This section discusses several "management tools" such as workforce planning and training, information technology (IT), and customer service. All of these tools help the Department of Health and Human Services (HHS) achieve its strategic goals and objectives. For example, building on IT tools to build greater consistency and efficiency into information technology management across the Department, and reducing threats to computer security contributes directly to Objective 5.1. In addition, it contributes to all the strategic objectives in direct or indirect ways.
The Department has committed itself to achieve results that improve the lives of Americans. Thus, all of the strategic goals of HHS are programmatic goals. At the same time, the Department recognizes that these goals will not be achieved without paying attention to the means or management methods that are employed to carry them out. Just as the Congress is instrumental in the development of strategies that support the achievement of programmatic goals, in the last ten years, the Congress has worked with the Executive Branch to provide an extensive array of management tools to help federal agencies improve program performance.
HHS resolved long ago to take full advantage of the tools that the Congress, the Executive Branch, and others have provided to improve the management and administration of our program responsibilities. In this appendix, we have summarized the HHS efforts to make use of a variety of management tools to support the improvement of program results. It is important to the Department that this strategic plan identifies in a broad way how these functional management tools can and will influence program improvement over the term of the plan. The Congressional and Executive Branch oversight staff who have contributed significantly to the development and utilization of these tools are important stakeholders and partners of the Department in our efforts to improve program results. The information that follows illustrates that their efforts will continue to influence the performance of HHS programs.
The Government Performance and Results Act (GPRA) is the principal tool that compels Federal programs to focus on results. In addition to this Strategic Plan, HHS will continue to use performance measures from its Annual GPRA Performance Plans and Reports to inform its decision making processes.
The financial management tools provided by the Chief Financial Officers (CFO) Act and the Federal Financial Management Improvement Act (FFMIA), in conjunction with the Federal Managers Financial Integrity Act (FMFIA) and the Debt Collection Improvement Act (DCIA), will continue to produce greater financial accountability across HHS for years to come.
The Clinger-Cohen Act has provided a solid and consistent basis for the planning and management of technology resources and policy issues. Presidential Decision Directive 63 (PDD63): Critical Infrastructure Development is a tool that recognizes that addressing computer-based risks to the nation's critical infrastructures requires an approach that involves coordination and cooperation across federal agencies and among public and private-sector entities and other nations.
The Executive Branch also provides for the development and sharing of best management practices and tools through the President's Management Council (PMC), the President's Council for Integrity and Efficiency (PCIE), and the Chief Financial Officers' Council.
The Office of Federal Procurement Policy Act and Executive Order 12931 seek to improve procurement efficiency in support of the mission accomplishments of federal agencies, and instruct agencies to establish clear lines of contracting authority and accountability. The Act promotes electronic commerce in the administration of procurement systems. The Presidential Directive on Electronic Commerce states that government must adopt a market-oriented approach to electronic commerce, one that facilitates the emergence of a global, transparent, and predictable environment to support business and commerce.
The Federal Acquisition Streamlining Act (FASA) broke new ground in acquisition methodology and embodies key principles of acquisition reform. FASA was designed to simplify and streamline the federal procurement process, offering reforms for more cost-effective government and the ability of businesses to compete for government contracts.
The private sector has offered tools, such as the Balanced Scorecard, that provide innovative methods for federal agencies to improve the accountability of their management functions.
Formal, ongoing measurement of employee satisfaction is the basis for continuous improvement under the Quality of Worklife Initiative. The programmatic goals and objectives that have been set forth in this HHS Strategic Plan cannot be achieved without attention to management. The Department uses the tools that the Congress and others have provided to improve management in support of our program policy goals.
Through the ongoing development of Major Management Challenges, the General Accounting Office (GAO) and the HHS Office of Inspector General (OIG) offer the Department an additional tool, through their reports, that assist us in identifying and defining management challenges which can affect the ability of HHS components to effectively achieve important program objectives.
LEADERSHIP AND COORDINATION
HHS will continue to employ management strategies that support and coordinate program activities across the Department.
