[Excerpt from authors] This paper provides practical guidelines for managers and health professionals looking to skill mix as a potential solution to health service delivery problems. These guidelines emphasise the need to evaluate the problem, and examine the context, before deciding if skill mix is the answer. The guidelines are provided in the knowledge that skill mix is rarely examined in a "pure" theoretical sense by organisations. They have to adopt a pragmatic approach which takes account of the day-to-day realities of their priorities and resources. The paper argues that changing skill mix is not a panacea for all the ills of an organisation. It has a role to play in improving organisational effectiveness and quality of care, but it must be recognised for what it is - a process for achieving change. Four phases of the skill mix cycle are described: evaluating the need for change; identifying the opportunities and barriers for change; planning for change; and making change happen. The paper concludes by emphasising that skill mix is not just a technical exercise. It is a method of achieving organisational change which requires careful planning, communication, implementation and evaluation if it is to achieve its objectives.