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S. Hrg. 111–633 

GETTING TO BETTER GOVERNMENT: FOCUSING 

ON PERFORMANCE 

HEARING 

BEFORE THE

FEDERAL FINANCIAL MANAGEMENT, GOVERNMENT 

INFORMATION, FEDERAL SERVICES, AND 

INTERNATIONAL SECURITY SUBCOMMITTEE 

OF THE

COMMITTEE ON 

HOMELAND SECURITY AND 

GOVERNMENTAL AFFAIRS 

UNITED STATES SENATE 

OF THE

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

SEPTEMBER 24, 2009 

Available via http://www.gpoaccess.gov/congress/index.html 

Printed for the use of the 

Committee on Homeland Security and Governmental Affairs 

( 


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COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS 

JOSEPH I. LIEBERMAN, Connecticut, Chairman 

CARL LEVIN, Michigan 

DANIEL K. AKAKA, Hawaii 

THOMAS R. CARPER, Delaware 

MARK L. PRYOR, Arkansas 

MARY L. LANDRIEU, Louisiana 

CLAIRE MCCASKILL, Missouri 

JON TESTER, Montana 

ROLAND W. BURRIS, Illinois 

PAUL G. KIRK, JR., Massachusetts 

SUSAN M. COLLINS, Maine 

TOM COBURN, Oklahoma 

JOHN MCCAIN, Arizona 

GEORGE V. VOINOVICH, Ohio 

JOHN ENSIGN, Nevada 

LINDSEY GRAHAM, South Carolina 

ROBERT F. BENNETT, Utah 

MICHAEL L. ALEXANDER, Staff Director 

BRANDON L. MILHORN, Minority Staff Director and Chief Counsel 

TRINA DRIESSNACK TYRER, Chief Clerk 

SUBCOMMITTEE ON FEDERAL FINANCIAL MANAGEMENT, GOVERNMENT 

INFORMATION, FEDERAL SERVICES, AND INTERNATIONAL SECURITY 

THOMAS R. CARPER, Delaware, Chairman 

CARL LEVIN, Michigan 

DANIEL K. AKAKA, Hawaii 

MARK L. PRYOR, Arkansas 

CLAIRE MCCASKILL, Missouri 

ROLAND W. BURRIS, Illinois 

JOHN MCCAIN, Arizona 

TOM COBURN, Oklahoma 

GEORGE V. VOINOVICH, Ohio 

JOHN ENSIGN, Nevada 

JOHN KILVINGTON, Staff Director 

WENDY R. ANDERSON, Professional Staff Member 

BRYAN PARKER, Staff Director and General Counsel to the Minority 

DEIRDRE G. ARMSTRONG, Chief Clerk 


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C O N T E N T S 

Opening statement: Page 

Senator Carper ................................................................................................. 1 

Prepared statements: 

Senator Carper ................................................................................................. 33 

Senator McCain ................................................................................................ 36 

WITNESSES 

THURSDAY, SEPTEMBER 24, 2009 

Jeffrey D. Zients, Deputy Director for Management and Chief Performance 

Officer, Office of Management and Budget ........................................................ 4 

Bernice Steinhardt, Director, Strategic Issues, U.S. Government Accountability Office ......................................................................................................... 6 

W. Craig Fugate, Administrator, Federal Emergency Management Agency, 

U.S. Department of Homeland Security ............................................................. 19 

Phea S. Suh, Assistant Secretary for Policy, Management, and Budget, U.S. 

Department of the Interior .................................................................................. 21 

Michelle Snyder, Acting Deputy Administrator and Deputy Chief Operating 

Officer, Centers for Medicare and Medicaid Services, U.S. Department of 

Health and Human Services ............................................................................... 22 

Paul L. Posner, Director, Public Administration Program, Department of Public and International Affairs, George Mason University .................................. 25 

ALPHABETICAL LIST OF WITNESSES

Fugate, W. Craig: 

Testimony .......................................................................................................... 19 

Prepared statement .......................................................................................... 63 

Posner, Paul L.: 

Testimony .......................................................................................................... 25 

Prepared statement .......................................................................................... 89 

Snyder, Michelle: 

Testimony .......................................................................................................... 22 

Prepared statement .......................................................................................... 74 

Steinhardt, Bernice: 

Testimony .......................................................................................................... 6 

Prepared statement .......................................................................................... 40 

Suh, Rhea S.: 

Testimony .......................................................................................................... 21 

Prepared statement .......................................................................................... 71 

Zients, Jeffrey D.: 

Testimony .......................................................................................................... 4 

Prepared statement .......................................................................................... 37 

APPENDIX 

‘‘Building a Better Government Performance System,’’ June 2009, Sponsored 

by Accenture Institute for Public Service Value, Georgetown Public Policy 

Institute, OMB Watch, submitted by Senator Carper ...................................... 103 

Questions and responses for the Record from: 

Mr. Zients .......................................................................................................... 165 

Ms. Steinhardt .................................................................................................. 170 

Mr. Fugate ........................................................................................................ 177 

Ms. Suh ............................................................................................................. 179 

Ms. Snyder ........................................................................................................ 181 

Mr. Posner ......................................................................................................... 188 


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GETTING TO BETTER GOVERNMENT: 

FOCUSING ON PERFORMANCE 

THURSDAY, SEPTEMBER 24, 2009 

U.S. SENATE, SUBCOMMITTEE ON FEDERAL FINANCIAL MANAGEMENT, GOVERNMENT INFORMATION, FEDERAL SERVICES, AND INTERNATIONAL SECURITY, OF THE COMMITTEE ON HOMELAND SECURITY

AND GOVERNMENTAL AFFAIRS, Washington, DC. 

The Subcommittee met, pursuant to notice, at 10:36 a.m., in 

room SD–342, Dirksen Senate Office Building, Hon. Thomas R. 

Carper, Chairman of the Subcommittee, presiding. 

Present: Senator Carper. 

OPENING STATEMENT OF SENATOR CARPER 

Senator CARPER. Good morning, everyone. Thank you all for joining us today. Our colleagues are going to be drifting in and out. We 

are working on the interior appropriations on the Senate floor, so 

there is a lot going on today. But as you all know, 8 months ago, 

we inaugurated a new President, and since coming into office, 

President Obama has faced—I think it is an understatement—a 

complicated set of challenges, both domestic and international. 

For example, our new President has faced soaring Federal defi- cits projected to reach some $9 trillion over the next decade. He 

has inherited an economic crisis that has required unprecedented 

international cooperation to jump-start the world’s economies. He 

has inherited dangerous security threats in Afghanistan and Pakistan, where I visited recently, and Iraq, Iran, and North Korea, 

among others. 

Those are just a few of the exceptional challenges that our country, including our government, needs to be prepared to address. As 

the Government Accountability Office (GAO) has pointed out, the 

Federal Government’s performance and the results that it achieves 

have a profound effect on the most important issues to the American people, for example, issues like creating jobs, providing better 

health care for less money, overseeing financial markets, reducing 

pollution, reducing the threat of climate change and global warming, and the challenge of sending additional troops to war to fight 

against terrorism. 

While the strength of our democracy rests on the ability of our 

government to deliver its promises to our people, we in Congress 

have a responsibility to be judicious stewards of the resources that 

taxpayers invest in America. We have a responsibility to ensure 


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those resources are managed honestly, transparently, and effectively. 

It has been more than 16 years since Congress passed the Government Performance and Results Act to help us better manage 

our finite resources and improve the effectiveness and delivery of 

Federal programs. Since that time, agencies across the Federal 

Government have developed and implemented strategic plans and 

routinely generated a tremendous amount of performance data. Are 

Federal agencies using their performance data to get better results? 

Producing information does not by itself improve performance. 

The GAO has shown time and again that Federal managers have 

much more performance information available today than they did 

a decade ago. However, the GAO findings also reveal that Federal 

managers have shown little or no progress in increasing their use 

of performance information to manage results. 

Several years ago, Senator Tom Coburn and I asked the GAO to 

examine how performance information was being used to better 

manage Federal agencies and how managers could employ it more 

frequently for better results. 

We also asked the GAO to consider the Clinton Administration’s 

implementation of the Government Performance and Results Act 

(GPRA) and the Bush Administration’s implementation of the Performance Assessment Rating Tool (PART). 

Today we look forward to GAO’s discussion of its final report, 

particularly key management practices that can promote the use of 

performance information in decisionmaking to improve results. 

We have a new Administration, with fresh ideas and a renewed 

commitment to getting results. To demonstrate that commitment, 

President Obama announced earlier this year the creation of a position for a chief performance officer, a post designed to improve 

government efficiency and reform budget practices. I am delighted 

that the Chief Performance Officer, Jeff Zients, is here today to discuss how his team will assist and motivate Federal agencies to improve the effectiveness, efficiency, and transparency of our government by using performance information well. 

I would like for us to focus our discussion today on several crucial questions. 

One, how will the Obama Administration design and structure 

its new performance improvement and analysis framework? 

Two, what strategies are necessary to support a government-wide 

transformation to a more results-oriented and collaborative culture? 

Three, for agencies that appear to be using performance information the least, to what extent do they employ practices GAO has 

identified that could facilitate or encourage the use of performance 

information? 

Four, how can Federal agencies make better use of performance 

information to improve results? 

And, five, what are some specific things that we in Congress can 

do to bring about a greater focus on performance in the Federal 

Government? 

And, finally, how can we use performance information to identify 

where the Federal Government is not performing well so that we 


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can make better decisions about where we should be putting our 

resources? 

Today we face unparalleled challenges both here and abroad, and 

these require a knowledgeable and nimble Federal Government 

that can respond effectively. With concerns growing over the 

mounting Federal deficit and national debt, the American people 

deserve to know that every dollar that they send to Washington is 

being used to its utmost potential. Performance information is an 

invaluable tool that can ensure just that. If used effectively, it can 

help us to identify problems, find solutions, and develop approaches 

that improve outcomes and produce results. 

