Effectiveness audit: The Department of Health and Human Services
Organization to be analyzed
The Department of Health and Human Services is the umbrella organization within the U.S. government devoted to improving the welfare of citizens through various wellness promotional efforts. Its website proclaims that "the Department of Health and Human Services (HHS) is the United States government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves" (About, 2013, HHS). The HHS focus is on the 'human' dimension of healthcare. This means that it has made a commitment to partnering with state and local offices to promote various health initiatives, such as disease containment and preventative medicine. This ensures that health needs can be met in an individualized manner, given that different groups and people have different health needs over their respective lifecycles.
According to the HHS website, "the Department's programs are administered by 11 operating divisions, including eight agencies in the U.S. Public Health Service and three human services agencies" (About, 2013, HHS). Such agencies include the Food and Drug Administration (FDA), the Centers for Disease Control (CDC), and National Institute of Health (NIH). Measuring the effectiveness of the organization requires attention to the following core components:
1. Motivation: Alignment of actions with stated goals
2. Productivity: Ability to achieve those goals
3. Diversity: Representing the interests of persons from historically-discriminated against groups as well as the majority population
4. Group development: The fostering of groups within the agency that address critical health concerns
5. Team building: Creating productive dialogue within departments as measured by the ability to address critical health initiatives
6. Collaboration and coordination with outside contractors: Creating productive external dialogue as measured by the completion of critical health initiatives
7. Decision-making: The ability to come to effective results-oriented decisions
8. Communication processes: The ability to communicate within government and to the public
9. Power and politics: The ability to support effective legislation and initiatives to improve human health
10. Organizational culture: The support of dynamic change vs. stasis
The current leadership of the HHS has shown a willingness to address some major demands currently placed upon the nation's health infrastructure. It was the agency responsible for overseeing the reforms of the nation's healthcare system through the Affordable Health Act. HHS Secretary Kathleen Sebelius has been unflagging in her motivation to implement the law. "In her zeal to make the health care law work, Ms. Sebelius has tested the limits of her authority. After Congress refused to provide as much as she wanted for a nationwide campaign publicizing the new insurance options, she shuffled money between government accounts and sought cash from outside groups" (Pear 2013:1). Because many states have refused to set up their own health insurance marketplaces, one of the provisions of the law, HHS has taken over this task, further expanding the federal government's role in the healthcare system (Pear 2013:1). However, to facilitate acceptance and to counteract critics of what is seen as federal interference, "instead of defining a uniform national set of essential health benefits, she has allowed each state to specify the benefits that must be provided in 10 broad categories" (Pear 2013:1).
HHS has also been highly motivated in bringing into action the First Lady's 'Let's Move' campaign for young people, in the fight against childhood obesity. The Let's Move initiative involves partnerships with schools, parents, and other community and faith-based organizations, in an effort to reduce childhood obesity. "The [obesity] numbers are even higher in African-American and Hispanic communities, where nearly 40% of the children are overweight or obese" (Initiatives, 2013, HHS). The rapid expansion of this initiative, which began only in 2010, is testimony to the ability to command organizational resources and the HHS motivation for change. HHS thus has shown a willingness to participate in setting health-related goals and to support them with meaningful policies, demonstrating true motivation and commitment to the current administration's articulated health objectives.
One of the problems with measuring the success rate of health-related initiatives is that that they take so long to be realized. Motivating changes in behavior regarding drug use, smoking, condom use, eating, and exercise can be very difficult, given that personal habits can be extremely ingrained in the individual's lifestyle. There are also many biological and sociological factors that can affect health-related decisions beyond a health agency's immediate control, such as a propensity to developing metabolic system or a lack of access to healthy foods. However, there are hopeful developments. For example, regarding the problem of childhood obesity, there are indications that levels are beginning to stabilize. According to the CDC, one of the agencies under the oversight of the HHS, "the rates of childhood obesity have remained statistically the same for the past 10 years (Toporek 2013). Although obesity has risen rapidly, the response of HHS seems to have had some productive effects on the lives of young people.
HHS regularly audits its core programs to ensure that they are producing expected results. For example, another component of the Department's commitment to overseeing the health of young people is its monitoring of visiting services to pregnant women and women with young children. Its Home Visiting Evidence of Effectiveness (HomVEE) program is designed to conduct a "thorough and transparent review of the home visiting research literature and provide an assessment of the evidence of effectiveness for home visiting programs models that target families with pregnant women and children from birth to age 5" (HomVEE, 2013, HHS). Although such programs may be administered through the states, HHS uses its own resources to ensure that the needs of women and children are adequately addressed. This is designed to satisfy a provision of the Patient Protection and Affordable Care Act called the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) that provides $1.5 billion over five years to states. "The Act stipulates that 75% of the funds must be used for home visiting programs with evidence of effectiveness based on rigorous evaluation research. The HomVEE review provides information about which home visiting program models have evidence of effectiveness as required by the legislation and defined by HHS, as well as detailed information about the samples of families who participated in the research, the outcomes measured in each study, and the implementation guidelines for each model" (HomVEE, 2013, HHS).
The fact that the HHS was able to move with relative swiftness to implement such a program and the vital need for scarce healthcare resources to be spent effectively is testimony to the agency's productivity in some areas. However, other components of HHS have been subject to a great deal of criticism: the FDA has been accused of being insufficiently proactive in approving drugs for cancer and other life-threatening conditions, for example, or of exercising oversight into critical areas of food and drug safety.
The issue of health affects all Americans, regardless of gender, socio-economic class, sexual orientation, ethnicity, or religion. Thus, the mission of HHS is by definition extremely broad. It is true that some of the HHS services are specific to issues that affect the poor in greater proportion, or certain population groups. For example, Indian Health Service (IHS) specifically addresses the needs of Native Americans and the National Institutes of Health (NIH) has subdivisions which address sufferers of various conditions and diseases, spanning from rare genetic disorders to women's health issues. Other components of HHS are more general, such as the FDA (Food and Drug Administration) which oversees the safety of all Americans in terms of the foods they consume and the drugs they use.
HHS is an EEOC employer, underlining the belief that a diverse workforce is often more sensitive to the concerns of employees. Given that historically the needs of specific groups such as African-Americans and women have been overlooked in medical research, the need to present a diverse face to the public is especially acute. The current head of HHS is female but more importantly the different divisions of HHS specifically note when maternal care and other group-specific needs are addressed within the overview of the agency scope. For example, even the very general component of the HHS entitled Health Resources and Human Service Administration specifically has areas devoted to maternal and women's health.
As noted in its official vision statement, HHS has a particularly important role in aiding persons who are disadvantaged due to socio-economic status. Poverty can cause health problems due to stress and a lack of affordable, healthy food as well as exacerbate the effects of unrelated health issues. Preventative medicine is particularly important in mitigating the effects of poverty, a fact acknowledged by HHS.
Collaboration within the agency is a vital component of serving its mission. Health-related programs require the participation of a variety of groups, including those devoted to research, information-gathering, program design, and program implementation. For example, part of the responsibilities of the CDC…