Planning guides and worksheets, provided in Appendix A , can assist motivated readers in formulating and structuring their initial reform efforts. Reform goals should be based on a shared vision and have the active support of a wide range of stakeholders who participate in achieving them. Reform strategies should be flexible to accommodate multiple solutions to a given problem. Reform may require redesigning organizational infrastructure. Reform is not cost-free.
Reform is an ongoing process.
Those developing a reform proposal, as well as those engaged in ongoing projects, are encouraged to use these lessons and planning guides to structure their activities. Although this report is intended to describe the important elements that underlie all successful reform efforts, readers are cautioned not to treat lessons as discrete elements that may be adopted in a piecemeal fashion.