took the form of posing questions and joint diagnosis, in which broad objectives were stated by leadership, but plans to operationalize these were open for discussion. This was seen, for example, in the nursing staff's recommendation to create an "electronic whiteboard" (see "Nursing Perspective: Focus on Clinical Best Practices, Patient Safety and Operational Efficiency" at p. 50 in this issue). Of course, management is faced with a dilemma when anxious employees seek answers that management is not yet able to provide. In an earlier study of hospital downsizing during restructuring in the 1990s, I observed two managerial responses to this challenge, but only one that was effective (Change Foundation 1997). In several hospitals, managers themselves did not yet know the specifics of the downsizing process (e.g., "Will 40 or 80 nurses have to be laid off?"). Those managers added to their difficulties by refusing to speak about an issue until they had all of the answers. This often led to increased rumours, thwarting the change leader's efforts to control information about proposed changes. Silence also affected the credibility of change leaders who were thought to be keeping secrets from those individuals who would soon be affected by the changes. A more successful approach to managing the unknown was simply to be honest with employees about the unknowns. For example, in that earlier study one CEO was unable to determine how many nurses were going to be laid off, but he was able to say how the layoffs would be managed