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Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health (1984)

Chapter: APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH

« Previous: APPENDIX A Study of the Organizational Structure of the National Institutes of Health
Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Page 68
Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Page 71
Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Page 81
Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Page 82
Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Page 83
Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Page 84
Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
×
Page 85
Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Page 86
Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Page 87
Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
×
Page 88
Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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Page 89
Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
×
Page 90
Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
×
Page 91
Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
×
Page 92
Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
×
Page 93
Suggested Citation:"APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH ." Institute of Medicine. 1984. Responding to Health Needs and Scientific Opportunity: The Organizational Structure of the National Institutes of Health. Washington, DC: The National Academies Press. doi: 10.17226/762.
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APPENDIX B THE CURRENT ORGANIZATIONAL STRUCTURE OF THE NATIONAL INSTITUTES OF HEALTH Thomas D. Morris Contents Part 1. Introduction: Purpose and Method Part II. Findings in Respect to the Organizational Structure of the NIH and Current Issues Pare III. Possible Near-Term Refinements in Organization

PART I INTRODUCTION: PURPOSE AND METHOD The objective of this paper is to provide the general reader with an overview of the internal organizational structure of the NIH as viewed by a management analyst, not from the perspective of either a scientist or a medical professional. It tries to portray observations on the dynamics of the organization--"what makes it tick"--and the motivations that appear to drive the organization, as well as its conventional management structure and processes. In Part III of this paper, suggestions are discussed which are aimed at preserving the great strengths of the current structure, while making it better able to cope with present and future demands on top management. Fact Finding Performed in Preparing This Paper The fact finding that underlies this paper consiatet of four steps which are briefly described below: Step 1. Interviews By far the most significant work performed has been personal discussions with over 70 key officials. In summary, they consisted of the following: Of f ice of the Director Bureaus and Institutes Research and Centra 1 Services Divis ions Agencies Proposed for Transfer to N IN PHS /HHS Of f ic ia Is No . 0 f Interviews 16 17 ~ plus a88Oc fates 28 ~ plus assoc fates 6 - 73 (over 100 individuals) The relatively large number of interviews in support ing organizations represents an effort to look closely at organizations many of whose costs are borne by levies on the Bureaus and Institutes, whose activities they support. It seemed~prudent to understand these activities due both to their costs ant to their importance in the overall operation of the NIH program from an organization structure viewpoint. The responsiveness and clarity of those contacted were generally outstanding.

65 Step 2. Key Document ~ In every interview we invited the submission of selected publications or reading materials to enhance our understanding. We were furnished with over 100 pieces, consisting of: Basic Data: Budget Justification volumes (4), Organization Handbook, NIH Fact Book, NIH Public Advisory Groups ~ Scientific Directory, NIH Data Book, NIH Draft Research Plan FY 1985, NIH Evaluation Plan FY 1983. Current News: The NIH Record published every two weeks for all employees; The Research Resources Reporter distributed to 22,000 readers on exciting developments in NIH supported research projects; The NIH Guide for Grants and Contracts, distributed monthly to 30,000 current and prospective grantees and contractors; the Search for Health (a weekly); and the News and Features from NIH (a monthly), distributed to the media. Program Publication. : One or more from every Institute and from most of the research support divisions, describing progress and plans as well as organization and operational matters. In several cases these are prepared by Councils or Boards as required by statute (as in the case of Arthritis, Diabetes, and Digest ive D isease s ~ . - These publications are skillfully written and i' fuse rated to bring complex subjects within the grasp of the non-scientist. The documen- tation of the NIH story is superb and without question the beat this observer has seen in the federal government. It would be a disservice to the nation to require curtailment of such high value educational materials. The list of available titles is in excess of 700 entries. Step 3. Special Analyses of the Volume of Research Grant Applications by Institute One of the most use fut ways to view the interaction among Institutes and Study Sections is to examine the flow of grant applications. The excellent information system maintained by the Division of Research Grants makes thin easy to do. Hence, we obtained computer printouts: by Study Sect ion, showing the number of applications reviewed for each Institute in FY 1983; and by Institute, showing the number of secondary or dual interest referrals made to other Institutes. These data are useful for examining the application review and award processes, as well as the degree of overlapping interests among the Institutes.

