1. Shared values—the organization’s fundamental, widely shared values that signal what is important to it (Bradach, 1996)

The committee believes that the department will derive great benefit from comprehensive organizational reform strategies that take into account fundamental structures and processes, such as those listed above.

While significant alterations in HHS structure would not be easy—or even possible—the decision-making and management processes at all levels of the department can change, and this is where the new secretary can make the most progress in responding to the concerns the House committee has raised.

The IOM committee’s recommendations (see Box 1-2) are interrelated and mutually supportive. Many of them would require involvement and approval from Congress and the White House. They would ensure value in HHS operations and would focus the department squarely on purpose, which is essential to both performance and accountability. The committee believes that improved performance and accountability could strengthen the cooperation with Congress that the department urgently needs in order to move forward. The recommendations would

  • focus the department on the most important health challenges for the nation (Recommendation 1),

  • strengthen its organizational capacity to address these challenges (Recommendation 2),

  • foster improved performance of the nation’s health system overall (Recommendation 3),

  • ensure the necessary workforce (Recommendation 4), and

  • increase the department’s accountability and give it more flexibility (Recommendation 5).

HHS has a long history of accomplishment and evolution to meet new needs, but it cannot afford to become stalemated by its own processes and precedents or by statutory restrictions that impede its ability to function effectively. Implementation of the committee’s recommendations would better position HHS to meet both rapidly emerging and enduring health challenges in the twenty-first century.

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