• establishes a small number of critical, measurable goals,

  • provides clearly delineated lines of responsibility,

  • sets quantifiable targets and time-specific milestones,

  • describes potential barriers and develops strategies to address them,

  • projects the investments to be made,

  • defines a process for regular reporting and assessment,

  • includes a reward and recognition system for staff that promotes achieving goals,

  • provides a clear understanding of whether progress is being made, and

  • implements corrective action, as needed.

A key question is, “To whom is the department accountable?” The committee believes HHS is primarily accountable to the White House, Congress, and the tax-paying public.


The current administration and HHS have undertaken major initiatives aimed at increasing performance measurement, which is an important aspect of accountability. The department currently operates under a complex web of internally and externally generated goal-setting and reporting requirements. These requirements include exercises that relate to Healthy People 2010, the Government Performance and Results Act of 1993 (GPRA), the Program Assessment Rating Tool (PART), and the President’s Management Agenda (PMA), described below. Box 6-1 defines these requirements and illustrates their relationship to the department and each other.

The trend toward greater HHS accountability may have begun with the first version of Healthy People, published in 1979, which set a series of 10 health goals for different age groups and described the actions the department would take to reach them. In subsequent iterations, Healthy People 2000 and Healthy People 2010, the number of health issues enumerated has grown considerably. Healthy People 2010 includes 28 focus

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