66 Public Hearings held by the Committee for the Study of the Organizational Structure of the National Institutes of Health, September 26-27, 1983 These excellent diacusaiona provided a feel for the viewpoints of the various communities with which NIH and the Congress work on a continuous basis. The hearings also presented an opportunity to study their official views in a series of position papers. In addition to the above, the committee Staff has furnished a number of manuscripts dealing with peat and current issues that are of high value. / r

PART II FINDINGS IN RESPECT TO THE ORGANIZATIONAL STRUCTURE OF THE NIH AND CURRENT ISSUES Figure 1 pictures an organizational structure in which 25 separate activities are reporting to the Director. By all rules of organization theory--the analyst would say--this is an unmanageable span of control. Added to this apparently impossible managerial burden are many other complexities. The organizational basis for the scientific research act ivit ies does not follow a consistent logic as indicated below: Some are by disease: cancer; arthritis, diabetes, digestive diseases, kidney diseases; neurological diseases; communicative disorders, stroke; allergies, infectious diseases. Some are by organ: heart, lung, blood; eye; dental. Some are by life stage: aging; child and human development. Some are by field of science: general medical sciences; environmental health sciences. Because all but one of the scientific research activities engage in a substantial in-house research program, requiring sophisticated laboratories and clinical facilities, there appears to the 'layman'to be a proliferation of such organizational entities in-the basic fields of science: biology, chemistry, genetics, pathology, etc. Then, as one begins to inquire into operations, the highly decentralized nature of the National Institutes of Health comes into still sharper focus. There are fourteen entities outside of the Director's immediate office which receive direct congressional appro- priations that are not subject to formal control by the NIH Director in the implementation stage. Most of these entities were, in fact, established by Acts of Congress, and their activities are'followed closely from year to year by both Authorizing and Appropriating Committees, as well as by the huge network of professional societies . *It should be noted that the Ins t i tute s re imburse several of the central service and research support activities; and are assessed to maintain the "General Expense Fund" used by the Director to finance selected NIH-wide projects ($12.8 million in FY 1983~.

r rev ~ S In _ - ~ ~ :' S t _ I' e .s ~ S S O ~ .° _ ~ ~ Z 68 _ ~ 41 S i' I I : l I - , _ s ~ ~ u" At.. E, E . '' 1 -- ! ~ 1 1 1 _ c ,! I -sit'' . r; , lo. ~ 3~a ; , 1 1 ]! 1 l 1 1 5 ~ ! - ~ o A!] a~ i A! - .! ~ ~ C .11 ~ .' ~ ~ Be: ~ .~] ~ ~ . ~ S r: 1 -.s 1 t 1 z 1 Ys . 1 53 ~' . s c 7 ~ . ~ _ ~ I] - :~! ~ .2 ;- ~ - i~t~ , ,, ~ I] _ . I,s ~ o} ·~— .u c o! _ ~ := z o 1 L ~ ~ C) ~o C~ - o o - _ C~ N L b L. ~ o x ~ 5: E" ~ z ~ - ~ c~ c' ~ o o

69 and associations that presses on many fronts for improvement in the nation's health care. Are the above complexities, in fact, serious problems or hindrances to successful performance? The resounding answer is NO, not today. The directors of each Institute were asked how they assess today's structure. Except for widespread concern with current Congressional initiatives to create an Arthritis Institute, and move other PHS functions into NIH, general satisfaction was expressed: "It is working." "It is working well now." "We have no problems." "Today the Institutes work out their problems by bargaining in good faith." "I am concerned by support costs." "We are constantly working out joint interests with others. We welcome Congressional attention." "No organization matters of concern." "Present organization works because of the people, not the 1-ogle. It is working well today." "Arthritis is inevitable. Support costs need tighter management . " "It is working well. . .planning with the community is the key." "Our Institute makes sense because it meets a need." "More overhead is not needed. NIH loses . " Based on fairly detailed interviews with its leaders, this paper examines how the present organizational structure achieves such satisfying results. The Major Organizational Components of NIH The three major components of NIH include: the Office of the Director; the Bureaus, Institutes and Divisions; and the NIH Research and Central Services Divisions. Figure 2 summarizes the size data for each of these components. The Office of the Director is a tiny structure--largely staff in nature--whose role is leadership. The Bureaus and Institutes are the "producing/mission" entities and control most of the funds applied to research programs. The Research and Central Services Divisions exist primarily to support the programs generated or sponsored by the Bureaus and Institutes, but have some self-initiated projects, as discussed later. As illustrated, the formal structure today employs over 16,000 people, full and part-time, intermittent, permanent and temporary, including experts and consultants. Its budget for FY 1983 was $4.0 billion. Congress increased this amount to $4.5 billion In 1984.

