Effective leadership is the key factor in directing and influencing change in an organization. In today's healthcare environment, leaders have less time to make decisions that will ensure their organization's survival, a fact that has forced them to recreate the way they do business and be cognizant of ways to remain competitive. In the environment of change, a new type of leader is needed--the instrumental leader--one who combines the charismatic traits of envisioning, energizing and enabling with the three key facilitating behaviors of controlling, structuring and rewarding. To these attributes the instrumental leader adds critical thinking, problem solving and a feedback mechanism. Leaders who focus on employees as individuals and on the organization as a whole will achieve greater success. Today's leader must share a picture of the intended reality with the organization's staff, constituents and the community. Those most affected by oncoming change must be included in future planning. A shared vision is, however, an ongoing process, with communication crucial for its success. At some point in the change process, leaders must spend time building teams, clarifying behaviors and administering rewards and punishments. Part of this process involves energizing and aligning employees who will find ways to implement the shared new vision. The instrumental leader understands the need for teams that will form the backbone of the integrated system. Creating objective measures for performance, based on the new shared vision, demonstrates the organization's values better than communication or vision alone. Additional training or dialogue may better clarify the organization's expectations of employees.