Introduction by the column editors: Implementation of a rehabilitation innovation in a clinical facility or program typically involves overcoming many obstacles. They include lack of administrative support and endorsement, unavailability of consultants who are experts in the innovation and who can assist staff in changing professional behavior, and lack of "internal champions" who can spearhead the requisite changes in the organization. Other obstacles include the incongruence between the philosophical assumptions of the innovation and those of the facility and its treatment traditions and satisfaction with the status quo, and hence lack of motivation for staff to change their practices.With the external stressors of managed care and other strategies for cost-efficiency now pressing on psychiatric agencies and institutions to change their practices, it is refreshing to read the following account from South Carolina State Hospital, where Rosalind Smith and a few key colleagues achieved a wholesale and successful transformation of the institution from a custodial orientation to an emphasis on rehabilitation. Ms. Smith and her team have done just about everything right, and their efforts and results during the past few years can serve well as a case study in organizational change. For those in the throes of change in our current climate of budgetary cutbacks and staff downsizing, important lessons can be learned from Ms. Smith and her team at the South Carolina State Hospital.