Chapman correctly observes that our industry is undergoing dramatic change. Before end of of this century, present pattern of health services financing, provision, and organization will be turned upside down and inside out. He, like Vladeck (1992) and many others, suggests that a higher level, and perhaps even a different type of leadership will be needed for health systems and hospitals to fulfill their most basic mandate: caring for community in ways that enhance health and well-being. Writing introspectively, with both passion and compassion, Chapman challenges health care executives to: reexamine their inner values, purpose and responsibility; create new models of health care delivery necessitated by changes in purchaser/customer demands and pending health care reform legislation; and nurture certain qualities of leadership (i.e., aligning organizational and community benefits, protecting interests of diverse constituencies, balancing short-term goals with long-term vision, and risk taking). His premise, observations, and admonitions are clearly on target. Using Chapman's article as a point of departure, we would like to comment on what seems to be his overarching question: In times of profound change, what type of leadership is needed Before addressing this question, some conceptual housekeeping is in order--we need to define leadership and describe two very different types of change. LEADERSHIP is central to management because there is virtually nothing of consequence that anyone can get done in organizations alone. Yet it remains an illusive concept. We define leadership as the process through which an individual intentionally influences other individuals and groups in order to accomplish a goal (Pointer and Sanchez, forthcoming 1994). * Management is a function performed in organizations by individuals who are. expected to execute a number of different roles (Katz and Kahn 1966), and one of hose roles is leadership (Mintzberg 1973). Leadership and management are not synonymous. Nor is leadership, as some would suggest, management heavily laced with vision and charisma. Although leadership is only one of manager's roles, it is probably single most important. Leadership is way managers get things done. * Leadership is a process. It is a verb--an action word--not a noun. Leadership manifests itself in doing; it is a performing art. * Only individuals lead. Groups and organizations do not lead, only people do. The locus of leadership is in a person, and all. leadership is inherently personal. * The focus of leadership is other individuals and groups. Leadership cannot exist absent this connection between someone who is leading and those who, for what ever reason, choose to follow. * Leadership is an act of influence. Influencing individuals and groups is what leadership role of management is all about. In leading, managers influence followers' behaviors as well as their ideas and feelings. * Leadership is intentional; it is not accidental. All of us unknowingly influence others hundreds of times each day. These, however, are not acts of leadership; they are merely happenings. * The objective of leadership is accomplishing goals; those that are so large and/or complex they cannot be tackled by individuals working alone. * Leadership is multidirectional. A manager can lead upward, outward, sideways, and downward. Change comes in two very different forms: evolutionary and revolutionary (Kuhn 1962; Prigogine 1984). Evolutionary change is continuous; its defining feature is embellishment and elaboration of an existing pattern. Revolutionary change is discontinuous; one pattern is replaced by another. For example, evolutionary change occurs when a caterpillar grows larger, becoming more of what it already is. A caterpillar undergoes a revolutionary change when it becomes something different, a butterfly. The environments of organizations are subject to successive waves of change--relatively long periods of evolution punctuated by brief revolutions (Toffler 1980). …