In reply:

We thank Drs. Adams and Moore for their commentary on our article. In accordance with our qualitative findings, we agree that leadership is the key to success in addressing emergency department (ED) crowding, rather than the "what" or "how." These exemplar leaders in our cohort were able to design and execute solutions that were specific to their hospital.1 We saw this in multiple hospitals, which reported that strategies were implemented, but not well executed. Thus, survey studies that focus on solutions such as inpatient boarding or providers in triage do not describe the entire picture.

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