Management of HHS: Using the Office of the Secretary to Enhance Departmental Effectiveness

Highlights

GAO examined the role and operations of the Health and Human Services' (HHS) Office of the Secretary (OS) in managing HHS programs and activities.

Recommendations

Recommendations for Executive Action

Agency Affected	Recommendation	Status
Department of Health and Human Services	The Secretary of Health and Human Services should develop and institute a departmental planning process to establish goals and objectives for the future of HHS operations and the nation's health and human services programs.	Closed – Implemented The Secretary now leads a departmentwide planning process with HHS component heads. HHS published a strategic plan which outlines national health and human services goals and objectives. The Secretary meets quarterly with program directors to review national health and human services policy and to improve intra-departmental coordination.
Department of Health and Human Services	The Secretary of Health and Human Services should develop and institute a departmental planning process to develop alternative strategies to accomplish those departmental goals and objectives.	Closed – Implemented The Secretary stated that HHS established planning activities to systematically develop departmental objectives, will use the Policy Council to develop key policy issues, and provide secretarial guidance in the development of regulatory and other policy proposals.
Department of Health and Human Services	The Secretary of Health and Human Services should establish some means to monitor and oversee the progress that HHS makes toward achieving desired goals and objectives.	Closed – Implemented The Secretary stated that HHS has established activities to monitor departmental milestones, and the Policy Council tracked key policy issues. The Secretary meets daily with key staff and uses monthly reports to keep on top of current activities and impending issues.
Department of Health and Human Services	The Secretary of Health and Human Services should use the Executive Secretary clearance process as the key vehicle for managing decisions and enhance its effectiveness by establishing some means to resolve significant disputes promptly, such as setting deadlines for when unresolved disputes will be referred to the Secretary.	Closed – Implemented The Secretary stated that he reinforced the role of the Executive Secretariat in managing the department's decisionmaking process, and clarified the role of each departmental component's participation in the clearance process.
Department of Health and Human Services	The Secretary of Health and Human Services should use the Executive Secretary clearance process as a key vehicle for managing decisions and enhance its effectiveness by integrating the clearance process with standing councils or other decision mechanisms used in HHS.	Closed – Implemented The Secretary stated that he enhanced the role of the Executive Secretariat in managing the department's decisionmaking process. He did not mention specifically that this includes stronger linkage with standing councils.
Department of Health and Human Services	The Secretary of Health and Human Services should use the Executive Secretary clearance process as the key vehicle for managing decisions and enhance its effectiveness by using the clearance process to provide early guidance on significant issues.	Closed – Implemented The Secretary stated that the Executive Secretariat's decisionmaking role has been strengthened, and that he has established a system for early warning and identification of policy issues. He does not state explicitly, however, that the new early warning system is included in Executive Secretariat activities.
Department of Health and Human Services	The Secretary of Health and Human Services should use the Executive Secretary clearance process as the key vehicle for managing decisions and enhance its effectiveness by preventing individuals from circumventing the process.	Closed – Implemented The Secretary stated that the Executive Secretariat's role has been strengthened and that the role of each departmental component in the clearance process clarified. Follow-up will determine if these actions were sufficient to prevent circumvention of the process.
Department of Health and Human Services	The Secretary of Health and Human Services should take steps to ensure that HHS: (1) consults in a timely manner with appropriate external parties having an interest in the policy being considered; and (2) pretests those policies that involve public education strategies.	Closed – Implemented The Secretary strengthened the HHS policy development process by clarifying the role of the Policy Council, eliminating the Management Council, and re-affirming the roles and relationships of key managers, particularly the Executive Secretary. OS will pretest policies prior to implementation, when appropriate.
Department of Health and Human Services	To help develop an effective leadership team and foster accountability within HHS, the Secretary of Health and Human Services should establish formal or informal means to oversee and monitor the performance of key departmental programs and administrative activities that are delegated to others to manage.	Closed – Implemented The Secretary stated that he will conduct daily meetings with key staff and use senior staff retreats for review of strategic plans and development of policy issues.
Department of Health and Human Services	To help develop an effective leadership team and foster accountability within HHS, the Secretary of Health and Human Services should, if he or she chooses to continue the use of the chief of staff position, define the duties and responsibilities of that position so that they do not conflict with the formal authorities assigned to other high-level departmental officials.	Closed – Implemented The Secretary stated that he has clarified the roles of the Under Secretary, Chief of Staff, and Executive Secretary. He did not state specifically, however, that the duties and responsibilities of each have been clearly delineated.
