Abstract
<jats:title>Abstract</jats:title> <jats:p>The identification and removal of sources of frustration and inefficiency requires a partnership of leaders and health care professionals in a people-centered organization. This participative management process treats health care professionals as trusted and respected colleagues. It results in a more friendly work environment and a cohesive team that is able to more readily navigate the occupational challenges that arise. The process of identifying and removing pebbles starts with an unrushed conversation with the health care professionals of a given work unit. The local challenges that often surface in these discussions frequently involve disorganization and processes that diminish meaning or that impede caring for patients.</jats:p>