In line with the structure and diversity of the Department and its program activities, HHS management strategies have reflected a move away from a "command and control" leadership structure. Program legislation has compelled HHS components to operate as large, independent, and distinct agencies. They have their own history, needs, and approaches to program administration, often legislatively delineated. To attempt to constrain the Department's large agencies into a homogeneous unit-even for planning purposes-would dilute their strengths and their unique values. As a result, program components will remain the core of the organizational focus of HHS. Staff units should remain small and engaged in activities that facilitate program coordination, prevent duplication of effort, and ensure consistent attention to the mission, goals, and objectives of the Department and the priorities of the Administration and the Secretary.
Consistent with HHS's organizational philosophy, the focus of management issues within the Department will be on substantive, policy issues rather than on formal, organizational management processes. Methods of decision making in HHS will be consensual and will engage high levels of interaction among program and staff executives. In the Department's budget process, for example, the Secretary and senior executives throughout HHS will develop the budget based on themes that reflect Departmental priorities. Each year, the HHS leadership will establish a manageable number of initiatives that call for collaborative efforts across separate Operating Divisions (OPDIVs) and the Office of the Secretary (OS). Collaborative management does not preclude regular high-level Departmental interest and guidance in the management of HHS components. To ensure and foster the kind of performance-based management that GPRA has prompted, the Deputy Secretary, along with the Chief of Staff, the Assistant Secretary for Management and Budget, and other senior executives of the Office of the Secretary, will continue to meet quarterly with the head and senior staff of each HHS Operating Division to address management issues.
As performance measures mature and performance trends emerge, HHS GPRA performance data will inform and support budget decisionmaking in HHS.
The GPRA is a valuable tool that will enhance the Department's efforts to improve programs that serve the American people. With the continued development of performance goals and measures for approximately 300 programs, HHS will compile an extensive body of information that will be informative across programs and agencies. Such data will become increasingly important to HHS's leadership and program coordination efforts. Although the Department consists of large agencies with many and disparate functions, HHS coordinates the focus and direction of its program activities through Departmental initiatives developed in the annual HHS budget decision-making processes. Performance measurement will steadily strengthen these processes as data on program performance trends become available and serve as indicators to support the persistent cultivation of strategies and objectives to improve programs across the Department. In particular, performance measurement will inform the following:
The budget process in which HHS develops coordinated Departmental initiatives and uses the annual performance plans to improve programs and support the achievement of HHS's long-term goals.
Program evaluation, to assist HHS in providing programs with a deeper assessment of program effectiveness than can be provided by performance data, and to inform the development of improvements in ongoing performance measurement.
The Strategic Plan, in which HHS sets out long-term goals and objectives for its program components and the external entities that engage in the day-to-day administration of HHS programs across the country.
Budget decision-making in HHS will be key to Departmental coordination of program activity and performance measurement in HHS. In recent years, HHS modified its Departmental budget formulation processes specifically to better bring together information and leaders from throughout the Department to define the program initiatives that will move HHS toward the accomplishment of its mission. Anticipating that GPRA information will enhance this decision-making process, HHS combined GPRA annual planning and reporting with the budget formulation process and into the HHS budget documents. The Department is an entity that is focused on concerted progress toward the achievement of the mission, goals, and objectives of this Strategic Plan through its Departmental initiatives. As GPRA implementation continues to mature, program executives and managers throughout HHS will use trend data on performance results to seek the coordinated improvement of HHS programs on an ongoing basis, specifically by: 1) assessing performance activity and results, 2) engaging in program evaluation activity where deeper assessment is required, 3) redefining program strategies to produce improved results, and 4) modifying future performance targets to be consistent with available resources and up-to-date priorities and policy decisions.
HHS is committed to ensuring that its evaluations yield valuable knowledge, and that this knowledge is used to complement annual performance planning and reporting.
In the era of results-oriented management, evaluations are playing an increasingly important role in strategic planning, performance management, and program improvement. Evaluations conducted by HHS agencies generally serve one or more of the following purposes: to evaluate program effectiveness, develop performance measurements, assess environmental impacts on health and human services (i.e., external factors affecting program performance), and improve program management.