Before I introduce our witnesses, I just want to take a moment 

and say that in yesterday’s markup in the Finance Committee on 

health care reform, I shared with my colleague the work that this 

Subcommittee has done, Senator Coburn and myself and others 

have done, on improper payments. I shared with them that earlier 

in this decade the Congress passed, and President Bush signed, 

legislation calling on agencies, requiring agencies to report improper payments. 

Some agencies did and some did not. As time has gone by, more 

agencies have subscribed and complied with the reporting requirement of reporting improper payments. Not all have but now most 

have. And we have identified, as of last year, some $72 billion in 

improper payments were reported by the agencies that are complying with the reporting requirements. 

I think the record would show that several agencies are not complying fully. They include, I think, the Department of Defense, the 

Department of Homeland Security, and a couple of others—I think 

Medicaid and Medicare, at least parts of Medicare. 

I shared with my colleagues, as I offered an amendment yesterday, that it is not enough for us just to identify improper payments. That is certainly important. It is a start. We have to report 

them. We have to reduce them. And we need to go out and recover 

monies that have been improperly paid, especially in overpayments. It is pretty logical. 

And we started down that road in one part of Medicare. About 

3 years ago, through private contractors, we basically said we want 

you to go out and work in California, Texas, and Florida to begin 

to recover overpayments. In some cases, fraudulent payments were 

made because of fraud. And the first year or two, they did not recover much. Last year, they recovered $700 million. 

When the Finance Committee reports out its legislation, hopefully by the end of this week, that experiment, which was started 

in three States, very successfully now, will be extended to all 50 

States to recover, not just Medicare maybe Part A and B, but also 

Part C and D. Part D is the prescription drug program. And we 

will take the lessons learned there to also begin going after monies 

that were overpaid, improperly paid, fraudulently paid with respect 

to the Medicaid program. 

So some work that actually started in Office of Management and 

Budget (OMB) in the previous Administration with input from this 

Committee, this Subcommittee, is now about to bear great fruit, 

enormous fruit, to not only reduce improper payments but to begin 

to recover monies that have been fraudulently or improperly paid. 


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1The prepared statement of Mr. Zients appears in the Appendix on page 37. 

So we are starting to realize some success there. We need to realize a lot of success, and we need to identify success with all this 

performance information that we are collecting to actually use it to 

get us to where we need to be, and that is better results in a very 

challenge environment at home and abroad. 

So we welcome this opportunity today, and in introducing our 

witnesses, I mentioned that Jeff Zients, I think his official title 

might actually be Deputy Director for Management at OMB, but he 

is also the government’s first ever performance officer. And when 

we are talking about this particular subject, he is the right person 

to have here, and we are delighted that you have made time to join 

us. 

Mr. Zients comes to government with an impressive resume, having worked for 20 years as a management consultant and entrepreneur. Mr. Zients also co-founded the Urban Alliance Foundation, a nonprofit that helps economically disadvantaged young people obtain year-round internships and job training. 

Sitting beside him is Bernice Steinhardt, the Director for Strategic Issues at the Government Accountability Office where she is 

responsible for examining governmentwide management issues. For 

over 9 years, she has led GAO’s efforts in strategic planning and 

helped to develop the organization’s first strategic plan. She has 

also held a number of positions at GAO, including Director of the 

Public Health Issues Group. And she has served as Associate Director for Energy, Natural Resources, and Science Issues as well as 

Environmental Protection Issues. 

We thank you both very much for joining us today and for testifying. I have just been handed a notice that says to remind the witnesses that they have roughly 5 minutes to speak. 

Mr. Zients, why don’t you lead us off? And, again, my thanks to 

both of you for coming. 

TESTIMONY OF JEFFREY D. ZIENTS,1 DEPUTY DIRECTOR FOR 

MANAGEMENT AND CHIEF PERFORMANCE OFFICER, OFFICE 

OF MANAGEMENT AND BUDGET 

Mr. ZIENTS. Thank you, Senator Carper. I really want to first 

thank you in that all of us are spending most of our days in that 

intersection of what is urgent and important, and you have a lot 

going on. The challenge with this terrain is that it sometimes does 

not feel urgent in the moment. But I think it is extremely important for this government at this point in time, so your example of 

improper payments would be a great story on that front. When you 

tackled it initially, it probably did not feel like it was the stuff of 

instant return or instant gratification, and now look at the payback. So I am very appreciative of you carving out this time from 

a very hectic schedule to do this. 

Senator CARPER. I am delighted and excited to be here. Thank 

you. 

Mr. ZIENTS. I appreciate the opportunity to be here and discuss 

our shared objective, which is increasing the effectiveness, efficiency, and transparency of government. Today I want to address 


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my remarks to your questions about Federal agency use of performance information for decisionmaking and resource allocation. 

As you said, the current fiscal challenge makes it even more important to maximize the effectiveness of every tax dollar we spend. 

We need to search continually for increasingly effective and efficient ways to get the job done. 

To accomplish this, it is not enough for Federal agencies to 

produce performance information. The ultimate test of our performance management efforts is whether or not the information is actually used, not just by government agencies but also by Congress, 

the public, and our service delivery partners. 

Across those 20 years, in the private sector as a CEO and an adviser to a CEO, I found that leadership measurement and a motivated workforce together create the foundation for good performance. I am confident after 3 months the same is true here in government. 

It is my initial sense after the short period of time on the job 

that important ground work for governmentwide performance management has been laid by Congress and previous Administrations, 

including, as you said, the Clinton Administration’s implementation of the Government Performance Results Act, and certain elements of the Bush Administration’s implementation of the PART 

system. 

But too much emphasis was placed historically on producing performance information for the purpose of complying with reporting 

requirements and too little attention paid to analyzing and acting 

on this information. It is time to pay far more attention to the use 

of Federal performance information as a powerful performance improvement tool for communicating priorities, progress, and raising 

issues, for illuminating what works and should be continued and 

what does not work that needs attention, for motivating the best 

from our workforce and our service delivery partners, and for allocating our scarce resources wisely. 

The good news here is that many public and private organizations have developed successful models for increasing the use of 

performance information, and my intention here is to look for best 

practices or best examples of what is working in other governments, the private sector, and in our own Federal efforts, and apply 

these practices across the Federal Government. 

The first step in taking on a challenge like this is putting the 

right leadership team in place, and I am pleased to announce a 

new member of my team, Shelley Metzenbaum, who is actually in 

Washington for her first day of work today. She is a leading expert 

in performance management with both a distinguished academic 

career and a wealth of government experience. She has authored 

numerous articles on practical, effective ways to use performance 

goals and measurement in government, and she has served in key 

leadership positions in past Administrations in the U.S. Environmental Protection Agency and in the State of Massachusetts. 

Our performance management agenda is already moving forward. In this year’s spring budget guidance, OMB Director Orszag 

asked all Federal agencies to identify a limited number of high-priority performance goals reflecting the near-term implementation 

priorities of each agency’s senior managers. These goals commuVerDate Nov 24 2008 11:41 Oct 18, 2010 Jkt 053843 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 P:\DOCS\53843.TXT SAFFAIRS PsN: PAT

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1The prepared statement of Ms. Steinhardt appears in the Appendix on page 40. 

nicate the priority targets that each agency’s leadership hopes to 

achieve across the next 12 to 24 months. And once this list is 

final—we will regularly review with agencies the progress they are 

making and the problems they are encountering and make any 

mid-course corrections. 

We will expect each agency to reach beyond their own organizational boundaries to get feedback about priorities and strategies 

and to enlist expertise and assistance to reach their targets. Improving the performance of our Federal programs will require cooperation and contribution from many places. Ms. Metzenbaum and 

I will be leading an effort to develop an improved Federal performance management framework that aligns these high-priority performance goals with GPRA performance reporting in many of the 

program-level performance metrics that were developed as part of 

PART. 

Our governmentwide performance measurement framework will 

be focused on outcomes, and it will allow comparisons across programs and agencies. It will also show trends across time. We will 

use new information technology to make this more feasible, less 

cumbersome to access, and, most importantly, to meet our ultimate 

goal of more use across the government. 

In addition, the Administration is proposing significant investments in rigorous and independent program evaluations. We will 

integrate these efforts into this larger performance framework. I 

am confident we will develop a performance management framework that better serves the needs of agency managers as well as 

the public, and Congress’ need for Federal performance transparency. 

These steps will go a long way to helping us improve the effectiveness, efficiency, and transparency of government. This is a cornerstone of my agenda and one of my highest-priority performance 

goals. 

I thank the Subcommittee, and you, Senator Carper, for your belief in improving Federal performance, and I look forward to working with you, with the other members of today’s panels, with Federal employees across the Nation, and with our service delivery 

partners to accomplish this objective. 

Mr. Chairman, I would be pleased to answer any questions you 

have. 

Senator CARPER. Thanks very much, and I have several questions, once Ms. Steinhardt has completed her testimony. 

Mr. ZIENTS. Thank you. 

Senator CARPER. Thanks so much for your testimony and for 

being here today. 

Ms. Steinhardt, you are recognized. Please proceed. Your entire 

statement will be made part of the record for both of you. 

TESTIMONY OF BERNICE STEINHARDT,1 DIRECTOR, STRATEGIC ISSUES, U.S. GOVERNMENT ACCOUNTABILITY OFFICE 

Ms. STEINHARDT. Thanks very much, Senator Carper, and I, too, 

appreciate the opportunity to be here today. 


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Let me just say first that I was delighted to hear about Shelley 

Metzenbaum’s joining your team. I think she will be a great addition, and we look forward to working with both of you. 

Senator CARPER. How do you know her or how do you know of 

her? 

Ms. STEINHARDT. She has been very involved in this area of performance information and management with information for a long 

time. She has written a lot about it. We have worked together in 

the past. We have relied on her expertise in doing our own work. 

So I think she will be enormously valuable here. 

Senator CARPER. So a pretty good hire? 

Ms. STEINHARDT. A very good hire. [Laughter.] 

Senator CARPER. That is good to hear. Thank you. 

Ms. STEINHARDT. Well done. 