70 Office of the Director Personnel (Appointment). . . .683 FY 1983 budget. . . .S25.7 milt (plus General Expense Fund from Institutes) i . 1 .. _ The Bureaus and Institutes Personnel (Appointment) FY 1983 Budget 10,173 $3,758.1 Research and Central Service. Division. Personnel (Appointments)] FY 1983 Budget , Central Services Units2 4, 777 ! Research Divisions3 618 S,395 · . Total Appointments: 16,251 F [OURE 2 Overview of ~ i7.e data. Central Services Unite2 (6302. 1)4 Research Divisions3 224.1 Total FY 1983 Budget: ¢4,025.45 milt Personnel Appointments data is total full and part-time including YiSit ing program, staff fellows, experts and consultants. These figures represent both ceiling and non-ceiling employment. 2Include.s Clinical Center, Division of Computer Research and Technology, Division of Research Services, and Off ice of Research Services. Concludes Division of Research Grant., Division of Research Resources, and Fogarty International Center. *he funds for the Central Services Units are included in the Bureaus/Institutes and Research Divisions budgets. SIncludes $17.S million for the N[H Buildings and Facilities Account. SOURCE; Based on data from the NIH Office of Administration; and TAPS Monthly Employment Report Summary, July 23, 1983.

71 Not displayed on the formal chart is the network of chartered advisory committees--some 149 in number and containing about 2,500 appointees, mostly non-government experts--which are a vital part of the NIH program: The National Advisory Councils. An advisory council is located in each institute and the Division of Research Resources and is a source of advice on policy and planning issues. Their major purview is the extramural research program, and, by statute, they must approve each grant or cooperative agreement before it qualifies for funding. Some institutes also have chartered advisory committees or boards that deal with particular program areas within the institute. The Director's Advisory Committee provides advice to the Director on NlH-wide issues but has no statutory basis or authority. The Boards of Scientific Counselors. Each institute with a major intramural research effort has a board of scientific counselors. The boards oversee the intramural program and periodically assess the work of each tenured scientist. .-The Scientific (Peer) Review Groups. There are three major types of scientific review groups. The most common type, known as the Study Sec t ions, works under the central coordination of the Division of Research Grants. Their function is the first Level review and rating of individual applications for research grants. A second type, known as the Review Committees, is attached to the Institutes. They conduct the first level review of applications for Center grants, program grants, and training grants. Finally, Institutes often have Program Advisory Committees, which suggest types of contractual projects that should be undertaken, and review conceptual plans for contracts. Other types of scientific review groups are used for more specialized purposes. In addition to the National Advisory Councils, some of the other committees are statutory, including the President's Cancer Panel, the the National Arthritis Advisory Board, the National Diabetes Advisory Board ~ the National Digestive Diseases Advisory Board, and the Board of Regents of the National Library of Medic ine . One final feature of the overall organizational profile is the budget and staffing profile, as outlined in Tables 1 and 2. The direct operations of NIH take place in the Bethesda enclave and at several leased locations in Bethesda (12,700 personnel including 2,600 in leased space); in Research Triangle Park, N.C. (the headquarters of NIEHS with 600 employees); and five other special sites: Poolesville, Md. (animal resources); Gerontology Laboratory,