The results of these evaluations are increasingly being used by HHS program managers to inform the annual performance planning process and the interpretation and reporting of annual performance data. Program effectiveness provides a way to determine the impact of HHS programs on achieving intended goals and objectives. Performance measurement is the primary mechanism used to monitor annual progress in achieving departmental strategic and annual performance goals. To support performance measurement, we are investing evaluation funds to develop and improve performance measurement systems and improve the quality of the data that support those systems. We use environmental assessment monitor and forecast changes in the health and human services environment that will influence the success of our programs and the achievement of our goals and objectives. In turn, this understanding allows us to adjust our strategies and continue to deliver effective health and human services. Program management evaluations program managers with the necessary information or data helpful for effectively designing and managing a program. These evaluations generally focus on developmental or operational aspects of program activities and provide understanding of services delivered and populations served.
All HHS resources are used appropriately, efficiently, and effectively. Decision makers should have timely, accurate, and useful program and financial information.
The HHS CFO Financial Management Status Report and Five Year Plan highlights the functions that will affect the financial condition and resources of HHS programs until 2005. This financial planning document, updated, and published every year, puts forth two strategic financial management goals for the Department (highlighted immediately above) that are focused on a vision where managers at all levels work with program partners to provide services to the American people.
Under the auspices of the Government Management Reform Act (GMRA), HHS continues to improve the financial management of its programs and supporting activities. Individual OPDIV and HHS financial statements and audits are key tools for determining how well the Department manages taxpayer funds. It is important that we continue to maintain our efforts to receive unqualified "clean" audit opinions from auditors for its accounts. The financial integrity of the Medicare program is an important Department objective. Although the Department as achieved a "clean" audit opinion for the program, we are continuing to improve the financial management system underlying the program. This includes validating the financial management systems of all Medicare claims processing contractors and evaluating commercial off-the-shelf software for development of an integrated general ledger system to standardize the accounting systems used by contractors (see Objective 3.6).
The annual HHS Accountability Report integrates financial information with key GPRA program performance results and other management reports. The report provides HHS managers, the Congress, and the public with information that will become increasingly important for decision making and will show the costs of the programs of HHS.
One of the management reports included in the HHS Accountability Report delineates the results of the HHS CFO Financial Management Status Report and Five Year Plan. This plan covers the many functions that affect the financial condition and resources of HHS and support the Department's financial management goals.
Six management priorities have been identified to achieve these goals:
Improve financial accountability.
Improve financial management systems.
Develop human resources and CFO organizations.
Improve management of receivables.
Use electronic commerce to improve financial management.
Improve administration of Federal grant programs.
BUSINESS MANAGEMENT FOR GRANTS AND ACQUISITION
HHS will better focus grant and contract resources toward achieving the Department's program objectives. We will support the Administration's goal of developing and utilizing the nation's small business capacity.
Another vital component of the Department's corporate strategy involves intense management of its relationships with the external contractor and grantee communities. These relationships play a crucial role in the delivery of HHS's mission objectives and account for the spending of over $155 billion annually. Our objectives, summarized immediately above, seek to focus grant and contract resources toward achieving the Department's program objectives and to support the Administration's goal of developing and utilizing the nation's small business capacity.
Prominent among the Department's strategies are the HHS Scorecards for acquisition and grants that strive to achieve balance among various perspectives and goals, such as efficient business processes, innovative leadership, empowered employees, satisfied customers, and dedicated grantees and vendors. This cost-effective grants and acquisition performance management approach will help HHS to:
Gauge the overall health of its grants and acquisition systems.
Target opportunities for organizational improvement.
Achieve its program missions.
Give grants and acquisition executives a useful risk management and decision-making tool.
Promote the sharing of successful practices.
Gauge our progress in implementing grants and acquisition reform initiatives.
The balanced scorecard strategies that have been devised by the Office of Grants and Acquisition Management in the Office of the Assistant Secretary for Management and Budget are being implemented by HHS Operating Divisions.
