Research and Service Programs in the PHS: Challenges in Organization (1991)

ACTIONS FOR CONGRESS:

• If reorganization of current agency structure is considered, it should be justified purely on policy grounds.

• When Congress initiates or authorizes new research or service programs, it should consult with the Secretary of Health and Human Services to determine the appropriate locus of program administration within the Department. Priority should be given to providing sufficient staff and financial resources to carry out a new function.

ACTIONS FOR THE SECRETARY OF HEALTH AND HUMAN SERVICES:

• The Secretary should further clarify the service mission of the PHS. Service programs should be given stability of organizational location, financing, personnel, and other resources.

• Below the agency level, research and service programs should be administered and conducted by separate institutes or offices.

ACTIONS FOR THE ASSISTANT SECRETARY FOR HEALTH:

• The Assistant Secretary for Health should assess and enhance the integration of program objectives related to the service mission across agencies in the PHS.

• All agencies within the PHS and each research institute should be mandated to develop five-year plans, the process for which shall be reviewed by the Assistant Secretary for Health.

• An interagency task force should be formed to develop a standard nomenclature for classifying basic and clinical research, demonstrations, dissemination, and service development activities across the PHS.

PROGRAMMATIC RECOMMENDATIONS:

• Validation through replication should be ensured in new and ongoing research demonstrations following single-site demonstrations and prior to national dissemination.

• A research program should be initiated to determine effective dissemination mechanisms for demonstrations and the results of health services research.

• A plan for incentives for translation of successful demonstration findings into the structure and delivery of services should be accompanied by opportunities for state review and comment on all types of federal demonstration applications.

• Potential sources of postdemonstration funding for successful demonstrations (i.e., federal, state, local, and private sources) also should be explored prior to initiating a demonstration project.

• Responsibility for technical assistance and clinical training programs for professionals and nonprofessionals should be a part of the explicit mission of agencies that fund and administer operating programs.