Department of Defense. HHS should go further in embracing this concept across its health and human services agencies. When programs are uncoordinated or operate at cross-purposes, less value is obtained.

It will not be possible to align all department activities with the recommended small number of goals, owing to agencies’ and programs’ existing responsibilities and commitments, many of which are congressionally mandated. However, a concerted effort should be made, especially within the department’s major units, to evaluate their current missions, goals, responsibilities, and available resources to ensure that, insofar as possible, they are aligned with the department’s overarching vision, mission, and goals.

Related Recommendation

  1. The heads of all department units should ensure that their activities and operations are aligned with the department’s vision, mission, and goals and marshal their resources to achieve them.

LIMIT THE NUMBER OF PEOPLE REPORTING TO THE SECRETARY

Many of this report’s recommendations begin with “The secretary” not because the committee believes that every decision should emanate from the secretary’s office, but simply because the person in that position bears ultimate responsibility for departmental operations. While the secretary needs a good rapport with the President, in addition to strong leadership and management skills, the committee places equal importance on the need for these skills among agency heads, who also must possess strong scientific and technical expertise and be able to work as a team led and coordinated, through some internal arrangement, by the secretary’s office.

Currently, 30 official positions report directly to the secretary (HHS, 2008). These positions are as powerfully endowed as the administrator of the Centers for Medicare and Medicaid Services, which is responsible for 85 percent of all HHS expenditures, and as narrowly focused as the director of the Center for Faith-Based and Community Initiatives. The sur-



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