Government Performance: Strategies for Building a Results-Oriented and Collaborative Culture in the Federal Government
Released: 2009-09-24T00:00:00

Letter

Adoption of Key Management Practices Promoted Greater Use of Performance Information at CMS

In 2000, significantly fewer managers at CMS—then known as the Health Care Financing Administration—reported using performance information for various management decisions, as compared to their counterparts in the rest of government. Between our 2000 and 2007 surveys, however, CMS showed one of the largest average increases in the percentage of managers who reported using performance information for certain decisions. This increase placed CMS in about the middle of our agency rankings, which were based on an index of 2007 survey results designed to reflect the extent to which managers at each agency reported using performance information. Our analysis of CMS survey results, management interviews, and agency policies, performance reports, and other relevant documents indicated that the adoption of key management practices contributed to this improvement.

Demonstrating Leadership Commitment to Using Performance Information

Our 2007 survey results showed that significantly more CMS managers agreed that their leadership is committed to achieving results, than they did in 2000 (see fig. 2).

Nearly all of the CMS officials we interviewed credited the commitment of one or more agency leaders—such as the CMS Administrator or the Chief Operating Officer—for their increased use of performance information to achieve results. One way in which leaders can demonstrate their commitment is through frequent communication of established goals and progress made toward those goals. As an example, in an effort to reduce the incidence of pressure ulcers among nursing home residents, a Region IV manager described to us how regional leadership began to routinely share performance information about the pressure-ulcer problem with the many stakeholders involved with patient care including hospital and nursing-home personnel, patient advocates, emergency medical technicians, and others. CMS contracts with states to assess the quality of care provided by Medicare and Medicaid-participating facilities, such as nursing homes, and is therefore several steps removed from the delivery of health-care services to patients and the resulting health outcomes. According to CMS Region IV managers we interviewed, this indirect influence had been considered a limiting factor in CMS’ ability to affect outcomes among nursing-home patients. However, these same managers said that leadership commitment to getting stakeholders to the table and sharing performance information with them were critical factors in bringing about a reduction in the incidence of pressure ulcers. In that region, between fiscal years 2006 and 2008, this improvement translated into nearly 2,500 fewer long-stay nursing-home residents with pressure ulcers.

Strengthening Alignment among Agency, Program, and Individual Performance Goals

Our survey results also indicated that between 2000 and 2007, a significantly greater percentage of CMS managers reported that they were held accountable for program results (see fig. 3).

In 2006, as part of a change throughout HHS, the agency adopted a new performance-management system that links organizational and program goals with individual accountability for program results. Top CMS headquarters officials said that the new system had made individual accountability for program results more explicit. They described how agency goals and objectives were embedded in the Administrator’s performance agreement and cascaded down through the management hierarchy, so that each level of management understood their accountability for achieving the broad department and agency-level goals.

To illustrate, broad goals for preventive healthcare cascade from HHS through a CMS director responsible for increasing early detection of breast cancer among Medicare beneficiaries, to a CMS Health Insurance Specialist responsible for communications to raise awareness of the importance of mammograms and other preventive measures.

Improving the Usefulness of Performance Information

Our survey results show that between 2000 and 2007, there was a significant decline in the percentage of CMS managers who reported that difficulty developing meaningful measures was a hindrance to using performance information (see fig. 4).

According to CMS officials, to ensure that performance information was useful to managers, they limited the number of measures for GPRA reporting purposes to the 31 that represented the agency’s priorities. This official noted that it would be unmanageable to measure and report on every aspect of their programs and processes. They ultimately settled on a set of performance goals that helped managers and staff identify performance gaps and opportunities to improve performance to close the gaps.

Developing Analytic Capacity to Use Performance Information

Our survey results and interviews with several CMS officials indicate that the agency also took steps to develop their staff’s capacity to use performance information, such as investing in improved data systems and offering increased training opportunities on a range of topics related to performance planning and management. Between 2000 and 2007, there was a significant positive increase on all six survey questions related to managers’ access to training over the past three years on the use of performance information for various activities (see fig. 5).

According to one official we spoke with, increasing her staff’s skills in conducting analyses of performance information and presenting findings was a gradual process that required training, coaching, and guidance.

FEMA and Interior Were Hindered in Using Performance Information for Decision Making by Weak or Inconsistent Application of Key Management Practices

Just as the adoption of key management practices can facilitate greater use of information and a greater focus on results, the absence of these practices can hinder widespread use. Fewer managers at FEMA and Interior reported making extensive use of performance information for decision making compared to managers at other agencies. Survey results, interviews with senior level-officials and regional and program managers, and a review of policies and other documents related to performance planning and management at both agencies showed that inconsistent use of these practices contributed to this condition.

