Results-Oriented Government: Practices That Can Help Enhance and 
Sustain Collaboration among Federal Agencies (21-OCT-05,	 
GAO-06-15).							 
                                                                 
The federal government faces a series of challenges in the 21st  
century that will be difficult, if not impossible, for any single
agency to address alone. Many issues cut across more than one	 
agency and their actions are not well coordinated. Moreover,	 
agencies face a range of barriers when they attempt to work	 
collaboratively. This report identifies key practices that can	 
help enhance and sustain agency collaboration. GAO also 	 
considered how the Government Performance and Results Act (GPRA) 
and the Office of Management and Budget (OMB) address		 
collaboration among agencies. To illustrate these practices, we  
selected the Healthy People, wildland fire management, and	 
Departments of Veterans Affairs and Defense's health resource	 
sharing collaborations. 					 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-06-15						        
    ACCNO:   A40118						        
  TITLE:     Results-Oriented Government: Practices That Can Help     
Enhance and Sustain Collaboration among Federal Agencies	 
     DATE:   10/21/2005 
  SUBJECT:   Federal agencies					 
	     Interagency relations				 
	     Productivity in government 			 
	     Strategic planning 				 
	     Performance management				 
	     Performance measures				 
	     Performance plans					 
	     OMB Program Assessment Rating Tool 		 
	     President's Management Agenda			 

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GAO-06-15

     

     * Results in Brief
     * Background
          * Federal Collaborative Efforts We Reviewed
               * Healthy People 2010
               * Wildland Fire Management
               * VA and DOD Health Resource Sharing
     * Key Practices That Can Help Enhance and Sustain Collaboration among
       Federal Agencies
          * Define and Articulate the Common Outcome
          * Establish Mutually Reinforcing or Joint Strategies
          * Identify and Address Needs by Leveraging Resources
          * Agree on Roles and Responsibilities
          * Establish Compatible Policies, Procedures, and Other Means to
            Operate across Agency Boundaries
          * Develop Mechanisms to Monitor, Evaluate, and Report Results
          * Reinforce Agency Accountability for Collaborative Efforts through
            Agency Plans and Reports
          * Reinforce Individual Accountability for Collaborative Efforts
            through Performance Management Systems
     * GPRA and OMB's Management Tools Offer Opportuniti
     * Conclusions
     * Recommendation for Executive Action
     * Agency Comments and Our Evaluation
     * Appendix I: Scope and Methodology
     * Appendix II: Federal Collaborative Efforts We Reviewed
     * Appendix III: GAO Contact and Staff Acknowledgments
          * GAO Contact
          * Acknowledgments
               * Order by Mail or Phone

                 United States Government Accountability Office

Report to the Chairman, Subcommittee on

 Oversight of Government Management, the Federal Workforce, and the District of
 Columbia, Committee on Homeland Security and Governmental Affairs, U.S. Senate

October 2005

RESULTS-ORIENTED GOVERNMENT

Practices That Can Help Enhance and Sustain Collaboration among Federal Agencies

                                       a

GAO-06-15

RESULTS-ORIENTED GOVERNMENT

Practices That Can Help Enhance and Sustain Collaboration among Federal
Agencies

  What GAO Found

Collaboration can be broadly defined as any joint activity that is
intended to produce more public value than could be produced when the
organizations act alone. Agencies can enhance and sustain their
collaborative efforts by engaging in the eight practices identified below.
Running throughout these practices are a number of factors such as
leadership, trust, and organizational culture that are necessary elements
for a collaborative working relationship:

     o define and articulate a common outcome;
     o establish mutually reinforcing or joint strategies;
     o identify and address needs by leveraging resources;
     o agree on roles and responsibilities;
     o establish compatible policies, procedures, and other means to operate
       across agency boundaries;
     o develop mechanisms to monitor, evaluate, and report on results;
     o reinforce agency accountability for collaborative efforts through
       agency plans and reports; and
     o reinforce individual accountability for collaborative efforts through
       performance management systems.

GAO has previously reported that GPRA, with its focus on strategic
planning, the development of long-term goals, and accountability for
results, provides a framework Congress, OMB, and executive branch agencies
can use to consider the appropriate mix of long-term strategic goals and
strategies needed to identify and address issues that cut across agency
boundaries. In addition, to provide a broader perspective on the federal
government's goals and strategies to address issues that cut across
agencies, we previously recommended that (1) OMB develop a governmentwide
performance plan as required by GPRA and (2) Congress consider amending
GPRA to require a governmentwide strategic plan.

OMB, through the PMA, has emphasized improving government performance
through governmentwide and agency-specific initiatives. One of these
focuses specifically on improving coordination, but only between the
Departments of Veterans Affairs and Defense for health programs and
systems. However, many other areas that cut across agency boundaries would
benefit from greater OMB focus and attention, including information
sharing for homeland security, which GAO recently designated as a
high-risk area. OMB has also used its PART diagnostic tool to determine,
among other things, whether individual programs duplicate other efforts
and if agencies coordinate and collaborate effectively with related
programs. The PART tool provides general guidance for assessing effective
program coordination and collaboration, but does not discuss practices for
enhancing and sustaining collaboration, such as those described and
illustrated in this report.

                 United States Government Accountability Office

Contents

Letter 1
Results in Brief 4
Background 6
Key Practices That Can Help Enhance and Sustain Collaboration among
Federal Agencies 10
GPRA and OMB's Management Tools Offer Opportunities to Foster Greater
Collaboration among Federal Agencies 26
Conclusions 29
Recommendation for Executive Action 30
Agency Comments and Our Evaluation 30
: Federal Collaborative Efforts We Reviewed

Appendix I Scope and Methodology

Appendix II Federal Collaborative Efforts We Reviewed

Appendix III GAO Contact and Staff Acknowledgments

Abbreviations

CDC               Centers for Disease Control and Prevention               
DOD               Department of Defense                                    
DOE               Department of Energy                                     
FDA               Food and Drug Administration                             
GPRA              Government Performance and Results Act of 1993           
HHS               Department of Health and Human Services                  
ICS               Incident Command System                                  
NIFC              National Interagency Fire Center                         
NIH               National Institutes of Health                            
OMB               Office of Management and Budget                          
OPM               Office of Personnel Management                           
PART              Program Assessment Rating Tool                           
PMA               President's Management Agenda                            
SES               Senior Executive Service                                 
USDA              U.S. Department of Agriculture                           
VA                Department of Veterans Affairs                           
VISN              Veterans Integrated Service Network                      

This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed in
its entirety without further permission from GAO. However, because this
work may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this material
separately.

United States Government Accountability Office Washington, DC 20548

October 21, 2005

The Honorable George V. Voinovich Chairman Subcommittee on Oversight of
Government Management,

the Federal Workforce, and the District of Columbia Committee on Homeland
Security and Governmental Affairs United States Senate

Dear Mr. Chairman:

Achieving results for the nation increasingly requires that federal
agencies work together. From combating terrorism, monitoring infectious
diseases, and responding to natural disasters, the federal government
faces a series of challenges in the 21st century that will be difficult,
if not impossible, for any single agency to address alone. Taking into
account the nation's longrange fiscal challenges, the federal government
must identify ways to deliver results more efficiently and in a way that
is consistent with its multiple demands and limited resources.

Our work has shown that many issues cut across more than one agency and
their actions are not well coordinated. Examples include the following:

o  Four years after the 9/11 terrorist attacks the federal government's
efforts to achieve interoperable communications among emergency responders
at all levels of government have been hampered in part by an inadequate
level of interagency collaboration. 1 , 2

1

GAO, Project SAFECOM: Key Cross-Agency Emergency Communications Effort
Requires Stronger Collaboration, GAO-04-494 (Washington, D.C.: Apr. 16,
2004) and Homeland Security: Management of First Responder Grant Programs
and Efforts to Improve Accountability Continue to Evolve, GAO-05-530T
(Washington, D.C.: Apr. 12, 2005).

2

For the purpose of this report we use the term "collaboration" broadly to
include interagency activities that others have variously defined as
"cooperation," "coordination," "integration," or "networking." We have
done so since there are no commonly accepted definitions for these terms
and we are unable to make definitive distinctions between these different
types of interagency activities. The background section contains a more
complete definition of collaboration as used in this report.

o  No overall strategy integrates the threat-reduction and
nonproliferation programs of the Department of Defense (DOD), Department
of Energy (DOE), and others, and the agencies' implementation of very
similar programs has not always been well coordinated. In particular,
there is no governmentwide guidance delineating the roles and
responsibilities of agencies managing border security programs. According
to DOD and DOE officials managing these programs, agencies' roles are not
well delineated and coordination could be improved. 3

We have also reported that agencies face a range of barriers when they
attempt to collaborate with other agencies. 4 One such barrier stems from
missions that are not mutually reinforcing or that may even conflict,
making reaching a consensus on strategies and priorities difficult.
Another significant barrier to interagency collaboration is agencies'
concerns about protecting jurisdiction over missions and control over
resources. Finally, interagency collaboration is often hindered by
incompatible procedures, processes, data, and computer systems. Instead,
federal agencies carry out programs in a fragmented, uncoordinated way,
resulting in a patchwork of programs that can waste scarce funds, confuse
and frustrate program customers, and limit the overall effectiveness of
the federal effort.

To help agencies overcome these barriers, and in response to your request,
this report identifies key practices that can help enhance and sustain
federal agency collaboration, along with illustrative examples from select
agencies. We also considered our prior work on how the Government
Performance and Results Act of 1993 (GPRA) 5 can be used to identify
opportunities for improved collaboration among federal agencies and on the
role played by the Office of Management and Budget (OMB)-as the focal
point for overall management in the executive branch agencies-in providing
leadership and direction to federal agencies' collaborative efforts.

3

GAO, Weapons of Mass Destruction: Nonproliferation Programs Need Better
Integration, GAO-05-157 (Washington, D.C.: Jan. 28, 2005).

4

GAO, Managing for Results: Barriers to Interagency Coordination,
GAO/GGD-00-106 (Washington, D.C.: Mar. 29, 2000).

5

Pub. L. No. 103-62, 107 Stat. 285 (1993). Under GPRA, federal agencies are
required to develop strategic plans, performance plans, and performance
reports that set long-term and annual goals along with the means for
accomplishing the goals and report on achieving them.

