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2013-03 

IMPROVING STRATEGIC PLANNING FOR 

FEDERAL PUBLIC HEALTH AGENCIES 

THROUGH COLLABORATIVE STRATEGIC MANAGEMENT 

Martin, Jennifer L. 

Monterey California. Naval Postgraduate School 
http://hdl.handle.net/10945/32864 
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NAVAL 

POSTGRADUATE 

SCHOOL 

MONTEREY, CALIFORNIA 


THESIS 


IMPROVING STRATEGIC PLANNING FOR FEDERAL PUBLIC 
HEALTH AGENCIES THROUGH COLLABORATIVE 
STRATEGIC MANAGEMENT 

by 

Jennifer L. Martin 
March 2013 

Thesis Advisor: Rodrigo Nieto-Gomez 

Second Reader: Ivan Zapata 


Approved for public release; distribution is unlimited 



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2. REPORT DATE 

March 2013 


6. AUTHOR(S) Jennifer L. Martin 


11. SUPPLEMENTARY NOTES The views expressed in this thesis are those of the author and do not reflect the 
official policy or position of the Department of Defense or the U.S. Government. IRB Protocol number_N/A_ 


13. ABSTRACT (maximum 200 words) 

Collaborative strategic management of public health emergency and homeland security issues can 
address gaps in roles and responsibilities and foster better coordinated planning at the federal level. 
Recent changes in the alignment of the national planning standards for public health emergency 
preparedness have created an opportunity to rethink the collaborative approach to strategic planning. This 
thesis considers the role that collaborative strategic management and collaborative frameworks may play 
in strengthening strategic planning at the federal level through a policy options analysis. Considerations for 
implementation and recommendations moving forward are provided for both existing collaborations and 
new collaborations. 


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131 


14. SUBJECT TERMS strategic planning, collaboration, strategic management, whole 
community planning, collaborative strategic management 


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4. TITLE AND SUBTITLE IMPROVING STRATEGIC PLANNING FOR 
FEDERAL PUBLIC HEALTH AGENCIES THROUGH COLLABORATIVE 
STRATEGIC MANAGEMENT 


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Master’s Thesis 


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I 


























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IMPROVING STRATEGIC PLANNING FOR FEDERAL PUBLIC HEALTH 
AGENCIES THROUGH COLLABORATIVE STRATEGIC MANAGEMENT 


Jennifer L. Martin 

Deputy Director, Office of Public Health Preparedness and Response, 
Baltimore City Health Department 
B.S., St. Lawrence University, 1996 
J.D., University of Maryland School of Law, 2007 


Submitted in partial fulfillment of the 
requirements for the degree of 


MASTER OF ARTS IN SECURITY STUDIES 
(HOMELAND SECURITY AND DEFENSE) 


from the 


NAVAL POSTGRADUATE SCHOOL 
March 2013 


Author: Jennifer L. Martin 


Approved by: Rodrigo Nieto-Gomez, Ph.D. 

Thesis Advisor 


Ivan Zapata 
Second Reader 


Daniel Moran 

Chair, Department of National Security Affairs 



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IV 



ABSTRACT 


Collaborative strategic management of public health emergency and homeland 
security issues can address gaps in roles and responsibilities and foster better 
coordinated planning at the federal level. Recent changes in the alignment of the 
national planning standards for public health emergency preparedness have 
created an opportunity to rethink the collaborative approach to strategic planning. 
This thesis considers the role that collaborative strategic management and 
collaborative frameworks may play in strengthening strategic planning at the 
federal level through a policy options analysis. Considerations for implementation 
and recommendations moving forward are provided for both existing 
collaborations and new collaborations. 


v 



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VI 



TABLE OF CONTENTS 


I. INTRODUCTION.1 

A. PROBLEM STATEMENT.2 

B. RESEARCH QUESTION.4 

C. DEFINITION OF TERMS.4 

1. Collaborative Strategic Management.5 

2. Federal Agency/Federal Level.5 

3. Healthcare Preparedness Capability.5 

4. Public Health Preparedness Capability.6 

5. Strategic Management.6 

6. Strategic Planning.7 

7. Whole Community Planning.7 

D. SIGNIFICANCE OF RESEARCH.7 

E. THESIS STRUCTURE AND OVERVIEW.8 

II. LITERATURE REVIEW.11 

A. PUBLIC SECTOR STRATEGY TYPOLOGIES.11 

B. PUBLIC SECTOR STRATEGY AT THE FEDERAL LEVEL.15 

1. Government Performance and Results Act.15 

2. Changes in National Preparedness and Public Health 

Preparedness Planning Policy.17 

C. COLLABORATIVE STRATEGIC MANAGEMENT.19 

1. Collaborative Strategic Management Models.20 

2. Developing Collaborative Strategic Management 

Frameworks.23 

a. Determinants of Collaborative Strategic 

Management Frameworks . 23 

b. Structural Components of Collaborative Strategic 

Management Frameworks . 26 

c. Relationship Between Collaborative Framework 

Structures and Outcomes/Success . 29 

D. SUMMARY.30 

III. METHODOLOGY.33 

A. POLICY OPTIONS.33 

1. Plan-Centric Outcomes Based Approach.33 

2. Process-Centric Outcomes Based Approach.34 

3. Hybrid Approach.34 

B. SELECT POLICY OPTIONS CRITERIA FOR JUDGING 

SUCCESS.35 

1. Ability to Meet Federal Strategic Planning Requirements . 35 

a. Assessment Against PPD-8 . 35 

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b. Assessment Against the CDC’s Public Health 

Preparedness Capabilities and ASPR’s Healthcare 
Preparedness Capabilities . 38 

2. Political Acceptability.40 

3. Effectiveness.40 

4. Externalities.40 

IV. PLAN-CENTRIC OUTCOMES BASED APPROACH.41 

A. OVERVIEW OF THE MODEL.41 

1. Background.41 

2. Overview and Description.41 

a. Planning under this model . 42 

b. Outcomes under this Model . 44 

c. Implementation under this Model . 44 

B. ASSESSMENT OF THE PLAN-CENTRIC OUTCOMES BASED 

APPROACH.45 

1. Ability to Meet Federal Strategic Planning Requirements. 45 

a. Assessment Against PPD-8 . 45 

b. Assessment Against the Public Health 

Preparedness Capabilities and Healthcare 
Preparedness Capabilities . 47 

2. Political Acceptability.47 

3. Effectiveness.49 

4. Externalities.50 

V. PROCESS-CENTRIC OUTCOMES BASED APPROACH.53 

A. OVERVIEW OF THE MODEL.53 

1. Background.53 

2. Overview and Description of Process-Centric Based 

Policy Approach.54 

a. Decision-Making Processes .55 

b. Monitoring and Evaluation Processes .57 

c. Communication and Information Flow Processes... 57 

d. Process-Centric Outcomes . 58 

e. Implementation . 59 

B. ASSESSMENT OF THE PROCESS-CENTRIC OUTCOMES 

BASED APPROACH.59 

1. Ability to Meet Federal Strategic Planning Requirements . 59 

a. Assessment Against PPD-8 . 60 

b. Assessment Against the Public Health 

Preparedness Capabilities and the Healthcare 
Preparedness Capabilities . 61 

2. Political Acceptability.62 

3. Effectiveness.63 

4. Externalities.64 

VI. HYBRID APPROACH.65 

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A. OVERVIEW OF THE MODEL.65 

1. Background.65 

2. Overview and Description.65 

a. Partnership Formation . 66 

b. Collaborative Strategic Plan Formation . 66 

c. Deliberate and Emergent Strategy Implementation. 67 

d. Realized Collaborative Strategy Implementation 

Outcomes . 67 

e. Feedback Loops . 68 

B. ASSESSMENT OF THE HYBRID APPROACH.69 

1. Ability to Meet Federal Strategic Planning Requirements. 69 

a. Assessment Against PPD-8 . 69 

b. Assessment Against the Public Health 

Preparedness Capabilities and the Healthcare 
Preparedness Capabilities . 70 

2. Political Acceptability.71 

3. Effectiveness.71 

4. Externalities.72 

VII. COMPARATIVE ANALYSIS OF THE THREE POLICY APPROACHES.73 

A. ABILITY TO MEET FEDERAL STRATEGIC PLANNING 

REQUIREMENTS.73 

1. Ability to Meet Federal Strategic Planning Requirements 

Based on PPD-8 .73 

2. Ability to Meet Federal Strategic Planning Requirements 

Based on the CDC/ASPR Capabilities.74 

B. POLITICAL ACCEPTABILITY.75 

C. EFFECTIVENESS.76 

D. EXTERNALITIES.77 

E. SUMMARY ANALYSIS MATRIX.78 

VIII. IMPLEMENTATION OF COLLABORATIVE STRATEGIC 

MANAGEMENT FRAMEWORKS.81 

A. COLLABORATIVE STRATEGIC MANAGEMENT FRAMEWORKS 

AS DISRUPTIVE TECHNOLOGY.81 

B. THE IMPLEMENTATION CHALLENGE.83 

C. STRATEGY IMPLEMENTATION UNDER THE THREE POLICY 

APPROACHES.84 

1. Plan-Centric Approach.84 

2. Process-Centric Approach.85 

3. Hybrid Approach.86 

D. A PROGRESSIVE APPROACH TO IMPLEMENTING 

COLLABORATIVE STRATEGIC MANAGEMENT FRAMEWORKS 
AT THE FEDERAL LEVEL.88 


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IX. CONCLUSION: RECOMMENDATIONS FOR IMPLEMENTING THE 
COLLABORATIVE STRATEGIC MANAGEMENT FRAMEWORKS IN A 


PROGRESSIVE MANNER.91 

A. EXISTING COLLABORATIONS.91 

B. NEW COLLABORATIONS.93 

APPENDIX. FUNCTIONS ASSOCIATED WITH THE EIGHT SHARED PUBLIC 
HEALTH PREPAREDNESS CAPABILITIES AND HEALTHCARE 
PREPAREDNESS CAPABILITIES. .95 

LIST OF REFERENCES.101 

INITIAL DISTRIBUTION LIST.107 


x 









LIST OF FIGURES 


Figure 1. Plan-Centric Based Model (From Federal Emergency Management 
Agency, Comprehensive Preparedness Guide (CPG) 101, Version 

2.0) .42 

Figure 2. Process-Centric Based Approach Framework (After Ring and Van 

deVen, 1994).55 

Figure 3. Hybrid Model (After Clarke & Fuller (2010)).66 






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XII 



LIST OF TABLES 


Table 1. Phases of Collaborative Strategic Management Models.22 

Table 2. Determinants of Collaborative Strategic Management Frameworks... 25 

Table 3. Planning under the National Preparedness Goal (From Department 

of Homeland Security, National Preparedness Goal) .37 

Table 4. Crosswalk of the CDC’s Public Health Preparedness Capabilities 

and ASPR’s Healthcare Preparedness Capabilities.39 

Table 5. Criterion la. Ability to Meet Federal Strategic Planning 

Requirements Based on PPD-8 .74 

Table 6. Criterion 1b. Ability to Meet Federal Strategic Planning 

Requirements Based on the CDC/ASPR Capabilities.75 

Table 7. Criterion 2. Political Acceptability.75 

Table 8. Criterion 3. Effectiveness.76 

Table 9. Criterion 4. Externalities.77 

Table 10. Summary Analysis Matrix of the Three Policy Options.79 


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XIV 



ASPR 

BSC 

CDC 

CPG 

DHHS 

DHS 

EOP 

ESF-8 

FEMA 

GAO 

GPRA 

IPS 

MOU 

PPD-8 


LIST OF ACRONYMS AND ABBREVIATIONS 

Assistant Secretary for Preparedness and Response 

Balanced Scorecard 

Centers for Disease Control 

Comprehensive Preparedness Guide 

Department of Health and Fluman Services 

Department of Flomeland Security 

Emergency Operations Plan 

Emergency Support Function-8 

Federal Emergency Management Agency 

Government Accountability Office 

Government Performance and Results Act 

Integrated Planning System 

Memorandum of Understanding 

Presidential Policy Directive-8 


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XVI 



EXECUTIVE SUMMARY 


Changes in national planning standards for improved alignment of public health 
and healthcare capabilities recognize the need for collaborative strategic 
planning; however, current national planning standards do not include a 
framework agencies can use to achieve ongoing collaborative planning. At the 
federal level, the focus on whole community planning and the inclusion of public, 
private, and nonprofit entities in healthcare coalitions to help strengthen public 
health emergency preparedness, has heightened the need for a collaborative 
planning framework that supports ongoing collaborative planning. This thesis 
considers the role that collaborative strategic management and various strategic 
planning frameworks may play in achieving whole community planning at the 
federal public health level. 

This thesis considers what type of collaborative strategic management 
framework is best suited to assist federal agencies with defining their roles and 
responsibilities in order to achieve the aligned public health and healthcare 
capabilities outlined by the CDC and ASPR. While the focus of the thesis is on 
improved strategic planning at the federal level, the ideas, findings, and 
conclusions can be applied to strategic planning at the state, local and tribal level 
as well. In order to answer the research question, three possible collaborative 
strategic management policy options are examined and evaluated based on 
select criteria. 

The three collaborative strategic management policy options considered in 
the thesis are (1) a plan-centric outcomes based approach; (2) a process-centric 
outcomes based approach; and (3) a hybrid approach that combines elements of 
both the plan-centric and process-centric approaches. The plan-centric outcomes 
based approach is focused on the formulation of a strategic plan to address one 
specific issue and requires a strong lead agency to direct the effort, and it is the 
current strategic planning approach endorsed by the federal government. 
Developing interagency processes for achieving collaborative planning goals is 

xvii 



the focus of the process-centric outcomes based approach. This approach favors 
decision-making and communication processes over the development of a 
strategic plan. The hybrid approach combines development of a strategic plan 
and strategic processes for meeting collaborative goals simultaneously. This 
approach requires a larger time commitment by participating agencies, but seeks 
to achieve both a concrete plan and improved understanding of roles and 
responsibilities by collaborative group members. 

Each policy option is evaluated against four criteria: (1) ability to meet 
federal strategic planning requirements; (2) political acceptability; (3) 
effectiveness; and (4) effect on externalities. In evaluating each policy option 
against its ability to meet federal strategic planning requirements, each policy 
option is assessed for its ability to meet the goals under PPD-8 and for its ability 
to meet the shared public health/healthcare capabilities developed by the CDC 
and ASPR. Specifically, the requirements to achieve whole community planning 
and complement state and local planning under PPD-8 and the requirements to 
support development of healthcare coalitions and foster community relationships 
under the public health/healthcare capabilities are assessed. The political 
acceptability of each policy option to Congress and federal agencies is also 
considered given the existing congressional oversight mechanisms for homeland 
security and public health emergency preparedness issues. Each policy option is 
assessed for its anticipated effectiveness based on two sub-criteria: (1) the ability 
of agencies to be able to continue to manage themselves in a strategic manner 
on an on-going basis through the development of a strategic plan, strategy 
content, and implementation; and (2) the ability to meet the requirements of the 
National Planning System, specifically the development of an interagency 
strategic plan and individual agency strategic plans. Finally, each policy option is 
assessed for down-stream, cascading effects on state and local level public 
health agencies and healthcare infrastructure. 

The policy options are rated against each other in a comparative analysis 
and given an overall ranking of GOOD, BETTER, or BEST. Based on the 

xviii 



rankings, the hybrid approach is determined to be the best of the three policy 
options. 

Challenges related to implementation of collaborative strategic 
management frameworks generally, and strategy implementation under the three 
policy approaches, are discussed. The plan-centric approach is found to work 
best when problems are well defined and the environment and partners are 
predictable. Because the public health emergency preparedness and homeland 
security environments are both unpredictable, the plan-centric collaborative 
strategic management approach is found to be ill suited to address the needs of 
public health emergency preparedness at the federal level. The process-centric 
collaborative strategic management approach is found to focus on strategy as an 
emergent process and runs the risk of creating fragmented and intuitive strategy 
that does not become formalized. The hybrid collaborative strategic management 
approach allows preferred conditions to be maintained and modified in order to fit 
changes in the environment through the use of a learning loop; however, success 
is dependent on shared consensus among partner organizations. 

The thesis finds that a progressive approach to implementing collaborative 
strategic management frameworks at the federal level may be productive. The 
current approach to collaborative strategic management at the federal level is the 
plan-centric approach. Moving towards a process-centric approach represents an 
incremental change that would lead to improved interaction and coordination 
among federal agencies. Once processes for collaboration are better 
established, collaborative groups can then move towards the hybrid approach 
and seek to incorporate feedback, institutionalize good strategies, and weed out 
bad strategies. A progressive approach is likely to be palatable at both the 
congressional and individual agency level because it allows for incremental 
change and maintaining existing foundational planning work while moving 
towards improved collaborative strategic management in the future. 


XIX 



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xx 



ACKNOWLEDGMENTS 


I thank the Naval Postgraduate School Center for Homeland Defense and 
Security program, including the faculty, administrative staff, and my fellow 
classmates, for granting me the opportunity to be a part of the master’s program. 
This thesis represents a few thoughts related to improving collaboration within 
the homeland security enterprise. I hope that these ideas and recommendations 
will be shared and implemented in our communities whether at the federal, state 
or local level. 

I would like to acknowledge those who guided me along the way: my 
thesis advisor, Rodrigo Nieto-Gomez, for supporting and guiding me during the 
course of my research and writing and my thesis reader, Ivan Zapata, for 
encouraging me to take on this subject area and all of its thorniness. The support 
of the leadership and my colleagues at the Baltimore City Health Department 
Office of Public Health Preparedness and Response was essential. I particularly 
appreciate the guidance and encouragement of Meghan Butasek throughout this 
program. 

Finally, I thank my friends and family—especially my parents, siblings, and 
Dan. Their love and support has accompanied me throughout this program. 
Without them, I would not be the person I am today. 


XXI 



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I. INTRODUCTION 


Two executive-level changes in national preparedness efforts are 
underway that directly affect public health preparedness. The first is a federal 
memorandum of understanding (MOU) to improve interagency grant 
coordination 1 and the second is the development of a National Preparedness 
System under Presidential Policy Directive 8: National Preparedness ( PPD-8 ). 2 
Additionally, within the past two years, the Centers for Disease Control (CDC) 
and the Office of the Assistant Secretary for Preparedness and Response 
(ASPR) have developed public health and healthcare-specific capabilities to 
establish a consistent national approach to public health preparedness. 3 These 
three changes in the federal preparedness planning landscape have created an 
opportunity for the federal public health agencies to rethink how preparedness 
planning will move forward and how strategic planning could be improved in 
order to achieve the public health and healthcare preparedness capabilities. 

Responding to public health threats requires the collaboration of public 
health agencies, the healthcare system, and emergency management bodies. A 
vast number of entities fall into these three categories. Emergency preparedness 
planning efforts also include input from stakeholders in each of these three 
categories. In response efforts, entities organize using the principles and 
frameworks of the National Incident Management System and the Incident 
Command System, but no comparable framework exists for multiagency strategic 


1 Trust for America’s Health, Ready Or Not? Protecting the Public’s Health from Diseases, 
Disasters, and Bioterrorism (Princeton, NJ: Robert Wood Johnson Foundation, 2011). 
http://healthyamericans.orci/assets/files/TFAH2011 ReadvorNot 09.pdf . [hereinafter TFAH] 

department of Homeland Security, National Preparedness System (Washington, DC: 
Department of Homeland Security, 2011). http://www. fema.gov/pdf/prepared/nps description.pdf . 