72 TABLE 1. Budget profile for fiscal year 1983. Item amount Percent (Millions) Research Grants S2, 687.6 Research Training Awards 164.7 R&D Contracts 320. 3 Subtotal $3,172.6 79 Covers some 23, 000 "ran' and contract. of all tYE 10, 600 research trainee. 1, 200 institutions. Intramural 500.9 12 2,700 research projects. Other Institute Cos ts Research Mgt . ~ Support 199. 8 NCI Disease Control & Const rue t ion 5 6. 6 Total Institutes 3, 929.9 98 & Research National Library Medicine Of f ice of Director 25. 7 Buildings & Facilities 17.5 TOTAL $4. 025 .4 1 00 SOURCE: Data from the NIH Of f ice of Administrat ion. TABLE 2. Staff profile as of July 23, 1983. Ful 1 Time . . _ Civil Service Commis s toned Corp s Vis it ing Sc lent is t s Staf f Fel lows Part-Time & Int ermi t t ent GS & Wage Experts, consultants Total Total of 16 appropriatio inc luding Inst itutes, NL FIC, DRR, OD and Facilit A ~ ignif leant feature 0 f budget from year to year that over 80: of annual funds are "c ommit ted" in advance . Total Appo intment 12, 110 837 282 851 4. 080 1,573 598 2.171 16.251 SOURCE: Data from TAPS Monthly Employment Report Summary, July 13, 1983.

73 Baltimore, Md. (NIA); Frederick, Md. (primarily NCI); Rocky Mountain Laboratory, Montana (NIAID); Phoenix, Arizona Pima Indian Project (NIADUK). -- The Office of the Director The Office of the Director is the "glue" that holds together the highly decentralized structure of the Institutes and Support Organizations (See Figure 3). Its major roles are, first, to provide such NIH-wide planning and administration as required in matters of program planning and evaluation, budget, personnel, contracting, public information--the normal functions of the front office of a major federal agency ; and, second, to facilitate attention to the numerous cross- cutting issues and initiatives that arise from emergencies, the interests of the Secretary, the concerns of Congress, and the proposals of innumerable outside groups. NIH has been blessed with the leadership of scientists with high sensitivity to the right degree of top management attention to these issues, and has avoided the micromanagement which tends to develop in most federal agencies. The Director himself has a team of three Deputies to help him as partners in overall leadership: one is a generalist; one is in charge of intramural programs; and one is in charge of extramural research and training programs. Their key technique of management is through staff meetings. The most important is the weekly meeting of the Directors of the Bureaus, Institutes and Divisions (BIDS) with the NIH Director. Similar sessions are held at regular intervals among the Scientific Directors, the Extramural Program Officials, the Executive Officers, the Planning and Evaluation Officers, International Representatives, etc. The impression one gets is that these devices are highly respected and effectively used at NIH. The immediate office of the Director and his Deputies contains a number of special assistants and small staff units, as well as Trans-NIH Committees which are set up, as needed, to attack high priority problems. Examples of the special staffs and special committees are as follows: Special Staffs. These include the Office of Intramural Affairs, the Office of Extramural Research and Training, and the Division of Equal Opportunity. Other special staffs include the Office of Medical Applications of Research (OMAR) and the Office for Protection from Research Risks (OPRR). OMAR is seeking to improve the translation of biomedical research results into knowledge that can be appl fed in the practice of medicine and public health. OMAR holds eight to ten consensus conferences each year. OPRR develops and supervises HHS-wide policies governing the care and treatment of both human and animal subjects used in medical research. Special Committees. These are communication and working groups covering a wide spectrum of cross-cutting subjects. Some

74 Director's Adviso~y1- Counc i I | Irnmed iate t)f f ice o t)f f ice of Medical Appl icat ion~ ~ f Research · ()~Eice for Protect ion from Research Risks · Division of Equal Opport~`nity · Special Assistant to the Director Sen for Sc ient i f ic Advisor Cormn i t t e e Mana gemen t t) f f i c e r Other Special Assistants Office of Extramural Research and ~ ra in ing · t)ffice of Intramural Affairs . Pe rsonne 1 ( Appo intment 5 ) Inonediate ()ffice -- 140 Staf f Act ivit ies -- S4 TOTAL -- 68 3 FIGURE ~ The ()ftice of the Director. S()URCE: Data from .`J[H t)ffice ~f Administration. Direc tor Deputy Director . Deputy for In t ramura l Research , ~ ISureaus and Institutes ( 12) Support ing Organ izat ions ( 7 )* l :;IH Sta f f _ Meeeings ( 14) Deputy for Ext ramura 1 Reseac h ·ralnlng Sta f f Act ivit tes Off ice of Program Planning and Evaluac ion 0 Off ice of Administration 0 Of f ice of Communicat ions - · Off ice of ttesearch Services* . _ _ _, Spec ta I ! Coneni t tees Research Re latet to Disease Prevent io AIDs Coord inat ing Group National Arthrit is Advi~ory Board National Diabetes Adivisory 80a rd Nat iona l Dige~ t ive Disease~ Adv isory Board Nutr i t ion Coord inat ing Comrai t tee 0 A. se ~ smen t ~ Tec hno 1 ogy Trans f e r Othe rs l 9 ~ 3 App ro Pr ia t ions ()f f ice of Director -- S25 . 7 mi ~ I ion B'lilding ~ Facilities -- S17.5 million . *()RS is classified in our an.alYsis as ~ "supporting <~rganization" and is discussed as such in a later section. Its ~;tatf c`'nta~ns 1,636 total appointments.