Last year, I was here to talk about the first part of the work that 

we undertook at your request, which, as you mentioned before, was 

based on a governmentwide survey of Federal managers. And as 

you said, Senator Carper, we found that while managers have a lot 

more information today than they did 10 years ago when we first 

started doing our surveys, there really has not been much progress 

over that period in the extent to which they use information to 

make decisions that could lead to better results. 

So to try to figure out what is behind this, we focused the second 

part of our efforts on a review of management practices at the Department of the Interior and at FEMA, whose managers were relatively low users of performance information compared to other 

agencies. And at the same time, we also looked at the Centers for 

Medicare and Medicaid Services (CMS), because they seemed to 

have made a good bit of progress in using performance information 

over that period, and we wanted to understand what contributed 

to that improvement. 

What we found was that a number of practices seemed to account for the difference between those places where performance 

information is widely used and those where it is not. These practices actually may seem obvious. They may seem like common 

sense. But, in fact, they are not always present, and when that is 

the case, it makes a big difference. 

From our past work, we know that several practices are key, and 

I will mention just a couple here, and I think Mr. Zients has alluded to a couple of them as well. 

First and foremost is the visible commitment of leadership to 

using and communicating that performance information and performance itself matters; and, second, having performance information that managers themselves find useful in doing their work. 

CMS actually turned out to be a good example of how these practices have made a difference. Between 2000 and 2007, the percentage of CMS managers who said that their top leadership demonstrated a strong commitment to achieving results went from 46 

to 69 percent—quite a big leap. 

Senator CARPER. Say that one more time. 

Ms. STEINHARDT. The percentage of managers who said that 

their top leadership demonstrated a strong commitment to using 

performance information was 49 percent in the year 2000, and it 

went up to 69 percent, so more than two-thirds of managers in 


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2007 viewed their top leadership as being committed to using performance information. 

Nearly all of the CMS officials that we met with credited this 

commitment, as well as other key practices, with helping to achieve 

better outcomes in the quality of care for nursing home patients, 

for one example, as well as in other critical areas. 

By the same token, the absence of these practices had a lot to 

do with the situations we encountered at the Interior and at 

FEMA. At both agencies, only about a third of the managers surveyed felt that the agencies’ top leadership demonstrated a strong 

commitment to achieving results. 

In delving further, it was clear that managers in both agencies 

had a very strong commitment to their agencies’ missions, but the 

level of commitment to using performance information varied 

greatly. One official in FEMA, for example, told us that he did not 

need performance information; he just relied on conversations with 

people to know whether or not things were running well. 

At Interior, we found that while the agency was collecting a lot 

of performance information, leadership was not effectively communicating to its managers how, if at all, they were using that information to achieve better results. Several Park Service managers 

that we talked to referred to the reporting process as ‘‘feeding the 

beast’’ because they got little or no feedback in response to the information that they fed upward. And so they assumed that no one 

in authority reacted to or acted on the information, and it was not 

always useful to the managers themselves either. 

At the same time, though, we found that both Interior and 

FEMA had pockets of good practices, places in the agencies, whether in different directorates or locations, where things were going 

well. And so our report to you includes several recommendations to 

the agencies that are intended to build upon these good practices. 

More widespread adoption of these key management practices is, 

of course, an important step to building a more results-oriented 

and collaborative culture in the Federal Government. But beyond 

this, both the President and the Congress can play vital roles in 

setting the tone at the top and communicating to agency leaders 

that performance matters. 

Given its vantage point, OMB can play a role in sharing leading 

practices among agencies and helping those that may need support 

to adopt them. But, importantly, OMB can also help support collaboration among agencies to achieve results in a number of areas 

like ensuring the safety of the food supply or combating terrorism, 

any number of the challenges that you mentioned at the outset, 

Senator Carper, where actions are required that go beyond the mission of any single agency. So, in this respect, we have long supported the idea of a governmentwide strategic plan and an annual 

performance plan that is supported by a system of key national indicators, which together could provide important tools for integrating efforts across agencies to address the challenging issues 

that continue to face our Nation in the 21st Century. 

So, with that, I will wrap up my statement and offer my thanks 

for your time and concern about these issues. And, of course, I 

would be happy to answer any questions. 


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Senator CARPER. Good. Thanks so much. Thank you so much for 

being here and for your testimony. A special thanks to GAO for 

your responsiveness to the request that Senator Coburn and I 

asked a couple of years ago for your help on this, so thank you. 

I am told by Wendy Anderson, who is sitting here behind me, my 

senior staff person on the Subcommittee, that you have mentioned 

a nursing home example of how managers in performance information were well utilized. I am going to ask you to take a minute and 

tell us that story. 

Before I do, I just want to mention, when I think of using performance information, I go back in time a little bit. As Governor 

of Delaware, we decided, along with most other governors in most 

other States, to establish vigorous academic standards about 15 

years ago in math, science, English, and social studies. We began 

trying to measure objectively student progress toward those standards to show what they knew and understood in math, science, 

English, social studies, and other subjects. 

Then we decided how to use that information to improve performance, to incentivize students and faculties, teachers, principals, 

and superintendents, how to hold folks accountable, including students, schools, school districts, and teachers. 

I probably have been to just about every public school in Delaware—there are several hundred—and I still go into them as often 

as I can, every week or two. I try to go into the schools where they 

have done a good job of being a so-so school in terms of scoring well 

and showing progress with respect to academic standards. And I 

find that the schools that usually make the most progress are 

schools that focus on the objective performance of students on our 

annual tests, and soon they will be more frequent. But it is the 

schools where the leadership of the school—the principal, the assistant principal—are able to convince their faculties to drill down 

on the information, the performance information, and to act on that 

performance information. 

It comes from the top. You are right about that. It comes from 

the top. And when you get the faculty members, the teachers, to 

sort of take ownership of that and believe in that, just amazing 

things happen in terms of student performance. 

Believe it or not—here in Congress—one of the things I love to 

do is every 2 years, right after the election, we have orientation for 

new Senators. It was an idea that Senators Voinovich, Alexander, 

and Mark Pryor of Arkansas came up with about 4 or 5 years ago. 

And we always had for years orientation for new Senators and 

spouses. We call it orientation for new governors and spouses that 

the National Governors Association holds. We never had that kind 

of thing for Senators, at least not that I knew of. So we took the 

National Governors Association idea, brought it to the U.S. Senate, 

starting in 2004. One of our first students was Barack Obama. He 

has done quite well. [Laughter.] 

But one of the things at the orientation for new Senators, we 

started to teach the new Senators all the things we had done 

wrong so they will not make the same mistakes that we made as 

new people or as older people in our jobs. 

One of the things I shared with them is how we measure performance in my office—not in every way, but in a couple of ways. 


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A lot of people focus on a Senator’s job and they think it is what 

they do in Washington. It is the amendments that we introduce, 

the bills we vote on and so forth, the legislation we write. That is 

all important. But a big part of what we do at home is help people. 

We literally help people. I hosted a family for lunch yesterday. 

They had won an auction to have lunch with their Senator and 

help the YMCA back home for a donation. And the kid said—these 

are kids like 6, 8, and 10. He said, ‘‘What do you do, anyway?’’ And 

I told him my job is to help make the rules for our country, and 

we call them laws, and like they have rules at school, rules at 

home. I said, ‘‘We have rules for our country, call them laws, I get 

to help make those with Barack Obama and Joe Biden and other 

people.’’ They were pretty impressed. They wanted my autograph. 

And they said, ‘‘Barack Obama, do you know him?’’ I said, ‘‘I have 

met him.’’ 

But a big part of what we do at home is we literally help—dozens 

of people call us every day with all kinds of problems—relatives in 

Iraq, relatives in Afghanistan, folks who are being pinged by the 

IRS for no good reason, Social Security problems, Medicare problems, veterans issues, all kinds of stuff. And we actually have 

helped thousands, probably 16,000 people in the last 8 years. 

Anyway, at the beginning of every month, we send out a customer satisfaction survey to the people, a representative sample of 

folks we served the previous month. And we asked them to evaluate our service—excellent, good, fair, or poor. And if they come 

back anything less than excellent or good, we call them on the 

phone and say, ‘‘Why were we fair?’’ Or ‘‘Why were we poor? What 

could we have done differently?’’ I think over the last several years 

we were, I think, about 98 percent excellent or good, so we are very 

proud of that. And it is great feedback for the folks who work on 

my staff in—we call it ‘‘constituent service.’’ 

The other thing we do is we measure mail. We used to get a lot 

of mail here. Now we get a lot of e-mails. We get faxes, we get 

phone calls. But with health care and some other issues, climate 

change legislation, we get thousands of e-mails, letters, and calls 

a week. And for a little State like Delaware, that is a lot. 

But we track the mail, who is writing what issues, and we track 

timeliness of responses, turn-around times and how long it has 

been for a response. We are not perfect, but we are very proud of 

the way we do that. But we actually measure that performance. I 

get a report every other week, and I review that with my staff and 

meet every week with my legislative correspondents by phone so 

they know this is important stuff. 

The idea is it starts from the top, and we emphasize how important it is, and it seems to work. 

Let me ask you to share with us that nursing home example of 

how managers used performance information well, if you just could 

start off with that. 

Ms. STEINHARDT. Well, first, I would really like to comment on 

your stories because I think they are outstanding examples of how 

that visible concern, that visible commitment to performance, really 

makes a huge difference. And I think the fact that you made appearances at the schools—it was not only what the principals did, 

but that you showed up, and as governor you showed that you 


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cared, I am sure that made a difference in how everyone at the 

schools felt about it. So, yes, leadership really does matter. 

In the case of CMS, I think the example that you referred to is 

one that we talk about in our report, and it is one that we found 

very compelling. CMS is an agency that is responsible for overseeing the quality of nursing home care, but it does it indirectly. 

It is obviously at the nursing home level where patient care is really affected. 

CMS, in one particular region, started collecting information 

about dimensions of quality of care, including the incidence of pressure ulcers or bedsores. And they started sharing that information 

with nursing home operators, with the State survey teams, and 

others who did have the ability to affect the outcomes. And just the 

availability of the performance information, the regular attention 

and monitoring of that information eventually led to a decline in 

the incidence of bedsores within the region by a considerable 

amount. Over 2,000 to about 2,400 fewer patients experienced pressure ulcers as a result of the attention that they were paying. 

