Finally, the secretaries put their emphasis on building a mission-centered culture within the department. It is easy for HHS to divide into a series of isolated silos that are far from a “family of agencies,” as the department’s current metaphor describes them. If the department is to restore and maintain public confidence in its programs and priorities, it must articulate a unifying message that reinforces its role as the premier locus for protecting and enhancing the quality of life for all Americans.


The secretaries interviewed for this project agreed that reorganization is one of many tools for improving organizational performance. Because this philosophy of reform originates in the scientific management movement spurred forward by operations research and Frederick Taylor, it also carries the hubris perhaps that there is “one best way” for building an efficient bureaucracy.

Scientific management still holds promise for improving organizational efficiency, whether through shared administrative, or “back office” functions or through organizational synergies that might not otherwise exist under a “czar” or other integrative mechanism. However, it is only one of several philosophies for reform and competes against those who believe that increased performance comes from more aggressive oversight against fraud, waste, and abuse; more transparency regarding organizational action; or breaking free of the rules that scientific management creates.

This is not to argue that reorganization is unwarranted in all cases—to the contrary, it provides significant benefits as discussed earlier in this paper. However, the history of reorganization suggests that it may be most effective when used as a tool of last resort—that is, policy makers might be well advised to try other methods for improvement before they use reorganizations. Such methods can be more easily reversed but may solve the problem at lower cost. Being conservative may be just as wise in reorganization as it is in medicine.

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