To meet these objectives, we reviewed the relevant literature, including
our prior reports, and interviewed experts in the area of collaboration.
On the basis of these sources, we identified eight broad practices that
can facilitate greater collaboration among federal agencies. We also
identified areas where federal agencies are engaged in collaborative
efforts. Although achieving results may involve the collaborative efforts
of both federal and nonfederal partners, for the purpose of this work we
focused on the practices that federal agencies can employ. 6

To illustrate these practices, we selected three areas where federal
agencies have developed substantial ongoing collaborations: Healthy People
2010-a long-standing effort to develop and track public health objectives
for the nation, wildland fire management, 7 and health resource sharing
between the Department of Veterans Affairs (VA) and DOD at selected
locations. We selected these areas based on expert views and our prior
work indicating that collaboration was taking place in the area. The
examples presented in this report are intended to be illustrative.
Therefore, we did not seek to show how the agencies in each of the three
collaborative areas engaged in every practice. In addition, because the
focus of our work was to identify practices for effective collaboration,
we did not assess whether the examples of collaboration practices we
highlighted resulted in improved agency performance in the three areas.

To obtain perspectives on the practices we identified, we interviewed
officials and reviewed documents from the federal agencies involved in the
three collaborative efforts -VA, DOD, and the Departments of Agriculture
(USDA), Education, Health and Human Services (HHS), and the Interior. In
addition, we visited selected locations from among these agencies that
were involved in sharing resources with each other. We also interviewed
nonfederal stakeholders involved in the collaborative efforts we selected.

Appendix I provides a more detailed description of our scope and
methodology.

6

For factors that enhance regional collaboration across federal, state, and
local entities see GAO, Homeland Security: Effective Regional Coordination
Can Enhance Emergency Preparedness, GAO-04-1009 (Washington, D.C.: Sept.
15, 2004).

7

In prior GAO work on wildland fire management, we defined coordination as
an activity that takes place among federal agencies and collaboration as
an activity that occurs among federal and nonfederal partners. In this
report we do not distinguish between the two terms. For further
explanation see footnote 2.

                                Results in Brief

We conducted our work from May 2004 through August 2005 in offices in the
Washington, D.C. metropolitan area; Boise, Idaho; Louisville and Fort
Knox, Kentucky; Pensacola, Florida; and Sacramento and Fairfield,
California, in accordance with generally accepted government auditing
standards.

Collaboration can be broadly defined as any joint activity that is
intended to produce more public value than could be produced when
organizations act alone. Agencies can enhance and sustain their
collaborative efforts by engaging in the practices identified below:

     o Define and articulate a common outcome. VA Gulf Coast Health Care
       System and the Naval Hospital Pensacola, for example, collaborated on
       building a new joint ambulatory care clinic in order to improve the
       quality, access, and efficiency of health care delivery for their
       respective populations.
     o Establish mutually reinforcing or joint strategies designed to help
       align activities, core processes, and resources to achieve a common
       outcome. VA and DOD, for example, developed a joint strategic plan for
       health resource sharing that discusses strategies such as developing
       joint guidelines and policies and providing joint training.
     o Identify and address needs by leveraging resources to support the
       common outcome and, where necessary, opportunities to leverage
       resources. For example, the National Interagency Fire Center (NIFC),
       in Boise, Idaho, identifies and allocates federal firefighting
       resources from different agencies as needed to suppress wildland
       fires.
     o Agree on roles and responsibilities, including leadership. Officials
       at the VA Northern California Health Care System and at Travis Air
       Force Base, for example, jointly developed a charter that specified
       the respective roles and responsibilities of an executive management
       team as well as a charter for a working group for health resource
       sharing.
     o Establish compatible policies, procedures, and other means to operate
       across agency boundaries, including compatible standards and data
       systems, and communicate frequently to address such matters as
       cultural differences. Federal agencies with wildland fire management
       responsibilities developed an interagency handbook that defines the
       common standards, policies, and procedures they are to use in wildland
       fire operations.
     o Develop mechanisms to monitor, evaluate, and report on the results of
       the collaborative effort. HHS holds periodic progress reviews to
       assess the status of achieving Healthy People 2010 objectives. The
       results of these reviews are publicly reported on the Healthy People
       website.
     o Reinforce agency accountability for collaborative efforts by using
       strategic and annual performance plans to establish complementary
       goals and strategies and by using performance reports to account for
       results. The Forest Service has a goal in its fiscal year 2004-2008
       strategic plan, "Reduce the risk from catastrophic wildland fire,"
       that complements the interagency goals contained in the 10-year
       strategy for reducing wildland fire risk.
     o Reinforce individual accountability for collaborative efforts through
       performance management systems by identifying competencies related to
       collaboration and setting performance expectations for collaboration.
       Interior evaluates the performance of its senior executives, in part,
       on their ability to successfully collaborate with customers, partners,
       and stakeholders.

For a number of these practices, it is critical to involve nonfederal
partners, key clients, and stakeholders in decisionmaking. Additionally,
running throughout these practices are a number of factors such as
leadership, trust, and organizational culture that are necessary elements
for a collaborative relationship.

We have previously reported that GPRA, with its focus on strategic
planning, the development of long-term goals, and accountability for
results, provides a framework that Congress, OMB, and executive branch
agencies can use to consider the appropriate mix of long-term strategic
goals and strategies needed to identify and address crosscutting federal
goals. For example, we have previously recommended that OMB could provide
a broader perspective on the federal government's goals and strategies to
address issues that cut across different federal agencies, including
redundancy and other inefficiencies in how the government does its
business, by fully implementing the GPRA requirement to develop a
governmentwide performance plan. Moreover, we recommended Congress amend
GPRA to require a governmentwide strategic plan to provide a framework for
identifying long-term goals and strategies for addressing crosscutting
issues.

OMB, through the President's Management Agenda (PMA), has emphasized
improving government performance through governmentwide and
agency-specific initiatives. OMB has established "standards for success"
for the initiatives and rates agencies' progress toward meeting these
standards. Among the PMA initiatives, only one focuses specifically on
improving coordination-coordination of VA and DOD programs and systems.
However, many other areas that cut across agency boundaries would benefit
from greater OMB focus and attention, including information sharing for
homeland security which we recently designated as a high-risk area. 8 OMB
has also used the Program Assessment Rating Tool (PART), a diagnostic tool
consisting of questions designed to provide a consistent approach to
rating federal programs. To determine whether programs are achieving
results, PART assesses, among other things, whether programs are
duplicative of other efforts-federal, state, local, and private-and
whether agencies coordinate and collaborate effectively with related
programs. The PART tool provides general guidance for assessing effective
program coordination and collaboration, but does not discuss any practices
for enhancing and sustaining collaboration, such as those described and
illustrated in this report.

We recommend that the Director of OMB continue to encourage interagency
collaboration by identifying additional programs in need of greater
collaboration to achieve common outcomes and promoting the collaboration
practices identified in this report. Options for encouraging interagency
collaboration include expanding the PMA initiatives and associated
standards for success to include a greater focus on collaboration and
supplementing the PART guidance with information about the collaboration
practices in this report.

We provided a draft of this report to the Director of OMB for comment.
OMB's Counsel to the Deputy Director for Management responded orally that
OMB agreed with the recommendation. We also provided relevant sections of
a draft of this report to the agencies involved in the three collaboration
efforts-VA, DOD, USDA, HHS, and the Departments of Education and the
Interior. They offered technical suggestions, which we incorporated as
appropriate.

Although there is no commonly accepted definition for collaboration, for

the purpose of this report we define it as any joint activity by two or
more organizations that is intended to produce more public value than
could be produced when the organizations act alone. 9 For example, joint
activities can range from occasional meetings between middle-management
employees in which the existing division of labor of the respective
agencies is reaffirmed to the more structured joint law enforcement teams

8

GAO, High-Risk Series: An Update, GAO-05-207 (Washington, D.C.: January
2005).

9

See E. Bardach, Getting Agencies to Work Together: The Practice and Theory
of Managerial Craftsmanship (Washington, D.C.: Brookings Institution,
1998).

Page 6 GAO-06-15 Results-Oriented Government

                   Federal Collaborative Efforts We Reviewed

Healthy People 2010

operating over a long period of time. 10 In contrast, absent effective
collaboration, routine interagency meetings can be dutifully attended
without having any substantive information communicated, joint agreements
reached among the agencies, or agreements implemented. Although, according
to this definition, collaboration can involve federal and nonfederal
governmental organizations as well as nongovernmental organizations, this
report focuses on the actions federal agencies can take to improve
collaboration.

To illustrate practices that can enhance and sustain collaboration among
federal agencies, we selected three federal collaborative efforts-Healthy
People 2010, wildland fire management, and VA and DOD health resource
sharing-in which federal agencies work across agency lines to achieve
common outcomes. Appendix II provides additional information on these
three efforts.

Healthy People 2010, a federal effort led by HHS and involving a number of
other federal agencies, is a set of national public health objectives,
with associated indicators to measure progress, which are revisited every
10 years. These objectives are intended to cover the most significant
preventable threats to health and support two broad national goals-(1)
increasing the quality and years of healthy life and (2) eliminating
health disparities. The Healthy People objectives are divided among 28
focus areas. In this report we looked at two focus areas that involved
multiple federal agencies-Nutrition and Overweight, and Disability and
Secondary Conditions. The goal of the Nutrition and Overweight focus area
is to promote health and reduce chronic disease associated with diet and
weight. The Food and Drug Administration (FDA) and National Institutes of
Health (NIH) are colead agencies for the Nutrition and Overweight focus
area. The goal of the Disability and Secondary Conditions focus area is to
promote the health of people with disabilities, prevent secondary
conditions, and eliminate disparities between people with and without
disabilities in the U.S. population. The Centers for Disease Control and
Prevention (CDC) and the Department of Education's National Institute on
Disability and Rehabilitation Research are colead agencies for Disability
and Secondary Conditions. Since it was established in 1979, Healthy

10

As Bardach maintains, if successfully done, occasional meetings by which
participants agree upon their respective responsibilities increase public
value. To successfully manage such agreement requires participants working
together collaboratively.

Page 7 GAO-06-15 Results-Oriented Government

Wildland Fire Management

People has engaged a diverse group of stakeholders throughout the country,
including public and private organizations.

