Research and Service Programs in the PHS Challenges in Organization (1991) / Chapter Skim
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Executive Summary
Executive Summary
Pages 3-12
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From page 3... ...
Since the agency's inception, the expectations for it have included sharper research focus on the interrelated ADM disorders, rapid translation of research into service delivery, and increased efficiency and effectiveness of treatment and prevention services through program integration. Over the past 25 years, a number of attempts have been made to reform the organizational structure of the Public Health Service (PHS)
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From page 4... ...
Specifically, the committee was asked for: · an evaluation of the appropriateness of administering health service programs in conjunction with the administration of biomedical and behavioral research; and · a determination of the extent of duplication among selected research programs of NIH and ADAMHA. To answer these questions, the committee was asked to develop and establish criteria and/or measures for determining the following: · the effects of administering service programs in conjunction with research and research-related activities; · the extent and effects of duplication, replication, and complementarity between the research activities of NIH and ADAMHA; · the administrative, program, and policy relationships among service programs and research activities of ADAMHA and its institutes, and the extent to which patterns of communication and leadership activities are attributable to co-administration or to other factors; and · the "appropriateness" of these effects, given both the statutory mission of the programs and the changing requirements of public policy, scientific opportunity, and economic conditions.
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From page 5... ...
The committee recommends that the Assistant Secretary for Health take responsibility for assessing and enhancing the integration of program objectives related to the services mission across agencies in the PHS. It is the impression of many science administrators in federal agencies, as well as other scientists interviewed for this study, that in the past five or ten years the research programs of ADAMHA institutes have benefited from an increasingly singular research focus.
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From page 6... ...
In cases where ADAMHA institutes currently have responsibility for treatment services demonstrations, service development, or block grant compliance programs, for example, such progroms might be placed more appropriately in an organizational unit that currently has responsibility for similar programs, along with staff of sufficient expertise in the substantive area to manage the programs effectively. Analyses conducted for this study suggest that at the agency level, there are few significant differences in the functioning of similar kinds of research programs in NIH and ADAMHA that can be attributed to organizational structure.
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From page 7... ...
PLANNING AND PRIORITY SETTING An important question for this study was whether specific mechanisms existed for relating the program objectives of research, prevention, and services development and demonstration programs both within ADAMHA and among the relevant agencies of the PHS. There is no single, coherent system that can be labeled priority setting; rather, priorities are determined as a result of myriad discrete activities involving Congress, the administration, the research and service communities, and individual program managers.
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From page 8... ...
These conflicts can result in insufficient resources being applied to a problem, inability to develop appropriate organizational structures for implementation, simple failure to initiate a program, or a deluge of demands for clarification of new legislation in the face of established, perhaps long-standing, policies that move in the opposite direction. Examples of the effects of conflicts among the expectations of the administration, Congress, and agencies include failure to replicate successful demonstrations across multiple sites prior to implementation and failure to evaluate the effectiveness of implementation prior to national dissemination.
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From page 9... ...
The committee recommends that replication, which is vital to basic and clinical research but which has not been considered a central element of demonstrations, be ensured in new and ongoing research demonstrations following single-site experiments and prior to implementation and national dissemination. A related question is whether there might be fewer obstacles to the translation of research findings into service programs in a single agency than when translation requires collaboration across a number of agencies.
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From page 10... ...
Serious questions were raised about how decisions are made about where to locate programs in the PHS and about the effects of frequent movement of programs. The committee recommends that, when Congress authorizes new research or services programs, it consult with the Secretary of Health and Human Services to determine, within a brief period of time, the appropriate locus of program administration within the department.
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From page 11... ...
The report itself and the background papers prepared for the committee provide significant information that can be used by Congress, the Secretary of Health and Human Services, the Assistant Secretary for Health, the agencies involved, and constituency groups to guide that reorganization. The responsibilities of PHS agencies and officials have grown in substantive, technical, and administrative complexity over the past 20 yeas, often without regard for order or consistency.
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From page 12... ...
While there may be strong and important reasons for making administrative changes (e.g., reorganization, joint planning efforts) , the world of service delivery is rarely affected by forms or styles of organization.
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