Abstract
On a journey to the future, an initial strategy of engagement and design is essential but inevitably inadequate. Instead, as bumps in the road emerge, the ability of leadership to regroup and refocus is the key. This is the story of one such journey-a journey pursuing the triple aim of excellence in patient care, patient and staff satisfaction, and economic sustainability. It is one chapter in the transformation of an 1800-employee patient care services organization. It is not the first chapter nor will it be the last.