Managing change in a changing environment.

Change comes from different directions and must be managed in different ways. Change may come from the top down (eg, from parents to children) or from the bottom up (eg, from staff to management). Introduced change is initiated by you; imposed change is initiated by someone else. Change is necessary to move forward and remain effective. If change is resisted, there is the risk of becoming complacent, outdated, or obsolete. There is no room for obsolescence in health care. Even under the best of circumstances, change will be met with resistance. To overcome resistance, involve people in planning for the change and ensure understanding through verbal and written communications. Be prepared to revise the plan, and always remain flexible.