Results-Oriented Government: Practices That Can Help Enhance and Sustain Collaboration among Federal Agencies
Published: 2005-10-21T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: The federal government faces a series of challenges in the 21st century that will be difficult, if not impossible, for any single agency to address alone. Many issues cut across more than one agency and their actions are not well coordinated. Moreover, agencies face a range of barriers when they attempt to work collaboratively. This report identifies key practices that can help enhance and sustain agency collaboration. GAO also considered how the Government Performance and Results Act (GPRA) and the Office of Management and Budget (OMB) address collaboration among agencies. To illustrate these practices, we selected the Healthy People, wildland fire management, and Departments of Veterans Affairs and Defense's health resource sharing collaborations.
section_title: What GAO Found
paragraphs: Collaboration can be broadly defined as any joint activity that is intended to produce more public value than could be produced when the organizations act alone. Agencies can enhance and sustain their collaborative efforts by engaging in the eight practices identified below. Running throughout these practices are a number of factors such as leadership, trust, and organizational culture that are necessary elements for a collaborative working relationship: define and articulate a common outcome; establish mutually reinforcing or joint strategies; identify and address needs by leveraging resources; agree on roles and responsibilities; establish compatible policies, procedures, and other means to operate across agency boundaries; develop mechanisms to monitor, evaluate, and report on results; reinforce agency accountability for collaborative efforts through agency plans and reports; and reinforce individual accountability for collaborative efforts through performance management systems. GAO has previously reported that GPRA, with its focus on strategic planning, the development of long-term goals, and accountability for results, provides a framework Congress, OMB, and executive branch agencies can use to consider the appropriate mix of long-term strategic goals and strategies needed to identify and address issues that cut across agency boundaries. In addition, to provide a broader perspective on the federal government's goals and strategies to address issues that cut across agencies, we previously recommended that (1) OMB develop a governmentwide performance plan as required by GPRA and (2) Congress consider amending GPRA to require a governmentwide strategic plan. OMB, through the President's Management Agenda (PMA), has emphasized improving government performance through governmentwide and agency-specific initiatives. One of these focuses specifically on improving coordination, but only between the Departments of Veterans Affairs and Defense for health programs and systems. However, many other areas that cut across agency boundaries would benefit from greater OMB focus and attention, including information sharing for homeland security, which GAO recently designated as a high-risk area. OMB has also used its Program Assessment Rating Tool (PART) diagnostic tool to determine, among other things, whether individual programs duplicate other efforts and if agencies coordinate and collaborate effectively with related programs. The PART tool provides general guidance for assessing effective program coordination and collaboration, but does not discuss practices for enhancing and sustaining collaboration, such as those described and illustrated in this report.

section_title: Letter
paragraphs: Achieving results for the nation increasingly requires that federal agencies  work together. From combating terrorism, monitoring infectious diseases,  and responding to natural disasters, the federal government faces a series  of challenges in the 21st century that will be difficult, if not impossible, for  any single agency to address alone. Taking into account the nation’s long- range fiscal challenges, the federal government must identify ways to  deliver results more efficiently and in a way that is consistent with its  multiple demands and limited resources.
GAO, Project SAFECOM: Key Cross-Agency Emergency Communications Effort  Requires Stronger Collaboration, GAO-04-494 (Washington, D.C.: Apr. 16, 2004) and  Homeland Security: Management of First Responder Grant Programs and Efforts to  Improve Accountability Continue to Evolve, GAO-05-530T (Washington, D.C.: Apr. 12,  2005).
For the purpose of this report we use the term “collaboration” broadly to include  interagency activities that others have variously defined as “cooperation,” “coordination,”  “integration,” or “networking.” We have done so since there are no commonly accepted  definitions for these terms and we are unable to make definitive distinctions between these  different types of interagency activities. The background section contains a more complete  definition of collaboration as used in this report.
No overall strategy integrates the threat-reduction and nonproliferation  programs of the Department of Defense (DOD), Department of Energy  (DOE), and others, and the agencies’ implementation of very similar  programs has not always been well coordinated. In particular, there is no  governmentwide guidance delineating the roles and responsibilities of  agencies managing border security programs. According to DOD and DOE  officials managing these programs, agencies’ roles are not well delineated  and coordination could be improved.
We have also reported that agencies face a range of barriers when they  attempt to collaborate with other agencies. One such barrier stems from  missions that are not mutually reinforcing or that may even conflict,  making reaching a consensus on strategies and priorities difficult. Another  significant barrier to interagency collaboration is agencies’ concerns about  protecting jurisdiction over missions and control over resources. Finally,  interagency collaboration is often hindered by incompatible procedures,  processes, data, and computer systems. Instead, federal agencies carry out  programs in a fragmented, uncoordinated way, resulting in a patchwork of  programs that can waste scarce funds, confuse and frustrate program  customers, and limit the overall effectiveness of the federal effort.
To help agencies overcome these barriers, and in response to your request,  this report identifies key practices that can help enhance and sustain  federal agency collaboration, along with illustrative examples from select  agencies. We also considered our prior work on how the Government  Performance and Results Act of 1993 (GPRA) can be used to identify  opportunities for improved collaboration among federal agencies and on  the role played by the Office of Management and Budget (OMB)—as the  focal point for overall management in the executive branch agencies—in  providing leadership and direction to federal agencies’ collaborative  efforts.
To meet these objectives, we reviewed the relevant literature, including  our prior reports, and interviewed experts in the area of collaboration. On  the basis of these sources, we identified eight broad practices that can  facilitate greater collaboration among federal agencies. We also identified  areas where federal agencies are engaged in collaborative efforts.  Although achieving results may involve the collaborative efforts of both  federal and nonfederal partners, for the purpose of this work we focused  on the practices that federal agencies can employ.
To illustrate these practices, we selected three areas where federal  agencies have developed substantial ongoing collaborations: Healthy  People 2010—a long-standing effort to develop and track public health  objectives for the nation, wildland fire management, and health resource  sharing between the Department of Veterans Affairs (VA) and DOD at  selected locations. We selected these areas based on expert views and our  prior work indicating that collaboration was taking place in the area. The  examples presented in this report are intended to be illustrative.  Therefore, we did not seek to show how the agencies in each of the three  collaborative areas engaged in every practice. In addition, because the  focus of our work was to identify practices for effective collaboration, we  did not assess whether the examples of collaboration practices we  highlighted resulted in improved agency performance in the three areas.
To obtain perspectives on the practices we identified, we interviewed  officials and reviewed documents from the federal agencies involved in  the three collaborative efforts —VA, DOD, and the Departments of  Agriculture (USDA), Education, Health and Human Services (HHS), and  the Interior. In addition, we visited selected locations from among these  agencies that were involved in sharing resources with each other. We also  interviewed nonfederal stakeholders involved in the collaborative efforts  we selected.
Appendix I provides a more detailed description of our scope and  methodology.