Wildland fires contribute to ecological health in forests and rangelands
by maintaining plant species diversity, limiting the spread of insects and
disease, and promoting new growth, among other things. However, past
management practices, including a concerted federal policy in the 20th
century of suppressing fires to protect communities and ecosystem
resources, unintentionally resulted in steady accumulation of dense
vegetation that fuels large, intense, wildland fires than can have
catastrophic effects on ecosystems and nearby communities. Federal
agencies responsible for wildland fire management (wildland fire agencies)
include the Forest Service at USDA and the Bureau of Indian Affairs,
Bureau of Land Management, Fish and Wildlife Service, and National Park
Service at Interior.

The first single comprehensive federal wildland fire policy for USDA and
Interior was established in 1995 in response to the prior year's fire
season with its 34 fatalities. 11 The 1995 policy is based on several
guiding principles including interagency cooperation-in particular, "fire
management planning, preparedness, suppression, fire use, monitoring, and
research will be conducted on an interagency basis with the involvement of
all parties." Interagency collaboration in the area of fire suppression,
however, predated this 1995 federal policy. For example, the Bureau of
Land Management and the Forest Service established a joint coordination
center at Boise, Idaho, in 1965. This center has since evolved into the
current NIFC, housing the five wildland fire agencies along with the
National Weather Service, Department of Commerce; Office of Aircraft
Services, Department of the Interior; United States Fire Administration,
Department of Homeland Security; and the National Association of State
Foresters. A series of catastrophic wildland fires in 2000 resulted in the
wildland fire agencies and their partners developing a long-term,
collaborative approach for reducing wildland fire risk and the reviewing
and updating of the 1995 federal wildland fire policy. The collaborative
approach and update are the basis for the current wildland fire management
policy and practice.

11

U.S. Department of the Interior and U.S. Department of Agriculture,
Federal Wildland Fire Management Policy and Program Review: Final Report
(Washington, D.C.: Dec. 18, 1995).

Page 8 GAO-06-15 Results-Oriented Government

VA and DOD Health Resource Sharing

VA operates one of the nation's largest health care systems. Of the 7.4
million total enrollees in fiscal year 2004, VA obligated $28.4 billion to
provide care to 5.2 million total patients, which included veterans and
eligible nonveterans. Currently, health care is provided through 157 VA
hospitals and nearly 900 outpatient clinics nationwide. DOD spends about
$30.4 billion on health care for over 9.1 million beneficiaries, including
active-duty personnel and retirees, and their dependents. Most DOD health
care is provided at more than 530 Army, Navy, and Air Force military
treatment facilities worldwide, supplemented by civilian providers. While
both agencies have distinct missions-the VA focuses on providing benefits
to veterans and their families and DOD focuses on maintaining the combat
readiness of the military-both provide health care services.

To encourage sharing of federal health resources between VA and DOD, in
1982 Congress passed the Veterans' Administration and Department of
Defense Health Resources Sharing and Emergency Operations Act (the
"Sharing Act"). 12 Previously, VA and DOD health care facilities, many of
which are colocated or in close geographic proximity, operated virtually
independently of each other. The Sharing Act authorizes VA medical centers
and military treatment facilities to become partners and enter into
sharing agreements to buy, sell, and barter medical and support services.
The intent of the law was not only to remove legal barriers, but also to
encourage VA and DOD to engage in health resource sharing to more
effectively and efficiently use federal health resources.

Additional legislation was passed in 2002 to encourage and foster VA and
DOD health resource sharing. Under the Bob Stump National Defense
Authorization Act for Fiscal Year 2003, VA and DOD were required, among
other things, to develop a joint strategic plan and incorporate the joint
goals and strategies into the respective departments' strategic and
performance plans that are required under GPRA. VA and DOD were also
required to establish a high-level interagency committee to develop and
implement collaborative efforts and to establish a joint incentive program
to provide incentives for implementing, funding, and evaluating creative
health resource sharing initiatives. VA and DOD are each required to make
a minimum contribution of $15 million from each department's
appropriations each year for four years to fund the joint program, 13 the
Joint Incentive Fund Program. Proposals for funding for either onetime

12

Pub. L. No. 97-174, 96 Stat. 70 (May 4, 1982); House Report 97-72; Senate Report
                                    97-137.

13

Pub. L. No. 107-314, S:721, 116 Stat. 2458, 2589-2595 (Dec. 2, 2002).

investments or recurring operations must be jointly developed by VA and
DOD. To ensure continuity of operations, projects involving recurring
costs must be self-sustaining and the incentive funds can be used for no
more than two years for operational costs.

We have pointed out that VA and DOD health resource sharing faces
longstanding barriers, including incompatible computer systems that affect
the exchange of patient health information, inconsistent reimbursement and
budgeting policies, and burdensome agreement approval processes. 14 OMB
has also singled out VA and DOD resource sharing for increased attention
through its PMA initiative. Nonetheless, our work has also shown that at
specific sites, VA and DOD are actively involved in health resource
sharing activities. 15 For this work, we reviewed health resource sharing
at three of those sites, covering the Army, Navy, and Air Force. See
appendix I for a complete list of the VA and DOD sites we visited.

Drawing from the literature we reviewed, the experts we interviewed, and
our prior work, we identified eight key practices that can help federal
Can Help Enhance agencies enhance and sustain their collaborative efforts.
The federal

collaborative efforts we reviewed helped further refine the practices and

  and Sustain

provided a wide variety of concrete illustrations of how the practices can
Collaboration among apply in different federal agency contexts.

While collaboration among federal agencies can take many different forms,
the practices generally consist of two or more agencies

     o defining and articulating a common outcome;
     o establishing mutually reinforcing or joint strategies to achieve the
       outcome;
     o identifying and addressing needs by leveraging resources;
     o agreeing upon agency roles and responsibilities;
     o establishing compatible policies, procedures, and other means to
       operate across agency boundaries;
     o developing mechanisms to monitor, evaluate, and report the results of
       collaborative efforts;

14

GAO, Opportunities for Congressional Oversight and Improved Use of
Taxpayer Funds: Budgetary Implications of Selected GAO Work, GAO-04-649
(Washington, D.C.: May 7, 2004).

15

GAO, VA and DOD Health Care: Resource Sharing at Selected Sites,
GAO-04-792 (Washington D.C.: July 21, 2004).

Page 10 GAO-06-15 Results-Oriented Government

     o reinforcing agency accountability for collaborative efforts through
       agency plans and reports; and
     o reinforcing individual accountability for collaborative efforts
       through agency performance management systems.

For a number of these practices, it is also critical to involve nonfederal
partners, key clients, and stakeholders in decision making. Additionally,
agencies can strengthen their commitment to work collaboratively by
articulating their agreements in formal documents, such as a memorandum of
understanding, interagency guidance, or an interagency planning document,
signed by senior officials in the respective agencies.

Running throughout these eight practices are a number of factors such as
leadership and trust that are necessary elements for a collaborative
working relationship. These factors are established, sustained, and
reinforced through that relationship, thereby fostering a collaborative
culture. 16

    Define and Articulate the Common Outcome

To overcome significant differences in agency missions, cultures, and
established ways of doing business, collaborating agencies must have a
clear and compelling rationale to work together. The compelling rationale
for agencies to collaborate can be imposed externally through legislation
or other directives or can come from the agencies' own perceptions of the
benefits they can obtain from working together. In either case, the
collaborative effort requires agency staff working across agency lines to
define and articulate the common federal outcome or purpose they are
seeking to achieve that is consistent with their respective agency goals
and mission. Moreover, the development of a common outcome takes place
over time and requires sustained resources and commitment.

Following the authority provided in the Sharing Act, a number of VA and
DOD facilities have collaborated to achieve their common goals. VA Gulf
Coast Health Care System and the Naval Hospital Pensacola, for example,
collaborated to build a new joint ambulatory care clinic to improve the
quality, access, and efficiency of health care delivery for their
respective

16

We identified a series of useful practices and implementation steps for
mergers and organizational transformation that address a number of these
same areas such as leadership and culture. See GAO, Results-Oriented
Cultures: Implementation Steps to Assist Mergers and Organizational
Transformations , GAO-03-669 (Washington, D.C.: July 2, 2003).

Page 11 GAO-06-15 Results-Oriented Government

populations. The VA wanted to expand its medical facilities and increase
the type of medical services available in the area, as most beneficiaries
who needed specialty care were transported by the VA to Biloxi,
Mississippi, or New Orleans, Louisiana, adding to the cost of care. 17 The
Navy, with several aging medical facilities, was facing a demand for
services from a growing population of retirees and students from the
cryptology school on the naval base. Over the course of nearly a year,
officials from the VA Gulf Coast Health Care System and the Naval Hospital
Pensacola, who had already shared medical services in the past, agreed to
build a joint ambulatory care center to provide closer and expanded
services as a way of improving access for both VA and Navy populations.
This agreement was formalized in a concept paper signed by the director of
VA Gulf Coast Health Care System and the Commanding Officer of the Naval
Hospital Pensacola.

USDA and Interior's current collaboration in managing wildland fires
stemmed from the catastrophic wildland fires of 2000. The fires prompted
the President to request that the Secretaries of USDA and the Interior
develop a response to severe wildland fires, reduce their effects, and
ensure sufficient firefighting resources in the future. 18 Additionally,
the conference committee report accompanying the fiscal year 2001 Interior
appropriations act directed the Secretaries to work with the relevant
Governors to develop a 10-year strategy for reducing wildland fire risk.
19 The Departments' response and conference committee direction resulted
in the National Fire Plan that included a collaborative approach for a 10

17The VA facilities in Biloxi and New Orleans are both over 100 miles from
the VA Pensacola Outpatient Clinic.

18

U.S.
           Department of the Interior and U.S. Department of Agriculture,
           Managing the Impact of Wildfires on Communities and the
           Environment: A Report to the President In Response to the
           Wildfires of 2000 (Washington, D.C.: Sept. 8, 2000).

U.S.
           House of Representatives, Making Appropriations for the Department
           of the Interior and Related Agencies for the Fiscal Year Ending
           September 30, 2001, and for Other Purposes, Report 106-914 (Sept.
           29, 2000).

19

year strategy and implementation plan to reduce the risk of catastrophic
wildland fires. 20

The fires in 2000 also led to a review of the 1995 federal fire policy,
which concluded that while the policy was sound and appropriate, the
implementation was incomplete, particularly where it involved
"collaboration, coordination, and integration across agency jurisdiction
and across different disciplines." 21 As a result of the review, as well
as studies by the National Academy of Public Administration and GAO, USDA
and Interior established the Wildland Fire Leadership Council in 2002 to
provide leadership and oversight in implementing the National Fire Plan
and the federal fire policy. This interagency council, comprised of senior
USDA and Interior officials, federal, state, tribal, and county
representatives, including the heads of the five wildland fire agencies,
meets regularly to foster policy coordination and the resolution of
interagency differences.

