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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: 

United States Government Accountability Office: 

GAO: 

October 2005: 

Results-Oriented Government: 

Practices That Can Help Enhance and Sustain Collaboration among Federal 
Agencies: 

GAO-06-15: 

GAO Highlights: 

Highlights of GAO-06-15, a 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: 

Why GAO Did This Study: 

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. 

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:

* define and articulate a 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 on results; 
* reinforce agency accountability for collaborative efforts through 
agency plans and reports; and
* 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. 

What GAO Recommends: 

GAO recommends that the Director of OMB focus on additional programs in 
need of collaboration and promote the practices in this report. Options 
include expanding the focus on collaboration in the President’s 
Management Agenda (PMA) and supplementing the Program Assessment Rating 
Tool (PART) guidance with information about these practices. OMB agreed 
with this recommendation. Agencies involved in the collaborations 
provided technical comments, which we incorporated as appropriate. 

www.gao.gov/cgi-bin/getrpt?GAO-06-15. 

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Bernice Steinhardt at 
(202) 512-6543 or steinhardtb@gao.gov. 

[End of section] 

Contents: 

Letter: 

Results in Brief: 

Background: 

Key Practices That Can Help Enhance and Sustain Collaboration among 
Federal Agencies: 

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

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: 

TableTable 1: Federal Collaborative Efforts We Reviewed: 

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: 

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 long-range 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: 

* 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.[Footnote 1],[Footnote 2] 

* 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.[Footnote 3] 

We have also reported that agencies face a range of barriers when they 
attempt to collaborate with other agencies.[Footnote 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)[Footnote 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. 

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.[Footnote 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,[Footnote 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. 

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. 

Results in Brief: 

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: 

* 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. 

* 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. 

* 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. 

* 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. 

* 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. 

* 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. 

* 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. 

* 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.[Footnote 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. 

Background: 

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.[Footnote 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 operating over a long period of 
time.[Footnote 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. 

Federal Collaborative Efforts We Reviewed: 

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: 

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

Wildland Fire Management: 

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.[Footnote 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. 

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").[Footnote 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,[Footnote 13] the Joint Incentive Fund Program. Proposals for 
funding for either onetime 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 long- 
standing barriers, including incompatible computer systems that affect 
the exchange of patient health information, inconsistent reimbursement 
and budgeting policies, and burdensome agreement approval 
processes.[Footnote 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.[Footnote 
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. 

Key Practices That Can Help Enhance and Sustain Collaboration among 
Federal Agencies: 

Drawing from the literature we reviewed, the experts we interviewed, 
and our prior work, we identified eight key practices that can help 
federal agencies enhance and sustain their collaborative efforts. The 
federal collaborative efforts we reviewed helped further refine the 
practices and provided a wide variety of concrete illustrations of how 
the practices can 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: 

* defining and articulating a common outcome; 

* establishing mutually reinforcing or joint strategies to achieve the 
outcome; 

* identifying and addressing needs by leveraging resources; 

* agreeing upon agency roles and responsibilities; 

* establishing compatible policies, procedures, and other means to 
operate across agency boundaries; 

* developing mechanisms to monitor, evaluate, and report the results of 
collaborative efforts; 

* reinforcing agency accountability for collaborative efforts through 
agency plans and reports; and: 

* 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.[Footnote 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 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.[Footnote 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.[Footnote 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.[Footnote 19] The 
Departments' response and conference committee direction resulted in 
the National Fire Plan that included a collaborative approach for a 10- 
year strategy and implementation plan to reduce the risk of 
catastrophic wildland fires.[Footnote 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."[Footnote 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 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,[Footnote 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 Reinforcing or Joint Strategies: 

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

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.[Footnote 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 Adults: The Evidence Report.[Footnote 24] 

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.[Footnote 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 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." 

Identify and Address Needs by Leveraging Resources: 

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 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. 

Agree on Roles and Responsibilities: 

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.[Footnote 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. 

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.[Footnote 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 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. 