Department of Health and Human Services	To help develop an effective leadership team and foster accountability within HHS, the Secretary of Health and Human Services should clarify early in his or her term the roles and authorities to be assigned to key HHS leaders, formally communicate those roles and authorities through updated mission and function statements, and adhere to the assigned lines of authority.	Closed – Implemented The Secretary stated that he has clarified the roles of the Under Secretary, Chief of Staff, and Executive Secretary. He did not state specifically, however, that the authorities of each have been clarified.
Department of Health and Human Services	The Secretary of Health and Human Services should establish and lead a departmental strategic workforce planning effort. Successful accomplishment of such planning will require integration of budget and personnel functions to consider both workforce size and skill needs.	Closed – Implemented After several assessments by the Assistant Secretary for Personnel (ASPER), HHS has put in place a strategic human resources planning process led by ASPER. The process involves HHS' operating divisions and develops short and long-range planning objectives reflecting budget and operational issues.
Department of Health and Human Services	The Secretary of Health and Human Services should establish and lead a departmental strategic workforce planning effort. Successful accomplishment of such planning will require cooperation between line and staff managers.	Closed – Implemented The Secretary has sponsored a departmentwide Total Quality Management (TQM) effort that encourages cooperation between line and staff managers. The HHS Quality Council, comprised of staff from the OS and component divisions, makes recommendations and identify TQM pilot projects.
Department of Health and Human Services	The Secretary of Health and Human Services should establish and lead a departmental strategic workforce planning effort. Successful accomplishment of such planning will require a new leadership role for the Assistant Secretary for Personnel Administration (ASPER) to guide and support human resources management (HRM) efforts throughout HHS.	Closed – Implemented The Secretary has endorsed the ASPER role in implementing TQM throughout the department. To guide and support HRM activities, ASPER now focuses on meeting the needs of HHS personnel lists and line managers as part of a new customer orientation.
Department of Health and Human Services	The Secretary of Health and Human Services should continue the HHS investment in its Information Resources Management (IRM) Program by ensuring that resources are available to develop needed IRM policies.	Closed – Implemented In June 1990, the Secretary ensured resources would be available to HHS IRM efforts by selecting a new Deputy Assistant Secretary for IRM. The DAS upgraded and instituted procedures to develop IRM strategic policies, and formulated subsequent action plans. IRM policies have been documented and published; as a result, there is much better awareness of IRM policy.
Department of Health and Human Services	The Secretary of Health and Human Services should continue the HHS investment in its IRM program by ensuring that resources are available to implement the Office of the Assistant Secretary for Management and Budget (ASMB) IRM strategic planning process, focusing on information planning and extending the process to include steps discussed in this report.	Closed – Implemented The Deputy Assistant Secretary for IRM has resources available to implement an IRM strategic planning process. Further, the DAS has formulated subsequent action plans needed to accomplish specific IRM objectives. The HHS budget provides resources for IRM strategic planning.
Department of Health and Human Services	The Secretary of Health and Human Services should continue the HHS investment in its IRM program by ensuring that resources are available to start and continue ASMB broad reviews of operating division IRM offices.	Closed – Implemented The Deputy Assistant Secretary for IRM has resources available to continue reviews of operating divisions' IRM offices. The DAS has a mandate to organize and build a departmentwide, coordinated IRM system.
Department of Health and Human Services	The Secretary of Health and Human Services should continue the HHS investment in its IRM program by ensuring that resources are available to assess HHS IRM skill needs.	Closed – Implemented The Deputy Assistant Secretary for IRM has resources available for assessing HHS IRM skill needs. The DAS coordinates with HHS components to address this area.
Department of Health and Human Services	The Secretary of Health and Human Services should continue the HHS investment in its IRM program by ensuring that resources are available to continue to provide technical support to OS.	Closed – Implemented The IRM Information Strategy Planning Process supports the department's strategic planning process and provides a rational process for funding IRM applications development. The DAS supports the integration of OS data systems, identifying barriers to effective systems, and elimination of redundant systems. The DAS will enhance systems interconnectivity by using a "information engineering" model.
Department of Health and Human Services	The Secretary of Health and Human Services should support the goals and objectives of the Phoenix plan by providing adequate funding for the upgraded systems.	Closed – Implemented The Secretary continues to fund and support the goals and objectives of the Phoenix project. The project is expected to meet its revised implementation milestones.
Department of Health and Human Services	The Secretary of Health and Human Services should support the goals and objectives of the Phoenix plan by providing enough qualified staff to operate and maintain the modern systems.	Closed – Implemented After experiencing a period of uncertainty regarding the extent of staff resources, the Phoenix project now receives adequate resources and complete secretarial support. The project is expected to be implemented fully and meet revised milestones.

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