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HHS in the 21st Century: Charting a New Course for a Healthier America
According to OMB, while higher scores are desirable, the more important results of the process are the agencies’ performance improvementplans, which, with occasional resetting of targets, are intended to produce “continuous improvement of program performance” (OMB, 2008a). The hope is that, by making the ratings database public and by increasing its use by Congress and others, programs will work more aggressively to improve their ratings. However, OMB acknowledges that ratings will not necessarily be reflected in increases or decreases in program budgets, depending on circumstances.
The White House, too, has an initiative to improve governmental operations, called the President’s Management Agenda. The following were the PMA’s government-wide goals and HHS scores (in italic), as of June 30, 2008:
Strategic management of human capital—Mixed results, butworsening since March 2008.
Competitive sourcing (now “commercial services management”)—HHS is successfully implementing its plans.
Improved financial performance—Initiative in serious jeopardy.Unlikely to realize objectives absent significant management intervention (OMB, 2008b).
Expanded electronic government—Mixed results, but improvingsince March 2008.
Budget and performance integration—Mixed results.
Although these scores appear to be low, OMB concluded that HHS was in fact making progress in all five areas against agreed-upon deliverables and time lines.
The IOM committee, in calling for greater accountability within HHS, recognizes that these efforts are already under way, but believes their very complexity may limit their usefulness to key audiences—especially Congress and the public. The two principal accountability systems, one mandated under GPRA and devolving from the department’s strategic plan, the other OMB’s PART system, would probably benefit from consolidation, coordination, and some rethinking, so that they produce more actionable results and the evaluation process becomes more efficient and less burdensome.
However accurate the department becomes at documenting the hundreds of data points in the several required reporting systems described, these systems are not sufficient to establish true accountability.