Our 2007 survey results indicated that, compared to the rest of government, a smaller percentage of FEMA managers agreed their top leadership demonstrated a strong commitment to using performance information to guide decision making (see fig. 6).

Our interviews with officials at FEMA were consistent with these survey results, indicating that management commitment was demonstrated inconsistently across the program directorates and regions we reviewed. Leaders and managers we spoke to throughout the management hierarchy were clearly committed to carrying out FEMA’s mission. The level of commitment to using performance information for decision making, however, appeared to vary among those we interviewed. For example, in the Disaster Assistance Directorate, one headquarters official told us that he does not need performance targets to help him determine whether his directorate is accomplishing its mission, relying instead on verbal communications with the leadership and with FEMA’s regions, joint field offices, and members of Congress to identify issues to be addressed and areas that are running well.

Another headquarters official within the Disaster Assistance Directorate’s Public Assistance program said he does not receive formal performance reports from regional program managers, nor are any performance reports required of him by his supervisors; rather, he said that he spoke to the regions on an ad hoc basis as performance problems arose. These officials expressed reluctance toward holding their staff accountable for meeting performance goals due to external factors, such as the unpredictability of disasters beyond their control. Further, they expressed uncertainty as to how they could use performance information in the face of uncontrollable external factors. As noted below, however, other managers in FEMA have found ways to take unpredictable occurrences into account as they monitor their progress in achieving performance goals.

FEMA faces other hurdles, including the lack of a performance- management system requiring managers to align agency goals with individual performance objectives, which makes it challenging for managers to hold individuals accountable for achieving results. The agency also lacks adequate information systems for ensuring that performance information can be easily collected, communicated, and analyzed. For example, in order to gather performance information across directorates, one official reported that it was necessary to write programs to generate specific reports for each of the systems and then manually integrate the information, making it difficult to produce repeatable and verifiable reports. Further, according to several officials we interviewed, there was a limited number of staff with the analytic skills necessary to work with performance metrics.

As with FEMA, at Interior we observed that leaders and managers at all levels conveyed a strong commitment to accomplishing the agency’s mission. Interior’s survey results were similar to FEMA’s results on items related to managers’ perceptions of their leadership’s commitment to using performance information. Interior’s 2007 results were also lower than those in the rest of government (see fig. 7).

According to officials we interviewed, leaders at Interior and NPS did not effectively communicate to their staff how, if at all, they used performance information to identify performance gaps and develop strategies to better achieve results. Several NPS managers referred to the performance reporting process as “feeding the beast,” because they receive little or no communication from either Interior or NPS headquarters in response to the information they are required to report, leading them to assume that no one with authority reviews or acts on this information.

Furthermore, some bureau-level managers at NPS and Reclamation said the performance measures they are required to report on were not always useful for their decision making, either because there were too many or because they were not credible. We have previously reported that to be useful and meaningful to managers and staff across an agency, performance measures should be limited at each organizational level to the vital few that provide critical insight into the agency’s core mission and operations. However, in the seven years since the inception of the former administration’s Performance Assessment Rating Tool (PART) initiative, Interior has expanded its performance reporting to include 440 PART program measures, in addition to the approximately 200 strategic performance measures used to track progress against its strategic and annual plans, as required by GRPA. A senior headquarters official at Interior said that the number of measures makes it difficult for senior leaders and managers to focus on priorities and easily identify performance gaps among the different program areas. At NPS alone, managers were required to report on 122 performance measures related to GPRA and PART.

Managers at both NPS and Reclamation also described performance information that lacked credibility because the measures either did not accurately define comparable elements or did not take into account different standards across bureaus or units. For example, several NPS managers noted that one of the measures on which they report, “percent of historic structures in good condition,” does not differentiate between a large, culturally significant structure such as the Washington Monument and a smaller, less significant structure such as a group of headstones. Consequently, a manager could achieve a higher percentage by concentrating on improving the conditions of numerous less significant properties.

Poorly integrated performance and management information systems further hindered NPS and Reclamation managers’ efforts to use performance information to inform their decision making. For example, according to some Reclamation managers we interviewed, there is no one centralized database to which a Reclamation executive can go to find out how the bureau is doing on all of Reclamation’s required performance goals. The lack of linkage among the different Reclamation systems required managers to enter the same data multiple times, which some managers said is a burden.

