tactics, and values are fundamental aspects which guide healthcare organizations' futures.

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While there are certainly many comprehensive, rich, and nuanced treatises on each of these subjects, the concise definitions listed previously are designed to help the ED leader(s) guide the direction of their EDs. It is difficult, if not impossible, for healthcare professionals to attain and maintain success without a clear sense of direction.

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Though these concepts are a fundamental activity at the highest level of hospitals and healthcare systems, few ED leaders have incorporated their institution's answers to these vital questions into their own guiding principles. It is even rarer that ED leaders have led their departments ...

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