Senator CARPER. That is a good story. Thank you. 

Ms. STEINHARDT. Yes, and it is real. It is personal. 

Senator CARPER. Mr. Zients, given your background in this issue, 

could you just share with us some insights as to why the overall 

use of performance information among Federal managers has not 

significantly increased, I think, over the last 15 or so years? And 

what strategies do you think are necessary to support our governmentwide transformation to a more results-oriented and collaborative culture? 

Mr. ZIENTS. Well, first of all, I think that, like you, it is in my 

DNA. So as I come in from the private sector, I come with that 

same mind-set that you have, that you are operating with each 

day. I have been surprised by the lack of attention to performance, 

prioritization, and focus starting at the top historically. And I do 

think it starts at the top. It has to cascade through the organization, but if the senior-most folks are focused on the right performance goals and metrics and are relentlessly tracking them the way 

you do weekly, then that cascades through the organization. And, 

unfortunately, if they are not, then it does not happen. 

I think we are off to a good start on this front. I chair a group 

called the President’s Management Council, which is comprised of 

deputy secretaries across all major agencies. And when you think 

about how busy secretaries are with their external-facing responsibilities, the deputies tend to be the point people for performance. 

And I am very impressed by the talent around the table and the 

commitment at that table to focus on a handful of performance 

goals. 

We asked, as in our spring guidance as part of the fiscal year 

2011 budget, for each agency to identify a handful of high-priority 

goals, and I think overall with some variability, the agencies, deputy secretaries, and secretaries did a very good job. 

Now, as those goals get finalized and incorporated appropriately 

into the budget process, we need to make sure that we set up the 

systems to review progress against those goals, spot problems 

early, and also reward successes, like your nursing home story, and 

your improper payment work, as they emerge. 


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I think we are off to a good start. It has to be done at a senior 

level. It has to be focused. There cannot be too many goals. As we 

move from goals to tracking and metrics, we need to make sure 

that those metrics are outcomes based. As stated earlier, we need 

to make sure we have the capabilities to go across program and 

even across agency in that a lot of our issues or problems or opportunities are not siloed or they do not reside just within a silo or 

an agency, or a program for that matter. 

As we begin to look at what has happened historically, we need 

to be careful not to throw it all out the window, because there is 

a lot of good stuff. And we need to at the same time make it more 

usable, and I think the way we do that is to leverage information 

technology and bring together the GPRA reporting with the pieces 

of PART that we want to keep and integrate that with the highpriority performance goal, and as we cascade down the organization, make sure that we have information that is outcomes based, 

that is usable, and that we track. 

I am optimistic. There is a lot of good stuff in place. The foundation has been laid. Now we have the challenge of raising the importance of it, which I think the President has done by making it a 

high priority. As the first Chief Performance Officer, it is a high 

priority for me. And as I see the deputies dig into their new jobs, 

it is clearly front and center for them. So I am optimistic that those 

statistics will continue to improve across time and, most importantly, we will have better outcomes for the American people. 

Senator CARPER. You mentioned the President. In a State, the 

chief executive, of course, is the governor, and in our State housing 

had not gotten a lot of attention. And we decided that we were 

going to provide more attention, not just talk about it but to make 

the director of the State Housing Authority a member of my Cabinet and to provide Cabinet status to say this is important. And it 

is amazing what we did in terms of improving quality of homes, 

homeownership, and just ensuring that people had a decent place 

to live, and also helped move people from dependency, living in 

subsidized housing, to becoming homeowners and moving out on 

their own. But it starts with a lot of things. It starts at the top. 

The designation in a senior position in this Administration for a 

Chief Performance Officer is, I think, a very good signal. 

Ms. Steinhardt, if I could go back to you, GAO has been monitoring agencies’ use of performance information, I think, for maybe 

more than a decade. Let me just ask, should OMB be doing this 

type of monitoring? And if so, how do you think they might go 

about it? 

Ms. STEINHARDT. I think OMB should be doing this kind of monitoring as a matter of fact. I think it is appropriate to the extent 

that they want to keep track of how agency managers are using information, it would be worthwhile for them to have the information. 

We now share it. We have been doing this survey every 4 years 

for the last decade or so, but I think as a regular part of OMB’s 

responsibilities, it would make sense for them to assume that kind 

of oversight function. 

Senator CARPER. From the work that you have done at GAO, 

could you provide us maybe with an example or two of how an 


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agency was able to bring about better outcomes through the use of 

performance information? You gave us one great example, the 

nursing home. Anything else that comes to mind? 

Ms. STEINHARDT. I wish that there were a huge long list of these 

examples, but I will just mention another one that we have observed in our experience. The National Highway Traffic Safety Administration, a very interesting agency, collects information on 

trends in safety across the country, and they have been looking at 

data, monitoring data on highway fatalities. And through this regular monitoring and through evaluations, they realized that seat 

belt usage was a major factor in reducing the incidence of highway 

fatalities. 

Now, the National Highway Traffic Safety Administration 

(NHTSA), does not run anything. They provide grants to States. It 

obviously states that control—that set traffic laws and regulations. 

But in their grants to States, they share this information with 

States. They initiated this click-it or ticket program to encourage 

States to enforce seat belt usage. And with that, the incidence of 

fatalities, highway traffic fatalities and injuries fell quite a lot. 

So I think just having information, sharing the information, staying on top of it, we have seen some really clear and very credible 

kinds of results. 

Senator CARPER. I will not get into it, but that is an example 

that for me comes very close to home. Thank you. 

Mr. Zients, if I could, another question for you. OMB has signaled that it intends to replace PART with a new performance information and analysis framework. What do you think that new 

framework will look like? How might it promote the use of performance information by managers? And, third, how will the new 

framework incorporate the perspectives of the Congress and other 

stakeholders on what areas of performance need to be reviewed? 

Just take those one at a time, if you want. What will the new 

framework look like? 

Mr. ZIENTS. Let me start with the role of OMB and, I think, 

agreeing with what you said. At the same time, I think that historically—certainly the last 8 years or so—OMB has played the role 

of a compliance officer rather than a teacher or a facilitator or a 

hub of best practice sharing. And I think given how big this government is and how talented our Federal workforce is and our 

manager ranks are, I think we need to move from compliance to 

teaching and sharing to really achieve what I think all of us agree. 

So I think there is a transition for OMB. Not to say that there 

is not some role for reviewing and prodding, if you will, but I think 

that in order to create usefulness, we need to make that transition. 

Part of that is the Performance Improvement Council (PIC), and 

it is a group that is made up of senior folks from agencies who are 

the accountable executives, on performance. That body came together, I believe, a couple of years ago and is getting real traction, 

and we have asked that group to work on exactly the question that 

you ask, which is: What do we do with PART? What do we do with 

GPRA? How do we integrate? How do we make this more usable? 

And I think that means we need to be more focused than we have 

been. There are too many metrics out there. So we have to figure 

out which metrics matter. 


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We need to make sure that those metrics are actually outcomesbased metrics and not just process or input metrics. We need to 

make sure that there are good tracking systems for those and review systems for those and good education systems because this is 

new. And we need to make sure that we are training and educating 

through the PIC and other bodies. 

So I think it needs to be a collaborative effort, and certainly we 

want to involve you and your staff in helping us think through how 

is it most useful to you, and ultimately this needs to come together 

and matter to Congress and to the American people and be transparent and available for all, and I think also be tied to the budget 

process to show that performance matters and that we are going 

to fund programs that work and we are either going to fix or not 

fund programs that do not. 

Senator CARPER. Thank you. A couple more questions for Ms. 

Steinhardt, if I could. 

We were just talking about how the Obama Administration has 

indicated that it intends to replace PART with a new performance 

improvement and analysis framework. What do you think OMB 

can do to make the successor to PART more relevant and useful to 

Congress and to agency managers? We have heard from Mr. Zients 

on what the plans are, but if you could just let us know, what do 

you think OMB can do to make the successor to PART more relevant, maybe more useful, and not just to Congress but also to 

agency managers? 

Ms. STEINHARDT. Well, first, I think one of the lessons we 

learned from our assessments at GAO of the PART process was 

that it was too broad, and it really would have benefited from a 

greater focus on priority areas. And I think that is what Mr. Zients 

has outlined here as the direction that OMB is taking. I think that 

is a constructive and hopefully effective approach. Rather than trying to look at everything, I think PART assessed a thousand programs. Focusing on priority areas should be very helpful. 

I think certainly consulting with Congress in that process would 

be very important and valuable. It was something that did not 

work very well during the PART process, and we have an opportunity now to do better. 

I think in terms of making information more useful or helping 

to support agency managers, I think what Mr. Zients has outlined 

as a kind of coaching, supportive approach to sharing information 

and good practices is also very important. We found in our past 

work that training in using performance information has actually 

been the factor that is singly most important in effecting use of 

performance information. So whatever OMB can do there to help 

promote good practices, to help support those agencies where it 

seems to be missing, and also to share what they learn from agencies where it is working well, those could be very valuable, I think, 

for going forward. 

Senator CARPER. Before I ask one more question of you, Mr. 

Zients, do you want to respond at all to anything that Ms. 

Steinhardt has said? 

Mr. ZIENTS. No. I read the report, there was not a single place 

where I paused and said, ‘‘Hmm.’’ It all felt exactly on point, and 

I do not think there is any disagreement around what needs to be 


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done here. It is about us putting our heads down and getting it 

done. 

I do think the training component is important. I was reminded 

of it last night. My oldest of four is 14, and to date, I have been 

OK at helping her with her math homework. She needs to go to 

her Mom for other stuff. But now she is into geometry, and I think 

she was not only disappointed but did not quite believe me that I 

could not do it. And then, if you go back and actually read it, geometry comes back to you, but, other math sort of sticks with you because you use it every day. 

There is a component here in that all of this stuff, when you see 

the right metrics, you say, yes, that is pretty obvious. But it is not 

a natural exercise, and we do need to sort of remind people of their 

geometry or teach their geometry. And once we do that and we 

have lots of folks who are capable of teasing out these right metrics 

and coming up with the right systems to do that relentless pursuit 

and review that you described, I think it will catch. We will hit a 

tipping point. But we need to do some training and education to 

ensure that happens. 

