Journal of Plastic, Reconstructive & Aesthetic Surgery (2009) 62, 855e857

LETTER FROM AMERICA

Mission Mania

3 http://tinyurl.com/6ppe2j download factsheet accessibilityverified 11/25/08.

4 http://tinyurl.com/5o8zme accessibility verified 11/25/08.The $1.7 billion included $650 million in fines and penalties. The

Americans are madly in love with missions. Missions are partof our essence. The clearest missions are those most simplyexpressed. In the 19th Century, ‘Go West, young man’exhorted us to fulfill our ‘manifest destiny’ and expand ourcountry to the Pacific Ocean.

Presidential missions

In the 20th century, John F. Kennedy clearly enunciated ourspace program’s mission by saying, ‘I believe that thisnation should commit itself to . landing a man on themoon and returning him safely to the earth’.1 Sometimesmissions are muddled. On May 1, 2003, standing beforea banner that said ‘Mission Accomplished’, George W. Bushdeclared the end to Operation Iraqi Freedom. Unfortu-nately, the Iraqi Insurgency continued for years afterwardsand resulted in even more casualties. Controversy remainsas to what Bush meant and who was responsible for thebanner.2

Mission statements

The concept that every organization needed a missionstatement gained ground in the 1990’s with cohorts ofconsultants exhorting executives to adopt mission state-ments as part of their corporate culture. Let us step backfor a moment and ask, ‘What is the mission of a missionstatement’? Simply put, a mission statement should statethe purpose of the entity, what its goal is.

Tell the truth

The first rule for a mission statement is that it be truthful.Take, for example, this seemingly noble statement froma large health care company:

‘‘Above all else, we are committed to the care andimprovement of human life. In recognition of this

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1748-6815/$ - see front matter ª 2008 Published by Elsevier Ltd on behalf ofdoi:10.1016/j.bjps.2008.11.071

commitment, we will strive to deliver high quality, cost-effective healthcare in the communities we serve.’’3

Were you inspired? Did you get a lump in your throat whenyou read this? Did it remind you of ‘mom, apple pie and theAmerican flag’ or whatever your local patriotic equivalent is?Consider this, the U.S. Justice Department indicted thiscompany for multiple counts of Medicare fraud and that aspart of its settlement it paid $1.7 billion - the largest healthcare fraud settlement in the U.S. at the time.4 A missionstatement must be more than an advertising slogan.

Keep it simple

Some mission statements are so long that by the time youhave finished reading them you have forgotten theirbeginning:

‘‘The educational objective of the School of Medicine is todevelop physicians who are highly competent andcompassionate practitioners of the medical arts, schooledin the current knowledge of both medical biology andpatient care. The aim is to produce physicians who will beamong the leaders in their chosen field, whether in thebasic medical sciences, academic clinical medicine, ormedical practice in the community.’’

This mission statement was created during the reign ofa dean who was not only a physician, but also an attorneyand former FDA bureaucrat. The only way to know it wasa mission statement is because that is how it is listed onthat university’s website.5 Contrast that masterpiece ofbureaucratese with this brief mission statement of theAmerican Medical Association:

company had previously plead guilty to 14 felonies as well. The NYTimes was a finalist for the Pulitzer Prize for its investigations ofthis matter http://tinyurl.com/57qqk7 accessibility verified11/25/08.

5 http://tinyurl.com/65d9wq accessibility verified 11/25/08.

British Association of Plastic, Reconstructive and Aesthetic Surgeons.

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856 Letter from America

‘‘To promote the art and science of medicine and thebetterment of public health.’’6

The restaurant menu strategy

In most medical mission statements, a recurrent theme playsout. Nouns and verbs are freely interchangeable. Creatinga mission statement is like ordering from a restaurant menu.You choose an appetizer, entree, sweet and drink from themenu:

These choice items are parts of current American plasticand hand surgery mission statements.7,8,9,10

The ‘sweets’ include:

� advance the science and art of plastic surgery� advance quality care to plastic surgery patients� foster and to promote the highest quality of hand care� advance the science and practice of hand and upper

extremity surgery

Before you get too hyperglycemic for rational thought,here are the ‘drinks’ from the same menus:

� the development and sponsorship of educationalprograms� communications with health care professionals and the

public� the endowment of research� surgical education, research, scientific presentations,

and professional interaction� encouraging high standards of training, ethics, physi-

cian practice and research in plastic surgery

The proliferation of mission statements has led to theinevitable parody of the process, and generic missionstatement generators are available on the internet.11

http://tinyurl.com/luuxk accessibility verified 11/25/08..http://www.handsurgery.org accessibility verified 11/25/08.http://www.aaps1921.org/about.cgi accessibility verified

25/08.http://www.plasticsurgery.org/about_asps/index.cfm acces-

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Advice from an astronaut

Too many medical mission statements are lost in space.Fortunately, several months ago, I attended a lecture bya former astronaut. James Bagian, M.D., P.E., a Columbiaspace shuttle disaster investigator who now headsa governmental organization on patient safety. Bagianbelieves that too often mission statements confuse goalsand tactics.12 This confusion makes it more difficult for theentity to achieve its goals. His organization’s missionstatement is a model of clarity:

‘‘Our goal is the nationwide reduction and prevention ofinadvertent harm to patients as a result of their care.’’13

Another noteworthy mission statement belongs to theFlorida Medical Association. It is a model of brevity and ismore powerful because it consists of an obvious andmeaningful goal without any mention of the means ofachieving the goal:

‘‘Helping Physicians Practice Medicine’’14

To and to does not equal for

It should be obvious by now that mission statements demandthought and should not be relegated to the lowest person onthe organization’s chart. With that in mind, let us view themission statement of the American Board of Plastic Surgery(ABPS). Of the more than two-dozen organizational missionstatements that I have reviewed, it is unique for tworeasons. First, it is self-referential. It begins: ‘The missionstatement of the American Board of Plastic Surgery is’, but itgets worse for it continues: ‘to promote safe, ethical, effi-cacious plastic surgery to [sic] the public.’15 Frankly, Ibelieve that the public would feel more secure if there wasless promotion ‘to’ it and more promotion ‘for’ it.

Personal mission statement precautions

Here is a word of caution before you embark upon the act ofcreating your personal mission statement. Think. I recentlyread this mission statement of a Miami plastic surgeon; it issimilar to the ABPS in being self-referential and having poorgrammar:

12 http://www.iom.edu/?idZ47981 accessibility verified11/25/08.

13 http://www.va.gov/ncps/index.html accessibility verified11/25/08.

14 http://fmaonline.org accessibility verified 11/25/08.15 http://www.abplsurg.org accessibility verified 11/25/08.

Letter from America 857

‘‘Dr. X’s mission statement is ‘‘TO PROVIDE ETHICAL,HONEST OPINIONS TO MY PATIENTS in order to meetTHEIR COSMETIC SURGERY NEEDS’’.16

I am glad that Dr. X aims for the admirable goals ofproviding ethical and honest opinions, but does he everoperate or only provide opinions? Maybe he should do somereconstructive surgery on his mission statement?

Now that I have enlightened you about Americans andour mission mania, I shall say farewell so I can return to my

16 http://tinyurl.com/5e9uje accessibility verified 11/25/08.

mission ‘To save lives, stamp out disease and make Miamia safer place to live’.17

M. Felix FreshwaterUniversity of Miami Miller School of Medicine,

Division of Plastic Surgery,9100 S Dadeland Blvd Ste 502, Miami,

FL 33156-7815, USAE-mail address: mfelix.freshwater@gmail.com

17 http://en.wikipedia.org/wiki/April_fool accessibility verified11/25/08.