That's what was missing from my lessons learned slides: What I have been learning for the last year or so (actually for the last 50 years, but I am a slow learner) is that actually bringing change to a system is really hard. It requires a careful analysis of the forces holding the old system in place, a keen sense of timing to understand when the "Time is Now", incredible attention to details- an ear to ground, contacts at every level of the government, knowledge about how the levers of power are actually pushed, and finally a recognition that, in order to counter any political force, you need another political force to knock it sideways. These are not things that one learns in medical school. The are people- politicians and their aides- who have a keen sense of how this work. When us medical people want something to change, we need to ally ourselves with these political chessplayers and let them show us how our knowledge can become political clout. Sobering lesson, but really important if one wants to change actually systems.
Michael's talk, however, was right on target and brilliant. He just needs to tell us more about the steps that we should take to make it all happen.
Bill signing tomorrow. I'm looking forward to it. I'll try to blog live.