We conducted our work from May 2004 through August 2005 in offices in  the Washington, D.C. metropolitan area; Boise, Idaho; Louisville and Fort  Knox, Kentucky; Pensacola, Florida; and Sacramento and Fairfield,  California, in accordance with generally accepted government auditing  standards.
subsections: section_title: Background
paragraphs: Although there is no commonly accepted definition for collaboration, for  the purpose of this report we define it as any joint activity by two or more  organizations that is intended to produce more public value than could be  produced when the organizations act alone. For example, joint activities  can range from occasional meetings between middle-management  employees in which the existing division of labor of the respective  agencies is reaffirmed to the more structured joint law enforcement teams  operating over a long period of time. In contrast, absent effective  collaboration, routine interagency meetings can be dutifully attended  without having any substantive information communicated, joint  agreements reached among the agencies, or agreements implemented.  Although, according to this definition, collaboration can involve federal  and nonfederal governmental organizations as well as nongovernmental  organizations, this report focuses on the actions federal agencies can take  to improve collaboration.
subsections: section_title: Federal Collaborative Efforts We Reviewed
paragraphs: To illustrate practices that can enhance and sustain collaboration among  federal agencies, we selected three federal collaborative efforts—Healthy  People 2010, wildland fire management, and VA and DOD health resource  sharing—in which federal agencies work across agency lines to achieve  common outcomes. Appendix II provides additional information on these  three efforts.
subsections: section_title: Healthy People 2010
paragraphs: Healthy People 2010, a federal effort led by HHS and involving a number of  other federal agencies, is a set of national public health objectives, with  associated indicators to measure progress, which are revisited every 10  years. These objectives are intended to cover the most significant  preventable threats to health and support two broad national goals—(1)  increasing the quality and years of healthy life and (2) eliminating health  disparities. The Healthy People objectives are divided among 28 focus  areas. In this report we looked at two focus areas that involved multiple  federal agencies—Nutrition and Overweight, and Disability and Secondary  Conditions. The goal of the Nutrition and Overweight focus area is to  promote health and reduce chronic disease associated with diet and  weight. The Food and Drug Administration (FDA) and National Institutes  of Health (NIH) are colead agencies for the Nutrition and Overweight  focus area. The goal of the Disability and Secondary Conditions focus area  is to promote the health of people with disabilities, prevent secondary  conditions, and eliminate disparities between people with and without  disabilities in the U.S. population. The Centers for Disease Control and  Prevention (CDC) and the Department of Education’s National Institute on  Disability and Rehabilitation Research are colead agencies for Disability  and Secondary Conditions. Since it was established in 1979, Healthy  People has engaged a diverse group of stakeholders throughout the  country, including public and private organizations.
section_title: Wildland Fire Management
paragraphs: Wildland fires contribute to ecological health in forests and rangelands by  maintaining plant species diversity, limiting the spread of insects and  disease, and promoting new growth, among other things. However, past  management practices, including a concerted federal policy in the 20th  century of suppressing fires to protect communities and ecosystem  resources, unintentionally resulted in steady accumulation of dense  vegetation that fuels large, intense, wildland fires than can have  catastrophic effects on ecosystems and nearby communities. Federal  agencies responsible for wildland fire management (wildland fire  agencies) include the Forest Service at USDA and the Bureau of Indian  Affairs, Bureau of Land Management, Fish and Wildlife Service, and  National Park Service at Interior.
The first single comprehensive federal wildland fire policy for USDA and  Interior was established in 1995 in response to the prior year’s fire season  with its 34 fatalities. The 1995 policy is based on several guiding  principles including interagency cooperation—in particular, “fire  management planning, preparedness, suppression, fire use, monitoring,  and research will be conducted on an interagency basis with the  involvement of all parties.” Interagency collaboration in the area of fire  suppression, however, predated this 1995 federal policy. For example, the  Bureau of Land Management and the Forest Service established a joint  coordination center at Boise, Idaho, in 1965. This center has since evolved  into the current NIFC, housing the five wildland fire agencies along with  the National Weather Service, Department of Commerce; Office of Aircraft  Services, Department of the Interior; United States Fire Administration,  Department of Homeland Security; and the National Association of State  Foresters. A series of catastrophic wildland fires in 2000 resulted in the  wildland fire agencies and their partners developing a long-term,  collaborative approach for reducing wildland fire risk and the reviewing  and updating of the 1995 federal wildland fire policy. The collaborative  approach and update are the basis for the current wildland fire  management policy and practice.
section_title: VA and DOD Health Resource Sharing
paragraphs: VA operates one of the nation’s largest health care systems. Of the 7.4  million total enrollees in fiscal year 2004, VA obligated $28.4 billion to  provide care to 5.2 million total patients, which included veterans and  eligible nonveterans. Currently, health care is provided through 157 VA  hospitals and nearly 900 outpatient clinics nationwide. DOD spends about  $30.4 billion on health care for over 9.1 million beneficiaries, including  active-duty personnel and retirees, and their dependents. Most DOD health  care is provided at more than 530 Army, Navy, and Air Force military  treatment facilities worldwide, supplemented by civilian providers. While  both agencies have distinct missions—the VA focuses on providing  benefits to veterans and their families and DOD focuses on maintaining  the combat readiness of the military—both provide health care services.
To encourage sharing of federal health resources between VA and DOD, in  1982 Congress passed the Veterans’ Administration and Department of  Defense Health Resources Sharing and Emergency Operations Act (the  “Sharing Act”). Previously, VA and DOD health care facilities, many of  which are colocated or in close geographic proximity, operated virtually  independently of each other. The Sharing Act authorizes VA medical  centers and military treatment facilities to become partners and enter into  sharing agreements to buy, sell, and barter medical and support services.  The intent of the law was not only to remove legal barriers, but also to  encourage VA and DOD to engage in health resource sharing to more  effectively and efficiently use federal health resources.
Additional legislation was passed in 2002 to encourage and foster VA and  DOD health resource sharing. Under the Bob Stump National Defense  Authorization Act for Fiscal Year 2003, VA and DOD were required, among  other things, to develop a joint strategic plan and incorporate the joint  goals and strategies into the respective departments’ strategic and  performance plans that are required under GPRA. VA and DOD were also  required to establish a high-level interagency committee to develop and  implement collaborative efforts and to establish a joint incentive program  to provide incentives for implementing, funding, and evaluating creative  health resource sharing initiatives. VA and DOD are each required to make  a minimum contribution of $15 million from each department’s  appropriations each year for four years to fund the joint program, the  Joint Incentive Fund Program. Proposals for funding for either onetime  investments or recurring operations must be jointly developed by VA and  DOD. To ensure continuity of operations, projects involving recurring  costs must be self-sustaining and the incentive funds can be used for no  more than two years for operational costs.