In the case of the Healthy People initiative, federal agencies, along with
state and local government agencies and nongovernmental organizations,
came together voluntarily to collaborate because they shared an overall
commitment to and responsibility for health promotion and disease
prevention. Recognizing that progress in improving the nation's health
required the active participation and leadership of this diverse array of
organizations, the collaboration has grown to over 600 organizations since
it began in 1988. Officials from several federal agencies with public
health responsibilities worked together to review and update as necessary
the Healthy People objectives. For example, the CDC, along with the
Department of Education's National Institute on Disability and
Rehabilitation Research, worked together to assess current public health
conditions and concluded that the health and well-being of people with

20

U.S.
           Department of the Interior, U.S. Department of Agriculture, and
           Western Governors' Association, A Collaborative Approach for
           Reducing Wildland Fire Risks to Communities and the Environment:
           10 Year Comprehensive Strategy (Washington, D.C.: August 2001);
           and U.S. Department of the Interior, U.S. Department of
           Agriculture, and Western Governors' Association, A Collaborative
           Approach for Reducing Wildland Fire Risks to Communities and the
           Environment: 10-Year Comprehensive Strategy, Implementation Plan
           (Washington, D.C.: May 2002).

U.S.
           Department of the Interior, U.S. Department of Agriculture,
           Department of Energy, Department of Defense, Department of
           Commerce, U. S. Environmental Protection Agency, Federal Emergency
           Management Agency, and National Association of State Foresters,
           Review and Update of the 1995 Federal Wildland Fire Management
           Policy (Washington, D.C.: January 2001).

21

disabilities was an issue that could be better represented in the Healthy
People 2010 agenda. Scientific and technological advances, societal
attitudes, and labor market changes had redefined the extent to which
physical or mental conditions are disabling, 22 and such changes should
also be reflected in the public health system. As a result of this
collaborative review, "Disability and Secondary Conditions" was included
as a new focus area for Healthy People 2010. The goal for this new focus
area is to "promote the health of people with disabilities, prevent
secondary conditions, and eliminate disparities between people with and
without disabilities." Specific objectives for this focus area include (1)
establishing a standardized operational definition for disability and
collecting information on people with disabilities, thereby enabling
government policymakers, researchers, and clinicians to make
better-informed decisions; (2) eliminating disparities in employment
between working-age adults with and without disabilities; and (3)
increasing the proportion of children and youth with disabilities in
regular education programs.

In defining and articulating a common outcome, where appropriate, federal
agencies should involve nonfederal partners, key clients, and
stakeholders. In doing so, federal agencies can better address their
interests and expectations and gain their support in achieving the
objectives of the collaboration. In developing the Healthy People 2010
objectives, HHS included as partners nonfederal organizations such as
state and local public health, mental health, and environmental agencies;
professional health groups; and health and recreation organizations. In
addition, HHS solicited public comments and invited individuals from
academia, businesses, the faith community, health care providers, advocacy
groups and community-based organizations, and nonprofit or voluntary
agencies to attend public meetings to discuss the proposed Healthy People
2010 objectives.

Establish Mutually To achieve a common outcome, collaborating agencies
need to establish Reinforcing or Joint strategies that work in concert
with those of their partners or are joint in Strategies nature. Such
strategies help in aligning the partner agencies' activities, core
processes, and resources to accomplish the common outcome.

22

We also reported on how these changes have affected the ability of people
with disabilities to work. See GAO, SSA Disability: Program Redesign
Necessary to Encourage Return to Work, GAO/HEHS-96-62 (Washington, D.C.:
Apr. 24, 1996) and SSA Disability: Other Programs May Provide Lessons for
Improving Return-to-Work Efforts, GAO-01-153 (Washington, D.C.: Jan. 12,
2001).

Page 14 GAO-06-15 Results-Oriented Government

Federal agencies have developed mutually reinforcing strategies to
accomplish the Healthy People 2010 goal for the nutrition and overweight
focus area-to promote health and reduce chronic diseases associated with
diet and weight. For example, USDA, in collaboration with HHS, updates the
Dietary Guidelines for Americans that provides advice on good dietary
habits and serves as the basis for federal food and nutrition education
programs. 23 One of FDA's strategies to achieve this goal is to require
that food labels provide information to consumers that will assist them in
planning healthful diets. And one of NIH's strategies towards this goal
was to promote the use of their evidence-based guidance for treating
overweight conditions and obesity-Clinical Guidelines on the
Identification, Evaluation, and Treatment of Overweight and Obesity in

24

Adults: The Evidence Report.

VA and DOD, on the other hand, have developed joint strategies. As
required by the Bob Stump National Defense Authorization Act for Fiscal
Year 2003, VA and DOD's Joint Executive Council, comprised of senior
leadership and staff involved in health and benefit activities from both
agencies, developed a joint strategic plan for the delivery of benefits
and services. 25 The plan identifies strategies for accomplishing each of
six strategic goals. The strategies include developing joint guidelines
and policies for the delivery of high-quality care and assurance of
patient safety, and providing joint training in multiple disciplines.

In the area of wildland fire management, federal agencies have involved
nonfederal partners, key clients, and stakeholders in the development of
joint strategies to achieve their common goal of preventing and
suppressing wildland fires. In the aftermath of a series of wildland fires
in 2000, the President directed the Secretaries of USDA and the Interior
to identify short-term strategies for responding to severe wildland fires.
Subsequently, the conference committee report accompanying the fiscal year
2001 appropriations act directed the Secretaries to work with

23

The dietary guidelines have been jointly issued every 5 years since 1980.
For the most recent guidelines see U.S. Department of Health and Human
Services and U.S. Department of Agriculture, Dietary Guidelines for
Americans 2005 (Washington, D.C.: 2005).

24

National Institutes of Health, Clinical Guidelines on the Identification,
Evaluation, and Treatment of Overweight and Obesity in Adults: The
Evidence Report, NIH Publication No. 98-4083 (Bethesda, Md.: September
1998).

25

Pub. L. 107-314 and Department of Veterans Affairs and Department of
Defense, Department of Veterans Affairs and Department of Defense Joint
Strategic Plan, Fiscal Year 2005 (Washington, D.C.: December 2004).

    Identify and Address Needs by Leveraging Resources

Governors of the affected states on a long-term strategy to deal with
wildland fires. Moreover, the Secretaries were directed to engage the
Governors in a "collaborative structure to cooperatively develop" a
comprehensive strategy with the states as "full partners in the planning,
decision-making and implementation" of such strategy. Serving as a conduit
for a broad range of nonfederal stakeholders, the Western Governors'
Association, in collaboration with USDA and Interior, developed a 10-year
comprehensive strategy and implementation plan that includes a number of
actions that are to be carried out in concert. For example, the Wildland
Fire Leadership Council, National Association of State Foresters, and
National Association of Counties are jointly responsible for assessing
"the training, equipment, safety awareness of, and services provided by
rural, volunteer, and other firefighters that work in the wildland-urban
interface."

Collaborating agencies should identify the human, information technology,
physical, and financial resources needed to initiate or sustain their
collaborative effort. Collaborating agencies bring different levels of
resources and capacities to the effort. By assessing their relative
strengths and limitations, collaborating agencies can look for
opportunities to address resource needs by leveraging each others'
resources, thus obtaining additional benefits that would not be available
if they were working separately.

Wildland fire agencies collaborate to quickly identify and address
resource needs for suppressing wildland fires. According to NIFC, no
single agency is capable of providing the resources needed to respond to
especially large fires or to multiple concurrent fires. NIFC monitors the
occurrence of wildland fires and coordinates and mobilizes wildland
firefighting resources nationally to suppress those fires. Local and
regional federal fire centers unable to meet personnel, equipment, and
supply needs contact NIFC in Boise, Idaho. In response, NIFC provides
certain resources and requests others from the closest available federal
agency. For example, NIFC could request firefighting resources, including
aircraft, personnel, telecommunications equipment, and ground and air
transportation for equipment and supplies, from the Forest Service, Bureau
of Indian Affairs, Fish and Wildlife Service, and the National Park
Service to respond to an incident on land under the jurisdiction of the
Bureau of Land Management.

In the three cases we examined of VA and DOD health resource sharing, the
agencies each had the incentive to work collaboratively to share
facilities, medical supplies, and skilled medical personnel, enabling them

    Agree on Roles and Responsibilities

to leverage resources. For example, in 1996 the Ireland Army Community
Hospital at Fort Knox entered into an agreement with the Louisville VA
Medical Center in which VA would provide primary care services for active
duty military personnel and their families. In return, the Army provided
VA with space, supplies, and equipment for a new outpatient clinic for VA
patients and agreed to fill some prescriptions for VA patients. As a VA
official noted, in a time of tight resources, there is an incentive for
the VA and the Army to be partners, enabling them to accomplish their
respective missions.

In another example, the VA Northern California Health Care Systems and the
David Grant Medical Center at Travis Air Force Base established a joint
dialysis clinic that expanded services and increased the number of VA and
Air Force patients served. Prior to the opening of the joint clinic, the
medical center made its dialysis clinic available on an emergency basis to
the VA, which lacked its own dialysis facilities. The VA sent its northern
California patients to private physicians in the area at a higher cost.
With a growing demand for dialysis services, the VA and Air Force worked
collaboratively to develop and submit a proposal to the national Joint
Incentive Fund for a joint clinic. This joint proposal was subsequently
awarded funding, enabling an expansion of the dialysis facility to serve
both DOD and VA patients.

Collaborating agencies should work together to define and agree on their
respective roles and responsibilities, including how the collaborative
effort will be led. In doing so, agencies can clarify who will do what,
organize their joint and individual efforts, and facilitate
decisionmaking. Committed leadership by those involved in the
collaborative effort, from all levels of the organization, is also needed
to overcome the many barriers to working across agency boundaries.