To further improve results through the objectives of the HHS grants and acquisition management enterprise, the Department will employ additional implementation strategies, such as:
Departmental business managers will team with OPDIV counterparts to develop creative policy guidance, techniques, and best practices.
Departmental training programs will develop and certify business managers throughout the OPDIVs.
A knowledge management system called the Knowledge Exchange Network (KEN) uses the Internet to automate training courses and provide operational business managers easy access to the guidance and latest techniques.
Participatory balanced scorecard improvement systems will allow OPDIV business offices to oversee and continually benchmark operations.
HHS corporate business managers team with the Office of Management and Budget (OMB) and counterparts in sister agencies to improve policies and develop new initiatives to manage and improve the government's business processes.
HHS leadership in the Inter-Agency Electronic Grants Committee will result in a "Federal Commons" designed to provide all types of grantee organizations, with a common "face" for conducting grants business electronically. As the largest grant-making component in the federal government, HHS plays a key role in the federal grants management arena.
HHS has developed systems to streamline, target, and improve the accountability of its partners consistent with Single Audit Act Amendments and various legislative initiatives. Systems will ensure that all grantees that are required to submit federal Single Audits do so.
For Electronic Government/Electronic Commerce (E-Gov/EC), HHS has set forth three goals to meet a Departmental E-Gov/EC vision. HHS's vision is for an enterprise-wide electronic environment where best business practices and enabling technologies are used to facilitate the most efficient exchange of business information resulting in streamlined and rapid response to the customer and supporting the HHS mission. The E-Gov/EC goals supporting this vision are:
Achieve flexibility, increased productivity, and a dynamic working environment through the application of E-Gov/EC.
Achieve efficient and effective responses to changing environments by the introduction of business process improvements or reengineering and the exploitation of E-Gov/EC technologies.
Achieve cultural changes from the current business practices through guidance and the attainment of necessary skills for the implementation of E-Gov/EC.
HUMAN RESOURCES MANAGEMENT
Mission accomplishment in HHS--as everywhere--means having the right people with the right skills doing the right jobs at the right time.
Workforce Planning. Making full use of the contributions of the work force requires analysis to know what skills are needed and planning to make sure that employees have those skills. Effective workforce planning supports budget requests, provides a solid basis for staffing requests, and documents our human resource needs. The workforce planning model that will serve the Department in meeting these objectives is based on a business model that analyzes the present workforce, identifies organizational objectives and the workforce competencies needed to achieve them, compares present workforce competencies to those needed in the future, and develops plans to transition from the present workforce to the future workforce. The definitive HHS workforce planning document, Building Successful Organizations, has been developed by the Office of Human Resources of the Office of the Assistant Secretary for Management and Budget. It outlines the Department's expectations for workforce planning over the next few years and provides a consistent model that program units throughout HHS can use to ensure that budget requests reflect and present the workforce conditions and needs of the agencies.
Workforce Improvement. HHS will collaborate with the President's Management Council as it generates Government-wide tools to elevate the principles upon which we evaluate the federal workforce. With renewed emphasis that workforce performance evaluation must rest on program results and feedback from customers and employees, the Department will direct its efforts to communicate clear expectations of performance to all employees and it will validate accountability through defined priorities and goals that apply across the executive leadership team.
Quality of Work Life. The Quality of Work Life Plan reflects the Department's commitment to three characteristics: improve employee satisfaction, strengthen workplace learning, and better manage change and transition. Achievement of these objectives requires a willingness to share power, extensive training for workers, managers, and executives, and considerable patience by all involved. Further, it requires openness, trust, and information sharing by management. It cannot be mandated by management, but rather it must involve process in which the employees buy into the concept. The HHS Quality of Work Life effort has identified a number of issues, including:
Strengthening family friendly programs.
Evaluate and enhance diversity practices.
Better planning and management of change.
INFORMATION TECHNOLOGY MANAGEMENT
To carry out its corporate mission and ensure critical infrastructure protection, HHS will optimize management of its information systems infrastructure.