We have pointed out that VA and DOD health resource sharing faces long- standing barriers, including incompatible computer systems that affect the  exchange of patient health information, inconsistent reimbursement and  budgeting policies, and burdensome agreement approval processes. OMB  has also singled out VA and DOD resource sharing for increased attention  through its PMA initiative. Nonetheless, our work has also shown that at  specific sites, VA and DOD are actively involved in health resource sharing  activities. For this work, we reviewed health resource sharing at three of  those sites, covering the Army, Navy, and Air Force. See appendix I for a  complete list of the VA and DOD sites we visited.
section_title: Key Practices That Can Help Enhance and Sustain Collaboration among Federal Agencies
paragraphs: Drawing from the literature we reviewed, the experts we interviewed, and  our prior work, we identified eight key practices that can help federal  agencies enhance and sustain their collaborative efforts. The federal  collaborative efforts we reviewed helped further refine the practices and  provided a wide variety of concrete illustrations of how the practices can  apply in different federal agency contexts.
While collaboration among federal agencies can take many different  forms, the practices generally consist of two or more agencies    defining and articulating a common outcome;    establishing mutually reinforcing or joint strategies to achieve the  outcome;  identifying and addressing needs by leveraging resources;    agreeing upon agency roles and responsibilities;    establishing compatible policies, procedures, and other means to operate    developing mechanisms to monitor, evaluate, and report the results of  collaborative efforts;  reinforcing agency accountability for collaborative efforts through agency  plans and reports; and  reinforcing individual accountability for collaborative efforts through  agency performance management systems.
For a number of these practices, it is also critical to involve nonfederal  partners, key clients, and stakeholders in decision making. Additionally,  agencies can strengthen their commitment to work collaboratively by  articulating their agreements in formal documents, such as a  memorandum of understanding, interagency guidance, or an interagency  planning document, signed by senior officials in the respective agencies.
Running throughout these eight practices are a number of factors such as  leadership and trust that are necessary elements for a collaborative  working relationship. These factors are established, sustained, and  reinforced through that relationship, thereby fostering a collaborative  culture.
subsections: section_title: Define and Articulate the Common Outcome
paragraphs: To overcome significant differences in agency missions, cultures, and  established ways of doing business, collaborating agencies must have a  clear and compelling rationale to work together. The compelling rationale  for agencies to collaborate can be imposed externally through legislation  or other directives or can come from the agencies’ own perceptions of the  benefits they can obtain from working together. In either case, the  collaborative effort requires agency staff working across agency lines to  define and articulate the common federal outcome or purpose they are  seeking to achieve that is consistent with their respective agency goals and  mission. Moreover, the development of a common outcome takes place  over time and requires sustained resources and commitment.
Following the authority provided in the Sharing Act, a number of VA and  DOD facilities have collaborated to achieve their common goals. VA Gulf  Coast Health Care System and the Naval Hospital Pensacola, for example,  collaborated to build a new joint ambulatory care clinic to improve the  quality, access, and efficiency of health care delivery for their respective  populations. The VA wanted to expand its medical facilities and increase  the type of medical services available in the area, as most beneficiaries  who needed specialty care were transported by the VA to Biloxi,  Mississippi, or New Orleans, Louisiana, adding to the cost of care. The  Navy, with several aging medical facilities, was facing a demand for  services from a growing population of retirees and students from the  cryptology school on the naval base. Over the course of nearly a year,  officials from the VA Gulf Coast Health Care System and the Naval  Hospital Pensacola, who had already shared medical services in the past,  agreed to build a joint ambulatory care center to provide closer and  expanded services as a way of improving access for both VA and Navy  populations. This agreement was formalized in a concept paper signed by  the director of VA Gulf Coast Health Care System and the Commanding  Officer of the Naval Hospital Pensacola.
USDA and Interior’s current collaboration in managing wildland fires  stemmed from the catastrophic wildland fires of 2000. The fires prompted  the President to request that the Secretaries of USDA and the Interior  develop a response to severe wildland fires, reduce their effects, and  ensure sufficient firefighting resources in the future. Additionally, the  conference committee report accompanying the fiscal year 2001 Interior  appropriations act directed the Secretaries to work with the relevant  Governors to develop a 10-year strategy for reducing wildland fire risk.  The Departments’ response and conference committee direction resulted  in the National Fire Plan that included a collaborative approach for a 10- year strategy and implementation plan to reduce the risk of catastrophic  wildland fires.
The fires in 2000 also led to a review of the 1995 federal fire policy, which  concluded that while the policy was sound and appropriate, the  implementation was incomplete, particularly where it involved  “collaboration, coordination, and integration across agency jurisdiction  and across different disciplines.” As a result of the review, as well as  studies by the National Academy of Public Administration and GAO, USDA  and Interior established the Wildland Fire Leadership Council in 2002 to  provide leadership and oversight in implementing the National Fire Plan  and the federal fire policy. This interagency council, comprised of senior  USDA and Interior officials, federal, state, tribal, and county  representatives, including the heads of the five wildland fire agencies,  meets regularly to foster policy coordination and the resolution of  interagency differences.
In the case of the Healthy People initiative, federal agencies, along with  state and local government agencies and nongovernmental organizations,  came together voluntarily to collaborate because they shared an overall  commitment to and responsibility for health promotion and disease  prevention. Recognizing that progress in improving the nation’s health  required the active participation and leadership of this diverse array of  organizations, the collaboration has grown to over 600 organizations since  it began in 1988. Officials from several federal agencies with public health  responsibilities worked together to review and update as necessary the  Healthy People objectives. For example, the CDC, along with the  Department of Education’s National Institute on Disability and  Rehabilitation Research, worked together to assess current public health  conditions and concluded that the health and well-being of people with  disabilities was an issue that could be better represented in the Healthy  People 2010 agenda. Scientific and technological advances, societal  attitudes, and labor market changes had redefined the extent to which  physical or mental conditions are disabling, and such changes should also  be reflected in the public health system. As a result of this collaborative  review, “Disability and Secondary Conditions” was included as a new  focus area for Healthy People 2010. The goal for this new focus area is to  “promote the health of people with disabilities, prevent secondary  conditions, and eliminate disparities between people with and without  disabilities.” Specific objectives for this focus area include (1) establishing  a standardized operational definition for disability and collecting  information on people with disabilities, thereby enabling government  policymakers, researchers, and clinicians to make better-informed  decisions; (2) eliminating disparities in employment between working-age  adults with and without disabilities; and (3) increasing the proportion of  children and youth with disabilities in regular education programs.
In defining and articulating a common outcome, where appropriate,  federal agencies should involve nonfederal partners, key clients, and  stakeholders. In doing so, federal agencies can better address their  interests and expectations and gain their support in achieving the  objectives of the collaboration. In developing the Healthy People 2010  objectives, HHS included as partners nonfederal organizations such as  state and local public health, mental health, and environmental agencies;  professional health groups; and health and recreation organizations. In  addition, HHS solicited public comments and invited individuals from  academia, businesses, the faith community, health care providers,  advocacy groups and community-based organizations, and nonprofit or  voluntary agencies to attend public meetings to discuss the proposed  Healthy People 2010 objectives.
section_title: Establish Mutually Reinforcing or Joint Strategies
paragraphs: To achieve a common outcome, collaborating agencies need to establish  strategies that work in concert with those of their partners or are joint in  nature. Such strategies help in aligning the partner agencies’ activities,  core processes, and resources to accomplish the common outcome.
