It is true that there are many reasons why some agencies seem to struggle year after year. People blame all sorts of things for not succeeding; State and Federal regulations that are always changing and making the job of caring for patients effectively and efficiently harder every year, lack of (RN/PT/OT/ST/Aide) staff, lack of committed staff who hold whatever values the leadership think are important, inability to find qualified managers or senior leaders, the economy, the inability to match the wages of the hospital to compete with the limited employee pool, the inability of leadership to understand the challenges and constraints of the field staff, the field staff’s inability to understand the challenges and constraints of the leadership, the lack of consistency in leadership’s message, and the revolving door in all areas of the organization. Did I miss anything?