To successfully navigate the complexities of running a residency program, a program director must create a team of individuals to ensure all necessary functions are fulfilled. But creating an effective team consists of more than just assigning several people to fulfill specific roles. Identifying, recruiting, and motivating key team members along with creating a culture and atmosphere to facilitate strong teamwork lead to the development of a high-functioning team that can successfully navigate the challenges associated with running a residency in a dynamic, ever-changing environment. This chapter will cover the leadership team roles, skills, and attributes that are important for leaders, and qualities and characteristics that produce a high-functioning team. Given that leadership often involves implementing and managing change, this chapter will also address basic change management skills. From steps to ensure an effective and efficient decision-making process to navigating the inherent resistance to change to change management and implementation, all components must be addressed to successfully implement a change.