Federal agencies have developed mutually reinforcing strategies to  accomplish the Healthy People 2010 goal for the nutrition and overweight  focus area—to promote health and reduce chronic diseases associated  with diet and weight. For example, USDA, in collaboration with HHS,  updates the Dietary Guidelines for Americans that provides advice on  good dietary habits and serves as the basis for federal food and nutrition  education programs. One of FDA’s strategies to achieve this goal is to  require that food labels provide information to consumers that will assist  them in planning healthful diets. And one of NIH’s strategies towards this  goal was to promote the use of their evidence-based guidance for treating  overweight conditions and obesity—Clinical Guidelines on the  Identification, Evaluation, and Treatment of Overweight and Obesity in  Adults: The Evidence Report.
VA and DOD, on the other hand, have developed joint strategies. As  required by the Bob Stump National Defense Authorization Act for Fiscal  Year 2003, VA and DOD’s Joint Executive Council, comprised of senior  leadership and staff involved in health and benefit activities from both  agencies, developed a joint strategic plan for the delivery of benefits and  services. The plan identifies strategies for accomplishing each of six  strategic goals. The strategies include developing joint guidelines and  policies for the delivery of high-quality care and assurance of patient  safety, and providing joint training in multiple disciplines.
In the area of wildland fire management, federal agencies have involved  nonfederal partners, key clients, and stakeholders in the development of  joint strategies to achieve their common goal of preventing and  suppressing wildland fires. In the aftermath of a series of wildland fires in  2000, the President directed the Secretaries of USDA and the Interior to  identify short-term strategies for responding to severe wildland fires.  Subsequently, the conference committee report accompanying the fiscal  year 2001 appropriations act directed the Secretaries to work with  Governors of the affected states on a long-term strategy to deal with  wildland fires. Moreover, the Secretaries were directed to engage the  Governors in a “collaborative structure to cooperatively develop” a  comprehensive strategy with the states as “full partners in the planning,  decision-making and implementation” of such strategy. Serving as a  conduit for a broad range of nonfederal stakeholders, the Western  Governors’ Association, in collaboration with USDA and Interior,  developed a 10-year comprehensive strategy and implementation plan that  includes a number of actions that are to be carried out in concert. For  example, the Wildland Fire Leadership Council, National Association of  State Foresters, and National Association of Counties are jointly  responsible for assessing “the training, equipment, safety awareness of,  and services provided by rural, volunteer, and other firefighters that work  in the wildland-urban interface.”
section_title: Identify and Address Needs by Leveraging Resources
paragraphs: Collaborating agencies should identify the human, information technology,  physical, and financial resources needed to initiate or sustain their  collaborative effort. Collaborating agencies bring different levels of  resources and capacities to the effort. By assessing their relative strengths  and limitations, collaborating agencies can look for opportunities to  address resource needs by leveraging each others’ resources, thus  obtaining additional benefits that would not be available if they were  working separately.
Wildland fire agencies collaborate to quickly identify and address resource  needs for suppressing wildland fires. According to NIFC, no single agency  is capable of providing the resources needed to respond to especially large  fires or to multiple concurrent fires. NIFC monitors the occurrence of  wildland fires and coordinates and mobilizes wildland firefighting  resources nationally to suppress those fires. Local and regional federal fire  centers unable to meet personnel, equipment, and supply needs contact  NIFC in Boise, Idaho. In response, NIFC provides certain resources and  requests others from the closest available federal agency. For example,  NIFC could request firefighting resources, including aircraft, personnel,  telecommunications equipment, and ground and air transportation for  equipment and supplies, from the Forest Service, Bureau of Indian Affairs,  Fish and Wildlife Service, and the National Park Service to respond to an  incident on land under the jurisdiction of the Bureau of Land Management.
In the three cases we examined of VA and DOD health resource sharing,  the agencies each had the incentive to work collaboratively to share  facilities, medical supplies, and skilled medical personnel, enabling them  to leverage resources. For example, in 1996 the Ireland Army Community  Hospital at Fort Knox entered into an agreement with the Louisville VA  Medical Center in which VA would provide primary care services for  active duty military personnel and their families. In return, the Army  provided VA with space, supplies, and equipment for a new outpatient  clinic for VA patients and agreed to fill some prescriptions for VA patients.  As a VA official noted, in a time of tight resources, there is an incentive for  the VA and the Army to be partners, enabling them to accomplish their  respective missions.
In another example, the VA Northern California Health Care Systems and  the David Grant Medical Center at Travis Air Force Base established a  joint dialysis clinic that expanded services and increased the number of  VA and Air Force patients served. Prior to the opening of the joint clinic,  the medical center made its dialysis clinic available on an emergency basis  to the VA, which lacked its own dialysis facilities. The VA sent its northern  California patients to private physicians in the area at a higher cost. With a  growing demand for dialysis services, the VA and Air Force worked  collaboratively to develop and submit a proposal to the national Joint  Incentive Fund for a joint clinic. This joint proposal was subsequently  awarded funding, enabling an expansion of the dialysis facility to serve  both DOD and VA patients.
section_title: Agree on Roles and Responsibilities
paragraphs: Collaborating agencies should work together to define and agree on their  respective roles and responsibilities, including how the collaborative effort  will be led. In doing so, agencies can clarify who will do what, organize  their joint and individual efforts, and facilitate decisionmaking. Committed  leadership by those involved in the collaborative effort, from all levels of  the organization, is also needed to overcome the many barriers to working  across agency boundaries.
The five federal agencies with wildland fire management responsibilities  jointly developed and update the Interagency Standards for Fire and Fire  Aviation Operations—an operations handbook that defines the roles and  responsibilities for all personnel engaged in managing wildland fire  operations, regardless of agency affiliation. For example, according to the  handbook, the Incident Commander for a wildland fire is responsible for  all incident activities, including developing the fire management strategy  and tactics, and ordering, deploying, and releasing resources. The Incident  Commander is supported by an Incident Command Staff that may include  a safety officer, information officer, operations section chief, planning  section chief, logistics section chief, finance section chief, and a liaisons  officer. In addition to specifying the roles and responsibilities, the  interagency handbook also identifies the qualifications required for each  position. For each wildland fire incident, staff meeting these qualifications  are assigned to these roles, regardless of the agency for which they work.
The VA and the Air Force in Northern California specified the roles and  responsibilities for health resource sharing in two joint charters. These  charters define a jointly staffed management structure for resource  sharing—the Executive Management Team and the Joint Initiatives  Working Group. One charter defines the roles and responsibilities of the  Executive Management Team in determining the workload and fiscal  implications of the sharing agreements, providing a dispute resolution  system for the collaborative effort, and setting policy for sharing  agreements and joint ventures. The other defines the roles and  responsibilities of the Joint Initiatives Working Group for making  recommendations to the Executive Management Team on sharing  opportunities, reimbursement methodologies, facility and space  considerations, and staffing personnel requirements. These charters have  helped sustain the collaborative effort, despite routine rotations of DOD  staff to other military installations.
