omh has said the enhancement initiative followed a decade of successful implementation of the 2000 standards, but the news media have reported on implementation problems, and the 2013 standards were released with an implementation manual almost 200 pages long. what do you think might be some barriers to implementation, and what would you suggest to encourage implementation? what do the expanded definitions of health and culture say in general about the way government framed health in 2013 as compared to 2010? what might have contributed to the change? how do you explain the differences between recommendations, guidelines, and mandates? what are the possible explanations for making all enhanced standards guidelines? which are the most important standards in your opinion? which are the least important? what would you change about these standards if you were in charge of the u.s. department of health and human services? does it seem unusual to you for a government agency to wait more than 10 years to review and revise standards like these? what might be the reasons for waiting? what arguments could be made for more frequent review