Senator CARPER. I was watching, and when you talked about 

your 14-year-old and hitting the point where homework, the math 

homework and geometry or advanced algebra or whatever, I saw 

some nodding heads. [Laughter.] 

Mr. ZIENTS. It is the least of my issues with my 14-year-old, but 

a lot of this I will not be able to relearn. 

Senator CARPER. Thanks for sharing that one with us. 

GAO has previously recommended that OMB should work with 

agencies to ensure they are making adequate investments in training on performance planning and measurements, with a particular 

emphasis on how to use performance information to improve program performance. 

But, again, you have covered this a little bit already, at least indirectly, but just talk with us again about what steps OMB has 

taken or what steps will you take to address this recommendation 

from GAO. 

GAO has previously recommended that OMB should work with 

agencies to ensure they are making adequate investments in training on performance planning and measurement, with a particular 

emphasis on how to use performance information to improve program performance. Would you respond to that in part? 

Mr. ZIENTS. I will cover some ground that we have already talked 

about. One is making sure that the deputies understand the importance of this, and so that when they are going through their budget 

allocation exercise, they are doing that consistent with their highpriority performance goals, but also preserving money for training 

and education across the board and on this specific topic. 

I think the Performance Improvement Council is a great vehicle 

here. It is meeting monthly. I am the chair of that council, and Ms. 

Metzenbaum will be dedicating a lot of time and energy to the 

meetings and to working sessions in between. So I think that it is 

the focus at the senior levels. It is the commitment to training. I 

think OMB can play a part here by putting our energy toward 

training and education and sharing best practices, and I think recognition here is very important, too, in that we need to make sure 


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that we are celebrating the successes. There are a lot of successes, 

and we need to make sure that we spend appropriate time celebrating those. 

Senator CARPER. Good. And one last question, if I could, Ms. 

Steinhardt, for you. You were good enough to give us an example 

or two from agencies in terms of performance. Do you have any examples in which Congress has articulated performance expectations in its oversight capacity and followed up with agencies to assess their progress toward meeting those expectations? 

Ms. STEINHARDT. Actually, there are probably many more examples than come to mind. But Congress has been very influential in 

affecting performance. Improper payments, the example you gave 

earlier, I think is one very vivid example of where setting a target 

or directing agencies to first understand where they are and then 

set targets for reducing it has made a very important difference. 

Another example that comes to mind has to do with the IRS. In 

the IRS Restructuring Act in 1998, among other things, Congress 

directed that IRS increase electronic filing. And it set a target in 

the legislation that by the year 2007 some 80 percent of tax returns 

would be filed electronically. And that has enormous implications 

for service to the taxpayer. For one thing, electronic filing could get 

taxpayers their refunds much more quickly. And it would reduce 

costs of processing enormously. 

And through setting the target and then overseeing IRS’ efforts 

along the way, that target has not been completely met, but I think 

now it is around 72 percent of tax returns are filed electronically. 

So we have made enormous progress through that direction that 

Congress set in statute. 

Senator CARPER. Mr. Zients. 

Mr. ZIENTS. I just thought I would add one, because I think there 

are many, and that is security clearance reform. Senator Akaka 

and Senator Voinovich held a hearing a couple weeks ago, and I 

am chair of the task force, and it is an honor to be part of such 

an important problem, but it is also nice to enter at a point where 

so much progress has been made. A stake was put in the ground 

as to progress across a period of time, and that group is on track. 

So, again, I think it is the power of setting a goal and the relentless pursuit of that goal. 

Senator CARPER. Well, good. With that, let me just close by saying I know you all have a lot on your plates. We very much appreciate the preparation that you put into coming here today and your 

commitment to making sure that at a time when we are facing 

enormous challenges, and a lot of them budgetary and fiscal in nature, that there is a real focus that comes in from the top, and we 

have GAO to make sure that we get some help and good advice and 

counsel in addressing these matters. 

I am told by my staff that we have some legislative ideas on a 

lot of what we have discussed here today, and let me just say we 

look forward to working both with GAO and with OMB on those 

in the weeks to come. 

Thank you very much. Keep up the good work. Everything I do 

I know I can do better. And, frankly, the same is true with almost 

everything we do in government and outside of government. And 

our job and our challenge is to make sure we do it better. 


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Thank you. 

Ms. STEINHARDT. Thank you. 

Mr. ZIENTS. Thank you. 

Senator CARPER. And with that I am going to ask our second 

panel to come forward and join us at the witness table, please. 

Good morning, everyone. It is great to see you. Thanks so much 

for joining us. I see Mr. Fugate, our FEMA Administrator, often. 

He has only been in the job a short while, but I see him a lot. But 

I do not get to see the rest of you quite that often, so we are delighted that you are here. 

I am going to provide a short introduction on each of you, but 

before I introduce our witnesses, I want to take a moment to thank 

you for appearing, but I think it is also impressive that you have 

not only been invited but you have shown up, and that the commitment of agency heads and senior leaders to results-oriented management is critical, which we heard from our first panel, critical to 

increased use of performance information for policy and program 

decisions. If it is not a priority at the top, it will not be a priority 

down the line. And that you are here is, I think, a testimony to 

your commitment, and for that we are grateful. 

I am going to start from my left, in introducing Craig Fugate. 

Mr. Fugate began serving in the position of Administrator of the 

Federal Emergency Management Agency in May 2009. It has only 

been about 4 or 5 months. It probably seems like 4 or 5 years. But 

you are holding up well. We are glad that you have joined us today. 

Prior to coming to FEMA, Mr. Fugate served as Director of the 

Florida Division of Emergency Management. If there is any way to 

learn about emergency management, that is a good State in which 

to get your training. In that role, I think since 2001, he managed 

138 full-time staff and a budget of $745 million. His agency coordinated disaster response, recovery, preparedness, and mitigation efforts with each of the State’s 67 counties and local governments. 

I come from a State with three counties, and some of my colleagues 

say that during the course of a year they will visit or every 2 years 

they try to visit all their counties. 

But in 2004, Mr. Fugate successfully managed the largest Federal disaster response in Florida history as four major hurricanes 

impacted his State in quick succession. Homeland Security Secretary Napolitano has called Mr. Fugate one of the most experienced emergency managers in the country, and he is. We are lucky 

to have him in this post. 

Rhea Suh, thank you so much for joining us. I understand you 

were sworn into office as the Assistant Secretary for Policy, Management, and Budget at the Department of the Interior in May, 

working with one of my old compadres from the Senate, Ken 

Salazar. I mentioned that Senator-elect Obama and his wife, 

Michelle, were in our very first orientation class for new Senators 

and spouses, and the only other Democrat in that class was Ken 

Salazar. So we have two who graduated, and one has gone on to 

be President and the other, Secretary of the Interior, where he 

works with you. 

But in your role at the Interior, you oversee, I am told the financial, administrative, and programmatic policy for the Department, 

including budget formulation, implementation, and accountability. 


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Prior to this, I believe you served as a program officer at the David 

and Lucile Packard Foundation—that is a big foundation; that is 

a big job—where you managed a $200 million, 6-year initiative designed to build ecological integrity and resilience in key land and 

watersheds in western North America. Our thanks to you and the 

foundation for that work. 

From 1998 to 2007, Ms. Suh was a program officer at the William and Flora Hewlett Foundation, where she managed the foundation’s portfolio of grants designed to protect the ecosystems of the 

western part of North America. 

And during the Clinton Administration, I believe you served as 

a senior legislative assistant on the staff of Senator Ben Nighthorse 

Campbell, a Native American, a former Olympian, I think, as I recall, and one of my colleagues. He and I used to work out together 

in the House gym, and he is an old compadre. It is nice to know 

you have worked with Senator Nighthorse Campbell. 

Michelle Snyder, Acting Deputy Administrator and the Deputy 

Chief Operating Officer for the Centers for Medicare and Medicaid 

Services (CMS). With the Acting Administrator, she oversees daily 

operations and a staff of over 4,000 people. A big operation. Formerly, I believe you were CMS’s Director of the Office of Financial 

Management and the agency’s first Chief Financial Officer. Is that 

right? 

Ms. SNYDER. That is right. 

Senator CARPER. Under your leadership, CMS achieved its first 

clean audit opinion and developed its first comprehensive strategic 

plan on program integrity. During that time, she also oversaw one 

of CMS’s most significant efforts involving the integration of its financial and accounting systems to better manage Medicare trust 

fund. Thank you for joining us. Thanks for your work. 

Dr. Paul Posner is Director of the Public Administration Graduate School at George Mason University. Prior to his current position, I understand that he directed the Federal budget work of the 

General Accounting Office for 14 years. Did you know anybody on 

our first panel? 

Mr. POSNER. A few of them, yes. 

Senator CARPER. I understand you are also the President of the 

American Society for Public Administration and a fellow of the National Academy of Public Administration. Dr. Posner, I understand 

you cut short an important California trip in order to be with us 

today, and we greatly appreciate that. We look forward to your testimony. 

With those introductions under our belts, Administrator Fugate, 

would you please proceed? Again, I would ask that you try to keep 

your comments to 5 minutes. 

Mr. Fugate, thanks again for your testimony. Let me again mention your entire testimonies will be made part of the record, so feel 

free to summarize as you see fit. Thank you. Please proceed. 


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1The prepared statement of Mr. Fugate appears in the Appendix on page 63. 

TESTIMONY OF W. CRAIG FUGATE,1 ADMINISTRATOR, FEDERAL EMERGENCY MANAGEMENT AGENCY, U.S. DEPARTMENT OF HOMELAND SECURITY 

Mr. FUGATE. Well, good morning, and thank you, Chairman Carper. 

When we talk about management performance, FEMA usually 

does not come to mind as one of the leading examples on how to 

do it right. 

Senator CARPER. You are probably right. That is a understatement. 

Mr. FUGATE. But I also think there is a double edge to this. 