The five federal agencies with wildland fire management responsibilities
jointly developed and update the Interagency Standards for Fire and Fire
Aviation Operations-an operations handbook that defines the roles and
responsibilities for all personnel engaged in managing wildland fire
operations, regardless of agency affiliation. For example, according to
the handbook, the Incident Commander for a wildland fire is responsible
for all incident activities, including developing the fire management
strategy and tactics, and ordering, deploying, and releasing resources.
The Incident Commander is supported by an Incident Command Staff that may
include a safety officer, information officer, operations section chief,
planning section chief, logistics section chief, finance section chief,
and a liaisons officer. 26 In addition to specifying the roles and
responsibilities, the interagency handbook also identifies the
qualifications required for each position. For each wildland fire
incident, staff meeting these qualifications are assigned to these roles,
regardless of the agency for which they work.

The VA and the Air Force in Northern California specified the roles and
responsibilities for health resource sharing in two joint charters. These
charters define a jointly staffed management structure for resource
sharing-the Executive Management Team and the Joint Initiatives Working
Group. One charter defines the roles and responsibilities of the Executive
Management Team in determining the workload and fiscal implications of the
sharing agreements, providing a dispute resolution system for the
collaborative effort, and setting policy for sharing agreements and joint
ventures. The other defines the roles and responsibilities of the Joint
Initiatives Working Group for making recommendations to the Executive
Management Team on sharing opportunities, reimbursement methodologies,
facility and space considerations, and staffing personnel requirements.
These charters have helped sustain the collaborative effort, despite
routine rotations of DOD staff to other military installations.

The leadership continuity provided by VA partners has also helped to
sustain collaborative efforts in the face of periodic changes in DOD
leadership. At the three local sites we visited, VA and DOD officials we
spoke with said that it was important to have committed VA individuals who
had a common understanding of both the VA and military environment and
resource needs. One official said such individuals are instrumental in
initiating and sustaining the collaboration for resource sharing.

The Incident Command System (ICS), the onsite management system, provides
a common organizational structure, procedures, and standards for agencies
responding to wildland fires. This ICS system has since been adopted
nationally as the National Incident Management System by the Department of
Homeland Security to be utilized for all emergencies including terrorism,
floods, and hurricanes. The ICS system has also been adopted by other
countries, such as Canada, Australia, and New Zealand.

Page 18 GAO-06-15 Results-Oriented Government

    Establish Compatible Policies, Procedures, and Other Means to Operate across
    Agency Boundaries

To facilitate collaboration, agencies need to address the compatibility of
standards, policies, procedures, and data systems that will be used in the
collaborative effort. Furthermore, as agencies bring diverse cultures to
the collaborative effort, it is important to address these differences to
enable a cohesive working relationship and to create the mutual trust
required to enhance and sustain the collaborative effort. Frequent
communication among collaborating agencies is another means to facilitate
working across agency boundaries and prevent misunderstanding.

The Interagency Standards for Fire and Fire Aviation Operations handbook
mentioned previously also specifies common standards, operational
policies, and procedures used for wildland fire operations. The
interagency handbook includes standards for training and firefighting
equipment as well as policies and procedures for developing a response to
wildland fire, aviation operations, and communications. For example, the
handbook specifies the standards for the chemicals used to suppress
wildland fires, such as long-term retardants, suppressant foam, and water
enhancers. It also establishes policies and procedures for the safe
application of aerial and ground suppressants in a way that does not harm
the ecosystem.

The interagency Wildland Fire Leadership Council was established by USDA
and Interior to facilitate collaboration across agency boundaries by
providing leadership and the consistent implementation of wildland fire
management goals and policy. The council deals with national policy
issues, such as nationwide resource allocation and prioritization that cut
across the different federal agencies. One official noted that the council
members are the ultimate authority within their departments for wildland
fire management. As such, they can negotiate and set wildland fire
management policy for their respective departments. Council members are to
ensure their respective agency's disparate interests, missions, and
multiple responsibilities are not adversely affected by policy decisions
the council makes collectively. While the council meets several times a
year, council staff-coordinators from both USDA and Interior-communicate
more frequently and serve as liaisons to the various agencies. 27

Collaborating agencies may also need to find common ground while still
satisfying their respective operating needs. For example, in discussing
where to locate the new joint ambulatory care clinic, VA and DOD at
Pensacola had to overcome differences in their respective security
standards. VA officials had expressed concern about their beneficiaries'
access to medical facilities located on military bases during periods of
heightened security. Navy officials wanted the new clinic to be within
walking distance from the Center for Cryptology so students attending the
school could have easy access. At the same time, the Navy had concerns
that easy access to the base could expose the cryptology school, which is
a top secret facility, to unauthorized individuals. To address differences
in security standards, the VA and the Navy agreed to install a security
fence around the new clinic, creating an enclave within the naval base
with a separate entrance that is accessible from a public highway.

The ability to work collaboratively requires mutual trust among the
respective parties-a shared belief that the partners will carry out their
part of the joint agreement. Experts in collaboration and agency officials
involved in all three efforts we examined-Healthy People 2010, VA and DOD
health resource sharing, and wildland fire management-mentioned trust as a
key to enhancing and sustaining collaborative efforts. Trust can be
fostered in a variety of ways. For example, officials at NIFC suggested
that trust among staff from the different wildland fire agencies was
fostered through joint activities that provided opportunities for
face-to-face interaction, such as interagency training and national or
regional conferences. Trust can also be a function of shared interest or
background in an area. In the case of NIFC, although staff have different
agency affiliations, most of them have field experience fighting fires.

Fostering an interagency culture, according to NIFC staff we interviewed,
can help facilitate collaborative efforts across agency boundaries and

Staffing for the Wildland Fire Leadership Council at USDA is under the
Forest Service's National Coordinator for the National Fire Plan, while
staffing at Interior is under the Office of Wildland Fire Coordination.
These two offices are also responsible for coordinating with the other
federal agencies and nonfederal partners, such as the Federal Emergency
Management Agency, U.S. Geological Survey, National Governors Association,
Intertribal Timber Council, National Association of State Foresters, and
National Association of Counties.

    Develop Mechanisms to Monitor, Evaluate, and Report Results

enhances a cohesive working relationship among staff from the different
federal agencies with wildland fire responsibilities. For example, the
agencies at NIFC reinforce a common interagency culture by hiring staff
who have had experience and feel comfortable working in an interagency
environment. An interagency environment, according to one official, is
reinforced at NIFC in a variety of ways, including staff wearing a common
interagency badge and co-location of staff by functional areas rather than
by agency, reflecting the integrated staffing.

Federal agencies engaged in collaborative efforts need to create the means
to monitor and evaluate their efforts to enable them to identify areas for
improvement. Reporting on these activities can help key decision makers
within the agencies, as well as clients and stakeholders, to obtain
feedback for improving both policy and operational effectiveness.

To monitor and report on the status of achieving the Healthy People 2010
objectives, HHS holds progress reviews in which the federal agencies with
lead responsibilities for a focus area report on the progress towards
achieving the objectives. Other federal agencies that do work related to
the focus area also participate in these meetings. The agencies discuss
the data trends, barriers to achieving the objectives, strategies
undertaken to overcome barriers, and alternative approaches to attain
further progress. A summary report of the progress review, including
contact information, is made available to the public through the Healthy
People website. Additionally, HHS conducts a midcourse review to assess
the status of the overall Healthy People objectives and identify the
significant health trends and gaps in preventive health issues. As the
midcourse review could result in the modification of the Healthy People
2010 objectives, the proposed revisions to the objectives will be made
available for public comment. 28

Federal wildland fire agencies assess fire operations through "after
action" reviews. According to interagency policy and standards, after each
wildland fire incident, the wildland fire agencies should conduct reviews
with personnel from different agencies along functional areas-for example,
the incident management team and smokejumpers (firefighters

28

The 30-day public comment period for the proposed midcourse review
revisions was held from August 15, 2005, through September 15, 2005, with
the final revisions to be issued in 2006. Additionally, according to NIH
officials, HHS uses a publicly available online database, DATA2010, to
monitor and report on the status of achieving the Healthy People
objectives.

Page 21 GAO-06-15 Results-Oriented Government

    Reinforce Agency Accountability for Collaborative Efforts through Agency
    Plans and Reports

who use parachutes to get to the fire). 29 As part of these reviews,
personnel who worked on the incident discuss the strengths and weaknesses
of the operations and determine what can be learned from it. Personnel
assess what was planned, what actually happened, why, and what can be done
to improve wildland fire management. Managers should address such aspects
as the initial assessment of resource requirements, safety and welfare of
personnel, fire suppression operations, and administrative
responsibilities. According to federal wildland fire management policy,
these after action reviews are then used to modify fire management plans.

Wildland fire agencies also plan to evaluate their overall joint
activities, although these evaluations have not yet been conducted. Under
the

Interagency Strategy for the Implementation of Federal Wildland Fire
Management Policy, USDA and Interior agreed to conduct fire management
reviews approximately every 4 years to provide information for improving
both policy and operational effectiveness. 30 According to the interagency
strategy, these evaluations will be consistent with GPRA requirements and
agency strategic plans.

A focus on results, as envisioned by GPRA, implies that federal programs
contributing to the same or similar results should collaborate to ensure
that goals are consistent and, as appropriate, program efforts are
mutually reinforcing. Federal agencies can use their strategic and annual
performance plans as tools to drive collaboration with other agencies and
partners and establish complementary goals and strategies for achieving
results. Such plans can also reinforce accountability for the
collaboration by aligning agency goals and strategies with those of the
collaborative efforts. Accountability for collaboration is reinforced
through public reporting of agency results.

USDA, a stakeholder for the Nutrition and Overweight focus area of Healthy
People 2010, uses its strategic plan to reinforce its commitment to
support key Healthy People 2010 objectives. The main goal for the
Nutrition and Overweight focus area in Healthy People 2010 is to "Promote

29

Smokejumpers conduct after action reviews after each mission rather than a
single review at the end of the wildland fire incident.

30

U.S. Department of Agriculture and U.S. Department of the Interior,
Interagency Strategy for the Implementation of Federal Wildland Fire
Management Policy, June 20, 2003. This policy was approved by the
departments on April 21, 2004.