^Centers for Disease Control, Public Health Preparedness Capabilities: National Standards 
for State and Local Planning (Atlanta, GA: Centers for Disease Control, 2011). 
http://www.cdc.gov/phpr/capabilities/DSLR capabilities July.pdf . [hereinafter Public Health 
Preparedness Capabilities]; Office of the Assistant Secretary for Preparedness and Response, 
Healthcare Preparedness Capabilities. National Guidance for Healthcare System Preparedness, 
Washington, DC: Office of the Assistant Secretary for Preparedness and Response, 2012. 
http://www.phe.aov/Preparedness/plannina/hpp/reports/Documents/capabilities.pdf . [hereinafter 
Healthcare Preparedness Capabilities], 


1 







planning. This thesis examines potential policy options related to collaborative 
strategic management frameworks that could improve federal interagency 
coordination. 

At the federal level it has been noted that there is a lack of clarification 
regarding roles and responsibilities in public health emergencies, particularly with 
respect to preparing for pandemics , * * 4 and a number of policymakers, analysts and 
other experts have criticized federal efforts at strategic planning, especially in the 
area of bioterrorism . 5 As the federal government moves towards improved 
interagency coordination, whole community planning, and achievement of the 
CDC’s public health and ASPR’s healthcare capabilities, it will be necessary to 
better define roles and responsibilities and chain of command for decision¬ 
making . 6 This is necessary for improving planning at the federal level and 
assisting the planning, response, and recovery efforts by state and local 
government and private healthcare entities. Collaborative strategic management 
implemented at the federal level can achieve these needs. 

A. PROBLEM STATEMENT 

Over the past two years the CDC and ASPR have created national 
planning standards for public health emergency preparedness that seek to align 
the public health and healthcare emergency capabilities. The CDC’s Public 
Health Emergency Preparedness Capabilities establish strategic planning 
priorities for state and local health departments and ASPR’s Healthcare 
Preparedness Capabilities set forth strategic planning priorities for the healthcare 
sector. There are fifteen Public Health Emergency Preparedness Capabilities as 

Government Accountability Office, “Strengthening Preparedness for Large Scale Public 

Health Emergencies,” accessed January 14, 2013. http://www.qao.gov/hiqhrisk/risks/national- 

challenqes-public-health/ . 

5 U.S. Library of Congress, Congressional Research Service, Federal Efforts to Address the 
Threat of Bioterrorism: Selected Issues and Options for Congress, eds. F. Gottron & D.A. Shea, 
CRS Report R41123 (Washington, DC: Office of Congressional Information and Publishing, 
February 8, 2011). 

6 See generally Department of Homeland Security, National Preparedness Goal (Washington, 
DC: Department of Homeland Security, 2011). http://www. fema.gov/Ddf/DreDared/npa. pdf ] Public 
Health Preparedness Capabilities', and Healthcare Preparedness Capabilities. 


2 






outlined by the CDC. Eight shared capabilities with the healthcare sector form the 
basis for healthcare coalition preparedness, a proposed concept for collaborative 
planning around the public health and healthcare capabilities. Healthcare 
coalitions are expected to include public health agencies and healthcare 
infrastructure membership. The development and alignment of the public health 
and healthcare sector planning capabilities by the CDC and ASPR has helped to 
standardize national planning for public health emergencies. Both sets of 
capabilities recognize the need for collaborative strategic planning; however, the 
CDC and ASPR capabilities do not propose a framework for achieving ongoing 
collaborative planning. 

The additional seven Public Health Preparedness Capabilities 
complement the shared capabilities, and include emergency public information 
and warning, mass care, medical countermeasure dispensing, medical materiel 
management and distribution, non-pharmaceutical interventions, public health 
laboratory testing, and public health surveillance and epidemiological 
investigation . 7 While the planning responsibility for these capabilities is reserved 
to public health agencies, their implementation requires great coordination 
among public health, emergency management, and healthcare entities. For 
example, emergency public information and warning includes activating an 
emergency public information warning system and issuing public alerts, 
warnings, and notifications . 8 Such systems and the distribution of alerts and 
notifications require input and action from healthcare infrastructure, as well as, 
public health and emergency management entities. As part of the emergency 
public information and warning system, healthcare infrastructure must be 
included as a collaborative partner when plans and protocols are developed by 
governmental entities. The same is true of the remaining Public Health 
Preparedness Capabilities. Healthcare infrastructure partners are critical partners 
in working towards achieving public health preparedness. 

7 Public Health Preparedness Capabilities, 4. 

8 lbid„ 11. 


3 



This thesis considers the role that collaborative strategic management and 
collaborative frameworks may play in developing collaborative planning related to 
the aligned public health and healthcare capabilities. A number of factors affect 
collaboration among organizations, including factors related to the environment 
surrounding entities and factors related to the organization of entities. The 
structural components of collaborative frameworks and overall framework design 
directly affect implementation, and collaborative structure affects outcomes and 
success. By examining various strategic management frameworks, this thesis 
considers which type of collaborative strategic management framework is best 
suited for achieving the CDC’s Public Health Preparedness Capabilities and 
AS PR’s Healthcare Preparedness Capabilities. 

B. RESEARCH QUESTION 

This thesis seeks to address the following question: 

• What type of collaborative strategic management framework is 
best suited to assist federal agencies with better defining their 
roles and responsibilities and achieving the CDC’s Public Health 
Preparedness Capabilities and ASPR’s Healthcare 
Preparedness Capabilities ? 

While the research question focuses on improving federal coordination in 
order to achieve the Public Health Preparedness Capabilities and the Healthcare 
Preparedness Capabilities, a multidimensional result is anticipated. The first 
dimension is the improved coordination and planning at the federal level and the 
second dimension is the achievement of the Public Health Preparedness 
Capabilities and the Healthcare Preparedness Capabilities at the state, local and 
tribal levels of government. Depending on the policy option implemented, these 
results may be achieved concurrently or successively. 

C. DEFINITION OF TERMS 

Because this thesis draws on multiple bodies of literature (strategic 
planning, strategic management, and public health) and because even within 


4 



bodies of literature authors use multiple terms to refer to the same concept, a 
short glossary of terms is presented here. 


1. Collaborative Strategic Management 

The term “collaborative strategic management” refers to the process 
involved in the formation of partnerships or alliances across organizations that 
represent collective, joint activity for the purpose of formulating a collaborative 
strategic plan and implementing tactics. 9 Strategic planning and implementation 
occur at both the collaborative and organizational levels. 10 

2. Federal Agency/Federal Level 

Throughout the thesis, the terms federal agencies and federal level are 
used interchangeably. The focus of the thesis is on federal agencies involved in 
planning for public health emergencies. Typically, this includes those agencies 
that are part of the Department of Health and Human Services (DHHS) and the 
Department of Homeland Security (DHS). However, other federal agencies are 
also involved in planning for public health emergencies, including the U.S. 
Department of Agriculture and the Environmental Protection Agency. The degree 
of involvement in public health emergency planning varies depending on the role 
of the agency in preparedness and response. Agencies that have not have 
traditionally been brought to the table previously may be included at one point or 
another depending on the type of collaborative planning framework that is 
employed. 

3. Healthcare Preparedness Capability 

In January 2012, ASPR released Healthcare Preparedness Capabilities, 
outlining healthcare-specific capabilities under Emergency Support Function-8 


9A. Clarke and M. Fuller, “Collaborative Strategic Management: Strategy Formulation and 
Implementation by Multi-Organizational Cross-Sector Social Partnerships,” Journal of Business 
Ethics 94, Suppl 1 (2010): 85-101. 

1 °lbid. 


5 



(ESF-8). 11 The Healthcare Preparedness Capabilities are based on the 
preparedness methodologies of the Federal Emergency Management Agency 
(FEMA) regarding whole of community planning and in accordance with PPD- 8. 
ASPR suggests that healthcare systems, healthcare coalitions, and healthcare 
organizations use these capabilities for emergency preparedness planning. 12 

4. Public Health Preparedness Capability 

The CDC has implemented a systematic process for defining a set of 
public health preparedness capabilities to assist state and local health 
departments with their strategic planning. The resulting document, Public Health 
Preparedness Capabilities: National Standards for State and Local Planning 
creates national standards for public health preparedness capability-based 
planning. The “standards are designed to accelerate state and local 
preparedness planning and provide guidance and recommendations for 
preparedness planning in order to assure safer, more resilient, and better 
prepared communities.” 13 

5. Strategic Management 

Strategic management is the process of managing an organization in a 
strategic manner on a continuing basis through the development of a strategic 
plan, strategy content and implementation. 14 Strategic management is intended 
to enhance all managerial decisions and actions that affect the long-term 
performance of an organization. Strategic planning is a component of strategic 
management. 


11 Healthcare Preparedness Capabilities , vii. 

12 lbid., vii-xvi. 

13 Public Health Preparedness Capabilities, 2. 

14 T. H. Poister, D. W. Pitts, and L. Hamilton Edwards, “Strategic Management Research in 
the Public Sector: A Review, Synthesis, and Future Directions,” American Review of Public 
Administration 40.5 (2010): 522-545. 


6 



6. Strategic Planning 

Strategic planning is concerned with formulating strategy in order to 
produce fundamental decisions and actions that shape and guide what an 
organization is, what it does, and why it does it. 15 Strategic planning is an 
element of strategic management. 

7. Whole Community Planning 

Whole community planning seeks to engage individuals, families, 
communities, private and nonprofit sectors, faith-based organizations, and all 
levels of government in emergency preparedness and response planning efforts. 
A whole community planning approach encompasses three key concepts. 16 The 
first concept is to understand and meet the true needs of the entire affected 
community. 17 The second concept is to engage all aspects of the community 
(public, private, and civic) in both defining needs and devising ways to meet 
them. 18 The final concept is strengthening the assets, institutions, and social 
processes that work well in communities on a daily basis to improve resilience 
and emergency management outcomes. 19 

D. SIGNIFICANCE OF RESEARCH 

The thesis proposes that an interagency collaborative strategic 
management framework should be developed in order to address gaps in roles 
and responsibilities at the federal level and to foster better coordinated planning 
at the federal level for public health preparedness. The goal of such a framework 
is to increase interagency collaboration and strengthen planning, not necessarily 

1 5j. Bryson, Strategic Planning for Public and Nonprofit Organizations: A Guide to 
Strengthening and Sustaining Organizational Achievement, 3rd ed. (San Francisco: Jossey-Bass, 
2004). 

1 ^Federal Emergency Management Agency, Comprehensive Preparedness Guide (CPG) 

101, Version 2.0 (Washington, DC: Federal Emergency Management Agency, 2010, 4-4). 
http://www.fema.qov/pdf/about/divisions/npd/CPG 101 V2.pdf . 

17 lbid. 

18 lbid. 

19 lbid. 


7 




develop a formal plan, although a formal plan may be produced. Collaborative 
strategic management frameworks allow agencies to collaborate and plan for 
increased public health preparedness both within the individual agencies and as 
a collaborative entity. It is important that the framework allow for planning 
achievements to be transmitted to state, local, and private organizations in order 
to further strengthen public health preparedness planning at all levels of 
government and within the healthcare sector. 

While this thesis focuses on public health preparedness, the concept of 
collaborative strategic management frameworks has broader implications for 
homeland security. Collaborative strategic management frameworks can provide 
a mechanism for federal agencies to come together before an incident to discuss 
roles and responsibilities, chain of command, and the inter-organizational 
structure of a multi-agency response, as well as, plan benchmarks related to 
tactical operations. A collaborative strategic management framework 
implemented prior to incidents will not only improve planning efforts, but will also 
improve management and execution of plans during incidents, improving the 
overall effectiveness of governmental response during homeland security 
incidents. 

The focus of the thesis is on the implementation of a collaborative 
strategic management framework to help improve role clarification and 
interagency coordination at the federal level; however, the policy options 
examined could be implemented at the state, local or tribal level as well. 

E. THESIS STRUCTURE AND OVERVIEW 

Chapter I introduced the current state of federal strategic planning efforts 
for public health preparedness, the problem statement, the research question this 
thesis seeks to answer, a short glossary of terms used throughout the thesis, as 
well as, a brief discussion of the significance of the research. Chapter II reviews 
the literature on public sector strategy, the federal government’s strategy 
typology, and collaborative strategic management frameworks generally. This 

thesis uses a policy options analysis as its research methodology, as outlined in 

8 



Chapter III. The three policy options that could be implemented at the federal 
level to improve collaborative strategic management of public health 
preparedness are described and assessed in Chapters IV—VI. A short 
comparative analysis of the three policy approaches is presented in Chapter VII, 
and Chapter VIII then discusses how to best implement collaborative strategic 
management within the federal public health agencies. Finally, Chapter IX 
concludes the thesis with recommendations for moving forward with 
implementation in a progressive manner. 


9 



THIS PAGE INTENTIONALLY LEFT BLANK 


10 



II. LITERATURE REVIEW 


The literature review considers public sector strategy typologies, the 
federal strategy typology as outlined by the Government Performance and 
Results Act (GPRA) and homeland security agencies, and collaborative 
frameworks for strategic management. The review begins by looking at public 
sector strategy typologies developed over the past twenty-five years. Next, 
GPRA is discussed as the structure by which the federal government has 
mandated public sector strategy be achieved by federal agencies. Recent 
changes in planning guidance related to public health preparedness are also 
briefly discussed. The final section of the literature review looks at collaborative 
strategic management and examines frameworks for strategy management, 
determinants of collaborative strategic management frameworks, the effect of 
structural components of frameworks on implementation, and the relationships 
between collaborative frameworks and their outcomes/success. 

A. PUBLIC SECTOR STRATEGY TYPOLOGIES 

A number of public sector strategy typologies have been developed over 
the past twenty-five years. Overall, the various typologies look at strategy as an 
entity and not as practice. Five public sector strategy typologies from the 
literature are reviewed below. 

The first public sector strategy typology compares explicit versus 
rationalized strategy. Explicit strategy occurs when an organization proactively 
sets forth guidance and subsequent action, whereas rationalized strategy looks 
retrospectively at events and constructs an organizational strategy based on 
internal and external factors. 20 According to Miller, there are three basic ways to 
think about strategy in public organizations. 21 The first way of thinking uses 
linear logic, that is, strategy “follows a linear logic in which plans precede 

20 G. Miller, “Unique Public-Sector Strategies,” Public Productivity & Management Review 
13.2 (1989): 133-144, 133. 

21 Ibid., 135-136. 


11 



action.” 22 This is similar to the concept of explicit strategy, and a number of 
studies in organizations outside of business have considered strategy as a 
rational decision technique. 23 The second way of thinking about strategy is 
through nonlinear logic. This is most similar to the ancient meaning of strategy. 24 
Relying on the reversal of opposites and deception, this view of strategy seeks to 
find ways to attack when the enemy is unprepared and uses inconvenience to 
strike and gain advantage. 25 The third way of thinking about strategy is to exploit 
opportunities by taking advantage of change such as elections, economic 
changes, or issue mutation. 26 According to Miller, this third type of strategy, 
which takes advantage of emerging and unrealized opportunities, is most 
appropriate for the public sector and is the normative approach in the public 
sector. 27 

Within the literature on public sector strategy, Miller’s conclusion regarding 
the exploitation of opportunities is consistent with other researchers. Eadie and 
Steinbacher found collective management of an organization’s strategic agenda 
needs to change as an organization’s problems and opportunities change. 28 In 
their article on transforming public organizations through strategic management 
and planning, Nutt and Backoff discuss the importance of assessing an 
organization’s distinctive competencies and looking for ways to apply them. 29 
Vinzant discusses the importance of “thinking ahead to the changes that are 
likely to confront” an organization in the future and the importance of encouraging 

22 lbid., 135. 

23 See J. Bryson and W. Roering, “Initiation of Strategic Planning by Governments,” Public 
Administration Review 48.6 (1988): 995-1004, 995. 

24 Miller, “Unique Public-Sector Strategies,” 135. 

25 lbid., 136. 

26 lbid. 

27 lbid. 

28 D. Eadie. and R. Steinbacher, “Strategic Agenda Management: A Marriage of 
Organizational Development and Strategic Planning,” Public Administration Review 45.3 (1985): 
424-430, 425. 

29 P. Nutt and R. Backoff, “Transforming Public Organizations with Strategic Management 
and Strategic Leadership,” Journal of Management 19.2 (1993): 299-347, 311. 


12 



creativity and innovation in order to meet the strategic needs of an 

organization. 30 

Nutt and Backoff propose an internal capacity and external 

responsiveness model that uses the two dimensions of capacity for action and 
need for responsiveness to create four types of public organization environments 
and assess how they might use strategy. 31 Change requires an organization to 
move towards both increased internal capacity and external responsiveness. 32 
Organizations that are imbalanced in their ability to meet the needs of their 

constituents and capacity will find it difficult to change. 33 Eadie and 

Steinbacher’s examination of strategic management planning techniques as 
applied by the Ohio Bureau of Employment Services also found that an agency’s 
capabilities must be balanced against the desired outcomes expected from the 
strategic management process. 34 In balancing desired outcomes and 
organizational capability, resources such as management skills, time, and 
finances must be considered against other development needs of the 
organization. 35 Nutt and Backoff’s typology uses six strategy categories and 
hypothesizes which best connect to various environments. 36 The six strategy 
categories are: understand history, explore the situation, uncover issues, identify 
strategy, assess feasibility, and implement strategic change. 37 

Osborne and Plastrik’s model sets forth five categories of strategy that 
organizations can use to help leverage change, the “5 Cs.” 38 The first is core 

30 D. Vinzant, “Strategic Management and Public Organizations: Lessons from the Past and 
Prescriptions for the Future,” International Journal of Public Administration 19.10 (1996): 1743- 
1779, 1758. 

31 Nutt and Backoff, “Transforming Public Organizations,” 307-312. 

32 P. C. Nutt, “Prompting the Transformation of Public Organizations,” Public Performance & 
Management Review 27.4 (2004): 9-33. 

33 lbid. 

34 Eadie and Steinbacher, “Strategic Agenda Management,” 425. 

35 lbid., at 426. 

36 Nutt and Backoff, “Transforming Public Organizations,” 314. 

37 lbid. 

38 D. Osborne and P. Plastrik, Banishing Beauracracy, Reading, MA: Addison-Wesley, 1997. 

13 



strategy that refers to clarifying an organization’s purpose and direction. This 
strategy helps steer the organization in the right direction. The second strategy is 
the consequences strategy, which helps an organization create incentives for 
performance. The customer strategy focuses on making an organization 
accountable to its customers. A fourth control strategy deals with decentralizing 
decision-making and empowering communities. Finally, the culture strategy looks 
to changing habitual behaviors and attitudes of public employees. 

Kaplan and Norton designed the balanced scorecard (BSC) typology for 
use in the private sector. 39 The BSC approach looks at specific, preidentified 
categories (customer, financial, internal process, and learning and growth) and 
focuses attention on issues related to each category. Challenges both within and 
across each category are aligned and the final product is a “strategy map” that 
represents the organization’s tactics. Because this approach uses preidentified 
categories, it is more useful for implementing strategy rather than actually 
developing strategy. Ultimately, it is about choosing measures and targets to 
meet already identified goals. 

Boyne and Walker’s public sector strategy typology considers two 
dimensions of strategy that they refer to as “strategic stance” and “strategic 
action.” 40 Strategic stance refers to the methods by which an organization seeks 
to maintain its performance, while strategic action refers to the specific steps that 
an organization takes in order to achieve its stance. 41 The organization’s 
strategy is thus a combination of its strategic stance and strategic actions. This 
typology combines the work of Miles and Snow and Porter, focusing on private 
sector business. 42 


39 R. S. Kaplan and D. P. Norton, The Balanced Scorecard: Translating Strategy into Action 
(Boston, MA: Harvard Business School Press, 1996). 

40q. A. Boyne and R. M. Walker, “Strategy Content and Public Service Organizations,” 
Journal of Public Administration Research and Theory 14.2 (2004): 231 -252, 232. 

41 Ibid. 

42 R. E. Miles and C. Snow, Organizational Strategy, Structure and Process, New York: 
McGraw-Hill, 1978; M. E. Porter, Competitive Advantage: Creating and Sustaining Superior 
Performance {New York: Free Press, 1985). 


