The pace of change impacting practice managers has never been greater. From consolidations, mergers, and acquisitions to re-engineering profit centers; managers are faced with what often appears to be "crisis" situations. And with crisis comes the fact that staff (and physicians) often experience anxiety, the offshoot of fear.

The following vignette offers practical lessons for handling the fear and resultant anxiety, which come with unexpected and unwanted change. While this true-life situation occurred in the clouds, the concepts are very much grounded in reality. Its lessons can be carried into the office, hospital, or lab.

Sunny skies, light winds, and gentle surf started yet another lovely spring day in Southern California. Full of optimism, I boarded a flight bound for New Orleans by way of Denver and a major speaking engagement.

I never made it.

Snow intervened in Denver, delaying our 747 while nozzles spewed chemicals onto the wings. The co-pilot explained the procedure and how she'd walk back into the cabin to visually inspect the coating. Once airborne, she told us we'd hear the landing gear go down a second time as they checked the mechanics. Finally off to New Orleans on Flight #1180.

Not.

A freak series of severe thunderstorms blew in from Texas, causing considerable jolting and bucking. The captain, a voice calm and deliberate, explained each deviation as he attempted to discover a better routing. We couldn't even get close. "I'm an old captain, not a bold captain", he explained when he announced we'd be diverting to Birmingham, Alabama. The passengers applauded his honesty with our safety while we all silently and not so silently moaned our fate. Cockpit voices told us we'd be informed as soon as the captain landed, walked through the jet, and called base operations. Birmingham was not this carrier's hub.

One hundred-fifty people, many with small children, listened patiently when he returned and explained the exiting procedure from the aircraft, where we'd lodge, and when we'd meet and "have another go at it" in the morning. Not one whimper or angry outburst arose. And true to his word, we all assembled after little sleep, no food, and for many, no change of clothes. We had now bonded in the experience and called out to one another, laughing and sometimes gasping as the still rocky air finally parted enough to bring us into New Orleans.

I lost income on that flight but I gained a strong metaphor for leadership principles in times of crisis and change. What the captain and crew engendered that is missing in so many of our downsized, fear-racked businesses was TRUST.

Let's use this word as an acronym for understanding exactly what happened on this trip and what all leaders must do in today's whitewater world.

T: Tell the truth and reveal feelings. Information abounded on Flight #1180. People deserve and need plenty of information about what's happening, why it's happening, and what are the next steps-- even if those next steps are to stop, take stock, and develop the next plan of attack. And the information has to be immediate. Waiting while the rumor mill churns out various versions of "the truth" creates anxiety, second-guessing, and sometimes panic. None of these are conducive for productivity. Notice that the captain also admitted that he was "old not bold". Leaders are not invincible. Employees can identify with this statement and also become reassured that the leader is not going to do anything foolhardy to jeopardize the organization and its people.

R: Respond consistently. Once the captain and crew established a reporting method, they continued with the updates. Voices never changed. A pattern of zigzagging to avoid storms was followed. Is it not true that business often needs to consistently be inconsistent in seeking improvements, finding new markets, responding to the marketplace?

U: Understand your role. Be competent. Be visible. With voice as well as physical presence, the captain and crew were "out and about". In times of change and crisis, seeing and hearing the leader is important. By walking through the cabin and putting a hand on different people's shoulders, he reassured passengers. The captain also invited people to stay with him and talk about the flight if anyone was concerned. In times of change and crisis, it is vital that leaders be seen and available for questions and feedback. Too often, the leader meets only with senior people or disappears behind closed doors.

S: See people as trustworthy. The captain stated what he would do and that he expected us to follow his instructions. He basically said, "I trust you to do what is right for yourselves and each other." If a leader wants to be trusted, that presumption must also be present.

T: Take action. Tickle funny bones. On Flight #1180, passengers were kept appraised of each action step and the results of that step, both positive and negative. Whether in the boardroom, the marketing department, or the cockpit, an action followed by course correction is a wise mode for handling any change or crisis. Lastly, the captain and the crew managed to find humor in the situation. Laughter, as Victor Borge used to say, is the shortest distance between people. Laughing over what cannot be controlled creates that element of bonding which is fundamental in maintaining trust.

A self-litmus trust test would benefit us all. What would people say about our behaviors during change or crisis? Would there be mutiny and fleeing the ship? Or would people stick with us to the next destination in the organization's journey? Let's trust they would.