75 special committees are required by statute such as the three groups for Arthritis, Diabetes, and Digestive Diseases. Special committees which are part icularly active at present include: the special committee for Research Related to Disease Prevention; the AIDS Coordinating Group; and the Nutrition Coordinating Committee. More than a dozen others were mentioned in the various interviews including Alzbeimer's Disease, Private Sector Coordination, Radiation, National Toxicology Program, Genetics Coordination, Recombinant DNA, and so on. Three of the major staff activities in the Director's Office are the Office of Communications, the Office of Program Planning and Evaluation, and the Office of Administration. All three of these offices practice high decentralization to Institute counterparts, subject to NIH-wide policies and procedures. All three have professional staffs of the highest skill. The functions of these offices are outlined as follows: The Office of Program Planning and Evaluation. This office advises the Director, NIH, and senior agency staff on health research and science policy issues, agency planning, evalua- tion, legislative, and program analysis responsibilities, and directs activities associated with the Director's -Advisory Committee. These responsibilities encompass major policy analysis and development, management of the agency's central planning process, the development of legislative proposals and provision of legislative liaison, management of the agency's evaluation program and the development of cross-cutting evaluation studies, and the monitoring of the flow of funds supporting health research and development and production of research personnel in bioscience and relevant health-related fields. Key publications include the annual NlK Research Plan, NIH Evaluation Plan, Legislative Highlights and Issues, NIH Data Book, summaries of the Director's Advisory Committee meetings, and a wide variety of policy analysis papers.. The Office of Communications. This office is responsible for ~ . the overall coordination, planning and direction of NIH information activities. As mentioned earlier, the documentation of the NIH story is superb and much of the credit is due to the leadership of this office. Among its publications are the NIH Record for internal current news,. and the Search for Health and News and Features which keep the media currently in tune with progress in medical research. The Office of Adminis trot ion ~ This of f ice performs the tasks involved in overall coordination of the budget, personnel, contracting for R & D, and surveys of misconduct allegations. A vital role is the continuous budget planning cycle which begins two years in advance of the fiscal year. This cycle

76 involves: planning sessions by the NIH Director and each ma jor organizational unit' s Director (a responsibility of OPPE and a major linkage between ache planning and budgeting functions); presentations to the Assistant Secretary and the Secretary and OMB; the final mark for the President 'a budget which the Director must allocate; the Congressional phase; and the implementation of the budget. lithe Director-of Finance points out that there are over 400 "cells" in the NIH budget as it is displayed to Congress and through which it must be managed. A continuing challenge appears to be achieving linkage between program planning and budget planning. Summing~'s Office One in impresses most of all with the highly informal atmosphere and the obvious stress on excellence as the only standard acceptable to the Director. Second, one is impressed with the absence of the normal trappings of bureaucratic authority; hence the NIN Director manages largely on the basis of persuasion, consensus and knowledge. Third, one is impressed with the number, quality, and effectiveness of the special staffs, committees, and staff meeting mechanisms; without them the task of internal communications would be impose ib le . The Key Quest ions Asked: Can this Office, as now constituted, effectively support further growth, such as Congress might mandate? Particularly, is closer management of the support actitivies needed, as suggested by some? Is the Office able to respond with sufficient speed and effectiveness to emergency and cross-cutting issues? These and related questions will be examined further in Part III. The Bureaus, Institutes, and Divisions The scientific research program is carried out largely through the Bureaus and Institutes which were established in all cases save one by Congress since 1937. A recapitulation follows.