14 



The literature on public sector strategy typologies reveals that most 
researchers have considered strategy as an entity and focused less on public 
organizations’ performance. However, many researchers view strategy as a 
combination of what is intended, what is emergent, and what is ultimately 
realized. 43 By comparison, the federal government has chosen to define strategy 
in terms of performance. The next section discusses public sector strategy at the 
federal government level as outlined by GPRA and current national 
preparedness efforts that affect public health preparedness strategic planning. 

B. PUBLIC SECTOR STRATEGY AT THE FEDERAL LEVEL 

The 1990s brought administrative reforms to all levels of government, and 
in 1993, the Government Performance and Results Act (GPRA) was passed, 
requiring all federal agencies to engage in strategic planning and nudging them 
towards comprehensive strategic management. 44 The recent development of 
homeland security has led to a need for multiagency, multisector strategic 
planning. Part 1 of this section examines GPRA and discusses why it is 
inadequate for achieving homeland security goals. Part 2 briefly describes 
current changes in national preparedness and public health preparedness that 
have created a need for improved strategic planning and management. 

1. Government Performance and Results Act 

GPRA requires federal agencies to set goals, measure performance and 
report on accomplishments. The six requirements for strategic planning are set 
out in Section 3 of the act and include: a comprehensive mission statement 
which sets forth the fundamental purpose of the agency; general strategic goals 

43 See Miller, “Unique Public-Sector Strategies,” 133-144; H. Mintzberg, “The Science of 
Strategy Making,” Industrial Management Review (pre-1986) 8.2 (1967): 71-81; R. Andrews, G. 
Boyne, J. Law, and R. Walker, “Strategy Formulation, Strategy Content and Performance: An 
Empirical Analysis,” Public Management Review 11.1 (2009): 1-22; and Bryson and Roering, 
“Initiation of Strategic Planning by Governments,” 995-1004. 

44 J. Bryson, F. Berry, and K. Yang, “The State of Public Strategic Management Research: A 
Selective Literature Review and Set of Future Directions,” American Review of Public 
Administration 40.5 (2010): 495-521,496. 


15 



and objectives that are results-related and reflect the tangible accomplishments 
that justify the existence of the agency’s programs; a description of how the goals 
and objectives are to be achieved, that is, the strategies to be employed and the 
resources needed to attain the goals and objectives; a description of how the 
annual performance goals are related to the general goals and objectives of the 
strategic plan; an identification of those key factors external to the agency and 
beyond its control that could significantly affect the achievement of the agency’s 
goals and objectives; and a description of the program evaluations used in 
establishing or revising agency goals and objectives with a schedule for future 
program evaluation. 45 When GPRA goals are not met, agencies must provide an 
explanation and present actions to help achieve unmet goals in their program 
performance plans. 46 

Overall, performance planning and measurement have become a part of 
federal agencies’ cultures since GPRA’s inception 47 In 2004 a Government 
Accountability Office (GAO) report found that despite these improvements, 
certain weaknesses in GPRA planning persist, such as “lack of detail on how 
annual performance goals relate to strategic goals and how agencies are 
coordinating with other entities to address common challenges and achieve 
common objectives.” 48 GPRA mandates that federal agencies must develop 
strategic planning, but it does not provide any guidance to agencies regarding 
how they should design and implement strategic planning. 

It is also difficult for agencies to distinguish between the results produced 
by the federal program itself and results produced by external entities and 


4 5 Government Performance and Results Act of 1993, Public Law 103-62, 107 Stat. 285 
(Aug. 3, 1993). 

46 Government Accountability Office, Results-Oriented Government: GPRA has Established a 
Solid Foundation for Achieving Greater Results, GAO-04-594T (Washington, DC: Government 
Accountability Office, 2004), 5. 

47 lbid., 7. 

48 lbid. 


16 



nonfederal actors. 49 This is especially true with grant programs, making the 
relevance of GPRA to federal grant programs questionable from a strategic 
planning view. Crosscutting issues, including homeland security issues, are 
difficult to address under GPRA due to mission fragmentation and overlap across 
federal agencies. 50 The GAO identified evolving national and homeland security 
policies as a major force requiring the federal government to rethink its approach 
to strategy and management in 2004. 51 

The GPRA Modernization Act of 201 0 52 seeks to address challenges 
related to crosscutting issues and barriers to effective federal agency 
collaboration. 53 Under the GPRA Modernization Act, the Office of Management 
and Budget is required to work with agencies to develop long-term, outcome- 
oriented goals for a limited number of crosscutting policy areas every four 
years. 54 It remains to be seen what effect this change will have on interagency 
strategic planning. 

2. Changes in National Preparedness and Public Health 

Preparedness Planning Policy 

Public health preparedness planning policy has undergone some recent 
changes at the federal level, creating an opportunity for federal public health 
agencies to reevaluate interagency strategic planning. These changes include 
interagency coordination of preparedness funds, the development of PPD-8, and 
the creation of public health and healthcare preparedness capabilities. 


49 ibid., 8. 

50 ibid., 9. 

51 Ibid., 3. 

52 GPRA Modernization Act of 2010, Public Law 111-352, 124 Stat. 3866 (Jan. 4, 2011). 

53 Government Accountability Office, GPRA Modernization Act Provides Opportunities to Help 
Address Fiscal, Performance, and Management Challenges, GAO-11-466T (Washington, DC: 
Government Accountability Office, 2011). 

54 Ibid. 


17 



In 2011, ASPR, CDC, FEMA, the Health Resources and Services 
Administration, and the Department of Transportation’s National Highway 
Transportation Safety Administration agreed through a MOU to engage in 
collaborative efforts to improve interagency grant coordination. 55 Each of these 
agencies distributes preparedness funds and provides technical assistance in 
support of national preparedness. 56 The MOU calls for senior leaders from each 
agency to participate in a working group to align grant processes and improve 
preparedness outcomes. 57 This effort appears to be focused on improved fiscal 
management of limited federal funding for preparedness. 

PPD-8, released in March 2011, charges DHS with building and sustaining 
preparedness through the development of a National Preparedness System. 58 
Planning is a core capability under the National Preparedness System, and DHS 
is seeking to develop a collaborative, whole community approach that will include 
all levels of government, the private and nonprofit sectors, individuals, and 
families. 59 Because DHS is in the early stages of developing the National 
Preparedness System, it remains to be seen if a framework for achieving whole 
community planning will be proposed. Initial planning documents state that a 
“flexible planning process that builds on existing plans” is necessary. 60 

Additionally, the CDC and ASPR developed national planning standards 
for public health emergency preparedness that seek to align the public health 
emergency capabilities in 2011. The CDC’s Public Health Emergency 
Preparedness Capabilities establish strategic planning priorities for state and 
local health departments and ASPR’s Healthcare Preparedness Capabilities set 


55 tfah, 41. 

56 lbid. 

57 lbid. 

f^The White House, Presidential Policy Directive / PPD-8: National Preparedness 
(Washington, DC: The White House, 2011). 
http://www.dhs.gov/xabout/laws/qc 1215444247124.shtm . 

59 Department of Homeland Security, National Preparedness System, 1. 

60 Department of Homeland Security, National Protection Framework (Washington, DC: 
Department of Homeland Security, 2012). http://www.fema.qov/library/viewRecord.do?id=5448 . 


18 





forth strategic planning priorities for the healthcare sector. Eight shared 
capabilities form the basis for healthcare coalition preparedness, a proposed 
concept for collaborative planning around the various public health capabilities. 61 
The alignment of public health and healthcare sector planning capabilities 
standardizes national planning for public health preparedness and recognizes the 
need for collaborative planning; however, the CDC and ASPR capabilities do not 
propose a framework for achieving collaborative planning. Collaborative strategic 
management may help achieve this federal planning priority. 

C. COLLABORATIVE STRATEGIC MANAGEMENT 

The development of public sector strategy for collaborations including 
public, private and nonprofit organizations is a relatively new but growing area 
within the literature on public sector strategy. Intersectoral planning has 
increased greatly in the past twenty-five years as more services and programs 
are delivered through collaborative arrangements, and collaborative strategic 
planning and management has become a new area of research and focus in the 
academic arena. 62 According to Eadie, strategic planning may be particularly 
beneficial when an issue is interdepartmental in nature, is heavily influenced by 
the external environment, and the environment is very complex and changing 
rapidly. 63 This section examines five contemporary models for collaborative 
intersectoral strategy management, determinants of collaborative strategic 
management frameworks, the structural components of collaborative 
frameworks, and the relationship between collaborative framework structures and 
outcomes/success. 


61 Healthcare Preparedness Capabilities, vii. 

62 Bryson et al., “The State of Public Strategic Management Research,” 504. 

63 D. Eadie, “Strategic Agenda Management: A Powerful Tool for Government,” National 
Civic Review 74.1 (1985): 15-20, 20. 


19 



1. Collaborative Strategic Management Models 

Gray and McCann developed the most widely referenced collaborative 
process model. 64 The Gray-McCann model focuses on three phases: problem 
setting, direction setting, and structuring. Problem setting concerns the 
identification of stakeholders who have a claim and role in the issue that joins 
them. 65 Direction setting occurs when stakeholders determine a common 
purpose and goals that drive future activities in order to achieve common goals. 
Structuring refers to the methods employed in order to support and sustain 
collective activities. 

A second model by Waddell and Brown identifies five phases of 
collaborative process: identifying preconditions for partnership; convening 
partners; setting shared directions; implementing action strategies, and 
institutionalizing/expanding successful intersectoral collaboration. 66 This process 
is more comprehensive than that of Gray and McCann because it offers distinct 
phases for identifying preconditions and implementing strategies. Waddell and 
Brown’s third step is similar to the direction-setting step of Gray and McCann, 
and the fourth and fifth steps combined are comparable to the structuring phase 
of Gray and McCann. 

Hood et al. offer a third model for collaboration that includes four stages: 
environmental factors, organizational factors, group interaction factors, and 
collaborative outcomes. 67 In their model, environmental factors (severity of the 
problem, complexity of the problem, and resource capability) and organizational 
factors (perceived interdependence, organizational interests, and commitment of 


64 B. Gray, “Conditions Facilitating Interorganizational Collaboration,” Human Relations 38.10 
(1985): 911-936; J. E. McCann, “Design Guidelines for Social Problem-Solving Interventions,” 
Journal of Applied Behavioral Science 19.2 (1983): 177-192. 

65i Gray, “Conditions Facilitating Interorganizational Collaboration,” 916. 

66 S. Waddell and L. D. Brown, Fostering Intersectoral Partnering: A Guide to Promoting 
Cooperation among Government, Business, and Civil Society Actors, I DR Reports (Boston, MA: 
Institute for Development Research, 1997). 

67 J. N. Flood, J. M. Logsdon, and J. K. Thompson, “Collaboration for Social Problem-Solving: 
A Process Model,” Business and Society 32.1 (1993): 1-17. 


20 



management) lead to group interaction factors. 68 The result is collaborative 
action. This model addresses collaboration only, not collaborative strategy and 
does not consider implementation at all. 

A fourth model developed by Seitdani and Crane focuses on partnerships 
between business and nonprofit organizations. 69 They propose a three-step 
process that includes partnership selection, partnership design, and partnership 
institutionalization. 70 Each stage has a number of sub-stages that delineate the 
micro-processes that must take place in order to build a collaborative 
relationship. For example, in the partnership design phase the sub-processes of 
setting up partnership objectives and drafting memorandums of understanding 
take place. 71 

None of the models discussed above consider individual organizational 
implementation separate from the overall collaboration’s implementation. A fifth 
model proposed by Clarke and Fuller seeks to consider both levels of 
implementation by expanding outcomes and incorporating feedback loops. 72 
Clarke and Fuller’s model consists of five steps: assessing the context/forming 
the partnership; formulation of a strategic plan; implementation of the plan by the 
individual organization and implementation of the plan by the collaboration; and 
realized outcomes of both the individual organization and collaboration as a 
whole. Realized outcomes can include outcomes related to the plan, the process, 
the partners, outside stakeholders, persons, and the environment. 73 External 
factors affecting formulation and implementation of strategy in organizations are 
accounted for through a series of feedback loops. Clarke and Fuller’s model is 


68 lbid., 5. 

69m. M. Seitanidi and A. Crane, “Implementing CSR through Partnerships: Understanding 
the Selection, Design and Institutionalisation of Nonprofit-Business Partnerships,” Journal of 
Business Ethics 85.2 (2009): 413-429. 

70 lbid., 416-422. 

71 Ibid., 418. 

72 Clarke and Fuller, “Collaborative Strategic Management,” 88. 

73 lbid., 90—91. 


21 



more dynamic than the other four models. The five collaborative strategic 
management models and their various phases are shown in Table 1. 


Table 1. Phases of Collaborative Strategic Management Models 


Gray- 

McCann 

Waddell & 
Brown 

Hood et al. 

Seitdani & Crane 

Clarke & Fuller 

Problem¬ 

setting 

Identify 

preconditions 

Environmental 

Factors 

Partnership 

selection 

Assessing the 
context/forming 
the partnership 

Direction¬ 

setting 

Convene 
actors and 
define 
problems 

Organizational 

Factors 

Partnership 

design 

Formulation of 
a strategic plan 

Structuring 

Set shared 
directions 

Group 

Interaction 

Factors 

Partnership 

institutionalization 

Implementation 
of the plan by 
the individual 
organization 


Implement 
joint action 
strategies 

Collaborative 

Outcomes 


Implementation 
of the plan by 
the 

collaboration 


Expand and 
institutionalize 

success 



Realized 
outcomes of 
both the 
individual 
organization 
and the 
collaboration 
as a whole 


The literature on collaborative strategic management models focuses on 
the management of collaborative groups, but does not address how to 
collaborate or how various organizations should move toward an integrated 
approach. Practitioner-oriented guidance for engaging in strategic planning and 
management is also lacking. In considering what type of model might be best 
suited for developing interagency collaboration, further examination of 
determinants of collaboration and the structural components of collaborative 
frameworks may be informative. The next section looks at the development of 

22 




collaborative strategic management frameworks, including the determinants of 
collaborative strategic management frameworks, the various structural 
components of collaborative frameworks, and the relationship between 
framework structure and implementation outcomes. 

2. Developing Collaborative Strategic Management Frameworks 

This section looks at two areas that affect the development of 
collaborative strategic management frameworks and the relationship of structure 
to outcomes. The various determinants of collaborative strategic management 
frameworks are briefly outlined. Then, the three structural components of 
collaborative strategic management frameworks, partners, forms, and processes, 
are examined. The section concludes by exploring the relationship between 
collaborative strategic management framework structures and outcomes. 

a. Determinants of Collaborative Strategic Management 
Frameworks 

Various environmental and organizational forces affect the context 
in which a collaborative relationship begins, and some forces work against 
collaboration while others draw partners together. 74 This section briefly 
discusses various factors that affect how collaborative frameworks are formed. 

Hood et al. break environmental factors into two components: the 
nature of the problem itself and institutional characteristics that encroach on the 
problem. 75 Problem characteristics include severity, complexity and resource 
availability. 76 Collaboration is more likely to occur when a problem is of high 
severity and of high complexity with low resource availability. Institutional 
characteristics that affect collaboration include stability, flexibility and conflict. 77 


74 S. A. Waddock, “Understanding Social Partnerships an Evolutionary Model of Partnership 
Organizations,” Administration and Society 21.1 (1989): 78-100, 81. 

75 Hood et al., “Collaboration for Social Problem-Solving,” 4. 

76 lbid., 5. 

77 lbid. 


23 



Organizations that exhibit high stability, high flexibility, and low conflict enter into 
collaborative frameworks more easily. 

Organizational factors that have a determining affect on 
collaborative strategic management frameworks include perceived 
interdependence, organizational interests, and commitment of top 
management. 78 Organizations are less likely to enter into collaborative efforts if 
it is perceived that problems can be solved by individual organizations. Likewise, 
organizations must believe that their fundamental interests are at stake in order 
to join a collaborative effort. These interests may relate to efficiency, stability or 
legitimacy. 79 Organizations are more likely to support collaborative efforts when 
there is a high perceived interdependence, high interests of the organization at 
stake, and commitment from top management. 

Waddock identifies seven environmental factors that affect the 
design and development of collaborative strategic management frameworks: 
legal requirements, existing networks, third party organizations, common vision, 
crisis, and visionary leadership. 80 Both existing networks and third party 
organizations can help spawn new collaborative groups to address problems that 
cross organizations. Waddock’s common vision and crisis categories are similar 
to Hood et a/.’s organizational factors. Waddock’s visionary leadership category 
is also similar to Hood et al.’s organizational factors, but it also includes 
champions for collaboration that may or may not be top management. Huxham 
identifies a list of necessary conditions in order for successful collaboration to 
occur that mirrors the work of Hood et at. and Waddock. 81 A summary of the 
various determinants discussed in the literature is shown in Table 2. 


78 ibid. 

79 lbid., 6. 

80 Waddock, “Understanding Social Partnerships,” 81. 

81 C. Huxham, “Pursuing Collaborative Advantage,” The Journal of the Operational Research 
Society 44.6 (1993): 599-611. 


24 



Table 2. Determinants of Collaborative Strategic Management Frameworks 


Determinant Type 

Hood et al. 

Waddock 

Huxham 


Problem 

Characteristics such 
as severity, 
complexity, and 
resource availability 

Mandates/Legal 

requirements 

Shared sense of 
mission/strategy 


Institutional 
Characteristics such 
as stability, 
flexibility, and 
conflict 

Existing networks 

Shared set of 
values 

Environmental 

Determinants 


3 ra party 

organizations/broke 

rs 

Shared ability to 
manage change 



Common 

vision/understandin 

9 

Shared power 
among those 
involved 



Crisis 

Shared decisions 
about how to 
manage the 
collaboration 



Visionary 

leadership 

Shared resources 

Organizational 

Determinants 

Perceived 

interdependence 


Acknowledgement 
of the complexity 
of the issue 

Organizational 

interests 


Mutual trust 


Commitment of top 
management 


Geographic 

proximity 


Not all of the determinants discussed above are necessary in order 
for collaboration to occur, but at least one of them must be present. The ability of 
these factors to pull and keep organizations in a collaborative group is tenuous at 
best, and it is unclear from the literature exactly how much they may influence 
the ultimate success of collaborations. Nevertheless, these determinants of 
collaboration must be considered when developing and implementing 
collaborative strategic management frameworks. Next, the structural components 


of collaborative frameworks are discussed. 

25 




b. Structural Components of Collaborative Strategic 
Management Frameworks 

Building off Gray and Hood et at., collaborative frameworks are 
organized around three structural components—partners, forms, and 
processes . 82 Each of these structural components affects the ability of the 
collaborative group to achieve strategic goals. 

The literature on collaborative frameworks focuses on three 
aspects of partners: key partners, partner engagement, and partner roles. The 
inclusion of key partners is important in order for collaborative groups to achieve 
their goals, and the selection of partners affects whether implementation is 
successful . 83 In considering the range of partners to include, consideration of the 
different values and agencies relevant to the problems is necessary, while 
keeping in mind that achieving actionable outcomes often requires a small 
number of partners . 84 

The outcomes of collaborative frameworks can vary considerably 
depending on the level of partner engagement, and engagement increases when 
partners believe that their involvement will increase the effectiveness of problem 
solving . 85 Previous collaborative or networking experience also increases 
partner engagement . 86 Additionally, role definitions greatly affect collaborative 
framework outcomes. Formal agreements that define roles and expectations may 
be necessary if the duration of a collaborative group is ongoing and exceeds the 
term of one representative . 87 Roles are also likely to evolve and change over 

82 Gray, “Conditions Facilitating Interorganizational Collaboration,” 911-936; Hood et al., 
“Collaboration for Social Problem-Solving,” 1-17. 

83 Huxham, “Pursuing Collaborative Advantage,” 608. 

84 lbid. 

