We consider three activities that are key to creating value for the organization: making excellent choices, actually bringing about change, and operating effectively with new choices. We recommend a process that involves lacing together a decision board and a project team as they work together through six work steps. The process is focused on alternative generation, evaluation, and implementation, and is grounded in decision analysis. Tools for creativity enhancement and structuring of analysis are crucial to success; much of this chapter is about creativity. Collaborative efforts to frame the assessment of risk and make explicit value trade-offs are integral to the process. Risk-management techniques expand the set of alternatives to add value and reduce risk. Companies and consultants have been very successful with this process.