1. 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.


The IOM committee strongly believes the secretary needs greater flexibility in program management and department operations, if flexibility is balanced with greater accountability, as described above. The IOM committee sees greater departmental accountability to Congress in exchange for greater flexibility from Congress as an opportunity to create a “new compact” between these two governmental authorities. What the committee is seeking in proposing the “new compact” is a more productive, working relationship between these two arms of government. Striving for greater accountability and greater flexibility undergird the committee’s recommendations and can be achieved through a number of mechanisms, described in this report:

  1. Meaningful engagement in priority-setting: The committee recommends involving Congress (and others) from the outset in establishing agreement on national priorities and HHS’s overall direction. Having to weigh future needs against the many current demands on the department—many of them congressionally mandated—may improve alignment between program needs, mandates, and the budgets to support them.

  2. A responsible appointment process: The committee recommends that the appointment process for key HHS officials not only ensure that its executives have the administrative, leadership, and technical or scientific expertise to manage their respective areas, but also that vacancies are promptly filled, so that agencies do not experience gaps in leadership.

  3. Improved accountability and reporting: The committee strongly believes that the department must be held strictly accountable for its performance. To enable this, the committee recommends a robust data collection and analytic system, building on current

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