As a virologist interested in health care and given the polarization brewing in the US over this issue I found these sets of guidelines most appropriate. (From Managing & Using Information Systems: A Strategic Approach 3rd ed. by Pearlson, K.E. & C.A. Saunders, 2006 Wiley)

Dear President Obama

Dozens of stories tell of companies that attempted reengineering, only to fail to realize the advantages they sought. Radically changing a business is not an easy task. Research done to determine why companies failed to reach their goals reveal some of the more common reasons.

Lack of senior management support at the right times and the right places.

Estimates suggest that 50% or more of the manager’s time is necessary to make radical change successful. With Iraq, Afganistan and the US economy I am sure your time and energies are spread fairly thin.

Lack of a coherent communications program.

Radical change scares may people who are unsure whether they will have the same health care when changes are completed. Companies that failed to communicate regularly, clearly and honestly experienced increased risk of failure.

Introducing unnecessary complexity into the new process design.

Companies that introduce new systems that are unproven or need extensive customization and training add a level of complexity to a reengineering project that is often difficult to manage. The American people have no idea what to do,where to go and who to ask for answers after all is said and done.

Understanding the amount of effort needed to redesign and implement the new processes.

Companies do not stop operations while they reengineer and therefore find themselves spread too thin. When trying to reengineer and continue operations. Some compare it to changing planes in midair. Not impossible but not easy. Enough said.

Combining reengineering with downsize

Many organization really just want to downsize their operations and get rid of some of their labor costs. They call the initiative reengineering rather than downsizing and think the everyone will understand that the new business design just takes fewer people. People are smarter than that and often make the implementation of the radical design impossible and are beginning to see it now.