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Chapter 4
ENSURING A MANAGEABLE STRUCTURE FOR NIH
Overall Coordination and Accountability
The complex organizational structure of NIH--with categorical
institutes and tiaciplinary study aectiona--reflecta both its mission
ant its environment. In any institution, however, organizational
arrangements Resigner to enhance communication along certain timenaiona
tent to diminish it along other timenaiona. There will always be
research arena, both basic ant applied, that crosa institute lines.
As Appendix B teacribea, NIH has been Successful in introducing a
number of coordinating mechanisms to alleviate the problem of communica-
tion across organizational bountariea.31 The disciplinary study
sections, because they cut across the categorical institutes, con-
tribute some degree of integration ant aafeguart scientific quality.
Other means of coordination include the program planning and budgetary
processes; trana-NIH ant other coordinating committees; weekly, biweekly,
or monthly meetings of officers from the bureaus, institutes, divisions,
and the Director'a office with common interests ant reaponaibilitisa
(intramural research, extramural research, planning and evaluation, ant
so on); ant various in-house publications. In addition, the abilities
both of the NIH Staff and its external advisors have helped to counter
the communication difficulties inherent in a growing, increasingly
elaborate organization.
Authority in NIH has become increasingly decentralized over the
years for a variety of reasons. The institutes have become more
autonomous, with their own congressional appropriations ant their own
Specific conatituencica. The Symbiotic relationship that evolves in the
late 19408 between NIH, the congressional committees overseeing it, ant
outsits interest groups has tented to break up into a number of Smaller
alliances, organized around more restricted areas of reaearch.32 In
addition, since the late 19608, the Department of Health, Education, ant
Welfare (ant now, Health ant Human Services) ant the Executive Office of
the President have asserted greater actual as well as nominal authority
over NIH. A Striking example is the independent Presitent'a Cancer
Panel, which wee eatabliahet in a time of perceived emergency. This
anomaly, the committee believes, should at Same point be reconaitered.
Given the current budgetary constraints and increasing congressional
ant public demand upon the agency, decentralization puts additional
prea sure on the NIH Director. When budgetary growth barely keeps pace
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31
with inflation, and when Presidential budget proposals often call for
extremely Small increases because Congress has historically voted large
increases, the task of determining overall priorities in a highly
decentralized organizational ~tructure--and making those dec is ions
stick--becomes extraordinarily difficult.
Thus, there are now strong incentives both for professional
societies ant the voluntary health associations to seek to enhance the
power and position of "their" institute. There are no analogous special
constituencies for the NIH Director, who has overall responsibility for
the health of the entire NIH system. In order to balance the
appropriate, but potentially destabilizing, centrifugal forces
associated with the categorical institutes, there should be a strong
central force to ensure coordination of crose-cutting research
activities, to oversee orderly long-range evolution, and to maintain
public accountability for NIH's overall program. The Office of the
Director is the logical locus for these functions.
The Authority of the NIH Director
The following series of recommendations is aimed at providing the
Director with adequate authority and resources to effectively lead NIH
in an increasingly complex environment.
Delegation of Authority to the Director
The committee recommends:
The Secretary of Health and Human Services should delegate to the
_ ._ . . .
Director of NIH the authority, direction, and control over NIH that the
position does not now possess, subject to the policy direction of the
Assistant Secretary for Health and to existing statutory limitations, as
_ _ in_ _ _
recommended to be modified below.
The Director of NIH is nominated by the Secretary of Health and
Human Services and appointed by the President, subject to confirmation
by the Senate. The authority of the Director, however, is not clearly
defined. There is a ~ izable collection of very specif ic authorities
delegated to the Director by the Secretary, but these are largely
housekeeping duties and do not get to the core of the Directory
institutional responsibilities. There is no official delegation to the
Director of the overall authority, direction, and control of NIH. Such
a delegation would give the Director the means for ensuring the
coordination of cros~-cutting research activities and for overseeing the
long-range evolution of NIH. It would also make it clear that the
Director has the responsibility for keeping the whole of NIH's research
program responsive to national health needs.
