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HHS in the 21st Century: Charting a New Course for a Healthier America
have a strategic perspective to enable them to anticipate and shape the evolution of cutting-edge research, public health and human services program initiatives, and regulatory oversight.
As a previous IOM committee remarked, “Healthy organizations require effective and stable leadership” (IOM, 2007). Once key officials are selected, they need to be in place long enough to appreciate fully the challenges, pressures, and opportunities their agencies face; to understand the strengths and weaknesses of major units and staff leaders; to effectively plan ways to build on strengths and shore up deficits; to become effective advocates for their agencies; to build productive relationships with the secretary, key agency staff, and important players outside the agency; and, in general, to carry out the administration’s, department’s, and agency’s immediate and long-term priorities. Such facility is not acquired overnight, which is one reason the committee endorses prompt filling of key scientific agency positions.
The committee is also persuaded that it would be helpful for Congress and the secretary to consider whether longer fixed-term appointments would be beneficial in establishing continuity and improving performance. Previous reports from the Government Accountability Office (GAO) and the National Academy of Sciences have reported that turnover in government agency leaders “is linked with a focus on short-term goals and uncertain accountability and that fixed terms … help to ensure stability and strengthen an agency’s leadership” (IOM, 2007).
The committee recognizes that an administration or secretary may have strong candidates of their own for these positions and that solid, trusting working relationships between the secretary and agency heads are essential. However, if agency head appointments are, as recommended, based on leadership, management skills, and scientific expertise, with minimal political considerations, then incumbents to these positions may well survive a change in administration. The committee recommends that multiyear, fixed terms be considered,3 because it would support greater management and intellectual continuity—especially for research projects with long trajectories—avoid at least some turnover that may be unnecessary, decrease the amount of time that top leadership
Note that the director of the National Science Foundation and the commissioner of the Social Security Administration currently have six-year terms; that commissioners of the Federal Communications Commission have five-year terms; and that past IOM committees likewise recommended a six-year term for the NIH Director and FDA Commissioner.