It is suggested that the leadership style of the executive was inappropriate for the successful implementation of
change. There appeared to be little planning, education and communication, involvement and participation,
transparency of evaluation and willingness to admit mistakes. The research on health service integration
demonstrates convincingly that HSI is difficult, costly and with mixed benefits. Research on managing change
points to the importance of "confronting the brutal facts"and reflecting upon the process of change
management rather than ploughing on without regard for either reality or reflexivity. All of these factors, but
especially trust and transparency, are critical for the success of any change process