Page 22 GAO-06-15 Results-Oriented Government

    Reinforce Individual Accountability for Collaborative Efforts through
    Performance Management Systems

health and reduce chronic disease associated with diet and weight." To
track progress towards that goal, Healthy People developed seven
objectives related to food and nutrient intake, such as fruit intake and
total fat intake. A goal in USDA's strategic plan for fiscal years
2002-2007 is to contribute to reductions in obesity of the American public
consistent with the goals of Healthy People 2010. Specifically, one of the
performance measures in USDA's strategic plan is to promote healthier
eating habits and lifestyles, setting as a goal for 2007, as a partner
with HHS, "to take actions to encourage a reduction in overweight and
obesity such that adult obesity will be no greater than 20% and child and
adolescent overweight will be no greater than 8%." 31

Federal agencies involved in wildland fire management have goals in their
strategic plans that are compatible with those of the National Fire Plan's
10-year comprehensive strategy to reduce the wildland fire risk to
communities and the environment. In its fiscal year 2003-2008 strategic
plan, Interior makes specific reference to the National Fire Plan and the
10-year comprehensive strategy. Additionally, the plan describes
strategies that include restoring fire-adapted ecosystems and reducing
hazardous fuels through collaboration, consistent with the 10-year
comprehensive strategy. Similarly, the Forest Service, also making
specific reference to the 10-year comprehensive strategy, has a compatible
goal-"Reduce the risk from catastrophic wildland fire"-in its strategic
plan for fiscal years 2004-2008.

High-performing organizations use their performance management systems to
strengthen accountability for results, specifically by placing greater
emphasis on fostering the necessary collaboration both within and across
organizational boundaries to achieve results. 32 Within the federal
government, the Office of Personnel Management (OPM) and OMB now require
such emphasis under the new performance-based pay system for agency senior
executives. Under this system, agencies are to hold executives accountable
for, among other things, collaboration and teamwork across organizational
boundaries to help achieve goals by requiring the executives to identify
programmatic crosscutting, and

31

Note that while USDA set these percentage targets to be achieved by 2007,
Healthy People 2010 has set targets of 15 and 5 percent, respectively, to
be achieved by 2010.

32

GAO, Results-Oriented Cultures: Creating a Clear Linkage between
Individual Performance and Organizational Success, GAO-03-488 (Washington,
D.C.: Mar. 14, 2003).

Page 23 GAO-06-15 Results-Oriented Government

partnership-oriented goals through the performance expectations in their
individual performance plans.

As a first step in reinforcing individual accountability for collaborative
efforts, agencies set expectations for senior executives for collaboration
within and across organizational boundaries in their individual
performance plans. For example, as part of its Senior Executive Service
(SES) performance management system, Interior, one of the agencies
involved in wildland fire management, requires all of its senior
executives to incorporate in their individual performance plans a
competency related to collaboration-"Building Collaboration and
Partnerships with Customers/Partners/Stakeholders." Specifically, for this
competency, senior executives are to communicate, consult, and cooperate
with customers, partners, and stakeholders to ensure that Interior's
missions and programs effectively empower citizens in the support of
conservation. According to an Interior official, Interior's bureaus have
the flexibility to cascade the required senior executive competency
related to collaboration to their non-SES employees' individual
performance plans.

In addition, we have recommended that agencies have senior executives
identify specific programmatic crosscutting goals that would require
collaboration to achieve in their individual performance plans. 33 To this
end, HHS holds all senior executives accountable for the crosscutting
"One-HHS" program objectives that relate to their job responsibilities. 34
For example, NIH senior executives are to cascade the One-HHS program
objectives into their individual performance plans, as appropriate. One of
these program objectives is to "improve the quality of health care" by
improving the coordination, communication, and application of health
research results. To meet this objective, an NIH senior executive, who is
the agency's colead for the Healthy People 2010 Nutrition and Overweight
focus area, set an expectation in her individual performance plan to
enhance health care quality and treatment through the coordination and
translation of nutrition sciences, obesity, and physical activity research
and policy-related activities, through collaborative and coordinated
interagency activities at the federal and other levels. Further, NIH is

33

GAO, Human Capital: Senior Executive Performance Management Can Be
Significantly Strengthened to Achieve Results, GAO-04-614 (Washington,
D.C.: May 26, 2004).

34

The One-HHS management and program objectives reflect the goals and
priorities of the Secretary of HHS for the department.

Page 24 GAO-06-15 Results-Oriented Government

beginning to cascade the One-HHS program objectives to all NIH employees
through their individual performance plans.

In addition, we have recommended that agencies have senior executives name
the relevant internal or external organizations with which they would
collaborate to reinforce a focus across organizational boundaries. 35 To
this end, a senior executive at Interior's Bureau of Land Management set
an expectation in his individual performance plan to assure that
interagency fire program policies and operational changes are made in
collaboration with interagency partners and stakeholders. In his
selfassessment for the year, the senior executive named the Fire Director
for the USDA Forest Service. The National Wildfire Coordinating Group, an
interagency activity coordinating group, tasked the executive and the Fire
Director to develop an interagency implementation strategy for the federal
wildland fire management policy. By closely collaborating with other
federal agencies and state representatives, the senior executive and the
USDA Fire Director designed a strategy that was approved for
implementation by the Wildland Fire Leadership Council last year.

High-performing organizations include results-oriented goals in individual
performance plans (or performance agreements) to encourage senior
executives to work collaboratively across traditional organizational
boundaries or "silos." We reported in October 2000 that the Veterans
Health Administration's Veterans Integrated Service Network (VISN)
headquartered in Cincinnati implemented performance agreements that
focused on patient services for the entire VISN and were designed to
encourage the VISN's medical centers to work collaboratively. 36 In 2000,
the VISN Director had a performance agreement with "care line" directors
for patient services, such as primary care, medical and surgical care, and
mental health care. In particular, the mental health care line director's
performance agreement included improvement goals related to mental health
for the entire VISN. To make progress towards these goals, this care line
director had to work across each of the VISN's four medical centers with
the corresponding care line managers at each medical center. As part of
this collaboration, the care line director needed to establish consensus
among VISN officials and external stakeholders on the strategic direction
for the services provided by the mental health care line across the VISN;

35GAO-04-614.

GAO, Managing for Results: Emerging Benefits From Selected Agencies' Use
of Performance Agreement s, GAO-01-115 (Washington, D.C.: Oct. 30, 2000).

Page 25 GAO-06-15 Results-Oriented Government

  GPRA and OMB's Management Tools Offer Opportunities to Foster Greater
  Collaboration among Federal Agencies

develop, implement, and revise integrated clinical programs to reflect
that strategic direction for the VISN; and allocate resources among the
centers for mental health programs to implement these programs.

GPRA, with its focus on strategic planning, the development of long-term
goals, and accountability for results, provides a framework that Congress,
OMB, and executive branch agencies can use to consider the appropriate mix
of long-term strategic goals and strategies needed to identify and address
federal goals that cut across agency boundaries. For example, we have
previously reported that the strategic and annual performance planning
processes under GPRA provide opportunities for federal agencies to
identify other agencies addressing related outcomes, and coordinate with
these agencies to ensure that program goals are complementary; strategies
are mutually reinforcing; and, as appropriate, common performance measures
are used.

OMB, as the focal point for overall management in the executive branch,
plays a key role in aligning the federal government's resources and
activities. To better manage the accomplishment of crosscutting policy
goals, we have recommended that OMB fully implement the GPRA requirement
to develop a governmentwide performance plan. 37 A governmentwide
performance plan could provide a broader perspective of the federal
government's goals and strategies to address issues that cut across
different federal agencies, including redundancy and other inefficiencies
in how the government does its business.

Moreover, we have recommended Congress amend GPRA to require a
governmentwide strategic plan to provide a framework for identifying
long-term goals and strategies for addressing crosscutting issues. A
strategic plan for the federal government, along with key national
indicators to assess the government's performance, could provide an
additional tool for governmentwide reexamination of existing programs, as
well as proposals for new programs. If fully developed, a governmentwide
strategic plan can potentially provide a cohesive perspective on the
long-term goals of the federal government and provide a much-needed basis
for fully integrating, rather than merely coordinating, a wide array of
federal activities.

37

GAO, Results-Oriented Government: GPRA Has Established a Solid Foundation
for Achieving Greater Results , GAO-04-38 (Washington, D.C.: Mar. 10,
2004).

Page 26 GAO-06-15 Results-Oriented Government

In addition to the role it could play in implementing GPRA, OMB could also
use its PMA (President's Management Agenda) and PART (Program Assessment
Rating Tool) tools to foster greater federal agency collaboration.
According to OMB, the PMA was implemented to remedy long-standing federal
agency management and performance challenges. The PMA consists of five
governmentwide initiatives-strategic management of human capital,
competitive sourcing, improved financial performance, expanded electronic
government, and budget and performance integration. For each initiative,
OMB has established goals or "standards for success," and OMB rates
agencies' status each quarter in achieving the goals and making progress
toward them. Additionally, the PMA has nine agency-specific initiatives
such as privatization of military housing and reform of food aid programs,
which OMB also rates quarterly. 38

Among the governmentwide initiatives in the PMA is the strategic
management of human capital. One of the standards for success for this
initiative is having performance appraisals and award programs for all
members of the SES and managers, as well as most of the workforce, that
effectively align with agency mission, goals, and outcomes and hold them
accountable for results. In addition, as stated earlier, high-performing
organizations can place greater emphasis on fostering necessary
collaboration to achieve results through their performance management
systems for all levels of employees. OMB and OPM have recognized this
strategic use of performance management and require SES members to be held
accountable for collaboration and teamwork across organizational
boundaries. 39 However, the PMA standards do not include a similar focus
on collaboration and teamwork for managers and the rest of the workforce,
and thus miss an opportunity to reinforce to agencies that their
performance management systems are strategic tools to strengthen
accountability for results.

One of the nine agency-specific initiatives focuses on improving
coordination of VA and DOD programs and systems to allow for the seamless
transition and continuity of care of beneficiaries from active duty

38

OMB, "The President's Management Agenda, Fiscal Year 2002" (Washington,
D.C.: August 2001). See also GAO, Management Reform: Assessing the
President's Management Agend a, GAO-05-574T (Washington, D.C.: Apr. 21,
2005).

39

Executive Performance and Accountability Regulations, 69 Fed. Reg. 45548
(July 29, 2004) (codified at 5 C.F.R. pts. 430, 1330).

Page 27 GAO-06-15 Results-Oriented Government

to veteran status. Apart from this case, however, our work has shown that
many issues cut across more than one agency and their actions are not well
coordinated. Therefore, such issues would benefit from the greater
attention and focus that PMA could provide. For example, information
sharing for securing the homeland is a governmentwide effort involving
multiple federal agencies, including OMB; DOD; the Departments of Homeland
Security, Justice, and State; and the Central Intelligence Agency. We have
recently highlighted this issue as a high-risk area in need of broad-based
transformation in order to facilitate information sharing among and
between government entities and the private sector. 40 To do this will
require an extraordinary level of collaboration among the federal, state,
and local governments and the private sector.