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Enhanced Budgetary Authority
The committee recommends:
The Director of NIH should hay; greater but etary authority and
discretion in two regards: 1 a tiacretionary fund, not to exceed 1.0
percent or the NIH budgets with which to seed selected areas through
existing inatitutes in accordance with a rigorous peer review Process;
and 2 limited authority to transfer up to 0.5 percent of the NIH
budget across institute lines in response to a public health emergency.
Once Congress passes an appropriation and the President signs it
into law, the Director of NIH has no authority to adjust the NIH
research agenda, either with discretionary funds or by reallocation
across appropriations categories. The Director can make adjustments
among institutes in the budget formulation stage, but only at the margin
and subject to action by the Department of Health and Human Services,
the Office of Management and Budget, and Congress.
Any work supported by the proposed discretionary fund should be
subject to peer review, ant there should be no permanent commitment that
would imbet the new effort in the budget before it got an appropriate
trial. The discretionary fund should be an add-on, not a tax on
existing activities. It would be used to promote emerging and
crosa-cutting research areas, especially those that are not obviously
categorical. The White House Science Council has made a similar
proposal for all federal research laboratories,33 and the National
Academy of Public Administration for all government agencies.34
The idea for emergency transfer authority is not new, but the AIDS
(Acquired Immune Deficiency Syndrome) episode provides an example of how
it could be valuable. Although Some scientists fount the response of
NIH to the crisis appropriate, others did not. In any case, there seems
to have been a failure adequately to inform the public of the steps that
were taken. There was a considerable period of time during which the
institutes, the NIH leaterahip, the Public Health Service, ant the
Congress debated the appropriate financial response to the AIDS
threat.35 Although Same scientists began research almost immediately
on already existing grants, ant others Sent in new applications on their
own, NIH wee Stow in formally responding with requests for
applications.36 Episodes like this may be rare, but emergency
transfer authority would be helpful in avoiding confusion ant ensuring a
prompt ant appropriate response.
NIH Policy and Planning Council
The committee recommence:
I. The current Director's Advisory Committee Should be converted
to a stronger and more independent NIH Policy and Planning
ounce .
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33
2.
3.
The council should provide,for the Director a continuous
evaluation of the re ~ notion of NIH and of
its component institutes, w ~ t
affect NIH as a whole or the interrelationship among the
institutes. It should advise the DO ~ ation
of long-term plans and in setting research Priorities.
The council should function both as a sensing mechanism and
mayor consensus-builder for the Director.
4. The council should be composed of twelve members appointed b
_ ~ Y
the Secretary of Health and Human Services from a list prepared
by the Director of NIH.
5. Appointments should be made for a single term of six years
with one-third of the council's membership replaced every two
years.
6. Members of the council should be selected on the basis of
scientific and professional competence and distinction.
The council should elect its own chair, prep-are its own agenda,
meet at least four times a year and whenever requested by the
Director of NIH, be assigned its own staff and have a defined
budget, and report annually to the Director of NIH.
The present 16-member Director's Advisory Committee, appointed by
the Secretary of Health and Human Services and chaired by the Director,
responds to specific requests from the Director, who also sets its
agenda. It has no independent staff or budget.
The proposed name change is intended to underscore this study
committee' intention that there be a qualitative change in the
council's nature and functions. Increasing its independence and
responsibility, the committee believes, will help make it more effective
in support of the Director's essential role of coordinating and
overseeing cross-cutting research areas. On the other hand, giving the
Director full authority to nominate the members should result in a
council with whom the Director could work more effectively. The council
would advise the Director on NlH-wide policy issues, such as research
training, the management of the peer review system, and the personnel
and salary structure for intramural scientists. It would also consider
long-range research priorities among the institutes, and the
effectiveness of mechanisms to coordinate crose-cutting research areas.
The committee intends that the council and the Health Science Board
complement each other. The council would concern itself exclusively
with the NIH and its components; the board would concern itself with the
NIH only in the context of the spectrum of Public Health Service
agencies ant the full range of their health research.