There is also the tendency—when we are asked to measure things, 

the natural tendency is to measure things that are easy to measure. That does not actually mean they change an outcome. 

I think that part of our challenge is defining what outcomes we 

are trying to achieve and then identifying the processes that will 

get us to that outcome. Just because it may be easy to measure 

does not necessarily lead to a successful outcome. 

It is our challenge at FEMA, as we look at how do we define 

what an outcome is and then make sure that we have the processes 

and procedures to support that outcome, to achieve what we are 

trying to achieve on behalf of the governors that we support in a 

disaster. What is it and how are we going to measure it? And, more 

importantly, how do we hold managers accountable to that performance? 

As we were discussing earlier, you cannot fix what you do not 

measure. You do not know where you are going if you don’t have 

a destination. And without some way to tell how fast the speedometer is going, you do not know when you are going to get there. 

So part of this comes back to, as we look at what we are doing 

at FEMA, is to make sure that we understand from the top down 

we have to be accountable as to the leadership for those outcomes. 

We have to be accountable that if we accept and state that these 

are going to be our performance measures, that we actually pay attention to it, and we look at what our performance is, we look at 

what the root issues are if we are not achieving that performance, 

and we take action. We do not wait for other folks to come in and 

tell us we need to improve. We self-improve ourselves, and we have 

to build the tools to do that. 

Secretary Napolitano and I are committed to defining these outcomes, providing these measures, and holding ourselves and our 

team accountable to achieving that improvement process. Mr. 

Chairman, to give you an example—I have several, but one which 

you are very familiar with. In the Post-Katrina Emergency Management Reform Act, we were defining a national housing strategy. 

Well, if you read the national housing strategy, it talks about process. 

I came back and asked the team, I said, ‘‘Well, I want to give 

you a number. Can you provide, and how would you provide, housing in a disaster for half a million families within 60 days of an 

event occurring?’’ 


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That challenged that strategy because it was not based upon an 

outcome; it was based upon describing process. 

How can we know we are getting close to or have built the tools 

to get us where we needed to be based upon the disasters we face 

if all we are doing is talking about a process and a strategy? 

And so these are the steps we are taking, and sometimes, as you 

say, and has been presented, sometimes the things we try to measure may not necessarily be what the outcome is, and that is where 

we are trying to go. 

The other part of this is to provide tools so that we have that 

dashboard approach, so we can look at things and see where we are 

and are we getting performance measures. 

I want to talk about something else that I think is very dear to 

you, Mr. Chairman. Coming up in October, we will be remembering 

the losses in this country, the line-of-duty deaths of firefighters and 

emergency medical personnel. You know what one of the leading 

causes of deaths in this country for these folks, line-of-duty deaths 

is? Going to and coming back from the emergency itself. 

I sat down with Chief Cochran. I said that we are collecting this 

data, but where is our emphasis on changing this? We have programs in place. We are putting emphasis on this. But we need to 

do more than just talk about dying and getting severely injured 

going to and coming from an emergency being unacceptable to how 

do we put some measures on that. Are our programs effective? So 

rather than just reporting out how many line-of-duty deaths are 

traffic crashes and how many injuries are traffic crashes, we want 

to look at what our data has been for the last couple years and say 

let us cut it in half. Now let us start driving our programs so we 

get an outcome that saves lives. 

You should not have deaths responding to and coming back from 

emergencies. Everybody should go home after the emergency. But 

if we just talk about how we measure the numbers but we do not 

say we need to reduce the numbers and now drive our programs 

to achieve that, we will continue to report line-of-duty deaths without a change in outcome. 

Thank you, Mr. Chairman. 

Senator CARPER. Thank you very much. Just coming out of our 

markup over in the Finance Committee on health care reform, 

there was a lot of discussion about defensive medicine and what we 

might want to do to reduce the incidence of defense medicine and 

improve the quality of health care outcomes and maybe reduce the 

frequency of litigation and medical malpractice. And what I think 

we are going to probably end up doing is really directing a series 

of robust demonstration projects in States using different approaches—health courts, safe harbors—a certification process. Let 

us say Dr. Posner is an actual medical doctor, he is my doctor, and 

he takes off the wrong leg in a procedure, and I want to sue him. 

In my State now, before I can do that, I have to go before a panel 

of people who are trained experts and say, ‘‘This is my case. What 

do you think?’’ And if they do not think I have a case, I do not 

make the case in court. So that would be an approach where—some 

States have caps on medical malpractice, non-economic damages, 

and so we will test a couple of those as well. 


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1The prepared statement of Ms. Suh appears in the Appendix on page 71. 

The idea is to see what is working in different States to robustly 

test them, analyze the results, and then hopefully encourage States 

to do more of what works and less of what does not. 

Ms. Suh, you may proceed. 

TESTIMONY OF RHEA S. SUH,1 ASSISTANT SECRETARY FOR 

POLICY, MANAGEMENT, AND BUDGET, U.S. DEPARTMENT OF 

THE INTERIOR 

Ms. SUH. Mr. Chairman, thank you. I sincerely appreciate the 

opportunity to appear before you today to talk about the management issues at the Department of the Interior. As we said earlier, 

in the interest of time, I will be submitting my full testimony for 

the record, and I will summarize my remarks briefly. 

One of my highest priorities as Assistant Secretary for Policy, 

Management, and Budget at the Department of the Interior is a 

rigorous and renewed focus on management. Effective management 

begins with a clear articulation of a success for the organization. 

If you do not know where you are going, any road is going to take 

you there. 

Senator CARPER. Did you guys collaborate on the testimony? 

[Laughter.] 

That was pretty good. 

Ms. SUH. So we are communicating very clearly with employees 

about the direction that the Department is taking, and we are 

building in performance information that holds them accountable 

for the achievement of these goals. But doing that well is not easy. 

Let me give you a few examples of the challenges and tell you how 

we are beginning to address these challenges. For these purposes, 

let us consider our national parks and the issue of restoration. 

First, performance information has to be specific enough for implementation, so for restoration purposes, we need information 

about restoration for every national park. Each national park is 

unique. We have 391 units of them. So collecting individual park 

information is critical. It is relevant to managers, and it allows us 

to hold them accountable and to set goals for what we can achieve. 

And yet performance information must also aggregate so that we 

can make agency-level decisions. 

Because there are 391 national park units, we must be able to 

pull the information up about restoration across these parks so 

that we know what is going on with the entire system. We are 

doing that by creating common measures that can be aggregated. 

But we must also be able to communicate about and assess what 

we are doing beyond just the national parks. We are, after all, a 

large and fairly complex agency of 70,000 people organized within 

nine different bureaus. We want all of our employees to know that 

what they do fits into a larger priority set within the Department. 

National Parks Service employees who work on restoration need 

to know why their work makes sense in the larger ambitions and 

mission of the agency. We are thus developing a framework that 

pulls together the vision for the entire Department. 

All of these challenges are really why we are revising the current 

existing strategic plan to reflect Secretary Salazar’s new vision and 


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1The prepared statement of Ms. Snyder appears in the Appendix on page 74. 

to provide a streamlined framework that embodies our existing 

functions. This framework will enable us to create a feedback loop 

that links policy, human resources, and financial information at the 

resource level up to the Department level and back down. 

Specifically, we will refine and refocus our existing performance 

benchmarks to ensure that we are not only measuring the things 

that are meaningful, but that the emphasis is less on compliance 

and more on performance. We will use these measures both as a 

mechanism to prioritize resources, expanding the link between performance and resource allocations as well as the tool to establish 

individual responsibility and accountability associated with these 

goals. 

We deeply appreciate your interest in performance management 

and very much support the need to expand the effective use of performance management data. The GAO report was very helpful to 

us, and as I have described, we are implementing many of its recommendations. 

Secretary Salazar, has established a new and very high bar of accountability for the Department. We take this quite seriously, and 

our renewed effort in expanding the meaningful use of performance 

measures is one of the most important tools, I believe, in meeting 

these high standards and in successfully accomplishing our critical 

resource protection and management goals. 

Mr. Chairman, that concludes my statement. Obviously, I would 

be pleased to answer any questions that you have. 

Senator CARPER. I will just ask one quick one before I turn to 

Ms. Snyder. There are 391 national parks or units of national 

parks in all across the country. Are there any States that do not 

have a national park? 

Ms. SUH. There are no States that do not have a national park 

unit. 

Senator CARPER. The answer is there is one. The first State to 

ratify the Constitution, the First State has no national park, and 

Ken Salazar was in our State earlier this year to announce that 

probably next year—you know the saying in the Bible, the first 

shall be last, the last shall be first. Well, the First State will become next year the last State to host a national park. 

Ken Burns, the documentary film maker of great renown, has 

completed a new film series. It is going to debut very soon, if it has 

not already, on national public TV, and it is called ‘‘America’s Best 

Idea: The National Park.’’ He grew up in Delaware. And maybe we 

will have a sequel to that. 

Ms. SUH. I stand corrected. Thank you, sir. 

Senator CARPER. You bet. Ms. Snyder, welcome. 

TESTIMONY OF MICHELLE SNYDER,1 ACTING DEPUTY ADMINISTRATOR AND DEPUTY CHIEF OPERATING OFFICER, CENTERS FOR MEDICARE AND MEDICAID SERVICES, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Ms. SNYDER. Good morning, Mr. Chairman. It is an honor and 

a pleasure to be here today to discuss with you CMS’s efforts to increase the use of performance information within the agency. 


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In total, as CMS outlays about $700 billion a year on health care 

expenditures, which is one of the largest categories of Federal Government spending. The Administration, the Congress, beneficiaries, 

and taxpayers clearly expect CMS to be accountable for the efficient and effective administration of the oversight of the Medicare, 

Medicaid, and Children’s Health Insurance programs. We take this 

role very seriously because we know that this oversight impacts 

over 98 million lives in this country. And our experience shows just 

how important it has been, and continues to be, to use performance 

information in the evaluation and running of those programs. 

When I talk about performance information, I really mean the 

data that is used by CMS to measure our progress towards the Department and agency goals that lead to the improvement of programmatic oversight, better quality of care for our beneficiaries, 

and more effective management of staff and resources. 

