• To Meet Future Mission, Embrace Change and Remember Constitutional Responsibilities, Duke Urges Employees
• Agency Planning Chief Recalls Merger, Challenges of HRSA's Early Years
• HRSA Led Early Efforts to Combat Spread of HIV/AIDS
• America's Worst Day in Last 25 Years Was Also HRSA's Toughest
• News Summary: $48M goes to hospitals and clinics; $20.4M to improve poison control services
• HRSA Employees On the Move

To Meet Future Mission, Embrace Change and Remember Constitutional Responsibilities, Duke Urges Employees

“Just because that’s the way we did something in the past doesn’t mean that’s the way to do it in the future. Problems develop when we get wedded to our sense of normal procedure,” she said.

“We’ll face new technologies in four or five years that we can’t even envision right now. More things can be automated. Health information technology is coming. Think back 15 years: we use technologies today that we couldn’t even think about 15 years ago. And 15 years hence there’ll be technologies that we can’t imagine today. Things we do today will be passé, and that reality will impact the way we administer our programs.”

Duke also foresees a greater use of personalized health care — with care targeted more closely to an individual’s genetic makeup and family medical history — and greater emphasis on disease prevention activities. “Disease prevention will become a much bigger feature of the way we look at health,” she predicted. “Look at the last few years, with the prevention component being added to Medicare.”

As befits a career Federal official and a professor of political science — she still teaches after work at area universities — Duke’s views of HRSA’s future stress service to the public and open government.

Duke said she considers Federal service a noble calling. “I believe that with my heart and soul. When I came here in 2001, I found that people needed a greater appreciation of their central role in guaranteeing the public’s trust.”

Serving the people means understanding the civil servant’s role in the constitutional process, she explained.

“As Federal employees, we understand that the people choose the head of the executive branch and we work for the head of the executive branch, the President of the United States. We know, too, that we have important responsibilities to the legislature. We must remain conscious of those responsibilities and our responsibilities to serve this republic.

“My message to the workforce is that we have the privilege to serve a very great and generous nation. We have the privilege of demonstrating day in and day out the best of America.”

Associated with that, Duke explained, “we made an effort to reach out to grantees to invite them to volunteer to be grant reviewers.”

Duke said she worked to expand the pool of objective reviewers to assure the public that there was “no old boys’ network” between grantees and HRSA program officials.

And making the review process accessible on the Web made it easier for people to become reviewers, she added. “It also helped make the process more transparent.”

Duke said the themes of continuity and change that HRSA faces in the near future were similar to the challenges she faced when HHS Secretary Tommy Thompson appointed her to be HRSA’s acting administrator in March of 2001.

"My goal when Secretary Thompson sent me here was to understand the agency's mission and get it on track. I was told I would be here for about eight weeks. I asked the secretary if he wanted me to be a caretaker or to do something. He said, 'Do something,' so I did."

Besides moving to reform the grants process, Duke saw that HRSA was an "older agency" that was "in some jeopardy because so many employees were or would soon be eligible for retirement." That recognition led to the creation of the HRSA Scholars program, which has added some 250 new employees to the agency since 2001 (see item on the incoming seventh Scholar class in "On the Move" in this issue).

Duke also acted to make sure the newly announced Presidential initiative to expand the health center network and the related expansion of the National Health Service Corps could be managed effectively.

"Fairly early on, it seemed that the expansion didn't have enough oral, mental health, and behavioral health aspects built in. We needed an aggressive approach there to treat the whole person. I pushed early and hard on that and I still do."

Additionally, Duke moved to bolster HRSA's efforts to improve health care for U.S. residents along the U.S.-Mexico border. "I concluded that our border health work was dispersed and needed to be better coordinated. They have great health care needs. So I put an emphasis there." That effort led eventually to the first Border Binational Health Week activities in October of 2004 and 2005.

Her determination to embrace change and 'do something' resonated with her boss. "After a few months the secretary told me I was his person for HRSA." She was named HRSA's sixth administrator in March 2002.

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