85 See Huxham, “Pursuing Collaborative Advantage,” 599-611; P. S. Ring and A. H. Van De 
Ven, “Developmental Processes of Cooperative Interorganizational Relationships,” Academy of 
Management Review 19.1 (1994): 90-118. 

88 Huxham, “Pursuing Collaborative Advantage,” 605. 

87 Ring and Van de Ven, “Developmental Processes of Cooperative Interorganizational 
Relationships,” 104. 


26 



time . 88 The role of the lead agency is important, and whoever “initiates 
collaborative problem solving has a critical impact on its success or failure .” 89 

The orchestrating mechanism or form of a collaborative framework 
refers to the coordinating activity of the agencies involved. The literature on 
collaborative frameworks generally recognizes two forms: the full partnership 
form and the individual partner form. The full partnership form is the specific 
interagency framework used to coordinate the ongoing involvement of all the 
partners . 90 It is often, but not always, a formalized structure. As noted above, in 
determining structure the assignment of a lead agency is a critical factor because 
if one partner takes primary responsibility for implementation it can discourage 
other partners from becoming or remaining engaged . 91 

The individual partner form recognizes that the relationship 
between the collaborative group and the individual agency is not a hierarchical 
relationship and that each agency retains autonomy. Collaborative goals are 
sometimes achieved by implementation within an agency, such as when funds 
are allocated to a specific agency to purchase equipment. According to Huxham, 
reliance upon the individual partner form is most appropriate when there is less 
detail in the collaborative strategic plan . 92 Huxham also argues that a full 
partnership form does not exist in isolation because the individual partner form is 
always involved in implementation of the collaborative strategy . 93 

The literature on collaborative frameworks identifies three key 
processes related to implementing strategy: decision-making, communication 
and information, and monitoring and evaluation. Decision-making can either be 
centralized or decentralized depending on the structure of a collaborative 

88 Waddell and Brown, Fostering Intersectoral Partnering, 18. 

89 Gray, “Conditions Facilitating Interorganizational Collaboration,” 923. 

"Hood et al., “Collaboration for Social Problem-Solving,” 6. 

91 Waddell and Brown, Fostering Intersectoral Partnering, 23. 

"Huxham, “Pursuing Collaborative Advantage,” 609. 

93 lbid., 607. 


27 



framework. When the power to make decisions lies with one entity within the 
collaboration, decision-making is centralized, but when decision-making power is 
spread across the entities within a collaborative framework, the structure is 
decentralized . 94 Ring and Van de Ven argue that decentralized decision-making 
can lead to improved implementation of strategies . 95 

Linkages between collaborative strategic plans and the strategic 
plans of the individual agencies participating in a collaborative framework are 
important. Communication and information processes can help coordinate the 
implementation of the collaborative group’s strategies and individual agency 
strategies. As with decision-making, communication can be concentrated in one 
entity and centralized, or dispersed through different individual agencies. Positive 
communication can improve trust, build relationships, and improve situational 
awareness leading to successful collaboration . 96 

Monitoring and evaluation refers to the processes by which a 
collaborative group evaluates progress. For collaborations that involve a full 
partnership form, monitoring ensures that actions are taken to achieve the 
strategic plan . 97 Monitoring and evaluation provide a means for reporting 
progress and triggering corrective actions as needed. The needs of the 
collaborative group and individual partners are supported by monitoring and 
evaluation. As mentioned above, keeping partners engaged in a collaborative 
framework can be challenging, but corrective actions can potentially include the 
exit and entry of partners needed for continued relevance . 98 


94 See H. Mintzberg, The Structuring of Organizations: A Synthesis of the Research 
(Englewood Cliffs, NJ: Prentice-Hall, 1979). 

95 Ring and Van de Ven, “Developmental Processes of Cooperative Interorganizational 
Relationships,”104-105. 

96 Huxham, “Pursuing Collaborative Advantage,” 605. 

97C. Huxham and D. Macdonald, “Introducing Collaborative Advantage: Achieving Inter- 
Organizational Effectiveness through Meta-Strategy,” Management Decision 30.3 (1992): 50-56. 

9 8 See e.g., Waddell & Brown, Fostering Intersectoral Partnering, 10-12; Hood et al., 
“Collaboration for Social Problem-Solving,” 6. 


28 



The structure of collaborative frameworks also directly affects the 
types of outcomes achieved and measures of success as discussed in the next 
section. 


c. Relationship Between Collaborative Framework 
Structures and Outcomes/Success 

Most studies of collaborative strategy making focus on the process 
of collaboration and the stages of forming a collaborative group, not outcomes of 
collaborative groups." This section of the literature review explores the types of 
outcomes or successes that may result from collaborative strategy making. 
Outcomes discussed in the literature are categorized as either tangible outcomes 
or action outcomes. Tangible outcomes include the solution to a concrete 
problem, enduring links and relationships among organizations, and personal 
outcomes for individuals engaged in collaborative groups. Action outcomes are 
simply the acts taken by the collaborative group as part of the implementation of 
strategy. Because this thesis considers policy options based on plan-centric 
outcomes, process-centric outcomes, and a hybrid plan/process approach, this 
section briefly discusses plan outcomes, process outcomes and emergent 
milestones. 

Plan outcomes are those that address the identified problems and 
are measured through the achievement of collaborative goals as outlined in a 
plan. Success is often measured as the overall success of the project and what 
organizations involved in the collaboration learned from the project . 100 Other 
authors have referenced the importance of strategy setting that seeks to achieve 
the solution to a concrete problem in order to attract partner agencies . 101 


99See e.g., Gray, “Conditions Facilitating Interorganizational Collaboration,” 911-936; 
McCann, “Design Guidelines for Social Problem-Solving Interventions,” 177-192; and Waddell 
and Brown, Fostering Intersectoral Partnering, 1-26. 

100 J. Bryson and P. Bromiley, “Critical Factors Affecting the Planning and Implementation of 
Major Projects,” Strategic Management Journal (1986-1998) 14.5 (1993): 319-337, 321. 

101 See e.g., J. M. Logsdon, “Interests and Interdependence in the Formation of Social 
Problem-Solving Collaborations,” Journal of Applied Behavioral Science 27.1 (1991): 23-37. 

29 



Huxham et al. also use the term substantive outcome to refer to the achievement 
of goals outlined in a strategic plan . 102 

Alterations, adaptations, and changes to the collaboration’s design, 
formation, and implementation are process outcomes . 103 Process outcomes can 
include enhanced linkages and understanding among partner agencies, strategic 
efforts such as pooling resources, and the development of a collaborative 
process. Huxham et al. have identified co-aligned agendas, negotiation making, 
established mechanisms for participation, and standardized templates for 
collaborative actions as process based outcomes . 104 

Emergent milestones are unplanned outcomes, expressed as either 
substantive or process achievements . 105 They often overlap with both plan 
based and process based outcomes to a certain extent . 106 Emergent milestone 
outcomes are interim, unplanned outcomes that often contribute to the on-going 
collaborative process and recognition of emergent milestones can help sustain 
collaborations . 107 Examples of emergent milestones include accomplished 
process improvements, notable past decisions/actions, completed written or 
event outputs like conferences, and demonstrable physical or organizational 
artifacts such as the purchase of tangible equipment or supplies . 108 

D. SUMMARY 

Public sector strategy typologies have classically considered strategy as 
an entity and not as practice or performance of the organization. In contrast to 
the focus of academic research on public sector strategy development, the 

102 C. Huxham, P. Hibbert, and P. Hearne, “Claiming Collaborative Success: Signifiers and 
Caveats.” Paper presented at the Academy of Management - Annual Conference, Anaheim, 
California, August 8-13, 2008, 12. 

103 Clarke and Fuller, “Collaborative Strategic Management,” 90. 

104 Huxham et al., “Claiming Collaborative Success,” table 4. 

105 lbid., 16. 

106 lbid. 

107 lbid. 

108 lbid., table 5. 


30 



federal government’s focus on strategic planning through GPRA focuses on 
performance. The relevance of GPRA to federal grant programs overall and 
those grant programs that deal in crosscutting issues, such as homeland 
security, is uncertain. The newly developed National Preparedness System 
under PPD-8, the Public Health Preparedness Capabilities, and the Healthcare 
Preparedness Capabilities establish national planning priorities that promote 
collaboration, but do not provide a framework for collaborative planning. 

Collaborative strategic management models may be adapted in order to 
provide federal agencies with a framework for developing and improving 
interagency collaboration that is based on strategy and strategic concepts. 
However, existing models focus on intersectoral partnerships and not 
relationships among federal agencies, and they do not address how entities 
should collaborate in an integrated way. A number of factors affect whether or 
not organizations will seek to collaborate with others. These determinants of 
collaboration affect the development of collaborative strategic management 
frameworks. Close examination of the various structural components of 
collaborative frameworks and their effect on implementation is also informative, 
and each collaborative framework structure has various types of outcomes and 
successes that are associated with it. This thesis will examine three potential 
policy options for implementing collaborative strategic management at the federal 
level. 


31 



THIS PAGE INTENTIONALLY LEFT BLANK 


32 



III. METHODOLOGY 


A collaborative strategic management framework for interagency public 
health preparedness can help achieve the established Public Health 
Preparedness Capabilities and Healthcare Preparedness Capabilities. This 
thesis considers three possible collaborative strategic management policy 
options and evaluates them based on selected policy criteria and the shared 
Public Health Preparedness Capabilities and Healthcare Preparedness 
Capabilities. The three policy options are outlined below. 

A. POLICY OPTIONS 

The three possible policy solutions for developing a collaborative strategic 
management framework for interagency public health preparedness considered 
in this thesis are a plan-centric approach, a process-centric approach, and a 
hybrid approach that combines process and planning. Each is briefly described 
here. 


1. Plan-Centric Outcomes Based Approach 

The plan-centric collaborative strategic management framework focuses 
on the formulation of a strategic plan. Situational considerations, such as the 
legal framework and regulations affecting partner agencies, can also be a focal 
point of this type of model. Expected outcomes of a plan-centric model include 
the solution of a concrete problem, substantive plans and protocols, or progress 
reports on plan outcomes. 

Multi-agency strategic plans for public health emergency preparedness do 
not currently exist. For example, numerous federal agencies are tasked with 
various bioterrorism planning and response areas, but no strategic plan exists 


33 



that frames the issues or prioritizes interagency efforts . 109 A pian-centric 
collaborative framework could help address this gap. Key to the success of this 
type of framework is the identification of a lead agency to direct the effort. 

2. Process-Centric Outcomes Based Approach 

The process-centric collaborative strategic management framework 
focuses on developing the processes that partners will engage in to achieve 
collaborative goals. This model focuses on process over an overall strategic 
planning document and seeks to address issues related to decision-making, 
communication and information, and monitoring and evaluating planning and 
collaboration among partners. Process-centric frameworks help strengthen links 
between agencies and lead to shared understanding of roles and responsibilities. 

A number of identified gaps within public health emergency preparedness 
could be addressed through a process-centric strategic planning approach, 
including role and responsibility clarification and sharing role and responsibility 
information with state and local government agencies. In order to be successful, 
this type of framework requires partner agencies to move towards decentralized 
authority in order to facilitate decision-making. Implementation of strategic goals 
is likely to improve when partner agencies have the discretion to employ both 
formal and informal procedures while participating in collaborative strategic 
planning. 

3. Hybrid Approach 

The hybrid approach seeks to combine elements from both the process¬ 
centric and plan-centric models. This approach focuses on both the development 
of plans to address concrete problems and the development of strategic 
processes for meeting collaborative goals. A substantive document, as well as, 


109 A. Mauroni, “Progress of “Biodefense Strategy for the 21st Century”:-A Five-Year 
Evaluation,” in Project on National Security Reform, CASE STUDIES WORKING GROUP 
REPORT VOLUME II., Ed. R. Weitz, 151-238, Carlisle Barracks, PA: Strategic Studies Institute, 
2012. http://www.strateqicstudiesinstitute.army.mil/pubs/display.cfm?publD=1100 . 


34 




improved decision-making and communication and information flow are the goals 
of this approach. 

The hybrid approach seeks the best of both worlds, but requires a larger 
commitment of time and effort by the involved agencies than the other policy 
options. However, this approach provides external partners with both a planning 
document and increased understanding of the roles and responsibilities of 
partner agencies and operational response processes. 

B. SELECT POLICY OPTIONS CRITERIA FOR JUDGING SUCCESS 

Each of the policy options discussed above will be evaluated against the 
following criteria: 

1. Ability to Meet Federal Strategic Planning Requirements 

The ability to meet federal strategic planning requirements is an 
important area for consideration in evaluating the three policy options. Each of 
the policy options requires political buy-in from a number of federal agencies 
engaged in the various components of public health emergency preparedness 
and must meet current federal planning requirements. This thesis will focus on 
the existing requirements set forth by PPD-8, the Public Health Preparedness 
Capabilities, and the Healthcare Preparedness Capabilities. 

a. Assessment Against PPD-8 

The purpose of PPD-8 is to strengthen the security and resilience 
of the United States through systematic preparation for the threats that pose the 
greatest risk to the security of the Nation, including acts of terrorism, cyber 
attacks, pandemics, and catastrophic natural disasters. 110 Overall, PPD-8 
emphasizes an all-hazards approach to national preparedness and encourages 
cooperation among federal, state, and local authorities. It calls for the 


110 The White House, “Presidential Policy Directive/PPD-8: National Preparedness,” 1. 

35 



development of a National Preparedness Goal and a National Preparedness 
System, further discussed below. 

(1) National Preparedness Goal. The National 
Preparedness Goal is the cornerstone of PPD-8, and it sets forth five mission 
areas for preparedness: prevention, protection, mitigation, response and 
recovery. Planning is a core capability, defined as the process of “engaging the 
whole community as appropriate in the development of executable strategic, 
operational, and/or community-based approaches to meet defined objectives.” 111 
Each mission area has defined planning targets as depicted in Table 3. 


111 Department of Homeland Security, National Preparedness Goal, 6. 


36 



Table 3. Planning under the National Preparedness Goal (From Department 
of Homeland Security, National Preparedness Goal) 


Mission Area 

Targets 

Prevention 

Identify critical objectives based on the planning requirement, provide a 
complete and integrated picture of the sequence and scope of the tasks to 
achieve the objectives, and ensure the objectives are implementable within 
the time frame contemplated within the plan using available resources for 
prevention-related plans. 

Develop and execute appropriate courses of action in coordination with 
Federal, state, local, and private sector entities in order to prevent an 
imminent terrorist attack within the United States. 

Protection 

Develop protection plans that identify critical objectives based on planning 
requirements, provide a complete and integrated picture of the sequence 
and scope of the tasks to achieve the planning objectives, and implement 
planning requirements within the time frame contemplated within the plan 
using available resources for protection-related plans. 

Implement, exercise, and maintain plans to ensure continuity of operations. 

Mitigation 

Develop approved hazard mitigation plans that address all relevant 
threats/hazards in accordance with the results of their risk assessment 
within all states and territories. 

Response 

Develop operational plans at the Federal level, and in the states and 
territories that adequately identify critical objectives based on the planning 
requirement, provide a complete and integrated picture of the sequence and 
scope of the tasks to achieve the objectives, and are implementable within 
the time frame contemplated in the plan using available resources. 

Recovery 

Convene the core of an inclusive planning team (identified pre-disaster), 
which will oversee disaster recovery planning. 

Complete an initial recovery plan that provides an overall strategy and 
timeline, addresses all core capabilities, and integrates socioeconomic, 
demographic, accessibility, and risk assessment considerations, which will 
be implemented in accordance with the timeline contained in the plan. 


(2) National Preparedness System. The National 
Preparedness System under PPD-8 sets forth an integrated approach for 
achieving the National Preparedness Goal in a consistent and measureable way. 
The National Preparedness System seeks to enable a collaborative, whole 
community approach to national preparedness that engages individuals, families, 
communities, private and nonprofit sectors, faith-based organizations and all 
levels of government. 112 Planning under the National Preparedness System 
promotes inclusion of the whole community. It recognizes that federal efforts 
must complement planning at the state and local levels of government, which are 


112 Department of Homeland Security, National Preparedness System, 1. 


37 




apt to focus on more likely risks. The shared planning efforts at each level of 
government will form a National Planning System. 113 

Currently, the National Planning System concept is in a 
nascent stage and in the near future frameworks will be developed for each 
mission area, supported by a federal interagency operational plan that provides a 
detailed concept of operations, a description of critical tasks and responsibilities, 
detailed resources, and personnel and sourcing requirements. 114 Each federal 
executive department or agency will then develop and maintain their own 
operational plans to deliver capabilities under each framework. 

Each of the policy options will be assessed for its ability to 
meet the goals under PPD-8. Specifically, each policy option will be assessed 
against the requirement for achieving whole community planning and planning 
that will complement state and local planning. Additionally, the ability of each 
policy option to contribute to an interagency operational plan will be considered. 

b. Assessment Against the CDC’s Public Health 
Preparedness Capabilities and ASPR’s Healthcare 
Preparedness Capabilities 

Each policy option is also evaluated for its ability to help meet the 
shared CDC’s Public Health Preparedness Capabilities and ASPR’s Healthcare 
Preparedness Capabilities. A crosswalk of the public health preparedness 
capabilities and the healthcare preparedness capabilities denoting the eight 
shared capabilities is shown in Table 4. 


113 lbid., 4. 
114 lbid. 


38 



Table 4. Crosswalk of the CDC’s Public Health Preparedness Capabilities 
and ASPR’s Healthcare Preparedness Capabilities 


Public Health Preparedness 
Capabilities 

Healthcare Preparedness 

Capabilities 

Community Preparedness/Healthcare System Preparedness 

Community Recovery/Healthcare System Recovery 

Emergency Opera 

tions Coordination 

Emergency Public Information and 
Warning 


Fatality Management 

Information Sharing 

Mass Care 


Medical Countermeasure Dispensing 


Medical Materiel Management and 
Distribution 


Medica 

1 Surge 

Non-pharmaceutical Interventions 


Public Health Laboratory Testing 


Public Health Surveillance and 
Epidemiological Investigation 


Responder Safety and Health 

Volunteer Management 


Each policy option will be evaluated for its potential ability to 
improve strategic planning and management for the eight shared public health 
and healthcare capabilities. The shared capabilities are broken into both public 
health and healthcare functions that represent the critical elements necessary for 
achieving the capabilities. The appendix lists all of the functions associated with 
the shared capabilities. This thesis focuses on collaborative interagency planning 
while the shared capabilities focus on multiagency representation and 
coordination between and among public health and healthcare entities. Each of 
the three policy options will be evaluated for its ability to help achieve the 
collaborative, interagency functions of the shared capabilities by assessing their 
ability to support the development of healthcare coalitions and to foster 
community partnerships to support health preparedness under Capability 1. 


39 




2. Political Acceptability 

The suitability of the policy option to Congress and federal agencies is the 
second criterion for evaluation. The various policy options create political 
consequences for the federal public health agencies and other federal agencies 
engaged in public health preparedness. Each policy option’s effect on Congress 
and the federal public health and homeland security agencies is explored to 
determine likelihood of success. 

3. Effectiveness 

The effectiveness of each of the policy options is an essential criterion for 
evaluation and is assessed based on two sub-criteria. First, each policy option is 
evaluated for the anticipated ability of agencies to be able to continue to manage 
themselves in a strategic manner on an on-going basis (through the development 
of a strategic plan, strategy content, and implementation). 115 Second, each 
policy option is evaluated for whether it will meet the requirements of the National 
Planning System, specifically the development of an interagency strategic plan 
and individual agency plans. 

4. Externalities 

Finally, the policy options are assessed for their effect on externalities, 
and the potential for a cascading effect throughout all levels of public health. 
Each of the options will have second order effects on other organizations 
engaged in public health emergency preparedness, particularly state and local 
level public health agencies. The policy options’ ability to affect strategic planning 
at the state and local health department level, as well as, at the healthcare 
infrastructure level is assessed. 


