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I think Skip has said it best, in fact nailed it. It's a methodology. Starting from scratch or an existing 'malfunctioning' IT structure, the excutives and Directors can not just pay lip service to the concepts or any methodology is doomed, ITIL included. In fact, those 'malfunctioning' service desks malfunction mainly because the average customer does not know or care what is or is not going to happen with their problem unless there is a frame of reference to show them. To make it work, you need to market the methodology as much as map and manage the processes.