Having worked in senior administration for some time I have found, at least for me, that all strategic planning is centered around our mission, vision and values and that it is increasingly more difficult to arrive at long-term goals.  The nature of healthcare moves us to adjust long-term goals based on market and that the facility is now more engaged in looking at community-based epidemiologic planning.  We have a tendency to adjust, based on  community need, more frequently now than we did five years ago and that success requires expendiency.