115 See Poister et al., “Strategic Management Research in the Public Sector,” 525. 


40 



IV. PLAN-CENTRIC OUTCOMES BASED APPROACH 


This chapter describes the first policy option for improved collaborative 
strategic management at the federal level. First, a brief overview of the plan¬ 
centric approach is given, and then each step in the model is described. Second, 
the plan-centric policy option is assessed against the policy options criteria as 
outlined in the methodology. 

A. OVERVIEW OF THE MODEL 

1. Background 

The plan-centric model focuses on developing a collaborative strategic 
plan, and while individual planners can use the process discussed here, it is 
intended to be used by a collaborative planning team. 116 The goal of the plan¬ 
centric model is to develop general strategic goals and objectives and a 
description of how the goals and objectives will be achieved. This is the current 
model employed within emergency preparedness. 

A possible focal point of the plan-centric approach is to consider the legal 
framework and regulations affecting partner agencies and developing a plan for 
integrated action around the existing framework. Key to the success of this 
approach is the identification of a lead partner organization to direct the 
collaborative group’s efforts. Expected outcomes of the plan-centric approach 
include the solution of a concrete problem, substantive plans and protocols, or 
progress reports on plan outcomes. 

2. Overview and Description 

This thesis uses the planning process developed by FEMA and adopted 
by the Healthcare Preparedness Capabilities as its model for the plan-centric 
approach. The model focuses on five-steps for forming a collaborative group and 


1 ^Federal Emergency Management Agency, Comprehensive Preparedness Guide (CPG) 
101, Version 2.0 ., 4-1. 


41 



developing a plan. The purpose of the collaborative group is to create a planning 
document, although situational considerations such as legal authorities and 
regulations may also be a focal point. The plan-centric approach is depicted in 
Figure 1. 


STEP 1 
Form a 
Collaborative 
Planning Team 


Identify 

Core 

Planning 

Team 


Engage the 
Whole 
Community 

in Planning 


STEP 2 
Understand 
* the 

Situation 


Identify 
Tin eats 
and 

Hazards 


STEP 3 
Determine 
Goals and 
Objectives 


STEP 4 
Plan 

Development 



STEPS 

Plan Preparation, 
Review, & 
Approval 


Write 
the Plan 


Review 
the Plan 


Approve 

and 

Disseminate 
the Plan 


STEP 6 

Plan 

Implementation 
& Maintenance 


Exercise 
the Plan 


Review, 
Revise, and 
Maintain 
the Plan 


Figure 1. Plan-Centric Based Model (From Federal Emergency Management 
Agency, Comprehensive Preparedness Guide (CPG) 101, Version 2.0) 

a. Planning under this model 

This section outlines and describes the five steps for forming a 
collaborative team and developing a plan under the plan-centric approach. 
Outcomes and implementation under this type of strategic management 
framework are also discussed. 

(1) Forming a Collaborative Planning Team. The first step 
under the plan-centric approach is to form a collaborative planning team. A team 
approach helps partner organizations understand each other’s roles and 
responsibilities. The planning team should establish a planning routine to help 
ensure partner organization buy-in and instill decision-making processes before 


42 
































an incident. 117 Initially, a core team should be established and then expanded as 
needed. 

(2) Understanding the Situation. The second step in the 
plan-centric models is to identify threats and hazards to better understand the 
planning environment. During this phase the planning team collects and refers to 
existing data and assesses risk/conducts a risk analysis. 118 The collaborative 
planning team determines goals and objectives based on the outcomes of the 
risk analysis. This step is often scenario driven. 

(3) Determine Goals and Objectives. Next, the planning 
team determines operational priorities and crafts goals and objectives that 
support accomplishing both the plan mission and operational priorities. The team 
also indicates the desired result or end-state that the goals and objectives are 
designed to yield. 119 This approach enables unity of effort and consistency of 
purpose among the multiple entities and activities involved in executing the 
collaborative plan. 120 

(4) Plan development. During the plan development 
phase, the planning team establishes and analyzes courses of action. The 
planning team generates, compares, and then selects a number of courses of 
action to be included in the collaborative plan. 121 Identification of resource, 
intelligence, and information needs occurs during the plan development stage. 122 

(5) Plan Preparation, Review and Approval. The planning 
team writes the plan by turning the courses of action into an emergency 
operations plan (EOP). Next, the EOP is reviewed against legal and regulatory 
frameworks and to ensure adequacy, completeness, feasibility, acceptability, and 


117 lbid., 4-2. 
118 lbid„ 4-7-4-9. 
119 lbid., 4-10. 
120 lbid., C-2. 

121 Ibid., 4-14. 
122 lbid„ 4-16. 


43 



compliance. 123 The plan is approved and promulgated after being vetted by 
individual partner organizations. 124 

(6) Plan Implementation and Maintenance. Once the plan 
has been disseminated, training and exercise occurs. 125 Feedback is 
incorporated and the plan revised on a regular basis Events such as major 
incidents or exercises, change in elected officials, or a change in the risk profile 
or demographics of a jurisdiction necessitate plan revision. 126 The planning 
cycle resumes at Step 2 with the addition of feedback and other new 
intelligence. 127 

b. Outcomes under this Model 

Outcomes under the plan-centric model are generally action 
outcomes that address the identified problems and the achievement of the 
collaborative goals defined in the strategic plan. Additional outcomes include the 
perception of strategic planning effectiveness and satisfaction with the planning 
process. 128 


c. Implementation under this Model 

Implementation under this model occurs at the individual 
organization level. Once the plan has been approved and promulgated, each 
organization involved in the planning process must train their personnel so that 
they are able to perform the tasks identified in the plan. Exercises and real world 
events provide an opportunity for the collaborative group to evaluate the 
effectiveness of the plan and make changes as necessary. 


123 ibid„ 4-17. 

124 lbid„ 4-25. 

125 lbid. 

126 lbid„ 4-26. 

127 lbid. 

128 Poister et al., “Strategic Management Research in the Public Sector,” 535. 


44 


B. ASSESSMENT OF THE PLAN-CENTRIC OUTCOMES BASED 

APPROACH 

This section assesses the plan-centric policy approach against the policy 
options criteria. 

1. Ability to Meet Federal Strategic Planning Requirements 

The plan-centric approach is the current model in homeland security for 
state and local government as promulgated by FEMA, and the CDC and ASPR 
have adopted it. Previous federal attempts at developing interagency planning 
guidelines included the Integrated Planning System (IPS) under the now defunct 
Homeland Security Presidential Directive-8 , 129 The IPS was the first attempt at 
implementing a process for developing federal interagency plans. FEMA’s 
Comprehensive Preparedness Guide (CPG) 101, Version 2.0 meets the IPS 
requirement for an all-hazards planning guide that federal, state, local and tribal 
levels of government can use. 130 Federal agencies can use the CPG, and DHS 
has encouraged federal agencies to use the IPS. 131 It is unclear if any agencies 
at the federal level have used the CPG model to engage in strategic planning. 

a. Assessment Against PPD-8 

The plan-centric model is likely to achieve limited success in 
meeting the requirement for whole community planning under PPD-8. Whole 
community planning requires the engagement of partners outside of government 
entities and consideration of the “true needs” of a community. The creation of a 
collaborative planning team under the plan-centric model provides an opportunity 
for partners outside of government to come to the table. However, the plan¬ 
centric model does not address the need for various public, private, and 
community organizations to determine processes for working together to address 

^Department of Homeland Security, The Integrated Planning System, Washington, DC: 
Department of Homeland Security, 2009, iii. http://www.hlswatch.com/wp- 
content/uploads/2009/01/dhs-inteqrated-planninq-svstem-ianuary-2009.pdf . 

130|bid., iv. 

131 Ibid., 1-2. 


45 





public health emergency preparedness on an ongoing basis. As the collaborative 
planning team works towards development of a strategic plan, it is expected that 
the need for collaborative processes will be identified and that some processes 
may be developed. Furthermore, successful whole community planning is not 
expected to be satisfying to nonpublic partners without a means for developing 
and strengthening processes among partner organizations. 

The plan-centric approach will not complement state and local 
planning very much unless state and/or local partners are part of the 
collaborative planning team, which is unlikely. Planning at the federal level is 
based on the National Planning Scenarios, fifteen scenarios developed by The 
Homeland Security Council in 2004. 132 State and local planning, on the other 
hand, is based on the specific risks and hazards identified within a limited 
jurisdictional area. The National Planning Scenarios contain several scenarios 
related to public health and healthcare preparedness, including pandemic 
influenza, aerosolized anthrax, food contamination, nerve agents, and blister 
agents. 133 Some of these scenarios are planned for at the state and local level, 
but to varying degrees depending on the jurisdiction’s risk and threat assessment 
and grant specific requirements. Moreover, there is an assumption at the federal 
level that any bioterrorist incident will be catastrophic and overwhelming to state 
and local governments, requiring the immediate need for federal intervention. 134 

The plan-centric approach does lead to the development of an 
interagency operational plan that individual agencies can use as the basis for 
developing their own operational plans. The development of a strategic plan is 
the main outcome of this approach. Identified problems during the second step of 
this approach (Understand the Situation) will be addressed in the plan, but there 


132 ibid„ iv. 

133 The Homeland Security Council, Planning Scenarios, Executive Summaries, Created for 
use in National, Federal, State and Local Homeland Security Preparedness Activities, 
Washington, DC: The Homeland Security Council, 2004. 

134 Mauroni, “Progress of “Biodefense Strategy for the 21 st Century,” 154. 


46 



is no mechanism for addressing emergent challenges that may be identified later 
during plan development. 

b. Assessment Against the Public Health Preparedness 
Capabilities and Healthcare Preparedness Capabilities 

The plan-centric approach is the suggested approach for the 
development of healthcare coalitions at the state, local, and tribal level, 
healthcare coalitions are tasked with enhancing public health emergency 
preparedness functions, including identifying and prioritizing essential healthcare 
assets and services, determining gaps in healthcare preparedness and 
identifying resources for mitigation of these gaps, and engaging with community 
organizations to foster public health, medical, and mental/behavioral health social 
networks. 135 Before a healthcare coalition can begin to develop a strategic plan, 
they must determine how to achieve these functions collaboratively. The plan¬ 
centric model does not provide a mechanism for developing the necessary 
functions to engage in strategic planning at the healthcare coalition level. 

The development of a collaborative planning team under this 
approach will bring together healthcare coalition partners who may not have 
engaged with one another before, but again the plan-centric approach does not 
provide mechanisms for fostering community partnerships to support health 
preparedness other than through the development of a strategic plan. The plan¬ 
centric approach does not provide for the creation and implementation of 
strategies for ongoing engagement with community partners who may be able to 
provide services to mitigate identified public health threats or incidents. 136 

2. Political Acceptability 

Federal agencies have been required to set goals and measure 
performance under GPRA for almost twenty years. Since 9/11, Congress has 
required federal strategic planning activities for public health emergency 

135 Healthcare Preparedness Capabilities, 5-7. 

136 Public Health Preparedness Capabilities, 19. 


47 



preparedness through provisions of the Homeland Security Act of 20 02, 137 the 
Pandemic and All-Hazards Preparedness Act, 138 and other legislation, yet 
policymakers, analysts, and others continue to criticize federal efforts at strategic 
planning. 139 

Congressional oversight of homeland security and public health 
emergency preparedness crosses the jurisdiction of many congressional 
committees, and congressional oversight is often issue-based. 140 Some critics 
have suggested that fewer committees might help focus and optimize oversight 
by centralizing the issues. 141 Others believe that Congressional policymakers 
are better positioned to identify synergies and duplications of effort more easily 
than decision-makers in individual agencies. 142 At this time, it appears that 
Congress will maintain its decentralized approach to monitoring homeland 
security and public health emergency preparedness activities. 

The plan-centric approach is very issue-based as the outcome of this 
approach is a strategic plan that will address a specific area of public health 
emergency preparedness. This approach relies on a strong lead agency, 
providing Congress with a lead agency to testify on behalf of the collaborative 
group. At the same time, other agencies that are part of the collaborative 
planning team may also provide status updates to Congress. Political 
acceptability by Congress for this approach is expected to be high. 

Because the plan-centric model is based on the CPG which meets the 
standards set forth in the IPS, DHS and the agencies under it are presumed to 
have no objections to its use for federal collaborative strategic management 
related to public health emergency preparedness. Likewise, the CDC and ASPR 


137 Homeland Security Act of 2002, Public Law 107-296, 116 Stat. 2135 (Nov. 25, 2002). 

138 Pandemic and all-Hazards Preparedness Act , Public Law 109-417, 120 Stat. 2831 (Dec. 
19, 2006). 

139 Gottron and Shea, Federal Efforts to Address the Threat of Bioterrorism, 5. 

140 lbid., Summary. 

141 Ibid., 6. 

142 lbid. 


48 



adopted the CPG approach to strategic planning through their guidance to state 
and local governments, as well as, the healthcare sector. There is no reason to 
believe that they would object to its use at the federal level. 

3. Effectiveness 

Success under the plan-centric model is dependent on the identification of 
a lead agency to direct the effort. It could be difficult to determine who the lead 
agency should be given that the roles and responsibilities of the principals in 
DHHS and DHS have shifted numerous times over the past few years. 143 
Currently, 

the Secretary of Homeland Security coordinates all federal 
emergency and disaster response activities; the DHS CMO 
coordinates both preparedness and response activities for public 
health and medical care, but only within DHS; and the Secretary of 
DHHS, through the ASPR, leads all federal public health and 
medical response activities, under the overall leadership of the 
Secretary of Homeland Security. 144 

The determination of a sole lead agency would be challenging under the current 
congressional schema. 

Adopting a plan-centric approach may lead to a strategic plan that is 
watered down and too general to be meaningful. The inclusion of all agencies 
currently recognized as having a role in public health emergency planning could 
potentially lead to a large and unmanageable collaborative planning team. 
Furthermore, by the time a robust collaborative planning team is able to develop 
a strategic plan, it is probable that the plan will already be outdated because the 
public health emergency preparedness environment is constantly evolving. 

The plan-centric approach will provide federal agencies with the ability to 
manage their individual agencies and the interagency collaborative group in a 
strategic manner on a limited basis. The plan-centric approach provides for 

143 U.S. Library of Congress, Congressional Research Service, Public Health and Medical 
Emergency Management: Issues in the 112th Congress, Ed. S. Lister, CSR Report R41646, 
Washington, DC: Office of Congressional Information and Publishing, February 18, 2011,3. 

144 lbid. 


49 



feedback to be incorporated back into Step 2 of the strategic planning process 
and the planning cycle restarted. 145 However, the focus of the plan-centric 
approach is on the development of the plan and not on the relationships among 
the individual partner agencies or the changes in the environment that affect 
overall strategy content. Development of strategy content is included in Step 3 
under this model and is quantitative as it is based on risk and threat 
assessments. Implementation is considered in terms of training and exercise 
under Step 6 and is based on achieving the strategy content of the plan. 

The outcome of this approach is the development of an interagency 
strategic plan, a requirement under the National Planning System. It is unclear 
how operational an interagency plan developed under this approach might be. 
The plan-centric approach calls for setting operational priorities and goals and 
objectives. 146 The collaborative planning team could incorporate the strict 
requirements under the National Planning System into the strategic plan 
developed under this approach although it may be difficult to incorporate a high 
level of specificity as to resource and personnel needs. It is possible that 
individual partner agencies could use the interagency strategic plan to inform 
their individual agency strategic plans, but again whether or not the level of 
specificity required under the National Planning System could be achieved 
remains to be seen. 

4. Externalities 

The plan-centric approach provides limited opportunities for strategy 
development to include partners outside of the collaborative planning team. State 
and local health departments are not expected to be included as part of the 
collaborative planning team at the federal level. Therefore, the opportunity for 
cascading effects at the state and local level is limited to those effects that may 
occur through the direct sharing of federal plans or parts of plans to state and 

145 Federal Emergency Management Agency, Comprehensive Preparedness Guide (CPG) 
101, Version 2.0 ., 4-26. 

146 lbid4-12. 


50 



local health departments. Based on the highly sensitive nature of federal level 
strategic plans for homeland security and public health emergencies, the direct 
sharing of federal plans either at the state or local level is extremely unlikely. Any 
cascading effect will likely occur through informal channels and thus be 
unreliable. 

Furthermore, while state and local health departments are required to 
develop some plans that address public health scenarios outlined in the National 
Planning Scenarios, state and local public health emergency planning 
encompasses many other areas based on state and local threat and risk 
assessments. As previously stated, the plan-centric approach does not facilitate 
complementary planning at the state and local level. 

With the alignment of the Public Health Emergency Preparedness and 
Hospital Preparedness Program grants at the federal level, healthcare 
infrastructure emergency planning has moved from facility-based planning to 
more of a whole community planning approach through the requirement for 
healthcare coalitions . 147 It is unlikely that the federal level collaborative planning 
team will include a private healthcare entity, so the only mechanism for sharing 
federal plans would be through state or local government or through ASPR 
directly. 


147 U.S. Department of Health and Human Services, From Hospitals to Healthcare 
Coalitions: Transforming Health Preparedness and Response in Our Communities, Washington, 
DC: U.S. Department of Health and Human Services, 2011, 134. 


51 



THIS PAGE INTENTIONALLY LEFT BLANK 


52 



V. PROCESS-CENTRIC OUTCOMES BASED APPROACH 


This chapter describes the second policy option for improved collaborative 
strategic management at the federal level. First, a brief overview of the process¬ 
centric approach is given, and then the processes and outcomes under the 
model are described along with implementation. Second, the process-centric 
policy option is assessed against the policy options criteria outlined in the 
methodology. 

A. OVERVIEW OF THE MODEL 

1. Background 

The process-centric model for strategic planning focuses on the processes 
partner organizations will engage in to achieve collaborative goals and the 
relationships among the collaborating entities. As discussed throughout the 
literature, decision-making, communication and information pathways, and 
monitoring and evaluating processes are the main processes that collaborative 
groups will establish and develop over the course of the collaboration . 148 

Through collaboration and integration of processes, collaborative groups 
can identify and avoid repetition of partially overlapping activities, build upon 
each partner organization’s contributions, and eliminate unnecessary repetition of 
tasks . 149 Additionally, collaborative process allows partner organizations to 
ensure activities they feel are important are not overlooked . 150 Omission of 
critical actions can occur when an activity is not identified as important or when 
an activity is the responsibility of more than one organization and each assumes 


148 See e.g., Mintzberg, The Structuring of Organizations, 1-512; Huxham, “Pursuing 
Collaborative Advantage,” 599-611; and Hood et al., “Collaboration for Social Problem-Solving,” 
1-17. 

149 Huxham, “Pursuing Collaborative Advantage,” 603. 

150 lbid. 


53 



the other is covering it. 151 Collaborative processes can also ensure that 
organizations move towards a common goal and effectively use resources. 

Setbacks to the development of successful collaborative process can 
occur if/when individual partner organizations feel threatened by a loss of control, 
flexibility and/or glory. 152 Collaborative processes can be imposed or can 
emerge from the activities of the collaborative group. 153 Additionally, external 
forces, such as funding, often shape and drive the processes of 
collaborations. 154 The process-centric based policy approach is described in the 
next section. 

2. Overview and Description of Process-Centric Based Policy 
Approach 

This thesis uses an adapted model from Ring and Van de Ven for its 
process-centric based approach. Ring and Van de Ven’s model focuses on four 
developmental and evolutionary processes for collaborations referred to as 
negotiations, commitments, executions, and assessments. 155 The negotiations, 
commitments, and executions stages are stages that represent decision-making 
processes. These three decision-making processes overlap in reality, but they 
are separated for the purpose of describing and analyzing this model. The 
assessments stage provides an opportunity for monitoring and evaluating after 
each of the decision-making stages. Throughout the collaborative cycle, 
communication and information processes are evident. The process-centric 
model is depicted in Figure 2. 


151 Ibid. 

152 lbid., 604. 