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34
Structure of the Director's Office
The committee recommence:
Extramural research and intramural research (and the related su rt
_ . . ppo
activities of each _shcu~c be grouped under two deputy NIH directors
~ 3_ L_
Individual institutes and staff responsibility for extramura1 and
~ the staff functions in the Director's
. . .
o: :r~ce enoulc be reorganized to improve span of control.
As Appendix B shows, there currently are 25 separate activities that
report to the Director of NIH. These include the IB bureaus,
instituter, and divisions, ant 7 functions in the Office of the Director
itself. The NIH Director has a team of three staff officer deputies:
one is a generalist, one deals with extramural and training programs,
and one deals with intramural programs.
None of the current deputy directors has line authority. The
committee proposes that the deputies for extramural research and
intramural research be given line authority over the support activities
related to their responsibilities, and that they continue to have staff
authority to advise the Director on the coordination and direction of
the research programs within the institutes. Such a reorganization
could improve the Director' ~ capacity to manage, and free his time and
attention from the day-to-day exigencies of bureaucratic life. It could
also reduce the Director's span of control to more manageable
proportions. One possible reorganization plan appears in Appendix B.
The organization of the Director's office should continue to
emphasize the centrality of the planning and budgeting functions. They
need to work together closely, and have direct access to the Director in
connection with resource planning and allocation decisions. The same
should be true at the institute level as well.
Clustering of Institutes
The committee recommend"
Where appropriate, support functions of individual institutes and other
components should be clustered to reduce unnecessii}~7~5337~[a7~~~ ~~
expense.
At present, each institute at NIH has both a program staff (the
director and his immediate office, program officers, planning officers,
and so on) and a support staff (personnel management, grants and
contracts management, budgeting, public information, and so on). The
current system is designed to maximize the effectiveness of the
individual institutes in carrying out their own research programs, but
can lead to unnecessary duplication.
In some cases it may be possible for institutes to share support
staffs. One way is to create a cluster of institutes with common
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interests and approaches Each instituted director would retain
responsibility for its scientific program, and have direct access to the
NIH Director. The cluster would provide support services, and even
scientific coordination if there were significantly overlapping research
interests. If a new institute is necessary, it might share the support
services of an existing institute but have an independent scientific
program and direct access to the NIH Director. Such an arrangement
could serve as an incubator for emerging research areas.
For instance, rather than establishing an independent National
Institute on Aging in 1974, this institute could have been clustered
with the National Institute on Child Health and Human Development.
Although the new institute would have had its own scientific program,
budget, and director, a cluster could have facilitated cooperation on
common scientific interests, such as basic research on human development
and social science approaches, as well as reduced administrative costs.
Clustering is a useful intermediate between complete centralization
of support services and their full replication in all institutes. It
has two benefits. First, it would help improve the NIH Director's span
of control by reducing the number of decisions that have to be made at
the NIH level. Second' it would reduce administrative costs. Together,
these mean that clustering could increase ability of NIH to respond to
emerging needs and opportunities by reducing the administrative and
financial costs of establishing new institutes.
Public and Scientific Accountability
The foregoing recommendations have dealt with improving the
efficiency and effectiveness of NIH. The following recommendations are
intended to facilitate accountability, both to the scientific community
and to the larger public, as well as to ensure a manageable structure
for NIH.
National Advisory Councils
The committee recommends:
Each institute should Provide its National AdvisorY Council members with
full and easily understandable information on its entire Portfolio of
currently funded grants and grant proposals; institute directors should
more uniformly involve their advisory councils in broad program and
· .
pa Icy Issues .
An institute's National Advisory Council has two major roles. One
stems from its statutory authority and responsibility to approve
research grants made by the institute it advises. In this capacity the
councils serve as a second level of review, approving grants initially
recommended by study sections. ~In most instances, the councils endorse
study section actions. Only rarely (1 to 2 percent of all grants for
most institutes) do councils modify study section recommendations,
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36
either by assigning high priority statue to grants deemed to have
high-relevance to the inatitute'a program or, lesa often, by assigning
low-priority atatus to grants with low program relevance.37 The
councils spent a large percentage of their time and energy on the review
of research grant proposals, and the committee believes the reviews are
carried out fairly and thoroughly.