Enterprise Infrastructure Management (EIM). Building on the information technology tools provided by the Clinger-Cohen Act and PDD 63: Critical Infrastructure Development, EIM signals the Department's intention to build greater consistency and efficiency into information technology management across HHS. Threats to computer security and the need to minimize information technology costs invite the enterprise approach to technology management that HHS is pursuing. The EIM effort that has been undertaken by the Office of Information Resources Management (OIRM) of the Office of the Assistant Secretary for Management and Budget emphasizes the importance of developing information systems that meet the need for more reliable network and systems availability, improved configuration management and software distribution, and flexibility in supporting changing needs while providing state of the art security and privacy.
HHS will prudently manage the personal and real property assets owned by HHS. To ensure high-quality stewardship over the Department's investment in property, HHS will continue to improve the accuracy of accounting for real and personal property.
For real property tracking, HHS will continue the implementation of the Foundation Information for Real Property Management (FIRM) database, an automated tool provided by the General Services Administration to enhance accountability for real property across the federal government. FIRM will ensure consistent, automated management and accounting for real property Department-wide. To assure high-quality stewardship over the Department's investment in property, HHS will continue to improve the accuracy of accounting for real and personal property and it will establish a self-assessment program for personal property management. The Department has already exceeded initial annual performance targets for the "location accuracy" of personal property, achieving a 97% accuracy rate in 1999, when a 92% rate was planned. HHS will now pursue maintaining this 97% accuracy rate over time.
PROGRAM INTEGRITY PARTNERSHIP WITH THE HHS OFFICE OF INSPECTOR GENERAL
The detection and elimination of health care fraud and abuse is a top priority of federal law enforcement.
Although by design the Office of Inspector General (OIG) is an independent entity to ensure the objectivity of its findings and reports, HHS and the OIG have established an unprecedented partnership to reduce fraud and abuse and improve program integrity, especially in the large Medicare and Medicaid programs. For this purpose, the Congress and the Administration have provided the tools that have made this partnership possible, and they have extended the partnership to include the Department of Justice. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) will continue to allow for the consolidation and coordination of HHS, OIG, and Department of Justice efforts to combat fraud through prosecutions and other enforcement actions, through collaboration and information sharing, and through prevention and outreach to the business community.
Customer service is a prominent element of HHS accountability and self-assessment.
Vice President Gore's National Partnership for Reinventing Government (NPR) has provided multiple tools that have enhanced the focus of HHS and other federal agencies on customer service over the past five years. In addition to an extensive array of programmatic initiatives focused on customer service throughout HHS, the Department will continue to work with the NPR in its use of customer service tools such as the High Impact Agency customer satisfaction surveys and public conversations with Americans to identify and act on feedback from HHS beneficiaries and customers. HHS will collaborate with the President's Management Council (PMC) and other federal agencies in their efforts to encourage federal agencies to look to the customer service features offered by the Balanced Scorecard method for their programs, particularly as an element that underlies agency and employee performance assessment.
GAO AND OIG DESIGNATED "MAJOR MANAGEMENT CHALLENGES"
HHS performance plans are a prominent tool for addressing the management challenges identified by the General Accounting Office and the HHS Office of Inspector General.
The Office of Inspector General (OIG) and the General Accounting Office (GAO) have also served HHS and other federal agencies through ongoing review and analysis of high-risk areas and major management challenges. HHS uses GAO and OIG findings to improve the management of its programs. Specifically, nearly all of the GAO and OIG major management challenges that were identified in an August 1999 letter to the Secretary of HHS from the Senate Committee on Governmental Affairs were addressed in the HHS GPRA performance plans. For example, one of the management challenges that were cited was "Medicare payment errors." As reflected in its GPRA annual performance plan and annual performance report, HCFA exceeded its FY 1999 GPRA performance goal of reducing Medicare fee-for-service payment errors to 9 percent. Medicare fee-for-service payment errors were 14 percent in 1996 and dropped to 7.9 percent in 1999. HCFA seeks to reduce the error rate to 6 percent in 2001 and 5 percent in 2002.