Frequently we are called upon to help improve emergency department performance and evaluate “how the ED team works together”. Invariably leadership becomes a crucial and relevant issue. It is not infrequent that hospital administration is extremely frustrated with the emergency department leadership, or lack thereof. When we quantify the costs associated with replacing leadership (either medical director or nursing director), the costs are staggering! A Coaching Intervention is much more cost effective and mitigates the detrimental Soft Costs.