If the councils are to act accountably, their membera must receive
sufficient information about their institutes' entire portfolio of
currently funded and competing grants. This information is particularly
important if council membera are to evaluate those applications that
fall at the border.
The second role of the councils is to provide the institutes with
broad program or policy advice. Our interviews with peat and present
council membera, however, indicate that this function is carried out
unevenly. Some institutes have developed a variety of ways to obtain
advice from council membera (special sessions, ad hoc committees, public
meetings, workshops, etc.), but other institutes make little use of
their councils in this regard. In fact, same council membera are barely
aware that they have this Second responsibility. This heterogeneity of
understanding is accentuated because the advisory role of councils is
not spelled out in detail in NIR documents, and because there is no
parent group (like the Division of Research Grants for study sections)
that focuses on their activities. To facilitate the councils'
involvement in this second role, the NIH Director's Office, through the
deputy director for extramural research, should provide all council
membera, at the time of their appointment, with a clearly written
statement informing them of their advisory role and the various means
used by NIH councils to facilitate that role.
Boards of Scientific Counselors
The committee recommends:
The NTH Director should assume overall resPonsibi1
~ _._. by for informing
membera of each institute's Board of Scientific Counselors of that
institute 8 response to its recommendations-about intramural research
. .
The Boards of Scientific Counselors review and evaluate the
intramural research programs for their respective inatitutea. Based on
discussions with past and present counselors, the committee believes
that the intramural programs usually are reviewed in a timely and
rigorous fashion by the boards. The board members expressed considerable
concern, however, about the lack of feedback to them on the institutes'
implementation of their recommendations. NIH has ant occasionally
employs procedures for phasing out or reducing support for intramural
laboratories that fail to Satisfy counselors of their productivity.
This is true even for tenured scientists. This practice is essential
for maintaining the high quality of the intramural research program.
Counselors usually are not informed of such actions, but should be.
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Co~unicat ion
The committee recommends:
The role and staffing of the Office of Communications should be
strengthened. The Director of NIH should establish an AdvisorY Panel on
Public Information2 to aS8iSt the of
distribution of current publications, and in employing additional media.
NIH needs to make the public more aware of its work. The committee
was impresses by NIH's present communications program, with its array of
publications and other communications services. The committee has seen
no evidence, however, that this information is reaching wider audiences
in a timely and regular fashion.
Quality of Scientific Advice
Lastly, the committee eurne to the issue of the quality and
independence of scientific advice rendered to NIH.
The committee recommends:
Quality should continue to be the overriding consideration in selecting
all NlH advisory croup members--ncientific clinical and lay. The
. , ,
expertise of the advisory groups must be of the highest possible quality
~ fill their statutory responsibilities and
to have credibility within the scientific commu~nitY,~~with Congress, and
_ . . ~
with the public at large. Further every effort should be made to
,
reduce the levels of review and to expedite the selection process so
. . ..
that advisory groups can always funct ion at full ~ trength.
The quality of NIH's performance depends upon many factors, but one
of the most important is the ability and integrity of the members of the
many advisory bodies that are an essential part of NIH.
The committee has received information, however, that the advisory
bodies are sometimes not able to operate at full strength because
vacancies are not filled in a timely manner. This delay is usually the
result of multilevel reviews of nominations put forward by NIH.
Further, the committee has found a widespread perception in the
scientific community that members of advisory groups are often selected,
at levels above NIH in the federal hierarchy, for reasons other than
quality, expertise, or eminence. The perception by many, including
members of Congress, that the scientific capacity of the advisory groups
is being eroded points to a continuing problem for NIH and the
Department of Health and Human Services. If the facts behind this
perception are accurate, the situation is unacceptable. Even the
existence of the perception is a matter of grave concern.
Representative terms from entire chapter:
intramural research
