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During a 13-month successful introduction of unit-based, multiskilled environmental workers at an academic medical center, responsibility for environmental support services migrated from centrally managed departments to more than 30 patient-care units. The authors discuss six project management lessons that may be used by clinicians and managers as they participate in service reorganization. Points related to the identification of committed leaders, exploration of barriers, planning, continuous training, negotiation, and communication are presented. Professional nurses who demonstrate their ability to work with these types of service innovations while clearly identifying clinical aspects best left unincorporated in such job descriptions will be in demand as participants in redesign efforts.