The leadership continuity provided by VA partners has also helped to  sustain collaborative efforts in the face of periodic changes in DOD  leadership. At the three local sites we visited, VA and DOD officials we  spoke with said that it was important to have committed VA individuals  who had a common understanding of both the VA and military  environment and resource needs. One official said such individuals are  instrumental in initiating and sustaining the collaboration for resource  sharing.
section_title: Establish Compatible Policies, Procedures, and Other Means to Operate across Agency Boundaries
paragraphs: To facilitate collaboration, agencies need to address the compatibility of  standards, policies, procedures, and data systems that will be used in the  collaborative effort. Furthermore, as agencies bring diverse cultures to the  collaborative effort, it is important to address these differences to enable a  cohesive working relationship and to create the mutual trust required to  enhance and sustain the collaborative effort. Frequent communication  among collaborating agencies is another means to facilitate working  across agency boundaries and prevent misunderstanding.
The Interagency Standards for Fire and Fire Aviation Operations  handbook mentioned previously also specifies common standards,  operational policies, and procedures used for wildland fire operations. The  interagency handbook includes standards for training and firefighting  equipment as well as policies and procedures for developing a response to  wildland fire, aviation operations, and communications. For example, the  handbook specifies the standards for the chemicals used to suppress  wildland fires, such as long-term retardants, suppressant foam, and water  enhancers. It also establishes policies and procedures for the safe  application of aerial and ground suppressants in a way that does not harm  the ecosystem.
The interagency Wildland Fire Leadership Council was established by  USDA and Interior to facilitate collaboration across agency boundaries by  providing leadership and the consistent implementation of wildland fire  management goals and policy. The council deals with national policy  issues, such as nationwide resource allocation and prioritization that cut  across the different federal agencies. One official noted that the council  members are the ultimate authority within their departments for wildland  fire management. As such, they can negotiate and set wildland fire  management policy for their respective departments. Council members are  to ensure their respective agency’s disparate interests, missions, and  multiple responsibilities are not adversely affected by policy decisions the  council makes collectively. While the council meets several times a year,  council staff—coordinators from both USDA and Interior—communicate  more frequently and serve as liaisons to the various agencies.
Collaborating agencies may also need to find common ground while still  satisfying their respective operating needs. For example, in discussing  where to locate the new joint ambulatory care clinic, VA and DOD at  Pensacola had to overcome differences in their respective security  standards. VA officials had expressed concern about their beneficiaries’  access to medical facilities located on military bases during periods of  heightened security. Navy officials wanted the new clinic to be within  walking distance from the Center for Cryptology so students attending the  school could have easy access. At the same time, the Navy had concerns  that easy access to the base could expose the cryptology school, which is a  top secret facility, to unauthorized individuals. To address differences in  security standards, the VA and the Navy agreed to install a security fence  around the new clinic, creating an enclave within the naval base with a  separate entrance that is accessible from a public highway.
The ability to work collaboratively requires mutual trust among the  respective parties—a shared belief that the partners will carry out their  part of the joint agreement. Experts in collaboration and agency officials  involved in all three efforts we examined—Healthy People 2010, VA and  DOD health resource sharing, and wildland fire management—mentioned  trust as a key to enhancing and sustaining collaborative efforts. Trust can  be fostered in a variety of ways. For example, officials at NIFC suggested  that trust among staff from the different wildland fire agencies was  fostered through joint activities that provided opportunities for face-to- face interaction, such as interagency training and national or regional  conferences. Trust can also be a function of shared interest or background  in an area. In the case of NIFC, although staff have different agency  affiliations, most of them have field experience fighting fires.
Fostering an interagency culture, according to NIFC staff we interviewed,  can help facilitate collaborative efforts across agency boundaries and  enhances a cohesive working relationship among staff from the different  federal agencies with wildland fire responsibilities. For example, the  agencies at NIFC reinforce a common interagency culture by hiring staff  who have had experience and feel comfortable working in an interagency  environment. An interagency environment, according to one official, is  reinforced at NIFC in a variety of ways, including staff wearing a common  interagency badge and co-location of staff by functional areas rather than  by agency, reflecting the integrated staffing.
section_title: Develop Mechanisms to Monitor, Evaluate, and Report Results
paragraphs: Federal agencies engaged in collaborative efforts need to create the means  to monitor and evaluate their efforts to enable them to identify areas for  improvement. Reporting on these activities can help key decision makers  within the agencies, as well as clients and stakeholders, to obtain feedback  for improving both policy and operational effectiveness.
To monitor and report on the status of achieving the Healthy People 2010  objectives, HHS holds progress reviews in which the federal agencies with  lead responsibilities for a focus area report on the progress towards  achieving the objectives. Other federal agencies that do work related to  the focus area also participate in these meetings. The agencies discuss the  data trends, barriers to achieving the objectives, strategies undertaken to  overcome barriers, and alternative approaches to attain further progress.  A summary report of the progress review, including contact information, is  made available to the public through the Healthy People website.  Additionally, HHS conducts a midcourse review to assess the status of the  overall Healthy People objectives and identify the significant health trends  and gaps in preventive health issues. As the midcourse review could result  in the modification of the Healthy People 2010 objectives, the proposed  revisions to the objectives will be made available for public comment.
Federal wildland fire agencies assess fire operations through “after action”  reviews. According to interagency policy and standards, after each  wildland fire incident, the wildland fire agencies should conduct reviews  with personnel from different agencies along functional areas—for  example, the incident management team and smokejumpers (firefighters  who use parachutes to get to the fire). As part of these reviews, personnel  who worked on the incident discuss the strengths and weaknesses of the  operations and determine what can be learned from it. Personnel assess  what was planned, what actually happened, why, and what can be done to  improve wildland fire management. Managers should address such aspects  as the initial assessment of resource requirements, safety and welfare of  personnel, fire suppression operations, and administrative responsibilities.  According to federal wildland fire management policy, these after action  reviews are then used to modify fire management plans.
Wildland fire agencies also plan to evaluate their overall joint activities,  although these evaluations have not yet been conducted. Under the  Interagency Strategy for the Implementation of Federal Wildland Fire  Management Policy, USDA and Interior agreed to conduct fire  management reviews approximately every 4 years to provide information  for improving both policy and operational effectiveness. According to the  interagency strategy, these evaluations will be consistent with GPRA  requirements and agency strategic plans.
section_title: Reinforce Agency Accountability for Collaborative Efforts through Agency Plans and Reports
paragraphs: A focus on results, as envisioned by GPRA, implies that federal programs  contributing to the same or similar results should collaborate to ensure  that goals are consistent and, as appropriate, program efforts are mutually  reinforcing. Federal agencies can use their strategic and annual  performance plans as tools to drive collaboration with other agencies and  partners and establish complementary goals and strategies for achieving  results. Such plans can also reinforce accountability for the collaboration  by aligning agency goals and strategies with those of the collaborative  efforts. Accountability for collaboration is reinforced through public  reporting of agency results.
