• Are the activities of its individual agencies aligned to optimally support the overall health mission of HHS? Should the operations of individual agencies be changed, consolidated, or realigned to make them collectively more effective in advancing the health of the nation?

  • How can the governance of HHS be best organized to support and manage its responsibilities, function, and mission? How could the focus of individual agencies be improved to enhance their accountability and efficiency?

  • How can relevant data be collected, integrated, and shared within and outside HHS in a way that is available, transparent, and useful for government and public decision making?

Assumptions and Approach

The 15-member IOM committee—all of whose members had either direct management experience in the department or significant expertise in relevant areas—used multiple resources to better understand the internal operational challenges that impede the department’s efficiency and effectiveness. The members received a summary of interviews with the secretaries who led the department during the six most recent presidential transitions, an analysis of key statutory requirements for the department, relevant management literature, and reports on HHS’s recent performance.

HHS has a staggering range of responsibilities. Addressing them is hampered by the diversity of its agencies’ missions and goals, little discretionary funding, workforce shortages (and impending retirement of expert staff), fragmentation of responsibility for health issues across congressional committees, varying stakeholder priorities—including those of Congress and the White House—and difficulty in partnering effectively with states and the private sector. Such challenges partially explain the lack of progress in achieving the nation’s health goals, enumerated in the best-known of several sets of departmental aims, the Healthy People 2010 objectives.

The most critical conclusion that the committee came to (especially in light of the representatives’ request that recommendations consider a shorter time frame and require minimal resources) was that large-scale reorganization of the entire department was not the best way to support key decision makers at HHS. The committee decided not to take the path of “moving around the boxes” for several reasons:

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