• enable the secretary to provide Congress with regular reports on progress toward achieving departmental goals,

• inform policy development,

• facilitate cross-department activities,

• provide operational information to program management for quality improvement and midcourse corrections, and

• support effective long-range planning.

4. For those outside the department, the system should

   • be accessible, transparent, timely, and reliable, and

   • provide useful, privacy-protected information regarding department activities.

5. The department should demonstrate accountability through continuous critical assessment of program efficiency, equity, impact on health, and cost-effectiveness, and through corrective action for underperforming programs.

6. The secretary, in collaboration with the surgeon general, should present Congress and the public with an annual “State of the Nation’s Health” report that describes progress toward achieving the vision for the nation’s health and the department’s key health goals.

7. Congress should establish a new, strategic initiative fund to enable the secretary to support cross-agency and cross-departmental activities that exhibit innovation in responding to twenty-first century challenges, and to respond quickly to new, unforeseen, or expanding public health threats.

The committee believes that improved accountability and more rigorous decision making will be fundamental to the department’s success in creating more value from its activities, in responding to the key health and cost challenges of the twenty-first century, and in earning congressional support for increased flexibility in executing its responsibilities.

To the committee, a strong system of accountability provides the information needed to continuously improve program performance in ways that result in better health for Americans. As used in this chapter, the term accountability involves a systematic approach that