However, the effectiveness of the organization of research and service activities is also expressed (4) in management functions such as planning, priority setting, and budgeting; (5) in the creation of mechanisms to allow for timely response to new information and policies such as research information and service problems; (6) in the development of mechanisms for effective dissemination of research findings into clinical practice, as well as for identification and translation of clinical issues into research priorities; and (7) in mechanisms for recruitment and retention of talented leadership. The committee evaluated each of these functions for ADAMHA and, as appropriate, for the National Institutes of Health (NIH) and the Health Resources and Services Administration (HRSA), as well as for the Public Health Service (PHS) as a whole.

This chapter begins with a discussion of the goals and missions (including funding) of the PHS and its agencies and then moves to a discussion of the research–services continuum—the relationship between research and services programs in the PHS. It continues with a discussion of management issues, including planning, priority setting, and budgeting; timeliness of response to new information and policies; and dissemination. It then discusses organizational effectiveness as seen in research, demonstration, and services development programs and concludes with a discussion of organizational capacity and program placement.


Congressional authorizations and statements of mission strongly influence the “culture” and activities of government organizations. Within DHHS, in some instances, the management of programs is assigned to a specific agency. In other instances, management is assigned to the Secretary, who may delegate primary program responsibility to one or more specific DHHS components. A department or an agency's mission is the purpose for which it was established. However, missions are more than statements of task. Goals and missions “describe what it is hoped the organization 's activities will do and produce; they say something about what and who is important. . . .” 1

While goals and missions, in and of themselves, do not define the organizational structures that are required to carry them out, they do define the arena within which government organizations can operate and the activities for which they will be held accountable. As

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