11 * Proposed Bureau of Health Resources Planning The purpose of this paper is to present a second proposal for an HRP organization. The discussion will attempt to deal with specific issues raised as a result of the initial Droposal and will not deal with those areas where there seemed to be general agreement. Two basic promises of the initial proposal bear reiteration. Namely: 1. The functional focus of the new HRP Headquarter's Bureau, the central office (CO), would be primarily on policy and program development while principal responsibility for day- to-day program operations and administration would reside with the regional offices and their HRP staffs (RO). In short the HRP program would be a highly decentralized one from a Federal and HEW standpoint. 2. The CO organization should be a relatively "flat" one without, at the same time, requiring an unduly wide span of control. The discussion of issues assumes these basic premises are still operative and deals, for the most part, with the relative importance or priority of certain functions in terms of their specific organizational reflections or emphases. The issues can be enumerated as follows: 1. Should there be a single organizational focus for liaison with and monitoring of regional office operations? If so, where should it be placed? 2. Should there be a discreet staff focus for overall program evaluation and policy coordination? 2- 3. Where should the Management Information Systems activity be located? 4. Should there be discreet staff offices for grants and contracts management, and for communications? 1. Should there be a single organizational focus for liaison with and monitoring of regional office operations? If so, where should it be placed? The draft proposal had assumed a fairly strong regional staff operation. Dr. Wherritt's recommendations clearly suggest an even stronger posture for the regions. We believe that our first assumption lies closer to future reality. That in itself, however, does not suggest a single organizational focus. On the other hand, if our objective is to develop and maintain a management control and monitoring system in the central office, it is hard to see how it could be managed otherwise. There is no question but what there will be a need for a great deal of input from the divisions into the development of such a system. Like- wise, the divisions will have a continuing interest in the results of monitoring. The proposal simply maintains that there should be a single focus for managing the system. The need for a single focus for liaison with RO's is not nearly so clear. If it inhibits communication between the RO's and the rest of central office operations, it should be discarded. If, on the other hand, it provides a vehicle for communication on issues which cut across division lines or which do not neatl,,, fall into any category, it would be useful. Since there is a great deal of concern about the former, the proposal drops all references to a liaison function. We believe, however, that -3- an effective operations monitoring activity will provide the desired communications linkages informally. 2. Should there be a discreet staff focus for overall program evaluation and policy coordination? The issue is primarily one of the relative importance of or need for these functions. For that reason, there is the corollary question of whether there should be a sinale organizational focus for both, or separate ones. The need for policy coordination, in an HRP bureau is reasonably clear. Certain other mechanisms, such as the executive committee concept have been proposed as a means for helping to ensure that. If the latter concept should be adopted, then a separate policy coordination staff or office might still be needed. It would be respon- sible (1) for identifying policy issues and areas, potential and actual, requiring executive committee consideration and decision; and (2) in helping the program divisions with the mechanics of policy development, drafting, and clearance. If the executive committee concept is not to be implemented, then such a policy coordination staff might be even more necessary. Presumably, it would, on behalf of the Bureau Director, be responsible for the substance as well as the mechanics of policy coordi- nation. The need for a central staff focus for program evaluation is possibly less clear. Certainly the Iiierarchial "demands" for such and the potential for "embarrassment" by the failure to give material attention to program evaluation, are less than in the case of policy coordination. Moreover, the track record in terms of pa--off has been minimal in most fl programs to date. Nonetlieless, it is likely that without discreet -4- ,y many issues high-level staff "leadership" for program evaluation stratec) will not be addressed at all or will be defined too narrowly to bring about improvements in policy and management processes. The proposal recognizes the need for both functions, but suggests that they are closely enough related to be more effectively mana-ed in a single staff reporting to the Bureau Director. 