153 C. Huxham and S. Vangen, “Leadership in the Shaping and Implementation of 
Collaboration Agendas: How Things Happen in a (Not quite) Joined-Up World,” Academy of 
Management Journal 43.6 (2000): 1159-1175, 1171. 

154 lbid.,1167. 

155 Ring and Van De Ven, “Developmental Processes of Cooperative Interorganizational 
Relationships,” 97-98. 


54 



Communication and Information Flow 



Figure 2. Process-Centric Based Approach Framework (After Ring and Van de Ven, 

1994) 


a. Decision-Making Processes 

During the negotiations stage the individual partner organizations 
develop expectations and focus on bargaining and choice behavior of the 
individual partners. The negotiations process involves the social-psychological 
process of sense making that leads to negotiations. This stage is when the 
individual partner organizations assess uncertainty, trust issues, and the nature 
of each partner organization’s role. 


55 




Partner organizations come to an agreement about how the 
collaborative group will be governed during the commitment stage. The structure 
of the collaboration is defined during this phase, and the norms by which 
individual partner organizations will interact with one another are established. 
During this stage, it is important to create systems that ensure meaningful 
participation by all parties. 156 The governance structure may be formalized 
legally or it may remain informal. 

Once the rules of action have been established, the collaboration 
enters the execution phase, at which point partner organizations carry out their 
commitments to the collaborative group. The collaboration may renegotiate and 
update commitments following the execution of agreed upon commitments by 
cycling through the model again. A renegotiations phase allows the collaborative 
group to rethink the terms of the collaborative relationship and decide whether 
additional problem solving is necessary. The cyclical nature of the decision¬ 
making processes also allows for balancing of formal and informal processes that 
commit partner organizations in critical decisions. 

The underlying mechanisms for decision-making are the allocation 
of authority, the allocation of resources, and corrective actions. Authority within 
the collaboration can be decentralized or centralized with decentralization leading 
to better innovation. 157 Resource sharing to take advantage of each partner’s 
strengths increases achievement of the collaboration’s strategic goals. 
Implementation of collaborative goals greatly increases when individual partner 
organizations have the authority to commit to and execute the collaborative 
strategic plan. 158 


156 Waddell and Brown, Fostering Intersectoral Partnering, 16. 

157 Mintzberg, The Structuring of Organizations, 1-512. 

158 Ring and Van de Ven, “Developmental Processes of Cooperative Interorganizational 
Relationships,” 104. 


56 



b. Monitoring and Evaluation Processes 

Monitoring and evaluation provide an opportunity to report progress 
and to trigger corrective actions if deemed necessary. These mechanisms help 
ensure that collaborative goals are achieved. During this assessment stage, 
collaborative partners determine how efficiently the collaborative group has 
worked together. Issues related to equity of action can be examined during the 
assessment stage. 


c. Communication and Information Flow Processes 

Communication and information processes are critical to 
coordinating among partner organizations and within the collaborative group. 
Within the process-centric model, communication needs to be both centralized 
within the collaborative group and decentralized into the individual partner 
organizations. Unidirectional (one partner learns from the other) and bidirectional 
(mutual learning) modes of information flow are expected outcomes of the 
process-centric approach. Communication and information processes both within 
the collaborative entity and between individual partner organizations and the 
collaborative entity can aid in coordination, especially between the collaborative 
strategic plan and the individual partner organizations’ plans. 159 

Building communication skills and norms that support participation 
is important. 160 Through the development of communication norms, the 
collaborative group can explore differences and assumptions among the partner 
organizations before analyzing problems and constructing strategies. 161 Sharing 
perspectives while developing processes can help make constructive use of 
individual partner organization differences. 162 


159 Huxham and Vangen, “Leadership in the Shaping and Implementation of Collaboration 
Agendas,” 1167. 

160 Waddell and Brown, Fostering Intersectoral Partnering, 16. 

161 Ibid. 

162 lbid., 15. 


57 



d. 


Process-Centric Outcomes 


Process-centric model outcomes include interpersonal relationships 
and action plans, but they often do not produce concrete outcomes until several 
years after the process has begun. 163 Partner organizations must get to know 
each other and build trust before concrete tasks can be achieved. The 
negotiations stage sets the groundwork for shared vision and strategy, two 
outcomes of this process-centric model. Shared processes and procedures are 
also outcomes under this approach, and they help lay the groundwork for further 
collaborative work. 

The resultant outcomes under the collaborative process model may 
not be congruent with the original goals of the collaboration. Collaborative goals 
are likely to change as the collaborative group’s understanding improves with 
better information and analysis. 164 Hood et al. established four dimensions for 
evaluating outcomes of collaborative process: effectiveness, sustainability, 
agenda expansion, and personal outcomes. 165 Effectiveness is often measured 
by determining whether the collaboration has addressed the real problem. 166 
Whether the collaboration is able to effectively manage the composition of and 
participation within the collaborative group is referred to as the sustainability 
dimension. 167 Agenda expansion is the ability of the collaboration to maintain the 
continuity of the collaborative group and the flexibility to address other aspects of 
a problem or even embark on a new endeavor. 168 The personal satisfaction of 
individual members and other benefits that individual members derive from 
participating in the collaborative group are referred to as personal outcomes. 169 


163 lbid„ 6. 

164 Hood et al., “Collaboration for Social Problem-Solving,” 10. 
165 lbid„ 10-11. 

166 lbid. 

167 lbid. 

168 lbid. 

169 lbid. 


58 



e. Implementation 

Partner organizations will have already completed substantial joint 
activity by the time they come to the point of implementation of a strategic plan 
under this model. Decisions related to collaborative structure and communication 
flow will have already been addressed, and a shared strategy for problem solving 
will have been established. 

During implementation, areas of disagreement highlighted early on 
in the collaborative process may return to the forefront. As these areas of 
disagreement and differences return, operational realities will set in. 170 
Implementation may also require the efforts of parties who were not present for 
the discussions that established the collaborative group’s processes initially. As 
individual partner organizations begin to work towards the collaborative goals, 
inevitably there will be a need to change policies, reallocate resources, or 
organize new ones. 171 Relationships will shift as implementation unfolds, 
resulting in changing power and control issues. Successful collaboration requires 
that individual partner organizations continue to monitor and evaluate the 
collaborative group’s processes in order to address implementation challenges. 

B. ASSESSMENT OF THE PROCESS-CENTRIC OUTCOMES BASED 

APPROACH 

This section assesses the process-centric collaborative model against the 
selected policy options criteria. 

1. Ability to Meet Federal Strategic Planning Requirements 

The GAO has identified a number of gaps within public health emergency 
preparedness that a process-centric collaborative strategic management 
framework could address, including role and responsibility clarification and 
information sharing related to federal agency roles/responsibilities with state and 


17 0waddell and Brown, Fostering Intersectoral Partnering, 17. 
171 Ibid. 


59 



local government agencies. 172 In order to be successful, this approach requires 
partner agencies to move towards decentralized authority in order to facilitate 
decision-making. Implementation of strategic goals is likely to improve when 
partner agencies have the discretion to employ both formal and informal 
procedures while participating in collaborative strategic planning. 

a. Assessment Against PPD-8 

The process-centric based approach is very likely to meet the 
standards for whole community planning. Whole community planning seeks to 
understand and meet the true needs of the entire community and to strengthen 
the assets, institutions, and social processes that work well in communities on a 
daily basis in order to improve resilience and emergency management outcomes. 
The process-centric approach provides an opportunity for individual partner 
organizations to identify existing systems and response mechanisms and to 
assess their strengths and weaknesses under the negotiations stage. During the 
commitment stage partner organizations determine how the collaborative group 
will operate, providing an opportunity for the collaborative group to consider how 
their collaborative actions can strengthen and improve the current assets, 
institutions, and social processes at the federal level. 

Improved interagency relationships are the main outcome of the 
process-centric model. Sharing improved decision-making and communication 
processes with state and local level government will help inform planning efforts 
at all government levels. Focusing on the processes that federal agencies will 
engage in as public health emergency preparedness planning moves forward will 
complement state and local planning well. While federal level planning may focus 
on specific areas of bioterrorism that state and local level governments are less 
focused on, knowing the processes by which decisions and response actions will 


172 Government Accountability Office, “Strengthening Preparedness for Large Scale Public 
Health Emergencies.” http://www.qao.qov/hiqhrisk/risks/national-challenqes-public-health/ . 


60 




be made is likely to be more beneficial to state and local governments than 
specific federal interagency plans based on the National Planning Scenarios. 

Because the process-centric approach focuses more on 
interagency relationships and process, it is unlikely that interagency plans will be 
developed for several years. The process-centric approach requires time for 
partner organizations to get to know each other and build trust; however, shared 
processes and procedures developed under this approach can provide the 
groundwork for further collaboration and development of an interagency plan. 

b. Assessment Against the Public Health Preparedness 
Capabilities and the Healthcare Preparedness 
Capabilities 

The process-centric approach is well suited to support healthcare 
coalition development. Again, healthcare coalitions are tasked with enhancing 
public health emergency preparedness functions including, identifying and 
prioritizing essential healthcare assets and services, determining gaps in the 
healthcare preparedness and identifying resources for mitigation of these gaps, 
and engaging with community organizations to foster public health, medical, and 
mental/behavioral health social networks. 173 Through the development of 
collaborative decision-making processes, partner organizations will be able to 
work towards achieving the functions under this capability and then work towards 
development of a strategic plan. 

Community partnerships that support public health preparedness 
are more likely to be fostered by the process-centric approach than the plan¬ 
centric approach. The creation and implementation of strategies for ongoing 
engagement with community partners is more likely to occur through the 
development of processes related to how partner agencies collaborate. This 
approach is more flexible than the plan-centric approach because it allows the 
collaborative group to develop processes that leverage each individual partner 


173 Healthcare Preparedness Capabilities, 5-7. 

61 



organization’s strengths and share perspectives in order to leverage individual 
partner organizations differences. By exploring assumptions and differences, the 
collaborative group will be better able to develop strategies to mitigate identified 
public health threats or incidents. 

2. Political Acceptability 

The process-centric approach is less likely than the plan-centric approach 
to lead to a completed strategic plan within a set time because it focuses on the 
development of interagency relationships and processes for interaction. While a 
strategic plan may not be forthcoming for some time, other deliverables such as 
procedures for interaction among agencies can be expected. Congress may not 
be amenable to the slow nature of the process-centric approach, and may find it 
difficult to accept processes as outcomes given that the congressional oversight 
mechanism is issue-based. The process-centric approach is more decentralized 
than the plan-centric approach, and therefore more in line with congressional 
oversight of homeland security and public health emergency preparedness. Still, 
the lack of a concrete deliverable keeps political acceptability for Congress low. 

Federal agencies may also find it difficult to accept the process-centric 
approach because of the lack of formality in producing a strategic plan. At the 
same time, the process-centric approach mirrors the table-top exercise in some 
ways so federal agencies are familiar with gathering together to talk through how 
they would interact and respond to public health emergencies. Adopting the 
process-centric approach would mean adapting the table-top model to focus on 
planning as opposed to response. While this may be a “new” approach, it should 
be acceptable to the federal agencies engaged in public health emergency 
preparedness. However, federal agencies will be less inclined to adopt this 
model if congressional support is unavailable. Congressional support may be 
possible given that the GAO has recommended that DHS and HHS conduct 
training and exercises to ensure that federal leadership roles are clearly defined 


62 



and understood, 174 and this model supports the development of a clearer 
understanding of federal agencies’ roles in public health emergencies. 

3. Effectiveness 

One of the main strengths of the process-centric approach is that it helps 
improve links between agencies and leads to shared understanding of roles and 
responsibility among the collaborative group. The development of a strategic plan 
will occur, but it may take years to develop as the individual partner organizations 
learn to work together effectively. The process-centric approach is more likely to 
enable both the collaborative group and the individual partner agencies to 
manage public health emergency planning in a strategic manner on an ongoing 
basis because it allows for the collaborative group to renegotiate following the 
execution of agreed upon commitments and cycle through the model again. The 
monitoring and evaluation processes also allow corrective actions to be 
implemented more easily than the plan-centric approach when necessary. 

Through the development of the collaborative group’s processes, partner 
organizations determine strategy content and work towards a strategic plan. 
Implementation of the strategic plan is more likely to be successful under the 
process-centric approach because by the time the collaborative group is ready to 
implement a strategic plan they will have worked together as a joint entity for a 
while. Successful implementation may require processes to be modified and 
additional partners added, but the strong foundational basis built by the 
collaborative group will allow the group to navigate through challenges and 
operational realities. 

As mentioned above, the development of an interagency plan is one long¬ 
term outcome of this plan as required under the National Planning System. At 
this time, the proposed National Planning System seeks to develop interagency 
plans that individual agencies will use as the basis for individual agency plans to 
support the interagency plan. Implementing the process-centric model will 

174 l_ister, Public Health and Medical Emergency Management, 3. 


63 



eventually lead to the fulfillment of the National Planning System as currently in 
place, but it may not achieve interagency and agency plans in a timely manner. 
However, because the process-centric approach focuses on interagency 
relationships and interactions, it seems likely that interagency and agency plans 
produced using this approach would be more likely to be realistic and achievable. 

4. Externalities 

The process-centric approach is well suited to meet the needs of whole 
community planning given its focus on the interrelationships among entities. 
Because the near-term focus is on the development of processes for interaction 
and decision-making, the initial outcomes of this approach are much less 
sensitive than federal level strategic plans. Therefore, it is much more likely that 
such outcomes will be shared at the state and local health department level. 
Improved knowledge at the state and local level of federal agency roles and 
responsibilities and processes for interaction will help inform state and local 
health department planning assumptions and objectives for all public health 
emergencies, not just those identified in the National Planning Scenarios. 

The expectation is the same at the healthcare coalition level. ASPR and 
state and local health departments will be in a position to share outcomes 
gleaned from a process-centric approach at the federal level with healthcare 
infrastructure comprising state and/or local healthcare coalitions. The shared 
outcomes related to how federal agencies will interact during public health 
emergencies will directly inform healthcare coalition planning efforts and 
ultimately lead to improved intergovernmental and private sector plans for 
responding to various public health emergency scenarios. 


64 



VI. HYBRID APPROACH 


This chapter describes the last policy option for improved collaborative 
strategic management at the federal level. First, a brief overview of the hybrid 
approach is given, and then each of the steps in the model is described. Second, 
the hybrid policy option is assessed against the policy options criteria outlined in 
the methodology. 

A. OVERVIEW OF THE MODEL 

1. Background 

The hybrid model combines components of both the process-centric and 
plan-centric models. It also expands on these models by providing a mechanism 
for emergent strategy to be incorporated by both the collaborative group and the 
individual partner organizations. Allowing emergent strategy to be incorporated 
into the system provides an opportunity for continuous collaborative planning 
improvements. 

This model incorporates implementation at a dual level by expanding 
outcomes of interest and incorporating feedback loops. 175 It focuses on the 
collaborative strategic plan and the processes that allow the collaboration to exist 
and operate. The hybrid approach provides a mechanism for incorporating 
feedback at both the individual partner organization and collaborative group 
levels, particularly the incorporation of organizational learning outcomes. It is 
comprehensive and better allows for integrated collaborative strategic plan 
formation and implementation processes. 

2. Overview and Description 

This thesis uses the collaborative strategic management model proposed 
by Clarke and Fuller as its hybrid approach model. The Clarke and Fuller model 
proposes an approach based on the identification of a strategic plan, as well as, 

175 Clarke and Fuller, “Collaborative Strategic Management,” 88. 


65 



processes for implementation that focus on the individual organization and the 
collaboration as a whole. This model builds off the process-centric model. 
Figure 3 depicts the hybrid approach, and then each component is briefly 
described. 



Figure 3. Hybrid Model (After Clarke & Fuller (2010)) 


a. Partnership Formation 

The first phase of the model is determining the context and 
formation of the collaborative group. The context includes the environmental and 
organizational factors related to the problems being considered by the 
collaborative group. Collaborative entity engagement and the designation of a 
lead organization partner, if deemed necessary to meet the goals of the 
collaboration, takes place during this phase. During this phase, processes related 
to the orchestration of the collaborative group are determined. 

b. Collaborative Strategic Plan Formation 

The second phase is the formulation of a collaborative strategic 
plan. During this phase, the partner organizations work together and develop a 
common vision or strategy for combating the problem at hand. The collaborative 


66 









vision, mission, and/or values are translated into collaborative objectives. 176 
Generally, contentious or controversial areas are not included in the collaborative 
document. 177 


c. Deliberate and Emergent Strategy Implementation 

The next two phases involve the implementation of the 
collaborative strategic plan. They incorporate the deliberate and emergent 
actions that occur at both the collaborative group level and at the individual 
partner organization level due to plan implementation. These phases occur 
simultaneously. 

At the collaborative group level, implementation actions relate to 
the broad objectives of the collaborative strategic plan and are pan- 
organizational. 178 The objectives may involve collaboration with either 
participating or non-participating organizations and may focus on environment 
specific areas such as the economic, legal or political, or regulatory matters. 179 

Implementation at the individual partner organization level is more 
narrow and organization specific. Actions here are specific to the capability of the 
individual partner organization and ongoing monitoring and evaluation take place 
here. Corrective actions within individual partner organizations are made as 
necessary to reach the goals of the collaborative group. 

d. Realized Collaborative Strategy Implementation 
Outcomes 

The last phase of the hybrid model is the achievement of 
collaborative strategy implementation outcomes at both the collaborative level 
and the individual partner organization level. Because this model is fluid, any 
number of outcomes is possible depending on how the collaborative group 

176 Clarke and Fuller, “Collaborative Strategic Management,” 88. 

177 Huxham and Macdonald, “Introducing Collaborative Advantage” 52. 

178 Clarke and Fuller, “Collaborative Strategic Management,” 90. 

179 lbid. 


67 



proceeds. Plan-centric and process-centric outcomes are both possible, including 
strategy-setting and concrete solutions to problems or enhanced linkages and 
understanding among partner agencies and the development of a collaborative 
process. Additionally, outcomes related to changes in organizational behavior or 
individual partner organizations are possible. 180 Change in the inter- 
organizational relationships between the collaborative group and non¬ 
participating organizations is another potential outcome of applying this model. 181 

Emergent milestones are possible under the hybrid model as 
outcomes. Emergent outcomes are unplanned and develop as a result of 
engaging in the collaborative process. They are expressed as substantive or 
process achievements, and occur at both the collaborative level and the 
individual partner organization level. 

e. Feedback Loops 

The hybrid model incorporates feedback loops throughout each 
step. The feedback loops allow for continuous readjustment to the collaborative 
process, a necessary feature especially when dealing with complex problems 
and environments. For example, each phase of the collaboration is affected by 
changes within the domain of the problem, which are outside of the control of the 
individual partner organizations or the collaborative group as a whole. 
Additionally, not all organizations involved in the problem domain are likely to be 
part of the collaborative group, so the feedback loops allow for making changes 
in the overall collaborative strategy as needed. 182 The model also allows for 
corrective actions, overlapping activities, and cyclical decision-making through 
the series of feedback loops attached to the “Changes in the Domain” box. 


180 lbid. at 90-91. 
181 Ibid. 

182 lbid. at 91. 


68 



B. ASSESSMENT OF THE HYBRID APPROACH 


This section assesses the hybrid approach against the selected policy 
options criteria. 

1. Ability to Meet Federal Strategic Planning Requirements 

The hybrid approach combines elements from both the plan-centric and 
process-centric models by focusing both on the development of a strategic plan 
and the inclusion of strategic processes for meeting collaborative goals. This 
approach requires a larger time commitment from agencies, but it also provides 
external partners with a planning document and improved understanding of roles 
and responsibilities, as well as, operational response processes. 

a. Assessment Against PPD-8 

Like the process-centric approach, the hybrid model includes a 
mechanism that supports whole community planning. The dual implementation 
phases provide an opportunity for the needs, strengths, and weaknesses of the 
whole community to be addressed both by the collaborative group and by the 
individual partner organizations. As community needs change, the changes can 
be incorporated into the collaborative group’s strategy formation and 
implementation via the model’s feedback loops. 