As you heard previously from GAO, CMS has made great strides 

in the use of data to assist in making key agency decisions. However, we also hear your charge that no matter how well we have 

been doing, we can always do better. 

One area that we focused on is appropriate oversight of our programs. An example is the CFO audit that CMS undergoes annually. In early audits, we were unable to provide sufficient documentation to support the amounts reported in our financial statements. 

We worked hard to fix that by putting plans in place to improve 

the collection of financial data, and we tracked our progress in 

strengthening our internal financial controls and addressing material weaknesses. Today a detailed corrective action plan is developed, monitored, and implemented for each finding in the CFO 

audit. This tracking has led to clean opinion audit ratings for each 

of the last 10 fiscal years, and a reduction in the number of material weaknesses that have, therefore, strengthened our financial 

oversight of the Medicare program. 

Performance information is also integral to achieving our vision 

of a transformed and modernized health care system and instrumental in improving the quality of health care for those 98 million 

Medicare, Medicaid, and CHIP beneficiaries that I mentioned. For 

instance, two CMS quality initiatives that rely on performance information include the Nursing Home Compare website that enables 

consumers, providers, States, and researchers to compare information on nursing homes in particular geographic areas. 

Many nursing homes have also made significant improvements 

in the care provided to residents, recording a decrease in the use 

of restraints and number of beneficiaries suffering pressure ulcers 

in nursing homes. 

And one other website I would like to mention is—— 

Senator CARPER. This sounds familiar. 

Ms. SNYDER. It sounds familiar. And the Hospital Compare 

website, which also includes public reporting and comparisons of 

hospital performance information. We have seen improvement in 

the results of the hospitals, including a decrease in the percentage 

of surgical patients receiving incorrect surgical care and antibiotics, 

which in turn reduces mortality, morbidity, and rehospitalization 

rates. 


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We continue to plan to build on these quality initiatives. Performance measurement is essential for health care providers to 

learn where they stand, and public reporting can be a powerful catalyst for improvement. 

Finally, I would just like to say that CMS has developed a series 

of strategies to utilize performance information to improve the efficiency and management of our staff. A key strategy is implementing performance plan evaluations for all CMS employees. 

These plans are developed with clear measurable and observable 

standards. Initially, and intentionally, the performance measures 

selected fit under and link with HHS and CMS goals. This cascading of goals, as we call it, allows CMS to align each employee’s 

work with our overall objectives. Through better use of performance information, we also plan to provide even more data tools to 

employees in their decisionmaking. 

This early work that we put in place is bearing fruit. We have 

been recognized for our improvements, but we do want to continue 

to evaluate and monitor our progress and improve on what we are 

doing. 

One example where we are also using the performance measures, 

which I think is something that is very important to folks in this 

room, is implementation of the Recovery Act at CMS. We are building on what we have learned in other parts of the agency in terms 

of project and performance management experience. We have designed a project management officer to manage and monitor implementation and ensure that the Department has information timely 

to work with us in implementing this key legislation. 

In addition, we are employing a tool which we call the Priority 

Project Tracker (PPT), that is giving us enhanced capability to look 

at dependencies across our projects and components and ensure 

timely information is made available to senior leadership in the 

agency. 

We look forward to working with you to make sure that performance information is available to ensure operational risks are immediately identified, employees are held accountable for meeting the 

agency’s goal, and our overall performance is easily measured. 

Thank you for allowing me to share how CMS uses performance 

information, and I look forward to answering any questions you 

may have. 

Senator CARPER. Thank you so much. 

When we go into the questions—I will just give you a heads up. 

You mentioned the stimulus package. One of the issues of great interest to us, particularly as we approach health care reform legislation, is the money that is in the package, $20 billion for health IT, 

the implementation of health IT. I might be asking you just to 

share some thoughts with us as to how we are doing in terms of 

getting that money out there and putting it to work. 

Dr. Posner, again, thanks so much. We are delighted. Again, we 

appreciate your being willing to change your own schedule to be 

here, and we are deeply grateful. Thank you. 


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1The prepared statement of Mr. Posner appears in the Appendix on page 89. 

TESTIMONY OF PAUL L. POSNER,1 DIRECTOR, PUBLIC ADMINISTRATION PROGRAM, DEPARTMENT OF PUBLIC AND 

INTERNATIONAL AFFAIRS, GEORGE MASON UNIVERSITY 

Mr. POSNER. Thank you, Mr. Chairman. Thank you for holding 

this hearing, and I want to tell you my personal metric for gauging 

the maturation of performance in government, 10 years ago, when 

I used to do these hearings, there were about five people in the audience, and now you have filled the room. So I think that is a good 

sign that there is greater interest here. And it is important—— 

Senator CARPER. When you are running a budget deficit, in the 

last 8 years we ran up as much new debt as we did in the first 

208 years of our Nation’s history, this year on track to our biggest 

budget deficit ever, and if we look forward to the next 10 years and 

$9 trillion of additional debt, we need to focus on improper payments, we need to focus on performance. And I think it is kind of 

like you guys and gals are going to be the stars and help point us 

in the right direction, and we need to be right there leading the 

way. Thank you. 

Mr. POSNER. Absolutely, you stated the importance much better 

than I could have. 

I think when we think about where we are, it is a good time to 

take stock. We have made surprising progress. Those who were 

there when the GPRA was passed in the middle of the night 

thought this would go in the dust bin of history along with PPB 

and ZBB and the rest, but it has not. It has stayed around for a 

long time. I think we have developed a supply side very well. Agencies have developed data and information thanks to PART and to, 

obviously GPRA. 

We still have concerns about the demand for this information. 

Managers are using this more, I think, for their own needs, which 

is very important. What we need to think about is how can we 

incent decisionmakers and the Congress and the Executive to use 

it for budget issues and the like. 

When we think about how to use this information in budgeting, 

by the way, one important thing to recognize is to set our expectations right. This is not going to eliminate politics from budgeting. 

It is not going to say if the performance goes up, we are going to 

increase money; if performance goes down, we are going to decrease 

money. We would not want to say if drug abuse goes up, we are 

going to cut money for drug programs. What it does, it provides 

questions for people to think about, not answers, which are properly political and priorities, among other things. 

So, with that in mind, how can we think about keeping the ball 

rolling and generating more use of this information. I have an 

agenda that I have laid out in the testimony. 

First of all, continuity is very important. I am pleased to see this 

Administration is continuing the effort of the previous two Administrations to put high-level emphasis on this from OMB down, and 

I think that trickles to the agencies and incents even Congress to 

take notice of this. 

Second, I think it is important to think about this as multifaceted. We have agencies, OMB and the Congress, all who have 


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to have a line of sight between performance and their own interests. And so this is going to look, I think, different for different 

kinds of actors in our system. 

First of all, I think it is important to keep the foundations going. 

This is a long-term enterprise getting performance right, if you 

will, particularly in the Federal level, much more difficult than at 

the local level. I started my career in the New York City budget 

office. Performance was pretty easy. People in Queens knew when 

the garbage would be picked up. We measured it, and we were able 

to improve things. 

Now, as Ms. Steinhardt said in her testimony, we are dealing 

with complex things where the Federal Government really writes 

the checks and issues the rules and leaves it to other people—State 

and local governments and nonprofits—to really do the work. How 

do you instill performance motivations and incentives in people 

who do not work for you, who have different values and interests? 

That is a really difficult challenge for Federal officials, so we need 

to think about how we get our grants and contracts aligned with 

performance as well as direct Federal employees. 

Then think about how we get our budget structures aligned. The 

appropriations and budget structures are oriented in many different ways. Some are focused on inputs. Some are focused on organizations. Some are focused on performance goals. It is not consistent. Other nations and States have kind of reformed their budget structures to focus decisionmakers on performance-related units 

of analysis. We have a long way to go there. Obviously, Congress 

has to be front and center. 

We need to think about imparting a more strategic focus to this. 

Yes, agencies are important, but many things that we care about 

as a Nation, like food safety, are scattered around 14 agencies. Job 

training, we have 60 programs. Student aid and higher education 

assistance, we have a welter of tax credits, loans, guarantees, and 

grants, all of which sing off of different pages and send different 

incentives. 

How can we figure out a way to be more strategic about what 

we are trying to achieve in these broad mission areas? I think it 

is one of the next stages of performance as we move forward. 

We need to keep the best of PART, which was a dedication to reexamine programs periodically, but we need to do it, as has been 

said here, in a more selective, targeted way, and a way that engages the interests of everybody in the process. 

The last point is the Congress. I want to say that the Congress 

is not the performance wasteland that many people portray. In 

fact, this hearing testifies to that. The use of performance in authorizing and appropriation committees is actually fairly impressive. 

How can Congress better select key areas in performance to review each year? How can it develop its own capacity to target key 

areas that need to be reviewed? Can it work with the President to 

agree on a set of targets and actually collaborate on some kind of 

an assessment process like they do in the Netherlands, like you see 

in other countries? Can we do that here? It is a real question, obviously. 


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Can you marshal the forces of my old agency, the GAO, and others to help you in this process, to synthesize what amounts to almost a fire hydrant of information? One of the problems with performance is we have too much information. We need a synthesis 

and filtering of that to make is useful for decisionmakers. 

And, finally, I make this point in the testimony which I have 

been making for years when I was at GAO. The one process that 

we have that annually looks at all programs together is the congressional budget process. The question is whether there is a way 

to take the budget resolution and make that into a performance vehicle. Can the budget resolution, in other words, become more of 

a performance resolution alongside its traditional functions? That 

is the question for the future. 

Thank you. 

Senator CARPER. Good. Thank you. Thank you very much for 

those comments. You got a lot in, in a relatively short period of 

time. 

One of the things that we are talking about, using performance 

in making budgetary decisions, we had a great debate a month or 

so ago in the Senate on the future of the F–22 fighter aircraft. It 

is an aircraft that is built—the components are built in maybe 30, 

40, 45 States. And so there are a lot of States that have an economic interest in the planes or sub-assemblies of the planes. They 

are very expensive. And along with Senator McCain and Senator 

Levin, I was very active in the floor debate with my colleagues saying, a plane that we have been building all these years, its missioncapable rate is down around 50 percent, where we spend, I think, 

about $40,000 per flight hour for the aircraft that has never flown 

a single mission in Iraq or Afghanistan, maybe that is not an airplane we should continue to build several hundred more. 

