Manage change or react to change. This option describes the full spectrum of choices available to healthcare leaders today. The continued volume and complexity of changes creates unique and, many times, frustrating challenges to those who wish to move their healthcare delivery system forward. For all involved in healthcare, from trustees to direct service providers, the pressures to anticipate, adapt, or at the very least, cope are accelerating. Added to the mix of service and payment problems is the explosion of innovations in information technology as well as clinical advances. The resultant picture could easily become overwhelming. In fact, the healthcare landscape is littered with failed attempts to manage change. However, several healthcare leaders continue to excel within this environment. This article presents the concepts and behaviors that seem to underpin their success.