Over the years,  CDC’s mission and scope of work have continued to expand in concert  with public health needs. 1.) 2.) 3.) A positive OD change made in 2003 was the assignment of an OD official  other than the agency’s Director to provide oversight authority for the  agency’s operations units, such as financial management and information  technology. Another  positive change made in 2003 was to align OD management team positions  with broad agency mission themes that cut across individual programs and  organizational units. However, despite the intention for the themes to  foster collaboration among CDC’s 11 centers and with its external  partners, clear connections between the management team’s deputy  positions, the mission themes, and agency mission activities have not been  made. However, no similar position or  combination of positions has been established in OD to oversee the  programs and activities of the centers, as no one below the Director on  OD’s management team has direct line authority for the centers’  programmatic work. Associate Director for Terrorism Preparedness and Response. 5.) Whether this structural arrangement can support effective oversight of the  agency’s programmatic work is uncertain, given the growth in the  demands on the CDC Director’s time along with the likely change in  directors over time. OD Has Improved Oversight of Public Health Emergencies, but Concerns Remain about Oversight of Ongoing Agency Activities

OD has implemented several changes in its approach to managing the  agency’s response to public health emergencies, including the creation  within OD of an emergency operations office that, during the SARS  outbreak, successfully coordinated the response efforts of CDC’s various  centers and staff offices. OD Has Improved Its Ability to Oversee the Agency’s Response to Public Health Emergencies

In recognition of past problems, OD initiated several structural and  procedural changes that improved its ability to oversee the agency’s  response to public health emergencies. Typically, the attention of  OD’s top officials has been focused on emergent public health issues, such  as infectious disease outbreaks, leaving little time for focusing on  nonemergency public health work and agency operations. Previously, scrutiny  of these expenditures was at the discretion of center management. OD Efforts to Foster Collaboration among Centers Are Incomplete

While OD has taken steps to improve the centers’ ability to effectively  collaborate during emergencies, more needs to be done for collaboration  on nonemergency public health work. Planning Tools That OD Needs to Manage Agency Priorities and Human Capital Challenges Are Not Yet Operational

In recent years, CDC’s OD has operated without an up-to-date agencywide  planning strategy with which to set agency mission priorities and unify the  work of its various centers. Strategic Planning Process Recently Initiated

In June 2003, OD initiated an agencywide strategic planning process called  the Futures Initiative, which is intended to involve all levels of staff and  some of the agency’s partners in developing long-range goals and  associated performance measures. A human capital  plan was initiated in April 2003, but this effort has been postponed while  the strategic planning process gets under way. Recommendations for Executive Action

To improve OD’s management of CDC’s nonemergency mission priorities,  we recommend that the CDC Director take the following three actions:  realign and clarify oversight responsibility for the centers’ programmatic  work at a level below the Director, including clarifying the roles of OD’s  deputy directors;    ensure that reporting requirements and tracking systems are developed for  OD to routinely monitor the centers’ operations and programmatic  activities; and    develop incentives to foster center collaboration as a standard agency  practice. We also recommend that the CDC Director take the following two actions:    ensure that the agency’s new strategic planning process will involve CDC  employees and external partners to identify agencywide priorities, align  resources with these priorities, and facilitate the coordination of the  centers’ mission-related activities and    ensure that the agency’s human capital planning efforts receive  appropriate leadership attention, including resuming human capital  planning, linking these efforts to the agency’s strategic plan, and linking  senior executives’ performance contracts with the strategic plan. To evaluate OD’s approach to managing the agency’s response to public  health emergencies, we looked at CDC’s emergency infrastructure and  communication processes. Appendix II: Comments from the Centers for Disease Control and Prevention
Why GAO Did This Study

The scope of work at the Centers for Disease Control and Prevention (CDC) has evolved since 1946 from a focus on communicable diseases, like malaria, to a wide and complex range of public health responsibilities. The agency's Office of the Director (OD) faces considerable management challenges to ensure that during public health crises the agency's nonemergency but important public health work continues apace. In 2002, the agency's OD began taking steps aimed at organizational change. GAO has observed elsewhere that major change management initiatives can take at least 5 to 7 years. In this report, GAO examined the extent to which organizational changes have helped balance OD's oversight of CDC's emergent and ongoing public health responsibilities. Specifically, GAO examined OD's (1) executive management structure, (2) approach to overseeing the agency's work, and (3) approach to setting the agency's priorities.

What GAO Found

The management team in CDC's top office--OD--is undergoing a structural change designed to provide a new approach to managing the agency's public health work. Through this effort, CDC has taken steps that have merit. For example, OD established a Chief Operating Officer position with clear oversight authority for the agency's operations units, such as financial management and information technology. However, a significant oversight weakness remains: there is no position or combination of positions on OD's management team below the Director's level to oversee the programs and activities of 11 centers that perform the bulk of the agency's public health work. Only CDC's Director has line authority for the centers, and the extraordinary demands on the Director's time associated with public health emergencies and other external events make the practicality of this oversight arrangement uncertain. Another of OD's structural initiatives was to align OD management team positions with broad mission "themes," or goals, that cut across the centers' institutional boundaries. The intent was to foster among the 11 independent centers a more integrated approach to performing the agency's mission. This purpose may be difficult to realize, however, as connections between certain themes and associated OD positions are not sufficiently clear. OD has made improvements in its ability to oversee the agency's response to public health emergencies--including the creation of an emergency preparedness and response office and the development of an emergency communication system--but concerns remain about OD's oversight of nonemergency public health work. OD's efforts to monitor the activities of the centers are not sufficiently systematic. For example, few formal systems are in place to track the status of centers' operations and programmatic activities. Although OD has a process for center officials to elevate important issues of concern, the information flow under this process is largely center-driven, as the subjects discussed are typically raised at the discretion of the center officials. Similarly, OD's efforts to foster coordination among the centers fall short of institutionalizing collaboration as standard agency practice. The planning tools that OD needs to set agency priorities and address human capital challenges are under development. In recent years, OD has operated without an up-to-date agencywide planning strategy with which to set mission priorities and unify the work of CDC's various centers. In June 2003, OD initiated an agencywide strategic planning process. In a separate planning effort initiated in April 2003, CDC began working on a human capital plan for meeting the agency's current and future staffing needs. This effort has been suspended while the strategic planning process gets under way, and no time frames have been established for resuming its development. At the same time, agency attrition and future limits on workforce growth suggest that agency leadership may be needed to ensure that workforce planning occurs expeditiously.