Despite the challenges facing FEMA and Interior, we also observed various initiatives and program areas within the agencies where leaders were committed to increasing the use of performance information; and were demonstrating that commitment by communicating the importance of using data to identify and solve problems, involving their managers in efforts to develop useful measures, and connecting individual performance with organizational results. Within FEMA, Mitigation Directorate officials we interviewed reported that they had begun to use performance information to plan for and respond to factors outside of their control, a change that they attributed in large part to the former Mitigation Administrator’s commitment to performance and accountability. For example, storms and other natural events can disrupt the Mitigation Directorate’s production work related to floodplain maps modernization, which is a key step in ensuring that flood-prone communities have the most reliable and current flood data available. To plan for possible disruptions, Mitigation Directorate officials said they reviewed performance information on progress toward map modernization goals on a monthly basis with their external stakeholders, including state and local governments and insurance companies and FEMA’s regional management, which sent a clear signal that Mitigation’s leadership was paying attention to outcomes. According to these officials, this review helped them to determine in advance if they were at risk of missing performance targets and to identify corrective actions or contingency plans in order to get back on track toward achieving their goals. Moreover, they said, they were able to meet or exceed their performance target of 93 percent of communities adopting new floodplain maps, in part, as a result of their frequent communication and review of performance information.

Mitigation Directorate officials said that developing measures and holding staff and contractors accountable for their performance was not an easy transformation. They said that one key to this culture change was for the leadership to strike an appropriate balance between holding managers accountable for agency goals and building trust among managers and staff that performance information would be used as an improvement tool, rather than as a punitive mechanism. Finally, Mitigation Directorate officials said that managers and staff became more supportive of their leadership’s efforts to use performance information in their decision making once they began to see that measuring performance could help them to improve results.

At Interior and NPS, officials were aware that managers continue to struggle with the high volume of performance information they are required to collect, and have initiated various strategies designed to improve the usefulness of performance information without adding to the existing data-collection and reporting process. For example, NPS’ Core Operations Analysis is a park-level funding and staffing planning process, recently adopted by several regions, that is intended to improve the efficiency of park operations and ensure that a park’s resource-allocation decisions are linked to its core mission goals. Regional-level managers who engaged in the Core Operations Analysis said it was useful in establishing goals based on the park’s priorities, monitoring progress toward achieving those goals, and holding park superintendents accountable for meeting established goals.

Our report contains recommendations to the Secretary of the Department of Homeland Security (DHS) for FEMA and the Secretary of the Interior, designed to build upon the positive practices we identified within these agencies. We recommended that FEMA augment its analytic capacity to collect and analyze performance information and strengthen linkages among agency, program, and individual performance. We also recommended that Interior, NPS, and Reclamation review the usefulness of their performance measures in conjunction with OMB and refine or discontinue performance measures that are not useful for decision making. Finally, to FEMA, Interior, and NPS, we made recommendations intended to improve the visibility of agency leadership’s commitment to using performance information in decision making. Both DHS and Interior generally agreed with these recommendations.

Building an Enduring Results-Oriented and Collaborative Culture Requires Demonstrated Leadership Commitment from the President and Congress

As we have noted in the past, the President and Congress both have unique and critical roles to play in demonstrating their commitment to improving federal agency performance results. Both OMB and Congress can send strong messages to agencies that results matter by articulating expectations for individual agency performance and following up to ensure that performance goals are achieved. At the same time, they also need to address performance problems in the areas of government that require the concerted efforts of multiple agencies and programs. Increasingly, many of the outcomes we look for—such as prevention of terrorist attacks, reduction in incidence of infectious diseases, or improved response to natural disasters—go beyond the scope of any one single agency. In these cases, agencies must work closely together to achieve desired results.

The President and OMB Can Promote Greater Use of Performance Information Governmentwide

The President can send a signal to federal managers that using performance information is critical for achieving results and maximizing the return on federal funds invested by selecting and focusing his attention on achieving certain critical goals, such as creating or retaining jobs through investments under the American Recovery and Reinvestment Act of 2009. As a first step, OMB has begun to issue guidance to agencies on identifying a limited number of high-priority performance goals, with the explicit message that performance planning is a key element of the President’s agenda to build a high-performing government. With this recent guidance, OMB has also put agencies on notice that the executive- branch leadership is paying attention to their performance, by establishing regular reviews of the progress agencies are making to improve results in these high-priority areas.

As the primary focal point for overall management in the federal government, OMB can support agency efforts to use performance information by encouraging agencies to invest in training, identifying and disseminating leading practices among agency managers, and assisting agencies in adopting these practices where appropriate. As we previously reported, our survey results showed a positive relationship between managers who reported receiving training and development on setting program performance goals and those who report using performance information when setting or revising performance goals. However, as we testified in July 2008, while our survey found a significant increase in training since 1997, only about half of our survey respondents in 2007 reported receiving any training that would assist in analyzing and making use of performance information. We previously recommended that OMB ensure that agencies 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. Although the agency has not yet implemented this recommendation, an official who oversees OMB’s management initiatives said that OMB has recently launched a collaborative Wiki page for federal agencies. According to this official, the Wiki is intended to provide an on-line forum for federal managers to share lessons learned and leading practices for using performance information to drive decision making.

