"I'm the one who's going to be held responsible," President Barack Obama said, referring to his health care plan, in a recent interview on CBS's "60 Minutes." "I have every incentive to get this right."

But as every CEO knows, organizational transformation can't just start, and stop, at the top.

The pitfalls are many, beginning with the fact that our government is, in essence, a negotiated entity. The majority of the negotiations begin at the executive and legislative branches. But the execution of this transformation — the point at which Americans will see and feel true change — lies with the agencies and employees tasked with delivering on a new system. The true challenge for government leaders will be to ensure that messages from the top are heard and embraced by all of them.

Given this complexity, it is hard to believe a transformation that will fix our health care system is at all possible. Yet the federal government has little choice but to tackle reform at this time. The private sector, faced with constant buffeting from changes in the competitive landscape, has had more experience with large-scale reform.

Here are some guidelines from the private sector that agency leaders should keep in mind:

• Select the right people for key leadership positions. Pendleton James, who was in charge of selecting appointees for the Reagan White House, used five criteria: Appointees must be philosophically committed to the president and his initiatives; they must possess the integrity to do the job; they must show the toughness necessary to deal with those vying to influence them; they must be reasonably competent in the specific area to which they are being appointed; and they must be team players — not sycophants, but people who believe in the administration's agenda more than their personal agenda. Those criteria represent a fine starting point for selection. Executives chosen to lead, or participate in, this new health care system should be selected with the leadership competencies needed to execute the mission and motivate the workforce.

• Education is not enough. While education and training may communicate the concepts behind the health care initiative, the behavioral requirements of change — what to do and how to do it — are tied to reality. And, since transformation involves people changing from something known and predictable to something unknown, there must be processes in place to help them adapt emotionally and proactively. They need encouragement and support to take risks.

• Leaders need to overcome organizational inertia. It will be up to the leaders of the new system to convince others that this change is worth it. They can encourage detractors to embrace change by involving them in the process. When individuals can envision their successful role in the future, the bandwagon effect takes hold. People become eager to be seen as contributing to the new organization and its success.

• Leverage the need to succeed. There are usually many talented and dedicated people in organizations, including the federal government. Most federal employees do their jobs well, abhor waste and want to be proud of their contributions. They hunger for leadership, just as their counterparts in the private sector. They need the pull of talented, relentlessly positive leaders and the push of disciplined transformational processes to create a better system.

• Successful transformation feeds on itself. Choose pilot programs — like the program at Intermountain Healthcare in Utah that Obama referenced in a Sept. 10 speech — as test-and-learns to make sure the change will likely stick. Celebrate genuine gains early and often. Once success is evident, transfer the lessons learned to people who are able to pollinate change elsewhere in the agency. Use the fact that many in government, both appointees and career executives, are competitive and ambitious. No leader or organization likes to be left behind. Change in one agency will lead to change in another until transformation spreads throughout government.

Finally, with all the restraining forces at work, and with limited time available, if the federal government wants to deliver meaningfully on its intention to transform the U.S. health care system, it must act soon. å

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Allen Parchem is a member of the board of directors of RHR International, a management consulting company.