HRSA Randomizes FQHC Program Officers, Likely Trading One Set of Problems for Another Set of Problems

In days of yore, most federal grantees had a dedicated program officer who handled budget issues, contract amendments, reports, and the like; the program officer would often conduct site visits, getting to know the executive director and the nuances of the agency and target area. This system began to atrophy during the Reagan administration with cutbacks to federal travel budgets, and today grantees rarely if ever see their program officer. For example, we’ve written many funded YouthBuild proposals for a South Central LA nonprofit, which hasn’t had a site visit from their HUD program office in 20 years of implementing over ten rounds of YouthBuild funding. Still, most grantees develop a virtual relationship with a specific program officer.

We write many HRSA proposals and were surprised to learn during a scoping call with the CEO of a long-time FQHC client that HRSA has changed this system. Instead of having an assigned program officer, HRSA program officers are now randomized. This means that when an FQHC—which often juggles multiple HRSA grants—has an issue, the problem is randomly assigned to one of a pool of program officers. This is more or less the system used when one waits in line at the DMV or Katz’s Delicatessen. At the DMV, this prevents a clerk from issuing fake drivers licenses for a bribe and the counter man at Katz’s from adding a little extra corned beef to his pal’s sandwich every day at lunchtime.

I assume the same reasoning applies at HRSA: randomizing program officers presumably is aimed at preventing special treatment for favored FQHCs or, I suppose, outright graft. Avoiding special treatment has a cost, though, as it’s likely to wildly increase inefficiency and systemic friction. One sees such problems most clearly in defense contracting, but any large bureaucracy can develop them.

In a randomized oversight management system, the program officer handling a particularly issue will have no agency background or context for the problem. I’m sure that HRSA management thinks thinks will lead to “fair” treatment for all grantees, while minimizing the potential for corruption, but it will also clog the system. HRSA program officers are probably GS 11s and 12s and, like most bureaucrats, they aren’t especially motivated to quickly solve grantee problems. Relationships with the grantees can improve motivation because most of us don’t want to be considered jerks by people we know and have repeated interactions with (why this is true is beyond the scope of this post, but Joseph Henrich’s account in The Secret of Our Success is recommended; it’s also a popular book written by a scholar, not a self-help book). Program officers get paid every two weeks, whether they solve problems or create them, as long as their breath clouds a mirror (to prove they’re still alive) when the paychecks are passed out.

HRSA is changing one set of real or imagined problems for a different set of problems. An unintended consequence of this change is also likely to be more congressional interference.

Why? Let’s say you’re the CEO of the fictional Owatonna Community Health Center and need a rapid decision to amend the agency’s NAP grant budget. In the Ancien Régime, the experienced program officer could probably be sweet-talked into a quick budget revision because of the interpersonal relationship and agency knowledge. In the new system, however, the program officer might put the request under her coffee cup and leave for five days of training, followed by vacation. Why does she care about what some random FQHC in Minnesota or wherever thinks or does?

Without any other recourse, the panicked CEO is likely to call their congressperson’s district office for relief, which will result in a field deputy harassing upper level HRSA management in Washington. This will lead to more friction and bad vibes, as management puts the congressionally-induced hammer to the program officer. The program officers will become even more bureaucratic in response, and they’ll make sure every last rule gets followed. Meticulously following rules is actually a CIA-approved method for organizational sabotage. No, seriously, it is: follow the preceding link.

We’ve written about the challenges of managing grants before. Like grant writing, grants management involves a specific set of skills and experience. Anything that makes managing grants harder is not going to help HRSA or FQHCs in the long run.

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