As discussed in Chapter 2, a clearly aligned vision and mission and a small set of measurable, time-specific goals are essential for the department to establish meaningful accountability. Without an accountability system keyed to these most important issues, the department will be unable to provide a cohesive, integrated picture of the nation’s health or its own performance. Current performance assessment systems, described above, do not support true accountability, as defined by the committee. In its view, true accountability requires a dual focus on program implementation (process) and results (outcomes) and should have four components:

  1. development of supporting information systems,

  2. regular feedback and progress reports to Congress on what these information systems reveal about program management and results,

  3. a commitment to make the changes necessary to increase program effectiveness, and

  4. a broad assessment—beyond the piecemeal approach of monitoring individual programs—of how well programs collectively are working to achieve departmental goals.

Challenges to Creating Effective Accountability Systems6

Accountability systems are, in large part, a means of achieving better long-term performance. However, the desire for higher performance can be thwarted if program managers feel threatened by the accountability process. “Few … officials want to publicly commit to hard-to-reach performance targets,” says Robert Kaplan, an originator of the Balanced Scorecard. The movement for increased transparency in government (well illustrated by increases the number of potential governmental critics and therefore may encourage agencies to set conservative goals and targets. “[L]ower-level department heads become reluctant to commit to any kind of performance target, much less one involving some degree of stretch” (Kaplan, 2000).


The committee owes a debt to Kaplan (2000) for the organization of this section.

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