In addition to providing support to help improve agency-level performance, OMB is uniquely positioned to facilitate collaborative, governmentwide performance toward crosscutting goals. As noted above, there are numerous performance challenges, ranging from combating terrorism to preventing the spread of infectious diseases, which transcend organization lines and require the concerted efforts of multiple agencies and programs. We have previously reported that GPRA could provide OMB, agencies, and Congress with a structured framework for addressing crosscutting program efforts. OMB, for example, could use the provision of GPRA that calls for OMB to develop an annual governmentwide performance plan to integrate expected agency-level performance. Such a plan could help the executive branch and Congress address critical federal performance and management issues such as conflicting agency missions, jurisdiction issues, and incompatible procedures, data, and processes. As we pointed out in our July 2008 testimony, this provision has not been implemented fully.

In addition to the annual performance plan, a governmentwide strategic plan could identify long-term goals and strategies to address issues that cut across federal agencies. To that end, we have also recommended that Congress consider amending GPRA to require the President to develop a governmentwide strategic plan. Such a plan—supported by a set of key national outcome-based indicators of where the nation stands on a range of economic, environmental, safety and security, social, and cultural issues—could offer 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.

Ensuring Performance Information Is Useful to and Used by Congress Is Key to Success of Governmentwide Performance Initiatives

By routinely incorporating agency performance issues into its deliberations and oversight, Congress can send an unmistakable message to agencies that they are expected to manage for results. As we have noted in our earlier work, however, Congress needs to be actively involved in early conversations about what to measure and how to present this information. We previously reported that the PART process used by the prior administration did not systematically incorporate a congressional perspective and promote a dialogue between Congress and the President. As a result, most congressional committee staff we spoke to did not use the PART results to inform their deliberations. Although the Obama Administration intends to adopt a new performance improvement and analysis framework, any new framework should include a mechanism to consult with members of Congress and their staffs about what they consider to be the most important performance issues and program areas warranting review. Engaging Congress early in the process could help target performance improvement efforts toward those areas most likely to be on the agenda of Congress, thereby increasing the likelihood that they will use performance information in their oversight and deliberations.

Additionally, as we noted in our July 2008 testimony, Congress could consider whether a more structured oversight mechanism would be helpful in bringing about a more coordinated congressional perspective on governmentwide performance issues. Just as the executive branch needs to better address programs and challenges that span multiple departments and agencies, Congress might find it useful to develop structures and processes that provide a coordinated approach to overseeing agencies where jurisdiction crosses congressional committees. We have previously suggested that one possible approach could involve developing a congressional performance resolution identifying the key oversight and performance goals that Congress wishes to set for its own committees and for the government as a whole. Such a resolution could be developed by modifying the annual congressional budget resolution, which is already organized by budget function. This may involve collecting the input of authorizing and appropriations committees on priority performance issues for programs under their jurisdiction and working with crosscutting committees such as the Senate Committee on Homeland Security and Governmental Affairs, the House Committee on Oversight and Government Reform, and the House Committee on Rules.

In conclusion, while federal agencies have become better positioned to manage for results, there is still much to be done to shift the focus of federal managers from merely measuring agency performance to actively managing performance to improve results. Our work indicates that widespread adoption of the key management practices we have identified is a critical first step. At the same time, the President and Congress each have unique and critical roles to play in building a high-performing, results-oriented, and collaborative culture across the government. Beyond this, the creation of a long-term governmentwide strategic plan, informed by a set of key national indicators, and an annual governmentwide performance plan could provide important tools for integrating efforts across agencies to achieve results on the challenging issues that increasingly face our nation in the 21st century.

Mr. Chairman, this concludes my statement. I would be pleased to respond to any questions you or other members of the subcommittee may have at this time.

GAO Contacts and Acknowledgments

For further information about this testimony, please contact me at (202) 512-6543 or steinhardtb@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this testimony. Individuals who made key contributions to this testimony were Elizabeth Curda (Assistant Director), Jessica Nierenberg, Laura Miller Craig, Kate Hudson Walker, Karin Fangman, Melanie Papasian, A.J. Stephens, and William Trancucci.

Appendix I: Agency Ranking Based on 2007 Survey Results on Use of Performance Information

Rank

National Aeronautics and Space Administration Department of Housing and Urban Development Department of the Treasury (excluding Internal Revenue Service)

Centers for Medicare & Medicaid Services United States Agency for International Development Department of Agriculture (excluding Forest Service)

Department of Homeland Security (excluding Federal Emergency Management Agency)

Department of Transportation (excluding Federal Aviation Administration)

Department of Health and Human Services (excluding Centers for Medicare & Medicaid Services)

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