When the Map Is Redrawn, Bring a Compass: Why Governance Tools Matter in the HHS Restructuring
By Tim Gieseke, Creator of the Governance Compass and the Governance Style Assessment
The recently leaked HHS reorganization plans — a 64-page, “pre-decisional” Office of Management and Budget document — have landed like a policy earthquake across America’s healthcare landscape. If implemented, these sweeping changes would dismantle or absorb major agencies such as the Health Resources and Services Administration (HRSA), the Administration for Community Living (ACL), and the Substance Abuse and Mental Health Services Administration (SAMHSA), consolidating many of their functions into a new entity: the Administration for a Healthy America (AHA).
But while the media focuses on budget lines and bureaucratic fallout, we risk overlooking a more fundamental crisis — and opportunity: the collapse and reformation of health care governance itself.
Governance is the Infrastructure Behind the Infrastructure
Behind every public health initiative, rural care program, or behavioral health service lies a governance system: who decides, who collaborates, who funds, who leads, and how power is shared. The fragmentation this reorganization introduces isn’t just structural — it’s epistemic. Former partners, co-funders, and collaborators will now find themselves in new constellations with new rules and fewer resources.
Without a way to understand and align these governance dynamics, even well-intended efforts will stumble. What’s needed now is not just organizational restructuring, but governance re-architecture.
A Governance Compass for the Collaborative Age
The GSA is a diagnostic and design tool built to help actors in complex systems — especially public health, social care, and community resilience — understand their governance preferences and align around shared frameworks. It helps organizations identify how they instinctively govern: through hierarchy, market logic, or network collaboration.
More importantly, it gives teams a way to talk about governance differences before they become barriers. When federal agencies dissolve or merge, and entire programs are eliminated — rural health, minority health, tribal health, youth violence prevention — it’s not just dollars that disappear. Governance relationships disappear too.
But relationships can be rebuilt — if we bring the right lens.
Meta-Governors for a Meta-Challenge
We are entering a period of meta-governance — where the biggest task isn’t just delivering services but organizing the organizers. The GSA supports the training of meta-governors — collaboration facilitators who guide groups through the process of designing governance frameworks that fit the problem and the people.
As state governments, nonprofits, and intermediary organizations scramble to fill the void left by federal retrenchment, they need more than funding. They need a shared governance language, a way to build adaptive, decentralized partnerships that can survive political whiplash.
From Breakdown to Breakthrough
Crises often clarify what we’ve taken for granted. The invisible scaffolding of our public systems — the rules, roles, and relationships that govern collaboration — can no longer be assumed. If the HHS document becomes reality, we are not just facing a budget cut. We are facing a governance collapse followed by a chaotic rebuilding.
This is not the time to be improvising governance in the dark.
We must bring a governance compass.
About the Author
Tim Gieseke is the creator of the Governance Style Assessment, a tool designed to help cross-sector collaborations align governance approaches for complex problem-solving.
Most of his career he has engaged in the landscape sustainability arena with common governance issues. He wrote Shared Governance for Sustainable Working Landscapes (2016) and defined a common governance unit. In 2019, he published Collaborative Environmental Governance Frameworks to introduce the governance compass and the need for meta-governors in our increasing complex world.
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