Develop Mechanisms to Monitor, Evaluate, and Report Results: 

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.[Footnote 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 who use parachutes to get to the fire).[Footnote 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.[Footnote 30] According to the interagency strategy, 
these evaluations will be consistent with GPRA requirements and agency 
strategic plans. 

Reinforce Agency Accountability for Collaborative Efforts through 
Agency Plans and Reports: 

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 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%."[Footnote 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. 

Reinforce Individual Accountability for Collaborative Efforts through 
Performance Management Systems: 

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.[Footnote 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 
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.[Footnote 33] To this end, HHS holds all senior executives 
accountable for the crosscutting "One-HHS" program objectives that 
relate to their job responsibilities.[Footnote 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 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.[Footnote 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 self-assessment 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.[Footnote 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; 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 and OMB's Management Tools Offer Opportunities to Foster Greater 
Collaboration among Federal Agencies: 

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.[Footnote 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. 

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.[Footnote 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.[Footnote 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 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.[Footnote 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.[Footnote 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. 

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. 

Conclusions: 

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. 

Recommendation for Executive Action: 

We recommend that the Director of OMB continue to encourage interagency 
collaboration by focusing attention on additional areas in need of 
greater collaboration to achieve common outcomes and promoting the 
collaboration practices identified in this report. Options for doing 
this could involve: 

* 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; 

* 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: 

* 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 steinhardtb@gao.gov. 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: 

[End of section] 

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 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 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. 

[End of section] 

Appendix II: Federal Collaborative Efforts We Reviewed: 

Table 1: Federal Collaborative Efforts We Reviewed: 

Federal collaborative effort: Healthy People 2010; 
Description: The Healthy People 2010 initiative provides a 
comprehensive set of national disease prevention and health promotion 
objectives to be achieved over a 10-year period along with indicators 
to measure progress; First issued in 1979 in Healthy People: The 
Surgeon General's Report on Health Promotion and Disease Prevention, 
and updated in 1990, the Healthy People 2010 initiative is the third 
time that HHS has developed 10-year Healthy People objectives for the 
nation; The Healthy People 2010 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 Condition focus area comprises 13 objectives 
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." This focus area was included as a 
new area for Healthy People 2010; The Nutrition and Overweight 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; 
Key federal agencies, partners, and stakeholders: The Healthy People 
initiative is led by HHS. HHS uses a broad consultation process in the 
development of the objectives involving state and territorial public 
health, mental health, substance abuse, and environmental agencies; and 
national professional, advocacy, and business sector organizations. HHS 
designated lead and colead federal agencies for each of the 28 focus 
areas. Additionally each focus area has a work group comprising 
representatives from both federal and nonfederal partners; CDC and the 
Department of Education's National Institute on Disability and 
Rehabilitation Research are the two colead agencies for the Disability 
and Secondary Conditions focus area. Work group members include 
representatives from the Department of Commerce and the Social Security 
Administration as well as HHS agencies, such as the Administration for 
Children and 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. 

Federal collaborative effort: VA and DOD health resource sharing; 
Description: In 1982, Congress passed the "Sharing Act" to promote 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; 
Key federal agencies, partners, and stakeholders: VA and DOD. 

Federal collaborative effort: Wildland fire management; 
Description: 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; 
Key federal agencies, partners, and stakeholders: 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. 

Source: GAO analysis of agency documents. 

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

[B] Bob Stump National Defense Authorization Act of 2003, Pub. L. No. 
107-314, §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). 

[End of table] 

[End of section] 

Appendix III: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Bernice Steinhardt, (202) 512-6543: 

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. 

FOOTNOTES 

[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. 

[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. 

[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. 

[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). 

[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. 

[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). 

[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, §721, 116 Stat. 2458, 2589-2595 (Dec. 2, 
2002). 

[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). 

[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). 

[17] The 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). 

[19] 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). 

[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). 

[21] 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). 

[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). 

[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). 

[26] 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. 

[27] 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. 

[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. 

[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. 

[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). 

[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. 

[35] GAO-04-614. 

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

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

[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 Agenda, 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). 

[40] GAO-05-207. 

[41] 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. 

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