You've probably heard some variation of the following phrase that the only thing that's constant is change. We will continue with our discussion of leadership and approaches to change in this segment, where we cover push versus pull models of change. We'll define what each of these approaches involves. I'll provide some non-clinical, non-health IT related scenarios to help you relate, and then we'll go over some examples in the Health IT sphere to see if you've mastered these concepts. When it comes to push versus pull approaches to communicating change, it's important to realize that every organization will undergo change at some point in time. When leading these activities and efforts, you can take on a traditional approach of push model of change, which is a top-down approach, often thought of as hierarchical. Leaders often have to impose the change on their staff because of performance targets that need to be met. They might need to use financial incentives, a contract might have been signed or there might be an upcoming kick off. Oftentimes with push change, there isn't this ability to empower the individuals who are actually implementing the change itself. Then, we have the pull model of change. This is a bottom-up approach based on developing organization. It uses the ability to get input from each stakeholder to help engender accountability, commitment. So, push versus pull, two very different approaches to communicating change. In my household, as the chief maternal officer or mother as I'm commonly called, if I were to have my way and change the way we eat dinner, in a push scenario, every single night we would have the best balance of healthy green vegetables, legumes, dairy, some omega-3s, and the right balance of fruit, vegetables and healthy oils. Of course, if I solicited input from those who live in the household, in a pull scenario, dinner every night would look a little bit different. Perhaps the right combination of cake pops, trips to Haagen-Dazs for ice cream, waffle cones, pastries. So, maybe the pull approach isn't always the right one to use. Now it's your turn. Is this example one of a push or pull model? Imagine that you work for a digital health start-up. You're invited to a weekend retreat fully paid for by the company, where the leadership is soliciting input on the vision for the organization. Based on this particular scenario, does it look like the upcoming change for your start-up is based on a push or pull model? The correct answer, of course, is that this would be a pull model of change. Basically, engendering commitment from the employees, fostering collaboration and really soliciting input from all of the key stakeholders. Now, what about this scenario? Imagine that you're a software engineer at a healthcare analytics company. The executives are cheering because they just landed a high-profile client. With this new contract, earnings for the next quarter are going to really, really be loaded. Of course, the contract that they just signed says that the kick-off meeting needs to be next week. So, what does this mean? Means that your engineering team will need to work over the weekend unexpectedly to make sure that everything is modified and pulled off according to what the client has demanded and what the client is expecting. Does this type of change feel like it's following the push model or the pull model? The answer, of course, is that this is more of the push model, where it's a top-down hierarchical approach to effectively implementing the change. So, the next time you witnessed change in your organization or you hear about a friend talking about some new contract that they've been told about in their workplace, think about whether the push or pull model of change management was being used. What leadership traits do you prefer at your organization? And if the push approach was used, did the leadership have a choice? Could they have gone with the pull model of change instead? These are the types of things you want to be thinking about on a day-to-day basis as you continue your active learning experience, thinking about change management in the field of Health IT and Health Informatics.