Guest Editorial: Are Large Public Organizations Manageable?

Americans like many big things: cars, open spaces, movies. But we don't like big bureaucracies. Americans think that large government organizations are too complex, too impersonal, too inefficient, and cost too much. They are partly right. But at the same time that Americans express a dislike of bureaucracy, they also treasure many of the programs that government runs. The paradox is illustrated by the comment of one individual: "Keep your bureaucratic hands off of my Medicare. " This paradox was very much on my mind in 1993 when the president asked me to become the chief executive officer (CEO) of one of the largest government organizations in the world. This was not my first encounter with the federal government; I had already served in the Carter administration and had close contact with government in my jobs as the president of two leading public universities. But I knew that taking over the leadership of the Department of Health and Human Services (HHS), a department whose budget, at that time, consumed 40 percent of federal spending--would be unlike anything I ever did before. (1) The Department of Health and Human Services (HHS) includes more than 300 programs, covering a wide spectrum of activities in medical and social science research; food and drug safety; financial assistance and health care for low income, elderly, and disabled Americans; child support enforcement; maternal and infant health; substance abuse treatment and prevention; and services for older Americans. The $354 billion budget for Fiscal Year 1997 is implemented by 59,000 employees. The department is the largest grantmaking agency in the federal government, providing some 60,000 grants per year. It is also the nation's largest health insurer, handling more than 800 million claims per year. The department's programs are administered by 11 operating divisions in both headquarter locations as well as ten regional offices. The department has a vast array of constituencies that reflect its multiple programs. It works closely with state and local governments since many of the services funded by the department are provided by state or county agencies or through private sector grantees. Because of its size and complexity, HHS is one of the most difficult jobs in the world for a public official. It is also a department whose policies touch the lives of every American. While HHS has many unique attributes, it shares a number of elements with other federal departments. I found, for example, that the reflections of Carter Administration Treasury Secretary Michael Blumenthal (1979) on his experience were very useful as I began my tenure in HHS. As I reflect on my experience over the years, I must acknowledge that we have not accomplished everything we wanted to. All of us have taken some wrong turns and endured the hard lessons of that great teacher: experience. Let me start by knocking down two myths. The first, described by Hargrove and Glidewill (1990), is that my job--and others like it--are simply impossible. Too many difficult clients. Too many internal conflicts. Too little public confidence. But I found that it is nor true. Managing a large organization is the art of the possible, the art of finding the possible within what might be viewed as impossible pressures. The second myth goes back to the theories of Frederick Taylor (1967). He viewed organizations as essentially machines. He did not focus on the human dimensions of management, the personal challenges that any manager faces. His approach would lead a manager to believe that if you pull the right levers in the right way, you'll get the right result. Were it only that easy! In complex organizations there will be failures for any number of reasons: poor communication, impractical or unclear goals, lack of public or congressional support, lack of sufficient expertise or resources, too much--or too little--oversight, and too much work. Between these two extremes--that nothing works or that everything can be made to work --lies some basic truths about large modern organizations. …