• Be consistent with each other, across the department’s health and human services programs.

  • Balance ongoing responsibilities and new demands.

  • Be challenging, realistic, and achievable.

Setting goals makes the secretary’s job even more complicated, because the choices are so many and current responsibilities are so great. The goals should align with the vision and mission statement and should be designed to meet the established priorities. Some of the department’s goals should respond to the nation’s greatest health challenges, as the secretary and other key advisers perceive them. Other goals may need to address internal challenges related to the department’s organization and operations.

The department faces an array of internal challenges that impede its efficiency and effectiveness. Some of the challenges listed below are general problems—such as the department’s likely workforce shortage; some are specific to certain departmental units; and some reflect organizational approaches that were better designed to deal with the health problems of yesterday, not today—and much less tomorrow. Progress in responding to these internal challenges will require attention and action from some combination of the secretary, Congress, and the White House. For example:

  • They must address the extraordinary diversity in the goals of the department’s individual health and human services programs, coupled with the need to customize programs to make them effective.

  • The personal nature of health care and health maintenance requires that policies and programs take into account diversity among patients and tailor interventions to individuals.

  • The dominance of entitlement programs and other mandatory spending in the department’s annual budget leaves department leaders little flexibility in spending, while federal budget constraints limit new funding.

  • At present, there is no mechanism to finance an effective response to public health emergencies (Lister, 2008).

  • Establishing effective partnerships with state and local governments and the private sector is desirable, but difficult.

  • Currently, the secretary has significant management demands, providing direct oversight of 11 operating divisions and 15 staff



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