Implementation of the hybrid model has the potential to lead to 
vertical integration with state and local level planning. The incorporation of 
feedback loops creates fluidity in the model, and a number of outcomes are 
possible, including the development of emergent strategy and milestones 
relevant to state and local level planning. As with the process-centric approach, 
emergent strategy related to how federal agencies interact with each other is 
especially of interest to state and local level planning. Additionally, this model 
provides for ongoing modification of strategy content and implementation based 
on changes to planning assumptions. 


69 



The hybrid model will lead to the development of an interagency 
plan, and the interagency plan can serve as the basis for individual agency 
operational plans. The development of a collaborative plan is an early step under 
this approach, and the model provides for both ongoing improvements and 
changes to the collaborative plan through the feedback loops. 

b. Assessment Against the Public Health Preparedness 
Capabilities and the Healthcare Preparedness 
Capabilities 

The achievement of a strong healthcare coalition is possible under 
this model. The Public Health Preparedness Capabilities and Healthcare 
Preparedness Capabilities documents provide a strong foundational basis for the 
development of a collaborative strategic plan. As the healthcare coalition moves 
forward with plan implementation, corrective actions and changes within the 
planning environment can be incorporated and the overall collaborative plan 
modified as needed. Under this model, a mechanism exists for individual partner 
organizations to work with non-participating partners in order to achieve the 
collaborative group’s goals. This may be particularly desirable given the large 
number of healthcare infrastructure entities that need to be included in public 
health and healthcare emergency preparedness. Individual partner organizations 
are easily added and subtracted under this model. 

The hybrid model is also well suited to foster community 
partnerships that support public health and healthcare preparedness for the 
same reasons that it is well suited to the development of a strong healthcare 
coalition. The fluidity built in to the model supports modification of strategy 
development and implementation as needed. Partners can be formally added to 
the group or can participate more informally through interaction with individual 
partner organizations that provide feedback to the collaborative group. The ability 
to include partners on a more informal basis allows for easier participation by 
non-healthcare organizations such as faith-based and human service 
organizations that do not necessarily provide direct medical services. 


70 



2. Political Acceptability 

The hybrid model is expected to be politically acceptable to both Congress 
and federal agencies because it combines aspects of both the plan-centric and 
process-centric approaches. This approach will lead to development of 
interagency and individual agency plans and improved decision-making 
processes at the federal level. Issue-based collaborative and individual agency 
plans will be acceptable to Congress. The hybrid approach is more holistic than 
the other policy options because it allows for both centralization at the 
collaborative level and decentralization at the individual agency level, which is 
also attractive to Congress and the congressional committees that oversee and 
evaluate strategic planning for public health emergency and homeland security 
issues. 

The hybrid approach requires a large commitment of time and effort by the 
individual agencies engaged in the collaboration. This could potentially be a 
drawback for the federal agencies; however, strong congressional support for 
this approach would overcome any reservations held by the federal agencies. 
Still, implementation of this approach may require a formal change in the federal 
strategic planning process by Congress. 

3. Effectiveness 

The hybrid model contains mechanisms for managing organizations in a 
strategic manner on an ongoing basis due to the feedback loops that provide for 
continuous readjustment to the collaborative process and strategy development 
both within the collaborative group and the individual partner organizations. A 
collaborative plan is developed early on in the process, but strategy content is 
constantly modified through the implementation actions both by the collaborative 
group and in the individual partner organizations. This provides an opportunity for 
the collaborative group to discuss what it wants to achieve while also 
implementing the collaborative strategic plan. Furthermore, changes in the 
environment of the problem domain are also considered under the hybrid model 


71 



and additional feedback loops allow for strategy content to be modified based on 
those changes as well. Implementation at both the collaborative level and the 
individual partner organization level are considered and strategy can be modified 
once operational realities rise to the surface during implementation. Both 
deliberate and emergent implementation outcomes are possible under the hybrid 
approach. 

The hybrid approach supports achieving the requirements of the National 
Planning System. The collaborative group develops an interagency strategic plan 
early on in the process. During the implementation phase, the individual partner 
organizations work towards achieving the goals of the interagency plan. At this 
stage, the individual organizations can produce their own individual operational 
plans to support the interagency strategic plan. As the individual operational 
plans are developed, both deliberate and emergent strategy can be included. 

4. Externalities 

Similar to the process-centric approach, the hybrid approach focuses on 
the interrelationships of individual partner agencies, which will be extremely 
beneficial to state and local health departments and healthcare coalitions as they 
further develop their plans for public health emergencies. The hybrid approach’s 
feedback loops provide for continuous quality improvement at the federal level, 
which should improve planning efforts at all levels of government and within the 
healthcare sector, as long as, federal improvements/changes are shared 
continuously with state and local health departments and healthcare coalitions. 
The hybrid approach allows externalities to benefit from continuous 
improvements to processes and both the collaborative entity’s strategic plan, as 
well as, the individual partner organizations’ plans. 


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VII. COMPARATIVE ANALYSIS OF THE THREE POLICY 

APPROACHES 


The preceding chapters have examined three collaborative strategic 
management frameworks that may be applied to public health emergency and 
homeland security planning and have weighed them against four policy options 
criteria: ability to meet federal strategic planning requirements, political 
acceptability, effectiveness, and externalities. This chapter provides a short 
comparative analysis of the three policy approaches. The succeeding sections 
provide a tabular summary of the findings. The policy options were weighed 
against each other and given an overall ranking of GOOD, BETTER, or BEST. 

A. ABILITY TO MEET FEDERAL STRATEGIC PLANNING 

REQUIREMENTS 

Each policy option was evaluated for its ability to meet federal strategic 
planning requirements based on requirements under PPD-8 and the Public 
Health Preparedness Capabilities and the Healthcare Preparedness Capabilities. 
This section compares the three collaborative strategic management policy 
options based on the findings. 

1. Ability to Meet Federal Strategic Planning Requirements Based 
on PPD-8 

The policy options were assessed for their ability to meet the goals under 
PPD-8. Specifically each policy options was assessed for its ability to achieve 
whole community planning, complement state and local planning, and contribute 
to an interagency operational plan. The findings based on PPD-8 are 
summarized in Table 5. 


73 



Table 5. Criterion la. Ability to Meet Federal Strategic Planning Requirements 

Based on PPD-8 


Policy 

Approach 

Ability to Meet Federal Strategic Planning Requirements 

PPD-8 

Overall 

Whole 

community 

planning 

Ability to 
complement 
state and local 
level planning 

Interagency 

Plan 

Developed 


Plan-Centric 

Limited 

No 

Yes 

GOOD 

Process- 

Centric 

Yes 

Yes 

Yes, but not 
immediately 

BETTER 

Hybrid 

Yes 

Yes 

Yes, ongoing 

BEST 


Based on ability to achieve the goals of PPD-8, the plan-centric approach 
was ranked good, the process-centric approach was ranked better, and the 
hybrid approach was ranked best. The plan-centric approach was found to have 
only a limited ability to address whole community planning and the true needs of 
collaborative partners. The plan-centric approach also does not complement 
state and local planning as well as the other two approaches. Both the process¬ 
centric and hybrid approaches are better suited to meeting whole community 
planning because they provide for the development of inter-organizational 
processes. The hybrid approach was ranked higher than the process-centric 
approach because it is better suited to achieve the development of an 
interagency plan. 

2. Ability to Meet Federal Strategic Planning Requirements Based 
on the CDC/ASPR Capabilities 

The three policy options were also evaluated for their ability to support the 
development of healthcare coalitions and to foster community partnerships under 
Capability 1 of the Public Health Preparedness Capabilities and the Healthcare 
Preparedness Capabilities. The findings based on the CDC/ASPR Capabilities 
are summarized in Table 6. 


74 




Table 6. Criterion 1 b. Ability to Meet Federal Strategic Planning Requirements 

Based on the CDC/ASPR Capabilities 


Policy 

Approach 

Ability to Meet Federal Strategic Planning Requirements 

CDC/ASPR Capabilities 

Supports 
development of 
healthcare coalition 

Fosters community 
partnerships to support public 
health preparedness 

Overall 

Plan-Centric 

Yes 

No 

GOOD 

Process- 

Centric 

Yes 

Yes 

BETTER 

Hybrid 

Yes 

Yes, partners easily 
added/subtracted; lots of 
fluidity 

BEST 


The plan-centric approach was ranked as good, the process-centric 
approach was ranked as better, and the hybrid approach was ranked as best 
based on Criterion 1b. The plan-centric approach was found to be the least likely 
to foster community partnerships because it does not provide a mechanism for 
partner organizations to discuss and develop interrelationships except through 
strategic plan development. The hybrid approach was ranked over the process¬ 
centric approach because it allows partners to be easily added and subtracted as 
needed due to its fluidity. 

B. POLITICAL ACCEPTABILITY 

Each of the policy options was measured for its political acceptability to 
Congress and the DHS and DHHS agencies. This section summarizes the 
findings as shown in Table 7. 

Table 7. Criterion 2. Political Acceptability 


Policy 

Approach 

Political Acceptability 

Congress 

DHHS agencies 

DHS agencies 

Overall 

Plan- 

Centric 

High 

High 

High 

BEST 

Process- 

Centric 

Medium-High 

Medium-High 

Medium-High 

GOOD 

Hybrid 

High 

Medium-High 

Medium-High 

BETTER 


75 





Based on Criterion 2, the plan-centric approach was ranked as best, the 
process-centric approach was ranked as good, and the hybrid approach was 
ranked as better. The plan-centric approach was ranked best because it is the 
current strategic planning approach and political acceptability is known to be high 
for this approach. The process-centric approach was ranked lowest because 
Congressional support for this approach is expected to be lower than the other 
approaches as strategic plan development is not guaranteed and may take a 
long time to achieve. The hybrid approach was ranked above the process-centric 
approach because a plan will be one outcome of this approach, and 
congressional support is expected to be high. Federal agency support is likely to 
be based in part on congressional support, but both the process-centric and 
hybrid approaches require a larger time commitment of agencies. 

C. EFFECTIVENESS 

The third criterion that the policy options were evaluated against was 
effectiveness. Each policy option was assessed for its ability to allow 
collaborative groups to continue to manage themselves in a strategic manner on 
an on-going basis and for their ability to meet the requirements of the National 
Planning System. The summary findings for this criterion are presented in 
Table 8. 


Table 8. Criterion 3. Effectiveness 


Policy 

Approach 

Effectiveness 

Ability to manage in a 
strategic manner on an 
on-going basis 

Meets National Planning 
System Requirements 

Overall 

Plan-Centric 

Medium 

Medium 

GOOD 

Process- 

Centric 

High 

Low 

BETTER 

Hybrid 

High 

High 

BEST 


Based on Criterion 3, the plan-centric approach was ranked as good, the 

process-centric approach was ranked as better, and the hybrid approach was 

ranked as best. The plan-centric approach has a limited ability to allow federal 

76 




agencies to manage both their individual agencies and the collaborative group in 
a strategic manner on an on-going basis because the focus is on plan 
development and not interrelationships. The plan-centric approach incorporates 
feedback on a limited basis. Additionally, it is unclear whether the specificity 
required under the National Planning System is achievable. 

Under both the process-centric approach and hybrid approach, federal 
agencies are highly likely to manage public health emergency planning in a 
strategic manner on an ongoing basis because of set feedback mechanisms that 
allow for renegotiation of commitments and interactions. The hybrid approach 
was ranked higher than the process-centric approach because formation of a 
plan is an expected outcome of the hybrid approach but is not necessarily an 
outcome under the process-centric approach. Therefore, the hybrid approach is 
better suited to meet the goals of the National Planning System than the process¬ 
centric approach. 

D. EXTERNALITIES 

Externalities was the last criterion that each policy options was assessed 
against. The ability of the collaborative strategic management framework to 
provide for second order effects on other levels of government and the private 
sector was considered. The summary of findings is presented in Table 9. 

Table 9. Criterion 4. Externalities 


Policy 

Approach 

Externalities 

State/Local Health 
Department 

Healthcare 

Infrastructure 

Overall 

Plan-Centric 

Low 

Low 

GOOD 

Process- 

Centric 

High 

High 

BETTER 

Hybrid 

High 

High 

BEST 


Based on Criterion 4, the plan-centric approach was ranked as good, the 
process-centric approach was ranked as better, and the hybrid approach was 
ranked as best. The plan-centric approach was ranked lowest because it was 

77 




determined that second order effects on externalities such as state and local 
health departments and healthcare infrastructure was low. Due to the sensitive 
nature of federal strategic plans based on the National Planning Scenarios, it is 
unlikely that the plans would be shared with agencies outside of those on the 
planning team. It is also unlikely that state and local health departments or 
healthcare infrastructure would be part of the collaborative planning team. 
Therefore, it is unlikely that agencies outside of the collaborative planning team 
would be influenced by this approach formally. 

The hybrid approach was ranked over the process-centric approach 
because the second order effects of the hybrid approach over the process-centric 
approach are expected to be higher. The hybrid approach provides for updates 
to individual partner organizations’ plans along with the collaborative entity’s 
plan, thereby providing externalities, such as state and local health departments 
and healthcare infrastructure, to benefit from the feedback mechanisms on a 
number of levels. 

E. SUMMARY ANALYSIS MATRIX 

A tabular summary analysis matrix of the three policy options is presented 

below. 


78 



Table 10. Summary Analysis Matrix of the Three Policy Options 


Policy 

Option 

Criterion 

la. 

Criterion 

1b. 

Criterion 2 

Criterion 3 

Criterion 4 


Plan¬ 

centric 

GOOD 

GOOD 

BEST 

GOOD 

GOOD 

Process¬ 

centric 

BETTER 

BETTER 

GOOD 

BETTER 

BETTER 

Hybrid 

BEST 

BEST 

BETTER 

BEST 

BEST 


Based on the rankings, the hybrid approach is the best of the three 
collaborative strategic management policy options for improving strategic 
planning among the federal public health agencies. The next chapter discusses 
challenges related to implementation of collaborative strategic management 
frameworks. 


79 




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80 



VIII. IMPLEMENTATION OF COLLABORATIVE STRATEGIC 
MANAGEMENT FRAMEWORKS 


Without exception, they knew what they had to do; their difficulties 
lay in how to achieve the necessary changes. 183 

A. COLLABORATIVE STRATEGIC MANAGEMENT FRAMEWORKS AS 

DISRUPTIVE TECHNOLOGY 

Collaborative strategic management frameworks represent innovative, 
disruptive technology that can be applied to planning within the public health 
emergency preparedness arena. Collaborative strategic management 
frameworks are a tool that, if implemented correctly, will improve interagency 
planning for public health emergencies. In order for such frameworks to be fully 
adopted and valued, two issues must be overcome at the individual partner 
organization level. 

The first hurdle to overcome is one related to the “pace of progress” in 
planning for public health emergencies at the federal level. While planning for 
public health emergencies is a part of many federal agencies’ overall mission and 
interagency planning is a federal requirement, federal agencies generally plan in 
relative isolation. Participation in collaborative strategic management requires 
federal agencies to interact with one another in a fluid environment. Engagement 
in a collaborative strategic management process may produce results that do not 
appear useful or necessary in the moment, but that become useful or necessary 
in the future. 184 Such innovations will be in direct contrast to traditional strategic 
planning at the federal level. Thus, participation in a collaborative strategic 


183 C.A. Bartlett and S. Ghosal, “Managing Across Borders: New Strategic Requirements,” 
Sloan Management Review 28.2 (1987): 7-17, 12. 

184 C.M. Christensen, The Innovator’s Dilemma: When New Technologies Cause Great 
Firms to Fail, 226, West Sussex, England: John Wiley & Sons Ltd, 1997, Kindle edition. 
According to Christensen, if entities do not realize that they need something, they will not ask for 
it. In this case, federal agencies may not realize that they need a certain level of interaction that 
participation in a collaborative strategic management framework will provide. 


81 



management process may affect agencies perceived “pace of progress” in 
developing strategic plans for public health emergencies. 

Second, in order for the implementation of collaborative strategic 
management frameworks to be successful, they must be politically attractive. 
Political buy-in at the federal agency head level and congressional level is 
necessary in order to prioritize interagency strategic planning for public health 
emergencies. Crosscutting issues, such as those related to public health 
emergencies and homeland security, are difficult to plan for strategically at the 
federal level because of mission fragmentation and overlap across federal 
agencies. At the federal level, prioritization of interagency collaboration and 
coordination with regard to public health emergency preparedness planning 
continues to be lacking even though public health emergency preparedness and 
homeland security have created a new market for federal strategic planning. As 
discussed previously, collaborative strategic management frameworks can help 
clarify roles and reduce overlap among federal agencies, which should make 
them politically attractive, but until interagency planning is prioritized by agencies 
themselves, agencies will be unlikely to dedicate the necessary resources and 
authority to participate in collaborative strategic management effectively. 185 

One approach to overcoming the above outlined hurdles is to think of the 
adoption of collaborative strategic management as a marketing challenge. The 
public health emergency preparedness arena is unstable and strategic planning 
and action must be flexible. Collaborative strategic management frameworks 
provide such flexibility, and successful marketing of collaborative strategic 
management frameworks relies on an evolving value network regarding federal 
level strategic planning. 

Furthermore, while each federal agency has specialized capabilities that it 
can leverage, public health emergencies create the need for a new, integrated 
approach to address the disruption caused by such emergencies. Collaborative 
strategic management is a social technology that can help shape the public 

185 Christensen, The Innovator’s Dilemma, 226-227. 


82 



health emergency preparedness planning and response environment. 
Furthermore, collaborative strategic management allows for strategy and 
strategic planning to evolve as the emergency preparedness environment 
evolves. The evolutionary aspect of collaborative strategic management is in 
direct contrast to the current approach to strategic planning at the federal level 
that is militaristic and focused on formal strategy versus emergent strategy. 

Implementation of strategic plans is also a challenge as discussed in the 
next section. 

B. THE IMPLEMENTATION CHALLENGE 

Once strategic plans have been developed, the real challenge may lie in 
implementation. Public agencies in particular vary in how purposeful and 
effective they are in executing strategy, how they go about implementing 
initiatives, and the extent to which their strategies are fully implemented. 186 One 
reason implementation remains such a challenge is that managers and 
executives try to implement strategies without accounting for all of the factors 
that need to be considered, including environmental uncertainty, organizational 
structure, organizational culture, operational planning, and resource allocation. 187 

Because the environment in which organizations function is constantly 
changing, strategic planning must consider how changes in the external 
environment might affect strategic stance, as well as, implementation of strategy. 
Additionally, the current organizational structure of partner agencies and potential 
changes in organizational structure will influence implementation at the 
collaborative level. Organizational culture will affect the implementation of 
strategic plans, and the implementation of a strategy may even seek to change 
an organization’s culture. Moreover, implementing strategy requires operational 
planning for implementation activities and the allocation of resources needed 
elsewhere in the organization. These are the same environmental and 

186 Poister et al., “Strategic Management Research in the Public Sector” 527. 

187 F . Okumus, “A Framework to Implement Strategies in Organizations,” Management 
Decision 41.9 (2003): 871-882, 875. 


83 



organizational factors that affect the type of collaborative relationship that 
organizations choose to enter into. 188 

The overall success of strategic planning depends on the ability of both 
the collaborative group and individual partner organizations to implement the 
collaborative strategy. 189 Strategic plans need to be specific and flexible at the 
same time, especially in unstable environments. 190 If the collaborative group and 
individual partner organizations are prepared to rework and amend plans 
incrementally as implementation proceeds, success is more likely. 191 Strategy 
implementation under the three policy options is explored in the next section. 

