efforts, that will provide meaningful information about the state of the nation’s health and departmental activities. HHS must use this system to inform decision making about future programs and to improve ongoing operations.

  1. A staff commensurate with the needs: The work of the department demands a high-performing staff, but the committee recognizes that the current HHS workforce is threatened by impending retirements and, at times, inadequate scientific or public health expertise. The secretary can work with the Office of Personnel Management (OPM) to foster flexibility in the hiring process for people who are outside government, in the structuring of benefits and work schedules to retain employees who would otherwise retire, and in supporting the education of a new generation of public health professionals and health scientists.

  2. Support for the department’s role in national health issues: For many reasons outlined in this report, the department must participate actively in any national health reform effort. Over time, Congress will need help in monitoring the impact of reform. It would be greatly aided by the committee’s recommendation that the department support (a) increased knowledge about the comparative effectiveness of various preventive and treatment methods and about the organization and delivery of care, as a basis for policy, (b) strengthened public information efforts, and (c) widespread adoption of health information technology.

  3. Increased flexibility: Were the committee’s recommendations adopted, the department would be held to a higher standard of accountability; it would have improved capacity to document and improve its own and the health system’s performance; and it would have a strong workforce, led by competent, credible executives, working toward widely agreed-upon priorities. In acknowledgement of those strengths, Congress should provide flexibility and opportunities for collaboration, and it should provide the department with adequate funding for its vital work.

Many factors would make this a complex set of negotiations between legislators and the administration. However, it is a worthy goal to try to rationalize this relationship, in light of the kind of responsible and nimble department the country needs today.

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