OMB developed PART as a diagnostic tool meant to provide a consistent
approach to assessing federal programs during the executive budget
formulation process. PART covers four broad topics for all programs
selected for review: (1) program purpose and design, (2) strategic
planning, (3) program management, and (4) program results. In conducting
PART assessments of federal agency programs, OMB considers, among other
things, whether the program coordinates and collaborates effectively with
related programs and whether duplication exists. In addition, consistent
with our recommendation, OMB has begun to use the PART framework to
conduct assessments of groups of programs in similar areas that cut across
agency boundaries. 41 The PART tool provides general guidance for
assessing effective program coordination and collaboration: to demonstrate
effective collaboration, agencies need to provide evidence of
collaborative efforts "leading to meaningful actions in management and
resource allocation"-for example, a joint grant announcement, planning
documents, or performance goals. However, while these are important steps,
as OMB recognizes, such evidence alone does not demonstrate that
meaningful collaboration has occurred.

40GAO-05-207.

See GAO, Performance Budgeting: Observations on the Use of OMB's Program
Assessment Rating Tool for the Fiscal Year 2004 Budget, GAO-04-174
(Washington, D.C.: Jan. 30, 2004). A follow-up report, scheduled to be
issued in October 2005, examines the effects the PART recommendations have
on agency operations and program results, the relationship between PART
and GPRA, and congressional involvement in the PART process.

                                  Conclusions

Agency officials from each of the case study agencies we interviewed
agreed that OMB could play an effective role in fostering greater
collaboration among federal agencies. Some officials we interviewed
indicated that the PMA and PART tools were appropriate vehicles for
sharing the practices in this report. For example, an official stated that
for VA and DOD resource sharing, being singled out as a PMA initiative
provided a high level of visibility to the issue-the additional attention
they have received by having a higher-level entity such as OMB focus on
the issue has been helpful in directing leadership attention and
resources. Furthermore, some officials stated that it would be helpful to
have more expanded criteria for assessing collaboration than the existing
guidance provided by OMB for its PART assessments.

As the challenges of the 21st century grow, it will become increasingly
important for Congress, OMB, and executive agencies to consider how the
federal government can maximize performance and results through improved
collaboration. Our prior work has shown that many issues cut across more
than one agency and their actions are not well coordinated. In this
report, we identify key practices that can help enhance and sustain
collaboration among federal agencies. We also describe how select
agencies' collaboration efforts to address common goals reflect one or
more of these practices. The specific ways in which the case agencies
implemented the practices may not be appropriate for adoption by other
federal agencies seeking to improve their collaboration. Nevertheless, the
practices themselves can be adapted to address the specific collaboration
challenges each agency faces.

The strategic, annual, and performance planning processes under GPRA
provide a means for agencies to ensure that their goals for crosscutting
programs complement those of other agencies; program strategies are
mutually reinforcing; and, as appropriate, common performance measures are
used and they place greater emphasis on collaboration in agency
performance management systems. Furthermore, as we have recommended,
governmentwide strategic and annual planning approaches led by OMB could
aid in improving collaboration across agency lines.

OMB has a central role in overseeing the management of federal agencies
and has used its role to promote results-oriented management practices.
Under its PMA initiatives, OMB has highlighted an agency-specific
initiative-coordination of VA and DOD programs and systems-for
improvement. However, this is only one of a number of areas that OMB could
be focusing on to improve coordination among federal agencies.

Moreover, given the problems we have previously identified with
interagency coordination and collaboration, OMB could bring greater agency
attention to improving collaboration by creating a governmentwide PMA
initiative related to coordination and collaboration akin to its other
five governmentwide initiatives. Furthermore, OMB does not specifically
emphasize collaboration in its standards for successful strategic human
capital management. In its PART program, OMB has also highlighted
effective coordination as one of its assessment criteria. But it does not
rely on sufficient information to assess the effectiveness of the
collaboration nor has OMB offered information on practices that could
assist agencies in enhancing their capacity to coordinate and collaborate
effectively. OMB could, therefore, complement its existing efforts by
looking to the practices in this report as additional evidence of
collaboration or to help diagnose why collaborative efforts have not
produced desired results.

We recommend that the Director of OMB continue to encourage

  Recommendation for

interagency collaboration by focusing attention on additional areas in
need

Executive Action of greater collaboration to achieve common outcomes and
promoting the collaboration practices identified in this report. Options
for doing this could involve

     o expanding the PMA initiatives and standards to include either an
       additional governmentwide initiative focused on improving
       collaboration across federal agencies or additional agency initiatives
       focused on specific areas in need of improved collaboration;
     o expanding the standards for the PMA's strategic management of human
       capital initiative to reflect the need for agencies to hold
       individuals accountable, through their performance management systems,
       for coordinating and collaborating within and across organizational
       boundaries in order to help the agencies achieve their mission, goals,
       and outcomes; and
     o supplementing the PART guidance on interagency coordination with
       information about the collaboration practices in this report.

                       Agency Comments and Our Evaluation

We provided a draft of this report to the Director of OMB for comment.
OMB's Counsel to the Deputy Director for Management responded orally that
OMB agreed with the recommendation. We also provided relevant sections of
a draft of this report to the agencies involved in the three collaboration
efforts-VA, DOD, USDA, HHS, and the Departments of Education and the
Interior. They offered technical suggestions which we incorporated as
appropriate.

We are sending copies of this report to other interested congressional
committees. We are also sending copies to the Director of OMB. We will
make copies available to others upon request. In addition, this report is
available at no charge on the GAO website at http://www.gao.gov.

If you or your staff have any questions about this report, please contact
me at (202) 512-6543 or at [email protected]. Contact points for our
Offices of Congressional Relations and Public Affairs may be found on the
last page of this report. Key contributors to this report are listed in
appendix

III.

Sincerely yours,

Bernice Steinhardt Director, Strategic Issues

                       Appendix I: Scope and Methodology

To identify key practices that can help enhance and sustain collaboration
as well as federal agency collaborative efforts that illustrate these
practices, we reviewed academic literature and prior GAO and Congressional
Research Service reports. In addition, we interviewed experts in
coordination, collaboration, partnerships, and networks from the National
Academy of Public Administration, the IBM Center for The Business of
Government, and the University of California, Berkeley. Although achieving
results may involve the collaborative efforts of both federal and
nonfederal partners, for the purpose of this work we focused on the
practices that federal agencies can employ.

Using our literature review and interviews, we derived a set of practices
that we believe can help enhance and sustain federal agency collaborative
efforts. After examining the various approaches, frameworks, and models
that have been used to describe collaboration practices, we derived from
that material a set of practices that are consistent with results-oriented
performance management and agency requirements under the Government
Performance and Results Act of 1993. Therefore, we do not consider our
categorization of the practices for collaborative efforts to be definitive
and recognize that alternative categorizations of practices could be
developed and additional practices included.

While we generally believe that the application of as many of these
practices as possible increases the likelihood of effective collaboration,
we also recognize that there is a wide range of situations and
circumstances in which agencies work together. Consequently, in some cases
the judicious adoption of even a few practices may be sufficient for
effective collaboration while in other cases the adoption of all these
practices may not be sufficient to guarantee an effective working
relationship.

To illustrate, and to also help refine these practices, we selected three
areas where federal agencies have developed ongoing collaborations:
Healthy People 2010-a long-standing effort to develop and track public
health objectives for the nation, wildland fire management, and health
resource sharing between Veterans Affairs (VA) and the Department of
Defense (DOD). We selected these areas based on expert views and our prior
work indicating that substantial collaboration was taking place. We
selected examples from among the three collaborative efforts that, in our
judgment, most clearly illustrated and supported the practices we
identified. Therefore, agencies other than those cited for a particular
practice may, or may not, be engaged in the same practice. As the
objectives of this work were to identify practices that can help enhance

Appendix I: Scope and Methodology

and sustain such collaboration, we did not assess whether the examples of
collaboration practices we highlighted resulted in improved performance in
these three areas.

For our review, we selected two Healthy People 2010 focus areas-
"Disability and Secondary Conditions" and "Nutrition and Overweight"- that
involve substantial collaboration among the Department of Health and Human
Services (HHS), which leads this initiative, and non-HHS agencies. The
Department of Education's National Institute on Disability and
Rehabilitation Research coleads the Disability and Secondary Conditions
focus area with HHS's Centers for Disease Control and Prevention (CDC).
While HHS's Food and Drug Administration (FDA) and National Institutes of
Health (NIH) colead the Nutrition and Overweight focus area, with the
CDC's National Center for Health Statistics providing the majority of data
for assessing progress toward attaining the Nutrition and Overweight
objectives, the U.S. Department of Agriculture (USDA) provides most of the
food and consumption data.

To obtain perspectives on the practices being used by the federal agencies
involved in Healthy People 2010, we reviewed literature on Healthy People
and met with officials from the National Academy of Public Administration
and the Robert Wood Johnson Foundation. We interviewed federal officials
from the Office of Disease Prevention and Health Promotion at HHS who
coordinate this effort. We also interviewed federal officials from USDA's
Agriculture Research Service, Center for Nutrition Policy and Promotion,
and Food and Nutrition Service; HHS's FDA, CDC, and NIH; and the
Department of Education's National Institute on Disability and
Rehabilitation Research.

We judgementally selected and interviewed officials from three state
health agencies that differed in their approaches to healthy people
initiatives-Iowa Division of Administration, Pennsylvania Bureau of Health
Planning, and the California Department of Health Services-to obtain
nonfederal perspectives on the federal collaborative efforts to develop
Healthy People 2010.

To obtain perspectives on the practices used by VA and DOD to share health
resources, we reviewed our prior reports and met with officials from VA's
Resource Sharing Office and DOD's DOD-VA Program Coordination Office. We
also spoke with VA and DOD staff and reviewed agency documents they
provided at the specific sites we visited in California, Florida, and
Kentucky covering the Air Force, Navy, and Army respectively. In
California, we visited the VA McClellan outpatient clinic in

Appendix I: Scope and Methodology

Sacramento and the David Grant Medical Center at Travis Air Force Base. In
Florida, we visited the VA Outpatient Clinic, Naval Hospital, and Corry
Station Branch Medical Clinic-all in Pensacola. In Kentucky, we visited
the Louisville VA Medical Center, the VA Community Based Outpatient Clinic
in Standiford Field, and Ireland Army Community Hospital in Fort Knox.