C. STRATEGY IMPLEMENTATION UNDER THE THREE POLICY 

APPROACHES 

This section discusses specific strategy implementation challenges posed 
by each of the three policy options. 

1. Plan-Centric Approach 

The plan-centric approach is similar to van der Heijden’s rationalist 
paradigm. The rationalist approach works well when problems are well defined 
and the environment behaves in predictable ways. 192 It separates thought and 
action, and implementation follows formulation of strategy. 193 The plan-centric 
model focuses on planning for problems identified in a threat or risk assessment, 
often based on probable frequency of occurrence. 194 The current plan-centric 
approach is militaristic in that it focuses on agency mission as referenced 

133 See Chapter II, Section C.2.a. supra. 

139 p 0 ister et al., “Strategic Management Research in the Public Sector,” 537. 

190 P. J. Brews and M. R. Hunt, “Learning to Plan and Planning to Learn: Resolving the 
Planning school/learning School Debate,” Strategic Management Journal 20.10 (1999): 889-913, 
906. 

191 Ibid. 

192 K . van der Heijden, Scenarios: The Art of Strategic Conversation, 23, 2nd ed., West 
Sussex, England: John Wiley & Sons Ltd., 2005, Kindle edition. 

193 lbid„ 21. 

194 Federal Emergency Management Agency, Comprehensive Preparedness Guide (CPG) 
101, Version 2.0. , 4-7 - 4-10. 


84 



throughout both the National Preparedness Goal and FEMA’s Comprehensive 
Preparedness Guide. Homeland security is a mission area. 195 

The rationalist paradigm derives objectives from the mission first and 
strategies to support the objectives second. 196 Then, the various strategic 
options are weighed and the best option selected. 197 This mirrors the plan¬ 
centric model and the development of goals and objectives to support the 
mission in Step 3. 198 The plan-centric model also requires the collaborative 
planning team to select “preferred” courses of action. 199 But, the rationalist/plan¬ 
centric approach is flawed because it assumes that there is a “best” solution or 
strategy. It also presupposes that all individual partners will arrive at the same 
conclusion regarding what the best strategy or solution is to a planning dilemma, 
and implementation follows formulation of the strategic plan. 

Rationality and van der Heijden’s rationalist approach can only be 
successful when problems are clear and predictable and all partners behave in a 
predictable manner. 200 The public health emergency preparedness and 
homeland security environments are full of uncertainty and unpredictability. 
Therefore, the plan-centric approach is ill suited to address the whole picture in 
collaborative strategic management of public health emergency preparedness. 

2. Process-Centric Approach 

The process-centric approach contains elements of van der Heijden’s 
evolutionary paradigm. The evolutionary paradigm believes that strategy is a 
process of random experimentation and emerges over time. This approach 


195 lbi<±, lntro-1. 

196 van der Heijden, Scenarios, 24. 

197 lbid. 

198 Federal Emergency Management Agency, Comprehensive Preparedness Guide (CPG) 
101, Version 2.0. ,4-12. 

1 "ibid, 4-14. 

200 va n der Heijden, Scenarios, 30. 


85 



contains elements of complexity theory and believes that overall system behavior 
is emergent. 201 There is no forecasting power under this paradigm. 

The process-centric approach to collaborative strategic management 
focuses on agreement and consensus-seeking behavior that emerge and 
develop over time. Formal, informal, and cultural processes help transform 
collaborative resources into things of greater value. 202 However, the process¬ 
centric approach runs the risk of creating a fragmented and intuitive strategy that 
may not become formalized. 203 Emergent strategy based on past patterns rather 
than formal strategy is very likely under a process-centric approach. 204 

3. Hybrid Approach 

The hybrid approach is in many ways similar to van der Heijden’s 
processual view of strategic management. 205 The processual view seeks to 
develop a mechanism for dealing with both long and short-term forecasts and 
looks at what is happening inside the individual partner organizations and the 
uncertainty of the planning environment. 206 It is a middle of the road approach 
focusing on long-term planning while being prepared for short-term changes in 
both the planning environment and the organizational environment of the 
individual partner organizations. The feedback loops in the hybrid approach 
policy option represent this flexibility. Like van der Heijden’s processual theory, 
the hybrid approach understands the process and tries “to find intervention points 
where influence can be exercised.” 207 


201 Ibid., 21 . 

202 Christensen, The Innovator’s Dilemma, 163. 
203 va n der Heijden, Scenarios, 32. 

204 lbid. 

205 lbid„ 35. 

206 lbid„ 36. 

207 lbid„ 35. 


86 



The processual view builds on the concept of continuous development 
and improvement much like the hybrid approach. 208 Because it utilizes a 
learning loop, the hybrid approach relies much less on forecasting than both the 
plan-centric and process-centric approaches. 209 Through its series of feedback 
loops, the hybrid approach attempts to make adjustments “such that a 
predetermined preferred condition can be maintained, but also modifies its 
preferred condition in line with the fit of the environment.” 210 Collaborative 
strategic management frameworks are much more likely to be successful if they 
“adopt the idea of the learning loop and build up related capabilities for 
perception, reflection, the development of theories about the environment, and 
joint action.” 211 Success is also dependent on the individual partner 
organizations being able to reach some consensus or shared meaning through 
conversations where “strategic cognitions can be compared, challenged and 
negotiated.” 212 

Learning via a learning loop as discussed above, can only work if 
individual partner organizations participate and share in order to work towards a 
common plan and action. 213 Without consensus, collaborations do not cohere 
and ultimately the collaborative group falls apart, and collaboration requires 
starting from shared basic principles. 214 The next section examines how 
collaborative strategic management can be implemented at the federal level 
using a progressive approach. 


208 lbid„ 38. 
209 lbid„ 38. 

21 °lbid., 40. 

21 "'ibid., 41. 
212 lbid„ 43. 
213 lbid., 42. 
214 lbid„ 42-43. 


87 



D. A PROGRESSIVE APPROACH TO IMPLEMENTING COLLABORATIVE 

STRATEGIC MANAGEMENT FRAMEWORKS AT THE FEDERAL LEVEL 

It may be helpful to consider the adoption of collaborative strategic 
management at the federal level progressively. The plan-centric approach is the 
current approach to collaborative strategic management for public health 
emergency planning. Moving the federal agencies towards a more process¬ 
centric approach to interagency strategic planning and management for public 
health emergencies is an incremental change that seeks to better define how the 
federal agencies will interact and coordinate. Once processes for collaboration 
are better established, the collaborative group could move towards strategic 
planning and management that incorporates feedback at both the collaborative 
group level and the individual partner agency level while working towards an 
interagency strategic plan, thus adopting the hybrid approach to collaborative 
strategic management. 

Collaborative groups need to start with a common understanding of the 
issues and concerns that the group will address. The rational, plan-centric 
approach provides individual partner agencies with a means for framing and 
shaping the strategic planning conversation. 215 The process-centric’s focus on 
the development of relationships and processes among individual partner 
organizations allows for strategy to emerge and evolve over time. This allows for 
weeding out of bad strategies and institutionalizing of good strategies. 216 

The hybrid policy approach further ensures the institutionalization of good 
strategies through feedback loops between the collaborative group and individual 
partner organizations. Of the three policy options, it is best suited to allow for the 
alignment of ideas and mental models that are critical to triggering a strategic 
planning loop through joint action. The feedback loops provide a mechanism for 
intended strategy under the collaborative plan and emergent strategy that 


215 ibid„ 43. 
216 ibid„ 44. 


88 



evolves out of individual partner organization and collaborative entity 
implementation to align. 

Adopting a progressive approach may be more palatable at both the 
congressional and federal agency level because it would allow agencies to 
change the current strategic planning process incrementally as opposed to 
changing it in a disruptive manner. A progressive approach is also in keeping 
with traditional planning and strategy development, which allows for incremental 
change, but not disruptive change. Taking a progressive approach towards 
strategic planning management would allow federal agencies to hold on to the 
foundational planning work that they have already achieved through the plan¬ 
centric model, while opening the door for improved strategic planning and 
strategic management moving forward. 

Additionally, a progressive approach provides an opportunity for federal 
agencies to consider the allocation of personnel devoted to interagency strategic 
planning for public health emergencies. Personnel time that can be devoted to 
participation in a collaborative strategic management process is limited and 
federal agencies have many missions and priorities that they are responsible for 
beyond public health emergency planning. Participation in a poorly defined 
collaborative strategic management process will not be highly prioritized by 
federal agency leadership. However, following a progressive implementation 
approach will allow federal agencies to build trust first by focusing on shared 
principles and intended strategies using the plan-centric model. Moving next into 
a process-centric approach will allow the collaborative group to enhance 
interrelationships and collaborative processes and evolve collaborative strategy 
as necessary. Finally, moving into the hybrid model, the collaborative group can 
vet emergent strategy against intended strategy and institutionalize the 
collaborative learned strategy while incorporating changes within the planning 
environment. 


89 



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90 



IX. CONCLUSION: RECOMMENDATIONS FOR IMPLEMENTING 
THE COLLABORATIVE STRATEGIC MANAGEMENT 
FRAMEWORKS IN A PROGRESSIVE MANNER 


As discussed throughout this thesis, the current approach to collaborative 
strategic planning and management is the plan-centric approach. However, 
partner agencies and organizations already engage in some process-centric type 
activity when they participate in table-top exercises. Table-top exercises are 
designed to discuss specific scenarios in order to assess plans, policies and 
procedures, 217 but typically the partners spend the time further discussing and 
establishing interrelationships and processes for interacting with each other. A 
natural next step in moving towards a hybrid approach to collaborative strategic 
management is to better leverage the existing plan-centric strategic planning 
model and the existing table-top exercise model in order to create a hybrid 
model. This thesis concludes with recommendations for implementing 
collaborative strategic management in a progressive manner for both existing 
collaborations and for new collaborations. 

A. EXISTING COLLABORATIONS 

For existing collaborations where a strategic plan has already been 
developed, the collaboration can move towards a process-centric approach by 
meeting for a series of table-top exercise-like meetings to discuss how individual 
partner organizations will interact with one another, renegotiate commitments, 
and communicate within the collaboration. The focus of the meetings will not be 
on response activities, but on interactions among the collaborative partners. The 
meeting can then be incorporated into both the collaborative group’s plan and the 
individual partner organization’s plans. 

During the course of the table-top exercise-like meetings, collaborative 
partners should focus on negotiating what each brings to the collaboration, 

21 department of Homeland Security, “About HSEEP,” accessed January 14, 2013, 
https://hseep.dhs.gov/paqes/1001 About.aspx#TerminoloqySection1 . 


91 




including legal authority, resources, and prior planning efforts. This is also the 
time for the group to determine how the governance of the collaboration can 
encourage meaningful participation by all partners. Because there is an existing 
plan, collaborative partners can reassess how efficiently the group has worked 
together and whether the planning assumptions made earlier need revision. 
Additionally, existing forms of communication and information flow can be 
evaluated and improved as needed. 

Shared vision and strategy will emerge as the collaborative group 
discusses and formalizes processes for participation and interaction. 
Incorporating this shared vision and strategy in the collaborative strategic plan 
and within individual partner agency plans is a logical and necessary next step. 
The adoption of the hybrid approach will ensure the emergent collaborative 
strategy is institutionalized by both the collaboration and the individual partner 
agencies. 

The collaborative group can then move towards a full hybrid approach to 
collaborative strategic management by developing a mechanism for continuous 
feedback within the collaborative group and within individual partner 
organizations. Biannual collaborative meetings during which collaborative 
partners meet to discuss changes within organizations and changes within the 
planning environment could provide such a feedback mechanism. Additionally, a 
biannual meeting would allow organizations not already part of the collaborative 
group to participate. Because not all organizations that could be involved in the 
problem domain are likely to be part of the collaborative group, participation in a 
biannual meeting provides a mechanism for including new partners as needed. 
Continuous feedback related to corrective actions, overlapping activities, and 
cyclical decision-making via a biannual collaborative meeting will provide an 
opportunity for both the collaborative plan and individual partner organization 
plans to be updated. 


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B. NEW COLLABORATIONS 


New collaborations, including healthcare coalitions, should begin with a 
table-top exercise-like approach prior to the development of a collaborative 
strategic plan. Instead of focusing on response measures based on an existing 
plan, partners should discuss interagency relationships and processes during the 
table-top exercise-like meetings. The meetings will provide partner organizations 
with an opportunity to flush out group processes and interactions, such as 
expectations, governance, and mechanisms for monitoring and evaluating the 
group. Additional needed partner organizations to include may be identified 
during this phase. The collaborative group should engage in as many pre¬ 
planning meetings as needed to build trust prior to drafting an actual plan. During 
the drafting of the collaborative plan, the collaborative group should continue to 
engage in process-centric activities such as decision-making processes, 
monitoring and evaluation processes, and communication and information flow 
processes. Continuing to work on the interagency processes for interaction will 
lead to a strategic plan that is more likely to be realistic and achievable. 

The final piece for adopting a hybrid approach is to incorporate a 
continuous feedback mechanism into the collaboration after the strategic plan is 
complete. Establishing a requirement for biannual collaborative meetings 
accomplishes this goal. The biannual collaborative meeting requirement should 
be negotiated in the initial development stages of the new collaboration. As 
discussed above, these biannual collaborative meetings will provide partners with 
an opportunity to discuss and incorporate organizational and environmental 
changes into both the collaborative plan and individual partner organization plans 
to be updated as needed. The biannual collaborative meeting also allows for 
collaborative partners to be added or subtracted as needed. 

Movement towards a hybrid approach to collaborative strategic 
management will ensure that agencies involved in public health emergency and 
homeland security planning remain nimble and able to focus on long-term 
planning while being prepared for short-term changes in both the planning 


93 



environment and within partner organizations. The overall success of strategic 
planning within the public health emergency and homeland security environment 
is dependent on the ability of the collaborative entity and the partner 
organizations to implement the collaborative strategy. Providing an opportunity 
for the collaborative group and the individual organizations to rework and amend 
their plans as the environment changes and implementation proceeds, will 
increase the likelihood of success. 


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APPENDIX. FUNCTIONS ASSOCIATED WITH THE EIGHT 
SHARED PUBLIC HEALTH PREPAREDNESS CAPABILITIES AND 
HEALTHCARE PREPAREDNESS CAPABILITIES. 


Capability 1.: Community Preparedness/H 

ealthcare System Preparedness 

Public Health Preparedness Functions 

Healthcare Preparedness Functions 



Function 1: Determine risks to the health of 
the jurisdiction 

Function 1: Develop, refine, or sustain 
healthcare coalitions 

Function 2: Build community partnerships 
to support health preparedness 

Function 2: Coordinate healthcare 
planning to prepare the healthcare system 
for a disaster 

Function 3: Engage with community 
organizations to foster public health, 
medical, and mental/behavioral health 
social networks 

Function 3: Identify and prioritize essential 
healthcare assets and services 

Function 4: Coordinate training or guidance 
to ensure community engagement in 
preparedness efforts 

Function 4: Determine gaps in the 
healthcare preparedness and identify 
resources for mitigation of these gaps 


Function 5: Coordinate training to assist 
healthcare responders to develop the 
necessary skills in order to respond 


Function 6: Improve healthcare response 
capabilities through coordinated exercise 
and evaluation 


Function 7: Coordinate with planning for 
at-risk individuals and those with special 
medical needs 


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Capability 2.: Community Recovery/Healthcare System Recovery 

Public Health Preparedness Functions 

Healthcare Preparedness Functions 



Function 1: Identify and monitor public 
health, medical, and mental/behavioral 
health system recovery needs 

Function 1: Develop recovery processes 
for the healthcare delivery system 

Function 2: Coordinate community 
public health, medical, and 
mental/behavioral health system 
recovery operations 

Function 2: Assist healthcare 
organizations to implement Continuity of 
Operations (COOP) 

Function 3: Implement corrective 
actions to mitigate damages from future 
incidents 



Capability 3.: Emergency Operations Coordination 

Public Health Preparedness Functions 

Healthcare Preparedness Functions 



Function 1: Conduct preliminary 
assessment to determine need for public 
activation 

Function 1: Healthcare organization multi¬ 
agency representation and coordination 
with emergency operations 

Function 2: Activate public health 
emergency operations 

Function 2: Assess and notify stakeholders 
of healthcare delivery status 

Function 3: Develop incident response 
strategy 

Function 3: Support healthcare response 
efforts through coordination of resources 

Function 4: Manage and sustain the public 
health response 

Function 4: Demobilize and evaluate 
healthcare operations 

Function 5: Demobilize and evaluate public 
health emergency operations 



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Capability 5.: Fatality Management 

Public Health Preparedness Functions 

Healthcare Preparedness Functions 



Function 1: Determine role for public health 
in fatality management 

Function 1: Coordinate surges of deaths 
and human remains at healthcare 
organizations with community fatality 
management operations 

Function 2: Activate public health fatality 
management operations 

Function 2: Coordinate surges of 
concerned citizens with community 
agencies responsible for family assistance 

Function 3: Assist in the collection and 
dissemination of antemortem data 

Function 3: Mental/behavioral support at 
the healthcare organization level 

Function 4: Participate in survivor 
mental/behavioral health services 


Function 5: Participate in fatality 
processing and storage operations 



Capability 6.: Information Sharing 

Public Health Preparedness Functions 

Healthcare Preparedness Functions 



Function 1: Identify stakeholders to be 
incorporated into information flow 

Function 1: Provide healthcare situational 
awareness that contributes to the incident 
common operating picture 

Function 2: Identify and develop rules and 
data elements for sharing 

Function 2: Develop, refine, and sustain 
redundant, interoperable communication 
systems 

Function 3: Exchange information to 
determine a common operating picture 



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Capability 10.: Medical Surge 

Public Health Preparedness Functions 

Healthcare Preparedness Functions 



Function 1: Assess the nature and scope 
of the incident 

Function 1: The healthcare coalition 
assists with the coordination of the 
healthcare organization response during 
incidents that require medical surge 

Function 2: Support activation of medical 
surge 

Function 2: Coordinate integrated 
healthcare surge operations with pre¬ 
hospital Emergency Medical Services 
(EMS) operations 

Function 3: Support jurisdictional medical 
surge operations 

Function 3: Assist healthcare organizations 
with surge capacity and capability 

Function 4: Support demobilization of 
medical surge operations 

Function 4: Develop Crisis Standards of 
Care guidance 


Function 5: Provide assistance to 
healthcare organizations regarding 
evacuation and shelter in place 
operations 


Capability 14.: Responder Safety and Health 

Public Health Preparedness Functions 

Healthcare Preparedness Functions 



Function 1: Identify responder safety and 
health risks 

Function 1: Assist healthcare organizations 
with additional pharmaceutical protection 
for healthcare workers 

Function 2: Identify safety and personal 
protective needs 

Function 2: Provide assistance to 
healthcare organizations with access to 
additional Personal Protective Equipment 
(PPE) for healthcare workers during 
response 

Function 3: Coordinate with partners to 
facilitate risk-specific safety and health 
training 


Function 4: Monitor responder safety and 
health actions 



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Capability 15.: Volunteer Management 

Public Health Preparedness Functions 

Healthcare Preparedness Functions 



Function 1: Coordinate volunteers 

Function 1: Participate with volunteer 
planning processes to determine the need 
for volunteers in healthcare organizations 

Function 2: Notify volunteers 

Function 2: Volunteer notification for 
healthcare response needs 

Function 3: Organize, assemble, and 
dispatch volunteers 

Function 3: Organization and assignment 
of volunteers 

Function 4: Demobilize volunteers 

Function 4: Coordinate the demobilization 
of volunteers 


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100 



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INITIAL DISTRIBUTION LIST 


1. Defense Technical Information Center 
Ft. Belvoir, Virginia 

2. Dudley Knox Library 
Naval Postgraduate School 
Monterey, California 

3. Rodrigo Nieto-Gomez 
Naval Postgraduate School 
Monterey, California 

4. Ivan Zapata 

Department of Homeland Security 
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