widely, and that the department’s activities must be aligned to achieve them (see Chapter 3).
A focus on purpose—vision, mission, and goals—is preferable to a focus on structure, because attention paid to purpose should result in a strategic cohesiveness within the entire department, while attention paid to structure and reorganization is likely to yield more limited benefits, at high cost (Waterman et al., 1980). The vision and mission statements should be intended to endure. They should provide program continuity in the face of presidential transitions and when new secretaries and new executive leadership comes aboard. Also, the vision and mission statements should encourage rather than stifle creativity and innovation.2
Clear purpose can help inform budget decisions and focus attention on long-term needs, including how to achieve sustainability in the department’s programs, especially Medicare and Medicaid. Guided by department goals, the budgets of the leading Public Health Service agencies—the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and Food and Drug Administration (FDA), in particular—could be more predictable, rather than showing wide year-to-year fluctuations (see Chapter 3). If more predictable funding arrangements could be worked out with Congress, this budgetary continuity not only would aid federal public health efforts, but could also stabilize federally funded community-based programs.
Clear purpose facilitates program evaluation, discussed in Chapter 6. Evaluation results should help refine goals, while the vision and mission remain intact.
Finally, clear purpose helps others—in Congress, throughout government, throughout the health sector, and in the nation at large—understand the role and importance of the department’s work.
Just as words are no substitute for action, vision and mission statements are no substitute for leadership. The department needs an effective leader to set it on course and keep it there, to achieve real progress. Within the limits imposed by Congress, ultimately, it will be the secretary’s responsibility to ensure department-wide integration of the vision, mission, and goals into HHS daily activities and operations.