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.

The case examines how Secretary Donna Shalala handle the tension between centralization and decentralization. What implications do you get in designing appropriate organization structure?