In this age of rapid change, organizations must relentlessly improve their structures, processes and systems if they hope to outperform their competitors. The best companies know which ingredients go into a successful change effort and how to mix and match them to achieve the most potent blend.An August 2001 study published in the Academy of Management Journal examines issue selling, the process by which individuals within an organization bring ideas or concerns, solutions and opportunities together in ways that focus others' attention and invite action. The process represents the earliest stage of change — that of focusing attention on an issue.To collect their data, the authors asked 42 midlevel managers at a nonprofit hospital to describe incidents in which they had tried to direct top managers' attention to a particular issue. (Issues were defined as any event, development or trend that could affect the hospital's performance; that is, updating a stale practice, increasing a budget, enhancing staff and patient safety, and so forth.) The managers were asked to describe both successful and unsuccessful issue-selling attempts.The study grounds an earlier, conceptual model with empirical evidence of what issue selling looks like in an actual organization.