By a fairly decent margin, we voted to pull the plug, and that 

sort of thing does not happen often enough. But we did use pretty 

good performance data, and I think it was instructive and helpful 

to my colleagues as they made the tough decisions for some of 

them. 

I need to leave so I am not going to keep you long. I have been 

summoned back into our Finance Committee markup. But let me 

just ask a question, if I could, of all of you. 

What suggestions do you have for the Obama Administration on 

how to design and structure their new performance and analysis 

framework? How can OMB support your efforts to create a more 

results-oriented culture in your organization? I would ask this really of the first three witnesses on this panel. 

Mr. Fugate, would you just lead us off? 

Mr. FUGATE. Thank you, Mr. Chairman. I actually consider myself part of the President’s team. 

Senator CARPER. You are. 

Mr. FUGATE. Within the team, I think my experience has been 

that you have to define what the outcome is. You have to then define what is your performance measures. You have to have either 

a dashboard or a reporting system that everybody can see. And 

then you have to hold managers accountable for those outcomes 

given the resources and other external factors that may affect the 

outcome. But you have to keep focused in on where you are going. 


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And that is the thing that oftentimes is the hardest. You identify 

what you are trying to do and you identify performance measures, 

and then other issues come up. And then you start getting away 

from that. And then you start getting distracted. And then it no 

longer is a management issue, because we are looking at something 

else. 

That either tells me that we were not serious about performance 

measures or we were not measuring the right thing, because it was 

not important enough to the organization to stay focused on it. 

I think that is where we have to work in partnership with OMB, 

is make sure we are measuring things that are important to 

FEMA, that we hold our leadership accountable, we give them the 

tools to measure it, and we are not out there just measuring things 

that will get distracted and chase that rabbit down another hole. 

It is core to our mission. Everybody understands and gets why we 

have to improve, and we hold ourselves accountable to that in such 

a way that, when you ask, I can show you our report card, and I 

can show you what we are doing to get better. 

Senator CARPER. Good. Thank you. I like to use a football analogy. Vince Lombardi, legendary former football coach of the Green 

Bay Packers, used to say, ‘‘Unless you are keeping score, you are 

just practicing.’’ And I would sort of lead that to the next step. I 

think the next step would be not just unless you are keeping score 

you are just practicing, but unless you actually study the films of 

the games and the films of not only your own games but your opponents’ games, and sort of drill down like we are doing in our 

schools, you are not doing yourself much good. So thank you. 

Ms. Suh. 

Ms. SUH. I have two specific responses. First, on what I think is 

working well, in the 2011 budget formulation process, as we have 

talked about earlier, we are working with OMB on something 

called high-priority performance goals. I think the goals which are 

essentially small logic models or strategic plans, if you will, are 

enormously helpful for us as a Department in defining our priorities and figuring out what our road maps are amongst those priorities. In addition, having it be tied to an actual budget process I 

think is an enormously helpful process that we are working 

through right now with OMB. So on that side, I think that is working very well. 

In terms of potential suggestions, I think all of us within the Department and within OMB seem to find ourselves in a disaggregated world, a world that has performance managers, a world 

that has budget managers, a world that has policy people, and 

those things are not often really working together as well as they 

can. Even in the structures that exist at OMB and the structures 

that exist at the Department of Interior, you tend to, again, get 

these silos of people that are only focusing on one thing and not 

really understanding the connections between them. 

And so as we struggle through this within our own agency, it 

would be helpful to be able to partner with OMB in developing 

ways to break down these silos and, again, to really think through 

all of the elements of budget performance management for personnel and policy systematically to ultimately perform much more 

satisfactorily. 


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Senator CARPER. Thank you. Ms. Snyder. 

Ms. SNYDER. I think one of the things that would be most helpful 

to us from OMB is a focus on really what are cross-cutting goals 

for government. All of us contribute in varied and different ways 

to overall achievements that are needed in government. So helping 

us know what those cross-cutting goals are and how we could contribute to that, I think, is important. 

The other thing is support for the identification of what we call 

the ‘‘vital few.’’ In our programs, we literally could have thousands 

and thousands of performance measures if we went down that 

route. But identifying what are the vital few, actually collecting the 

data, and then knowing that you have a demonstrated result that 

you are held accountable for I think is really the key to making it 

work inside an agency and really anywhere in government. 

And the other thing that I would say is this is one of those things 

you cannot just talk about it once a year, so talking about it, having regular, discussions, whether it is through some council mechanism for performance improvement, whatever that may take, it has 

to be kept on the front burner, or it just simply gets caught up in 

the press of other business. 

And I think the only other thing that I would say is there is a 

big difference between just reporting on things and folks looking at 

it to see that you really did demonstrate a result, a change, an improvement. And so talking about those changes and improvement 

versus just saying we collected these data, I think, is absolutely 

key to really making it a real program. 

Senator CARPER. Good. Thank you. 

Dr. Posner, I saw you nodding your head in agreement with some 

of what Ms. Snyder was saying. Do you want to underline—— 

Mr. POSNER. I thought it was very good. I appreciate those. If I 

could just make a distinction, OMB wears two hats—the budget 

hat and the management hat. The budget hat, good budgeting includes good performance analysis. It always had. Small ‘‘p.’’ I think 

the budget process needs to kind of become more performance oriented so that the process is about a performance discussion: What 

metrics are we going to achieve? What targets are we going to 

achieve with the resources we have? I think they have made 

progress in that area, starting from GPRA, and I think that has 

got to continue. 

But the management hat is different. The management hat involves this kind of ironic way of promoting, learning, and innovation from the top down. Not easy to do. Scorecards and shame do 

not necessarily produce that. They produce short-term gain, not 

necessarily long-term change. So I think the challenge and trick for 

OMB is how can you instigate a culture of learning and innovation 

that these people are talking about here from the top down, and 

that is what remains to be seen. 

Senator CARPER. All right. Good. 

Ms. Snyder, I said I was going to come back and raise the issue 

of information technology, trying to infuse and really expand the 

use of information technology in the delivery of health care. There 

is about a $20 billion allocation in the stimulus package. I had not 

planned on raising this, but any comment you could give us, brief 


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comments, in terms of how we are using that money, how we are 

putting it to use? 

Ms. SNYDER. Well, the first thing we did when we got the legislation was we used some of our performance management tools. We 

took our Project Planning and Tracker, and we sat down and we 

figured out what provisions have to get implemented and when. 

How do you bring this program up to achieve congressional intent? 

That is well underway. We have mapped all of that. 

The other thing is the key partners in this, in HHS, are the Office of the National Coordinator, Dr. Blumenthal, and working with 

CMS. We are joined, literally joined at the hip on this and are 

working through the issues. 

We believe that we are going to be on time in getting the first 

regulation out so that we will be able to get information back on 

what constitutes meaningful use, so we look forward to working 

through that regulatory process. We are anticipating probably a 

number of comments to that. There is a great interest, as in the 

provider community. 

We are also starting to look at what do we need to do operationally to change underlying systems to bring all that together to get 

the program up and running and to get payments out the door, as 

Congress intended, as soon as we can. 

It is a big job. Right now we look like we are on schedule, according to our tracker right now. 

Senator CARPER. Great. Thank you for that update and for the 

approach you all are taking to it. 

I just received a more urgent summons to go to the Finance 

Committee markup, so this will be my last question, unfortunately, 

and I am going to direct it to Dr. Posner, if I could. 

You talked a bit about this already, but how can this new Administration get agency leaders to use performance information to 

improve their management decisions? I realize you talked about 

this a bit already, but I want you to flesh it out just a little bit 

more. How can the leaders of an organization get its managers to 

pay more attention to outcomes to achieve superior performance? 

Again, you have spoken to that as well, but just kind of wrap it 

together in one response. 

Mr. POSNER. I think it is partly setting the tone at the top that 

has been talked about here and setting a series of discrete goals 

and objectives. I think the problem with many initiatives at the 

State, local, and Federal levels, there is too much and there are too 

many goals, too many data points. And so it is the vital few, I 

think was mentioned, that is very important, and targeting that 

and being persistent and consistent with that in all phases of the 

process, including paying attention to it in budgeting is very important. 

Senator CARPER. Thank you. I feel badly that I have to go, but 

what we are working on just down the hall in the next building is, 

I think, of historic consequence. What we are doing here is really 

of great consequence as well. And as I think Dr. Posner reflected, 

the number of people in this audience today as compared to the 

number that might have been here a few years ago is indicative 

that folks are starting to better understand that importance. 


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We are looking at ways to enable me to maybe be in two places 

at once, and I do not think we are going to allow human cloning 

anytime soon. I joke with my colleagues that maybe what we could 

is create cardboard cutouts of us, and the real person could be do 

in one place, but maybe we have a cardboard cutout here in this 

chair and a member of my staff—we would cut out the lips, and 

then a member of my staff would be behind the cardboard cutout 

and just ask the questions and say—people always say that at the 

end of the hearing, ‘‘It was a good hearing, but he seemed stiff.’’ 

[Laughter.] 

We have not figured out how to perfect this just yet, but I am 

really glad that I could be here. I am really glad that each of you 

could be here, and our first two witnesses, one of whom is still 

here. And I am grateful for the time and the thought that you have 

put into your presentations, and this is important. This is important stuff, and we are going to do better. We have got to do better 

as a Nation and as a government. 

This hearing record will be open for the next 2 weeks for the submission of some additional statements and questions. I expect we 

will have some. There will not be a huge volume, but there will be 

some. And if you receive those, I would just ask for your cooperation in providing prompt responses to those questions that might 

be submitted for the record. 

With that, one last thank you, and on behalf of the people of our 

country, the taxpayers of our country, I especially want to say 

thank you. 

With that, this hearing is adjourned. 

[Whereupon, at 12:15 p.m., the Subcommittee was adjourned.] 


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