Centers for Disease Control and Prevention:

Agency Leadership Taking Steps to Improve Management and Planning, but Challenges Remain

GAO-04-219: Published: Jan 30, 2004. Publicly Released: Jan 30, 2004.

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The scope of work at the Centers for Disease Control and Prevention (CDC) has evolved since 1946 from a focus on communicable diseases, like malaria, to a wide and complex range of public health responsibilities. The agency's Office of the Director (OD) faces considerable management challenges to ensure that during public health crises the agency's nonemergency but important public health work continues apace. In 2002, the agency's OD began taking steps aimed at organizational change. GAO has observed elsewhere that major change management initiatives can take at least 5 to 7 years. In this report, GAO examined the extent to which organizational changes have helped balance OD's oversight of CDC's emergent and ongoing public health responsibilities. Specifically, GAO examined OD's (1) executive management structure, (2) approach to overseeing the agency's work, and (3) approach to setting the agency's priorities.

The management team in CDC's top office--OD--is undergoing a structural change designed to provide a new approach to managing the agency's public health work. Through this effort, CDC has taken steps that have merit. For example, OD established a Chief Operating Officer position with clear oversight authority for the agency's operations units, such as financial management and information technology. However, a significant oversight weakness remains: there is no position or combination of positions on OD's management team below the Director's level to oversee the programs and activities of 11 centers that perform the bulk of the agency's public health work. Only CDC's Director has line authority for the centers, and the extraordinary demands on the Director's time associated with public health emergencies and other external events make the practicality of this oversight arrangement uncertain. Another of OD's structural initiatives was to align OD management team positions with broad mission "themes," or goals, that cut across the centers' institutional boundaries. The intent was to foster among the 11 independent centers a more integrated approach to performing the agency's mission. This purpose may be difficult to realize, however, as connections between certain themes and associated OD positions are not sufficiently clear. OD has made improvements in its ability to oversee the agency's response to public health emergencies--including the creation of an emergency preparedness and response office and the development of an emergency communication system--but concerns remain about OD's oversight of nonemergency public health work. OD's efforts to monitor the activities of the centers are not sufficiently systematic. For example, few formal systems are in place to track the status of centers' operations and programmatic activities. Although OD has a process for center officials to elevate important issues of concern, the information flow under this process is largely center-driven, as the subjects discussed are typically raised at the discretion of the center officials. Similarly, OD's efforts to foster coordination among the centers fall short of institutionalizing collaboration as standard agency practice. The planning tools that OD needs to set agency priorities and address human capital challenges are under development. In recent years, OD has operated without an up-to-date agencywide planning strategy with which to set mission priorities and unify the work of CDC's various centers. In June 2003, OD initiated an agencywide strategic planning process. In a separate planning effort initiated in April 2003, CDC began working on a human capital plan for meeting the agency's current and future staffing needs. This effort has been suspended while the strategic planning process gets under way, and no time frames have been established for resuming its development. At the same time, agency attrition and future limits on workforce growth suggest that agency leadership may be needed to ensure that workforce planning occurs expeditiously.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: GAO recommended that CDC's Director ensure that the agency's new strategic planning process involve CDC employees and external partners to identify agency-wide priorities, align resources with these priorities, and facilitate the coordination of the centers' mission-related activities. CDC's Futures Initiative, a strategic development process which involved its staff, federal partners, and stakeholders, addressed this recommendation by helping CDC to prioritize its strategies, programs, and resources and to reorganize its structure. Thus, CDC now has systems and processes in place to align its programs, science, budget, and procurement processes with its goals. For example, goal teams, led by CDC senior staff, are responsible for drafting goal action plans, which include a prioritized set of objectives, roles and responsibilities of organizational units across the agency, and for recommending alignment of resources needed to accomplish these objectives. As a result, CDC's budget activities are aligned to health protection goals at the division level. CDC's Futures Initiative has also led to a new organizational design, which facilitates the coordination of the centers' mission-related activities through the establishment of four new coordinating centers. Due to the new organizational design, the coordinating centers are positioned to provide greater agency-wide coordination across multiple centers responsible for conducting CDC's mission activities.

    Recommendation: The CDC Director should ensure that the agency's new strategic planning process will involve CDC employees and external partners to identify agencywide priorities, align resources with these priorities, and facilitate the coordination of the centers' mission-related activities.

    Agency Affected: Department of Health and Human Services: Public Health Service: Centers for Disease Control and Prevention

  2. Status: Closed - Implemented

    Comments: CDC has developed incentives to foster center collaboration as a standard agency practice through the establishment of its four coordinating centers in April 2005. The coordinating centers are organizational structures that group together centers that conduct similar or complimentary work. For example, the Coordinating Center for Health Promotion brings together three centers that focus on preventive care, including National Center on Birth Defects and Developmental Disabilities, National Center for Chronic Disease Prevention and Health Promotion, and the Office of Genomics and Disease Prevention. CDC stated that this structure was chosen to capitalize on opportunities for coordination and integration of research between centers, decrease duplication and redundant activities in center programs, and provide leadership, management, and accountability for goals and programs across centers.

