Vision is that of change, though there are barriers of the "good old boys" with emotional, pride and ego ties that do not make wise cultural and business changes for the benefit of the facility as a whole. Revolving door of value added individual leaders, is a high price to pay. Know your house North, from the top down. The frontline staff are the gold in the pot, don't loose your wealth.
Great patient population, hardworking and dedicated front line staff
Fear based, lack of processes, lack of management retainment