3. Where should the MIS activity be located? This discussion addresses the issue of an MIS which is limited to the need to manage, control, and carry out our specific program. The direction and content of the committee discussions seemed to indicate concern that MIS should be much larger. The idea of an on line system which reaches out to the agency level is certainly an indication of this. We believe that concept should be deferred, however, in favor of the more immediate need for a basic MIS. 'Fhere seem to be three alternative approaches to organizationally locating MIS. One would be to place it in the office which will be most concerned with the input and use of program data for operations and monitoring. Certainly, it is likely that the system would be appropriately used, at least for the purposes of that Division. On the other hand, the needs of other Divisions, both for data and systems support, might well be neglected when priorities are addressed. A second approach would be to separate the entire MIS activity from any pro- gramniatic Division (including both systems support and data management) and attempt to make it responsive to all needs equally by giving it strong central leadership either through a steering committee or a program manager. The risk in this approach is that the system may become self- serving and of no particular value to anyone. The third approach--one embraced by this proposal--would attempt to strike a balance. It would place the responsibility for management of the data in the office likely to have the greatest need (Operations Monitoring) and the,systems support (systems analysis, programming and report production) activities in a separate position to serve all Bureau needs equally. The obvious waekness in this approach is that it depo-.ids on close cooperation between two separated groups of people who will both tend to see the MIS as "theirsit. Frankly, there is no easy answer to the question as to where the MIS activit,r should be located. T,3 us there are no compelling arguments for any of the alternatives. Hoivever, since we will have at least one other information gathering operation (CHRPI) which may require automated systems support, we believe the recommended approach haj the best chance for ultimate success. 4. Should there be discreet staff offices for Grants and Contracts Management, and communication? There will be a definite need for the ability to respond to Congressional and Public inquiries. Since such correspondence will most likely come to us in a controlled manner from higher levels, and the function of internal control and response is not a major or demanding one, it would not appear to require specific organizational highlighting. On the other hand, if such an activity were combined with an Executive Secretariat function, it would warrant separate status. That combination is included in this proposal. The grants management function must be viewed in terms of the contemplated -6- CO/RO relationship discussed earlier. It i.s not likely that we will want to--or that we should--maintain the kind of activity that has been the ex- per.ience, for instance, in D@IP. Grants Management is clearly the major function of regional office staffs. The central office activity will be largely limited to policy setting and interpretation on the one hand and monitoring of RO operations on the other. What is needed then, rather than a grants management staff separately identified, is to have these re- sponsibilities clearly delineated in the functional statements of the office of Operations Monitoring and the Policy Coordination and Evaluati.on Staff as proposed. Contracts management, unlike grants management, is almost exclusively a central office concern. The proposal contemplates that management of individual contracts will be performed by program analysts serving as project officers in various and appropriate places in the Bureau. In support of these activities a technical review and assistance function will be located in the Office of Management. Contracts planning or contracts strategy will reside in two places. Insofar as evaluation contracts are concerned, that will be the responsibility of the evalua- tion staff. At the same time, the Division of Planning Methods and Technology will be given responsibility for non-evaluation contracts planning and coordination since it is that Division which will be managing the bulk of any contracts which we may be contemplating. The Executive Committee Another issue which has been raised is whether there should be an executive committee of key bureau officials with the responsibility for setting and coordinating overall program policies, procedures, and the like. Since 7- the organization proposal does not require resolution of this issue, we have not addressed it here. In any case, the issue deserves much more consideration and discussion than has taken place up to this point. We would expect to see it on the agenda for future executive staff meetin-s. tH 0 >1 U) 0) o .,i 0 4-) +-) H Cld 14 > H > 00 4- U) 0 H 4-) Cd cd cn 0 u@ 4-1 0 V) 4-) tH r_ z 0 e) 0 4-) P4 z H 0 U) u bO .1i a) Cd > 0 > r_ r-i Cd 0) tH ct Q) CTJ 41 ti-4 P H bO 0 b,O t44 0 0 -4 bo V) 0 tax bb 0 .,4 0 tH 0 r_ .,q r- 4 u 0 0 -H M 9 4J 0 Ef) H @ -r-i cd a) 0 4-) 0 U Cd 4J 0 0 'H -r-i 4J 4J tH u m Cd tH .H z Cd -4 -H 4i 0 10 Cd E/) k 0 tk 0 r_ 0 u