    Recommendation: To improve OD's management of CDC's nonemergency mission priorities, the CDC Director should develop incentives to foster center collaboration as a standard agency practice.

    Agency Affected: Department of Health and Human Services: Public Health Service: Centers for Disease Control and Prevention

  3. Status: Closed - Implemented

    Comments: In 2005, CDC began implementing HealthImpact.net, a full-cycle planning, execution, results and evaluation reporting system. In August 2009, CDC reported that this system contains data for all projects across the agency from fiscal year 2006 to the present approximately 1300 projects per year. HealthImpact.net generates both standard and ad hoc reports that are used for workload planning, budget planning, and review, approval, and monitoring of specific projects. For example, CDC's Procurement and Grants Office uses data from HealthImpact.net to monitor workload planning in support of the agency's acquisition and assistance activities. CDC's Financial Management Office (FMO) uses the data from HealthImpact.net to carry out its responsibility of planning the finances of the agency prior to the beginning of the fiscal year. Specifically, this data is referenced in budget planning decisions that FMO senior leaders have with the leadership of individual program offices. HealthImpact.net also provides data which CDC's Coordinating Office for Terrorism and Emergency Response uses to review the scope of potential activities, to approve those activities, and also as a basis for how it tracks the performance of ongoing activities throughout the year. HealthImpact.net is the only enterprise-wide application that is universally accessible to anyone within CDC, and it is the only application that can provide a complete source of knowledge of all the work of the agency in one venue.

    Recommendation: To improve OD's management of CDC's nonemergency mission priorities, the CDC Director should ensure that reporting requirements and tracking systems are developed for OD to routinely monitor the centers' operations and programmatic activities.

    Agency Affected: Department of Health and Human Services: Public Health Service: Centers for Disease Control and Prevention

  4. Status: Closed - Implemented

    Comments: We previously reported a weakness in oversight of CDC's centers due to the fact that only the Director of CDC had line authority over the centers' programs and activities. In addition, we reported that the distinction between the Deputy Director for Science and Public Health and the Deputy Director for Public Health Service had not been clearly made. This resulted in GAO recommending that (1) the CDC Director realign and clarify oversight responsibility for the centers' programmatic work at a level below the Director and that (2) the roles of the Deputy Directors be clarified. In April 2005, the internal reorganization that CDC implemented was officially approved. This reorganization helped to realign and clarify oversight responsibility for the centers' programmatic work through the establishment of four new coordinating centers, which are organizational structures that group together centers that conduct similar or complimentary work. The coordinating centers have management structures that oversee the centers, and the centers' directors report to their respective coordinating center directors. Previously, the 11 center directors reported to the Director of CDC. Now, the 4 coordinating center directors report to the Director of CDC helping to streamline the flow of information for leadership decision-making. As part of its internal reorganization, CDC has also taken steps to clarify the roles and responsibilities of its senior management officials responsible for the agency's science and public health efforts. Specifically, CDC eliminated the Deputy Director for Science and Public Health and the Deputy Director for Public Health Service positions and established the Chief Science Officer and the Chief of Public Health Practice. These positions have their own distinct descriptions, which clearly outline the separate roles and responsibilities of each office.

    Recommendation: To improve OD's management of CDC's nonemergency mission priorities, the CDC Director should realign and clarify oversight responsibility for the centers' programmatic work at a level below the Director, including clarifying the roles of OD's deputy directors.

    Agency Affected: Department of Health and Human Services: Public Health Service: Centers for Disease Control and Prevention

  5. Status: Closed - Implemented

    Comments: Over the past year, CDC has embarked on several initiatives, which address our recommendation that the CDC Director ensure that the agency's human capital planning efforts receive appropriate leadership attention. In May 2005, CDC completed the human capital planning effort it had initiated in April 2003 and released its agency-wide human capital plan, Strategic Management of Human Capital Plan, for fiscal years 2005 through 2008. CDC's strategic planning resulted in the development of six key strategies to guide agency decisions and priorities. CDC's human capital plan is linked to three of these strategies--leadership, global health impact, and accountability. Moreover, a review of some of CDC's performance plans for senior management officials, such as Coordinating Center Directors, Chief Operating Officer, Chief Science Officer, and the Chief of Public Health Practice, showed that the plans made references to strategic planning initiatives. In addition, in June 2005, the mission for the newly established Office of Workforce and Career Development was approved. The mission of this office includes the following: developing a comprehensive strategic human resource leadership program; collaborating with the Office of Strategy and Innovation; and collaborating with Office of Director when appropriate. Some of the human capital activities proposed by the Director of Office of Workforce and Career Development included strategic and targeted recruitment, succession planning, and strategy/innovation planning.

    Recommendation: The CDC Director should ensure that the agency's human capital planning efforts receive appropriate leadership attention, including resuming human capital planning, linking these efforts to the agency's strategic plan, and linking senior executives' performance contracts with the strategic plan.

    Agency Affected: Department of Health and Human Services: Public Health Service: Centers for Disease Control and Prevention

 

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