To obtain perspectives on the practices being used by the federal agencies
involved in wildland fire management, we reviewed our prior reports and
documents we obtained from these agencies. We interviewed officials from
the Office of the National Fire Plan Coordinator at the Forest Service and
the Office of Wildland Fire Coordination at the Department of the
Interior. We also visited the National Interagency Fire Center (NIFC) at
Boise, Idaho, and interviewed NIFC staff from six federal agencies-the
Bureau of Land Management, Bureau of Indian Affairs, Fish and Wildlife
Service, and National Park Service of the Department of the Interior; the
Forest Service of USDA; and the National Weather Service of the Department
of Commerce. While at NIFC, we also interviewed staff from Interior's
Office of Aviation Services. To obtain a perspective from stakeholders on
federal interagency collaboration, we interviewed representatives from the
Western Governors' Association and the National Association of State
Foresters.

We conducted our work from May 2004 through August 2005 in offices in the
Washington, D.C. metropolitan area; Boise, Idaho; Louisville and Fort
Knox, Kentucky; Pensacola, Florida; and Sacramento and Fairfield,
California, in accordance with generally accepted government auditing
standards.

Appendix II: Federal Collaborative Efforts We Reviewed

               Table 1: Federal Collaborative Efforts We Reviewed

Federal                                     Key federal agencies,          
collaborative                               partners, and stakeholders     
effort         Description                  
Healthy People The Healthy People 2010      The Healthy People initiative  
2010           initiative provides a        is led by HHS. HHS uses a      
                  comprehensive set of         broad consultation process in  
                  national disease prevention  the development of the         
                  and health promotion         objectives involving state and 
                  objectives to be achieved    territorial public health,     
                  over a 10-year period along  mental health, substance       
                  with indicators to measure   abuse, and environmental       
                  progress. First issued in    agencies; and national         
                  1979 in Healthy People: The  professional, advocacy, and    
                  Surgeon General's Report on  business sector organizations. 
                  Health Promotion and Disease HHS designated lead and colead 
                  Prevention, and updated in   federal agencies for each of   
                  1990, the Healthy People     the 28 focus areas.            
                  2010 initiative is the third Additionally each focus area   
                  time that HHS has developed  has a work group comprising    
                  10-year Healthy People       representatives from both      
                  objectives for the nation.   federal and nonfederal         
                  The Healthy People 2010      partners.                      
                  objectives are designed to   
                  achieve two overarching      
                  goals-(1) increase quality   
                  and years of healthy life    
                  and (2) eliminate health     
                  disparities. The 467         
                  objectives are organized     
                  around 28 focus areas, such  
                  as access to quality health  
                  services, cancer, medical    
                  product safety, and physical 
                  activity and fitness.        
                  The Disability and Secondary CDC and the Department of      
                  Condition focus area         Education's National Institute 
                  comprises 13 objectives to   on Disability and              
                  "promote the health of       Rehabilitation Research are    
                  people with disabilities,    the two colead agencies for    
                  prevent secondary            the Disability and Secondary   
                  conditions, and eliminate    Conditions focus area. Work    
                  disparities between people   group members include          
                  with and without             representatives from the       
                  disabilities in the U.S.     Department of Commerce and the 
                  population." This focus area Social Security Administration 
                  was included as a new area   as well as HHS agencies, such  
                  for Healthy People 2010. The as the Administration for      
                  Nutrition and Overweight     Children and                   
                  focus area comprises 18      
                  objectives to "promote       
                  health and reduce chronic    
                  disease associated with diet 
                  and weight." Nutrition has   
                  been included as a focus     
                  area in the Healthy People   
                  initiative since its         
                  inception in 1979.           
                                               Families, Indian Health        
                                               Service, and                   
                                               Substance Abuse and Mental     
                                               Health                         
                                               Services Administration.       
                                               FDA and NIH are the two colead 
                                               agencies for the Nutrition and 
                                               Overweight focus area. While   
                                               the CDC's National Center for  
                                               Health                         
                                               Statistics provides the        
                                               majority of the data to track  
                                               the achievement of             
                                               objectives in this area, USDA  
                                               is also a partner in this      
                                               effort. Work group members for 
                                               this focus area also           
                                               include representatives from   
                                               other HHS agencies-such as the 
                                               Administration on Aging, CDC,  
                                               Indian Health Services, and    
                                               Health Resources and Services  
                                               Administration-and the         
                                               Department of Education.       

Appendix II: Federal Collaborative Efforts We Reviewed

Federal                                              Key federal agencies, 
                                                        partners, and         
collaborative     Description                        stakeholders          
effort                                               
                     In 1982, Congress passed the       VA and DOD            
VA and DOD health "Sharing Act" to promote           
resource sharing  cost-effective use of health care  
                     resources and efficient delivery   
                     of care. a                         
                     Specifically, Congress authorized  
                     VA medical centers and DOD         
                     military treatment facilities to   
                     enter into sharing agreements with 
                     each                               
                     other to buy, sell, and barter     
                     medical and support services. In   
                     2002,                              
                     Congress passed additional         
                     legislation to encourage and       
                     foster health                      
                     resources sharing between VA and   
                     DOD. For example, VA and DOD       
                     were required to establish a       
                     high-level joint committee for     
                     developing                         
                     and establishing collaborative     
                     efforts; develop a joint strategic 
                     plan;                              
                     provide start-up funds for sharing 
                     projects; and fund                 
                     resource-sharing demonstration     
                     projects.b                         
                     VA and DOD sharing activities fall 
                     into three categories:             
                     1. national sharing initiatives    
                     designed to lower costs and        
                     provide                            
                     better access to goods and         
                     services by purchasing nationally  
                     rather than by individual          
                     facilities;                        
                     2. joint-venture sharing           
                     agreements aimed at reducing costs 
                     by                                 
                      pooling resources, for example to 
                        build a new facility or jointly 
                                                    use 
                     an existing facility; and          
                     3. local sharing agreements        
                     pertaining to inpatient and        
                     outpatient                         
                     care, ancillary services-such as   
                     diagnostic and therapeutic         
                     radiology, dental care, and        
                     specialty care-and other support   
                     services such as administration    
                     and management, research,          
                     education and training, patient    
                     transportation, and laundry.       

Wildland fire management

Source: GAO analysis of agency documents.

aVeterans' Administration and Department of Defense Health Resources
Sharing and Emergency Operations Act, Pub. L. No. 97-174, 96 Stat. 70 (May
4, 1982).

Page 36 GAO-06-15 Results-Oriented Government

Federal fire agencies use the interagency 2001 Federal Wildland Fire
Management Policy and the National Fire Plan to manage wildland fires.c
The 2001 federal fire policy provides the broad policy foundation for
federal fire management programs and activities, including those under the
National Fire Plan.

The 2001 federal fire policy contains nine guiding principles for the
management of wildland fires including: firefighter and public safety is
the first priority in every fire management activity; standardization of
policies and procedures among federal agencies is an ongoing objective;
and federal, state, tribal, local, interagency, and international
coordination and cooperation are essential.

The National Fire Plan comprises various documents including-(1) a
September 2000 report from the Secretaries of Agriculture and the Interior
to the President in response to the wildland fires of 2000,d

        (2)
                a conference committee report accompanying the fiscal year
                2001 appropriations act,e and (3) a 10-year comprehensive
                strategy and implementation plan for reducing fire risks.f
                The National Fire Plan addresses five key issues: (1)
                firefighting resources and personnel, (2) rehabilitation and
                restoration,

(3)
           hazardous fuels reduction, (4) community assistance, and

(5)
           accountability.

The five federal agencies with wildland fire responsibilities are the
Forest Service at USDA; Bureau of Indian Affairs, Bureau of Land
Management, Fish and Wildlife Service, and National Park Service at the
Department of the Interior. The Federal Emergency Management Agency is
also involved to the extent that wildland fires at the urban interface may
involve buildings. Key nonfederal stakeholders include the Western
Governors' Association/National Governors Association, National
Association of State Foresters, National Association of Counties, and the
Intertribal Timber Council.

Appendix II: Federal Collaborative Efforts We Reviewed

b

Bob Stump National Defense Authorization Act of 2003, Pub. L. No. 107-314,
S:721-22, 116 Stat. 2458, 2589-98 (Dec. 2, 2002).

c

U.S. Department of the Interior, U.S. Department of Agriculture,
Department of Energy, Department of Defense, Department of Commerce, U.S.
Environmental Protection Agency, Federal Emergency Management Agency, and
National Association of State Foresters, Review and Update of the 1995
Federal Wildland Fire Management Policy (Washington, D.C.: January 2001).

d

U.S. Department of the Interior and U.S. Department of Agriculture,
Managing the Impact of Wildfires on Communities and the Environment: A
Report to the President In Response to the Wildfires of 2000

(Washington, D.C.: Sept. 8, 2000).

e

U.S. House of Representatives, Making Appropriations for the Department of
the Interior and Related Agencies for the Fiscal Year Ending September 30,
2001, and for Other Purposes, Report 106-914 (Washington, D.C.: Sept. 29,
2000).

f

U.S.
           Department of the Interior, U.S. Department of Agriculture,
           Western Governors' Association, A Collaborative Approach for
           Reducing Wildland Fire Risks to Communities and the Environment:
           10-Year Comprehensive Strategy (Washington, D.C.: August 2001);
           and U.S. Department of the Interior,

U.S.
           Department of Agriculture, Western Governors' Association, A
           Collaborative Approach for Reducing Wildland Fire Risks to
           Communities and the Environment: 10-Year Comprehensive Strategy,
           Implementation Plan (Washington, D.C.: May 2002).

Appendix III: GAO Contact and Staff Acknowledgments

Bernice Steinhardt, (202) 512-6543

GAO Contact

                                Acknowledgments

Thomas M. Beall, Mallory B. Bulman, Elizabeth H. Curda, Patricia A.
Dalton, Bertha Dong, Martin H. De Alteriis, Janice C. Latimer, Benjamin T.
Licht, Allen C. Lomax, William A. McKelligott, Michael L. Rose, and Lisa
R. Shames made major contributions to this report. In addition, Aditi Shah
Archer, Cynthia A. Bascetta, Michael T. Blair, Jr., David P. Bixler,
Chester

M. Joy, Jacqueline M. Nowicki, and Sarah E. Veale provided key assistance.

(450336)

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