USDA, a stakeholder for the Nutrition and Overweight focus area of  Healthy People 2010, uses its strategic plan to reinforce its commitment to  support key Healthy People 2010 objectives. The main goal for the  Nutrition and Overweight focus area in Healthy People 2010 is to “Promote  health and reduce chronic disease associated with diet and weight.” To  track progress towards that goal, Healthy People developed seven  objectives related to food and nutrient intake, such as fruit intake and total  fat intake. A goal in USDA’s strategic plan for fiscal years 2002-2007 is to  contribute to reductions in obesity of the American public consistent with  the goals of Healthy People 2010. Specifically, one of the performance  measures in USDA’s strategic plan is to promote healthier eating habits  and lifestyles, setting as a goal for 2007, as a partner with HHS, “to take  actions to encourage a reduction in overweight and obesity such that adult  obesity will be no greater than 20% and child and adolescent overweight  will be no greater than 8%.”
Federal agencies involved in wildland fire management have goals in their  strategic plans that are compatible with those of the National Fire Plan’s  10-year comprehensive strategy to reduce the wildland fire risk to  communities and the environment. In its fiscal year 2003-2008 strategic  plan, Interior makes specific reference to the National Fire Plan and the  10-year comprehensive strategy. Additionally, the plan describes strategies  that include restoring fire-adapted ecosystems and reducing hazardous  fuels through collaboration, consistent with the 10-year comprehensive  strategy. Similarly, the Forest Service, also making specific reference to  the 10-year comprehensive strategy, has a compatible goal—“Reduce the  risk from catastrophic wildland fire”—in its strategic plan for fiscal years  2004-2008.
section_title: Reinforce Individual Accountability for Collaborative Efforts through Performance Management Systems
paragraphs: High-performing organizations use their performance management  systems to strengthen accountability for results, specifically by placing  greater emphasis on fostering the necessary collaboration both within and  across organizational boundaries to achieve results. Within the federal  government, the Office of Personnel Management (OPM) and OMB now  require such emphasis under the new performance-based pay system for  agency senior executives. Under this system, agencies are to hold  executives accountable for, among other things, collaboration and  teamwork across organizational boundaries to help achieve goals by  requiring the executives to identify programmatic crosscutting, and  partnership-oriented goals through the performance expectations in their  individual performance plans.
As a first step in reinforcing individual accountability for collaborative  efforts, agencies set expectations for senior executives for collaboration  within and across organizational boundaries in their individual  performance plans. For example, as part of its Senior Executive Service  (SES) performance management system, Interior, one of the agencies  involved in wildland fire management, requires all of its senior executives  to incorporate in their individual performance plans a competency related  to collaboration—“Building Collaboration and Partnerships with  Customers/Partners/Stakeholders.” Specifically, for this competency,  senior executives are to communicate, consult, and cooperate with  customers, partners, and stakeholders to ensure that Interior’s missions  and programs effectively empower citizens in the support of conservation.  According to an Interior official, Interior’s bureaus have the flexibility to  cascade the required senior executive competency related to collaboration  to their non-SES employees’ individual performance plans.
In addition, we have recommended that agencies have senior executives  identify specific programmatic crosscutting goals that would require  collaboration to achieve in their individual performance plans. To this  end, HHS holds all senior executives accountable for the crosscutting  “One-HHS” program objectives that relate to their job responsibilities.  For example, NIH senior executives are to cascade the One-HHS program  objectives into their individual performance plans, as appropriate. One of  these program objectives is to “improve the quality of health care” by  improving the coordination, communication, and application of health  research results. To meet this objective, an NIH senior executive, who is  the agency’s colead for the Healthy People 2010 Nutrition and Overweight  focus area, set an expectation in her individual performance plan to  enhance health care quality and treatment through the coordination and  translation of nutrition sciences, obesity, and physical activity research  and policy-related activities, through collaborative and coordinated  interagency activities at the federal and other levels. Further, NIH is  beginning to cascade the One-HHS program objectives to all NIH  employees through their individual performance plans.
In addition, we have recommended that agencies have senior executives  name the relevant internal or external organizations with which they  would collaborate to reinforce a focus across organizational boundaries.  To this end, a senior executive at Interior’s Bureau of Land Management  set an expectation in his individual performance plan to assure that  interagency fire program policies and operational changes are made in  collaboration with interagency partners and stakeholders. In his self- assessment for the year, the senior executive named the Fire Director for  the USDA Forest Service. The National Wildfire Coordinating Group, an  interagency activity coordinating group, tasked the executive and the Fire  Director to develop an interagency implementation strategy for the federal  wildland fire management policy. By closely collaborating with other  federal agencies and state representatives, the senior executive and the  USDA Fire Director designed a strategy that was approved for  implementation by the Wildland Fire Leadership Council last year.
High-performing organizations include results-oriented goals in individual  performance plans (or performance agreements) to encourage senior  executives to work collaboratively across traditional organizational  boundaries or “silos.” We reported in October 2000 that the Veterans  Health Administration’s Veterans Integrated Service Network (VISN)  headquartered in Cincinnati implemented performance agreements that  focused on patient services for the entire VISN and were designed to  encourage the VISN’s medical centers to work collaboratively. In 2000,  the VISN Director had a performance agreement with “care line” directors  for patient services, such as primary care, medical and surgical care, and  mental health care. In particular, the mental health care line director’s  performance agreement included improvement goals related to mental  health for the entire VISN. To make progress towards these goals, this care  line director had to work across each of the VISN’s four medical centers  with the corresponding care line managers at each medical center. As part  of this collaboration, the care line director needed to establish consensus  among VISN officials and external stakeholders on the strategic direction  for the services provided by the mental health care line across the VISN;  develop, implement, and revise integrated clinical programs to reflect that  strategic direction for the VISN; and allocate resources among the centers  for mental health programs to implement these programs.
section_title: GPRA and OMB’s Management Tools Offer Opportunities to Foster Greater Collaboration among Federal Agencies
paragraphs: GPRA, with its focus on strategic planning, the development of long-term  goals, and accountability for results, provides a framework that Congress,  OMB, and executive branch agencies can use to consider the appropriate  mix of long-term strategic goals and strategies needed to identify and  address federal goals that cut across agency boundaries. For example, we  have previously reported that the strategic and annual performance  planning processes under GPRA provide opportunities for federal agencies  to identify other agencies addressing related outcomes, and coordinate  with these agencies to ensure that program goals are complementary;  strategies are mutually reinforcing; and, as appropriate, common  performance measures are used.
OMB, as the focal point for overall management in the executive branch,  plays a key role in aligning the federal government’s resources and  activities. To better manage the accomplishment of crosscutting policy  goals, we have recommended that OMB fully implement the GPRA  requirement to develop a governmentwide performance plan. A  governmentwide performance plan could provide a broader perspective of  the federal government’s goals and strategies to address issues that cut  across different federal agencies, including redundancy and other  inefficiencies in how the government does its business.
Moreover, we have recommended Congress amend GPRA to require a  governmentwide strategic plan to provide a framework for identifying  long-term goals and strategies for addressing crosscutting issues. A  strategic plan for the federal government, along with key national  indicators to assess the government’s performance, could provide an  additional tool for governmentwide reexamination of existing programs,  as well as proposals for new programs. If fully developed, a  governmentwide strategic plan can potentially provide a cohesive  perspective on the long-term goals of the federal government and provide  a much-needed basis for fully integrating, rather than merely coordinating,  a wide array of federal activities.
