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Such a change would require a formal modification of the State 's approved NPDES program , and the State would have to demonstrate that its program meets all of the minimum criteria specified in 40 CFR Part 123 , Subpart B for substantive and procedural regulations . To make any substantive change will require each of you to become more than who you were when you were appointed to this Commission , as distinguished as that may have been , and to overcome not only the obvious politics of Washington , D.C ., but to rise above our own - - our own - - personal belief systems and professional tribal politics to focus on how all of us can become a team for our common purpose . " The health care environment is complicated and multi-layered , and perhaps the most effective change may require a mix of approaches involving competition and regulation to ensure patient safety and quality of care . The consequences of these changes will require policymakers to address a variety of land use , transportation , economic and social issues . The proposed changes will require schools to hold the fat content of menus ( averaged over a week ) to not more than 30 percent of calories , with not more than 10 percent of fat as saturated fat . Profound changes would require longer-term secular shifts in party support throughout these countries . This change may require some states to make major funding and administrative adjustments to their Medicaid and child welfare programs . Finally , the nature and scope of technological change may require authorities to rebalance their emphases on regulatory rules and industry discretion . These changes will require a new approach to organizational management and human relations . Health policy decisions and changes will require quantitative input to yield data as one of the components of future decision-making regarding national health policy issues and the quality of medical care . The proposed changes will require some legislative and regulatory changes by federal and provincial governments . Everyone , from the rector to the hospital residents , says the medical system needs to change , but the system is still centralized and any significant change would require support on the federal level . Eventually any successful change will require a change in people 's behavior or a change in the people .