Managing Decentralized Departments: The Case of the U.S. Department of Health and Human Services

Since its creation in 1953 as an amalgam of several existing agencies, the U.S. Department of Health and Human Services (originally the Department of Health, education and Welfare) has struggled to find the appropriate balance between centralized functions in the Office of the Secretary and autonomy to the various agencies and bureaus contained within its boundaries. Over the years, the pendulum has swung back and forth between emphasis on centralization and decentralization. This report examines the efforts by Secretary Donna Shalala to delegate many functions to the operating components, while attempting to devise processes that emphasize coordination and crosscutting approaches as appropriate. Leadership