In addition to the role it could play in implementing GPRA, OMB could  also use its PMA (President’s Management Agenda) and PART (Program  Assessment Rating Tool) tools to foster greater federal agency  collaboration. According to OMB, the PMA was implemented to remedy  long-standing federal agency management and performance challenges.  The PMA consists of five governmentwide initiatives—strategic  management of human capital, competitive sourcing, improved financial  performance, expanded electronic government, and budget and  performance integration. For each initiative, OMB has established goals or  “standards for success,” and OMB rates agencies’ status each quarter in  achieving the goals and making progress toward them. Additionally, the  PMA has nine agency-specific initiatives such as privatization of military  housing and reform of food aid programs, which OMB also rates  quarterly.
Among the governmentwide initiatives in the PMA is the strategic  management of human capital. One of the standards for success for this  initiative is having performance appraisals and award programs for all  members of the SES and managers, as well as most of the workforce, that  effectively align with agency mission, goals, and outcomes and hold them  accountable for results. In addition, as stated earlier, high-performing  organizations can place greater emphasis on fostering necessary  collaboration to achieve results through their performance management  systems for all levels of employees. OMB and OPM have recognized this  strategic use of performance management and require SES members to be  held accountable for collaboration and teamwork across organizational  boundaries. However, the PMA standards do not include a similar focus  on collaboration and teamwork for managers and the rest of the  workforce, and thus miss an opportunity to reinforce to agencies that their  performance management systems are strategic tools to strengthen  accountability for results.
One of the nine agency-specific initiatives focuses on improving  coordination of VA and DOD programs and systems to allow for the  seamless transition and continuity of care of beneficiaries from active duty  to veteran status. Apart from this case, however, our work has shown that  many issues cut across more than one agency and their actions are not  well coordinated. Therefore, such issues would benefit from the greater  attention and focus that PMA could provide. For example, information  sharing for securing the homeland is a governmentwide effort involving  multiple federal agencies, including OMB; DOD; the Departments of  Homeland Security, Justice, and State; and the Central Intelligence  Agency. We have recently highlighted this issue as a high-risk area in need  of broad-based transformation in order to facilitate information sharing  among and between government entities and the private sector. To do  this will require an extraordinary level of collaboration among the federal,  state, and local governments and the private sector.
OMB developed PART as a diagnostic tool meant to provide a consistent  approach to assessing federal programs during the executive budget  formulation process. PART covers four broad topics for all programs  selected for review: (1) program purpose and design, (2) strategic  planning, (3) program management, and (4) program results. In  conducting PART assessments of federal agency programs, OMB  considers, among other things, whether the program coordinates and  collaborates effectively with related programs and whether duplication  exists. In addition, consistent with our recommendation, OMB has begun  to use the PART framework to conduct assessments of groups of  programs in similar areas that cut across agency boundaries. The PART  tool provides general guidance for assessing effective program  coordination and collaboration: to demonstrate effective collaboration,  agencies need to provide evidence of collaborative efforts “leading to  meaningful actions in management and resource allocation”—for example,  a joint grant announcement, planning documents, or performance goals.  However, while these are important steps, as OMB recognizes, such  evidence alone does not demonstrate that meaningful collaboration has  occurred.
Agency officials from each of the case study agencies we interviewed  agreed that OMB could play an effective role in fostering greater  collaboration among federal agencies. Some officials we interviewed  indicated that the PMA and PART tools were appropriate vehicles for  sharing the practices in this report. For example, an official stated that for  VA and DOD resource sharing, being singled out as a PMA initiative  provided a high level of visibility to the issue—the additional attention  they have received by having a higher-level entity such as OMB focus on  the issue has been helpful in directing leadership attention and resources.  Furthermore, some officials stated that it would be helpful to have more  expanded criteria for assessing collaboration than the existing guidance  provided by OMB for its PART assessments.
section_title: Conclusions
paragraphs: As the challenges of the 21st century grow, it will become increasingly  important for Congress, OMB, and executive agencies to consider how the  federal government can maximize performance and results through  improved collaboration. Our prior work has shown that many issues cut  across more than one agency and their actions are not well coordinated. In  this report, we identify key practices that can help enhance and sustain  collaboration among federal agencies. We also describe how select  agencies’ collaboration efforts to address common goals reflect one or  more of these practices. The specific ways in which the case agencies  implemented the practices may not be appropriate for adoption by other  federal agencies seeking to improve their collaboration. Nevertheless, the  practices themselves can be adapted to address the specific collaboration  challenges each agency faces.
The strategic, annual, and performance planning processes under GPRA  provide a means for agencies to ensure that their goals for crosscutting  programs complement those of other agencies; program strategies are  mutually reinforcing; and, as appropriate, common performance measures  are used and they place greater emphasis on collaboration in agency  performance management systems. Furthermore, as we have  recommended, governmentwide strategic and annual planning approaches  led by OMB could aid in improving collaboration across agency lines.
OMB has a central role in overseeing the management of federal agencies  and has used its role to promote results-oriented management practices.  Under its PMA initiatives, OMB has highlighted an agency-specific  initiative—coordination of VA and DOD programs and systems—for  improvement. However, this is only one of a number of areas that OMB  could be focusing on to improve coordination among federal agencies.
Moreover, given the problems we have previously identified with  interagency coordination and collaboration, OMB could bring greater  agency attention to improving collaboration by creating a governmentwide  PMA initiative related to coordination and collaboration akin to its other  five governmentwide initiatives. Furthermore, OMB does not specifically  emphasize collaboration in its standards for successful strategic human  capital management. In its PART program, OMB has also highlighted  effective coordination as one of its assessment criteria. But it does not rely  on sufficient information to assess the effectiveness of the collaboration  nor has OMB offered information on practices that could assist agencies in  enhancing their capacity to coordinate and collaborate effectively. OMB  could, therefore, complement its existing efforts by looking to the  practices in this report as additional evidence of collaboration or to help  diagnose why collaborative efforts have not produced desired results.
section_title: Recommendation for Executive Action
paragraphs: We recommend that the Director of OMB continue to encourage  interagency collaboration by focusing attention on additional areas in need  of greater collaboration to achieve common outcomes and promoting the  collaboration practices identified in this report. Options for doing this  could involve    expanding the PMA initiatives and standards to include either an  additional governmentwide initiative focused on improving collaboration  across federal agencies or additional agency initiatives focused on specific  areas in need of improved collaboration;    expanding the standards for the PMA’s strategic management of human  capital initiative to reflect the need for agencies to hold individuals  accountable, through their performance management systems, for  coordinating and collaborating within and across organizational  boundaries in order to help the agencies achieve their mission, goals, and  outcomes; and    supplementing the PART guidance on interagency coordination with  information about the collaboration practices in this report.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to the Director of OMB for comment.  OMB’s Counsel to the Deputy Director for Management responded orally  that OMB agreed with the recommendation. We also provided relevant  sections of a draft of this report to the agencies involved in the three  collaboration efforts—VA, DOD, USDA, HHS, and the Departments of  Education and the Interior. They offered technical suggestions which we  incorporated as appropriate.
