A common theme emerges when talking to managers working in high pressure, high profile sectors – their description of working in what feels like a relentless squeeze. A squeeze created by heavy workloads, constant pressure and sometimes just enough organisational resources to get the work done. Another common theme is that of great fatique, the inadequacy of annual leave to refresh or regenerate and their distress in realising that their heart may have gone out of their job, even though they like aspects of it. People face difficult choices when they reach this point. It helps if they know themselves well: the factors that motivate and demotivate them; know what they will and will not be able to tolerate any more; know their own personal values and which of those may be compromised by the values operating in their organisation. Making decisions to change certain things is certainly difficult and requires courage…..