We are sending copies of this report to other interested congressional  committees. We are also sending copies to the Director of OMB. We will  make copies available to others upon request. In addition, this report is  available at no charge on the GAO website at http://www.gao.gov.
If you or your staff have any questions about this report, please contact me  at (202) 512-6543 or at steinhardtb@gao.gov. Contact points for our Offices  of Congressional Relations and Public Affairs may be found on the last  page of this report. Key contributors to this report are listed in appendix  III.
section_title: Appendix I: Scope and Methodology
paragraphs: To identify key practices that can help enhance and sustain collaboration  as well as federal agency collaborative efforts that illustrate these  practices, we reviewed academic literature and prior GAO and  Congressional Research Service reports. In addition, we interviewed  experts in coordination, collaboration, partnerships, and networks from  the National Academy of Public Administration, the IBM Center for The  Business of Government, and the University of California, Berkeley.  Although achieving results may involve the collaborative efforts of both  federal and nonfederal partners, for the purpose of this work we focused  on the practices that federal agencies can employ.
Using our literature review and interviews, we derived a set of practices  that we believe can help enhance and sustain federal agency collaborative  efforts. After examining the various approaches, frameworks, and models  that have been used to describe collaboration practices, we derived from  that material a set of practices that are consistent with results-oriented  performance management and agency requirements under the  Government Performance and Results Act of 1993. Therefore, we do not  consider our categorization of the practices for collaborative efforts to be  definitive and recognize that alternative categorizations of practices could  be developed and additional practices included.
While we generally believe that the application of as many of these  practices as possible increases the likelihood of effective collaboration,  we also recognize that there is a wide range of situations and  circumstances in which agencies work together. Consequently, in some  cases the judicious adoption of even a few practices may be sufficient for  effective collaboration while in other cases the adoption of all these  practices may not be sufficient to guarantee an effective working  relationship.
To illustrate, and to also help refine these practices, we selected three  areas where federal agencies have developed ongoing collaborations:  Healthy People 2010—a long-standing effort to develop and track public  health objectives for the nation, wildland fire management, and health  resource sharing between Veterans Affairs (VA) and the Department of  Defense (DOD). We selected these areas based on expert views and our  prior work indicating that substantial collaboration was taking place. We  selected examples from among the three collaborative efforts that, in our  judgment, most clearly illustrated and supported the practices we  identified. Therefore, agencies other than those cited for a particular  practice may, or may not, be engaged in the same practice. As the  objectives of this work were to identify practices that can help enhance  and sustain such collaboration, we did not assess whether the examples of  collaboration practices we highlighted resulted in improved performance  in these three areas.
For our review, we selected two Healthy People 2010 focus areas— “Disability and Secondary Conditions” and “Nutrition and Overweight”— that involve substantial collaboration among the Department of Health and  Human Services (HHS), which leads this initiative, and non-HHS agencies.  The Department of Education’s National Institute on Disability and  Rehabilitation Research coleads the Disability and Secondary Conditions  focus area with HHS’s Centers for Disease Control and Prevention (CDC).  While HHS’s Food and Drug Administration (FDA) and National Institutes  of Health (NIH) colead the Nutrition and Overweight focus area, with the  CDC’s National Center for Health Statistics providing the majority of data  for assessing progress toward attaining the Nutrition and Overweight  objectives, the U.S. Department of Agriculture (USDA) provides most of  the food and consumption data.
To obtain perspectives on the practices being used by the federal agencies  involved in Healthy People 2010, we reviewed literature on Healthy People  and met with officials from the National Academy of Public Administration  and the Robert Wood Johnson Foundation. We interviewed federal  officials from the Office of Disease Prevention and Health Promotion at  HHS who coordinate this effort. We also interviewed federal officials from  USDA’s Agriculture Research Service, Center for Nutrition Policy and  Promotion, and Food and Nutrition Service; HHS’s FDA, CDC, and NIH;  and the Department of Education’s National Institute on Disability and  Rehabilitation Research.
We judgementally selected and interviewed officials from three state  health agencies that differed in their approaches to healthy people  initiatives—Iowa Division of Administration, Pennsylvania Bureau of  Health Planning, and the California Department of Health Services—to  obtain nonfederal perspectives on the federal collaborative efforts to  develop Healthy People 2010.
To obtain perspectives on the practices used by VA and DOD to share  health resources, we reviewed our prior reports and met with officials  from VA’s Resource Sharing Office and DOD’s DOD-VA Program  Coordination Office. We also spoke with VA and DOD staff and reviewed  agency documents they provided at the specific sites we visited in  California, Florida, and Kentucky covering the Air Force, Navy, and Army  respectively. In California, we visited the VA McClellan outpatient clinic in  Sacramento and the David Grant Medical Center at Travis Air Force Base.  In Florida, we visited the VA Outpatient Clinic, Naval Hospital, and Corry  Station Branch Medical Clinic—all in Pensacola. In Kentucky, we visited  the Louisville VA Medical Center, the VA Community Based Outpatient  Clinic in Standiford Field, and Ireland Army Community Hospital in Fort  Knox.
To obtain perspectives on the practices being used by the federal agencies  involved in wildland fire management, we reviewed our prior reports and  documents we obtained from these agencies. We interviewed officials  from the Office of the National Fire Plan Coordinator at the Forest Service  and the Office of Wildland Fire Coordination at the Department of the  Interior. We also visited the National Interagency Fire Center (NIFC) at  Boise, Idaho, and interviewed NIFC staff from six federal agencies—the  Bureau of Land Management, Bureau of Indian Affairs, Fish and Wildlife  Service, and National Park Service of the Department of the Interior; the  Forest Service of USDA; and the National Weather Service of the  Department of Commerce. While at NIFC, we also interviewed staff from  Interior’s Office of Aviation Services. To obtain a perspective from  stakeholders on federal interagency collaboration, we interviewed  representatives from the Western Governors’ Association and the National  Association of State Foresters.
We conducted our work from May 2004 through August 2005 in offices in  the Washington, D.C. metropolitan area; Boise, Idaho; Louisville and Fort  Knox, Kentucky; Pensacola, Florida; and Sacramento and Fairfield,  California, in accordance with generally accepted government auditing  standards.
section_title: Appendix II: Federal Collaborative Efforts We Reviewed
section_title: Appendix III: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact
section_title: Acknowledgments
paragraphs: Thomas M. Beall, Mallory B. Bulman, Elizabeth H. Curda, Patricia A.  Dalton, Bertha Dong, Martin H. De Alteriis, Janice C. Latimer, Benjamin T.  Licht, Allen C. Lomax, William A. McKelligott, Michael L. Rose, and Lisa R.  Shames made major contributions to this report. In addition, Aditi Shah  Archer, Cynthia A. Bascetta, Michael T. Blair, Jr., David P. Bixler, Chester  M. Joy, Jacqueline M. Nowicki, and Sarah E. Veale provided key  assistance.