77 Bureau or Date of Personnel Institute Establishment* (Appointments) FY 1983 Budget (as of 7/23/83) (millio-~--~~ Bureaus NCI 1937 2, 860 $987. 6 NHLBI 1948 1, 075 624. 2 NIADDK 1950 836 413.5 NLM 1956 659 S2.3 Institutes NIA 1974 505 94.0 NIDR 1948 449 79. 3 NICKS 1963 190 369. 8 NIEHS 1969 (Non-statutory) 939 164. 9 NINCDS 1950 914 - 297.1 NIAID 1948 878 279.1 NICHD 1963 5 77 254.3 NEI 1968 - 291 141.9 Total 10. 1?3 $3. 758. 0 SOURCE: Data from the NIH Office of Administration; TAPS monthly Employment Report Sublunary, July 23, 1983; and 1983 NIH Almanac. It should be noted that the only distinction between "Bureau" and "Institute" is one of hierarchical rank. Bureaus in the classical structure have Divisions as their components. Institutes, however, are themselves Divisional entities. In practice, the term "Institute" is the significant title. (See Figure 4.) How Is An Institute Organized? A typical structure is shown in Figure 5. The Of f ice of the Institute Director in small and a microcosm of the Office of the NIH Director, i.e., one finds here the Office of Administration, the Office of Program Planning ~ Evaluation, the Communications function and special assistants. At the Director's level are the National Advisory Councils covering the extramural program, and the Boards of Scientific Counselors covering the intramural. The Intramural Program. With a FY 1983 budget of $500.9 million, the intramural program represents about 12% of the total NIH budget. The majority of the intramural program is located on campus in Bethesda and consists of a staff of over 5, 000 laboratory and clinical workers, plus a substantial portion of the supporting staffs discussed later, as well as a substantial share of the overhead management staffs of the NIH and Institute Directors. *Many were established under other names, some as divisions.

78 THE NIH BUREAUS _ NATIONA L CANCE R I NSTI TUTE ~. NATI ONA L HEART LUNG & BLOOO INSTITUTE ~ ~;~ NATIONAL INSTITUTE OF ARTHRITIS DIABETES& DIGESTIVE, & KIDNEY DISEASES AG I NG ~ ~_ ~=Z DENTAL RESEARCH GENERAL MEDICAL SCI ENCES THE NIH INSTITUTES "a ~ l ~ ~, ~ ~.t ENVI RONMENTAL HEALTH SCIENCES NEUROLOGICAL & COMMUNICATI VE DISORDERS & StROKE FIGURE 4 The NIH bureaus and institutes. SOURCE: NIH Peer Review o f Research Grant NATIONAL LIBRARY Of MEDICINE . ALLERGY & INFECTIOUS DISEASES : ~ "-'' ~ ~- CHILD HEALTH & HUMAN DEVE LOPMENT 1 icat ions ~ January ~ 1983 .

79 The overseer of the Intramural Program within the institutes is designated the Scientific Director. This official enjoys wide latitude in the organizat ion and work program of the Institute, with oversight from the Board of Scientific Counselors. The Scientific Directors meet regularly with their counterparts from other institutes under the chairman- 3hip of the Deputy Director for Intramural Research. A second key official in entitled "Clinical Director" and these officials meet periodically with the Director of the Clinical Center and a designee of the Deputy Director for Intramural Research to set policies for the Clinical Center and patient care practices. A key factor in the NIH intramural program is the stress on excellence. Selection and promotion of tenured appointees is controlled by the Scientific Directors. Only 5% of Staff Fellows can expect to reach tenure and that must occur within ~ TYPICAL INSTITUTE NATIONAL OFFICE OF THE BOARD OF ADVISORY __ _ INSTITUTE _ _ SCIENTIFIC COUNCI L DI RECTOR COUNSELORS _~ En EXTRA:= ~;~ / | PROGRAMS 1 \ / \ ~}{~} 4~{~i ~ INTRAMURA L ~ FIGURE 5 A typical institute. This figure, taken from an NIH publication, mixes mechanisms (bottom line) with structure. It should not be interpreted to mean that extramural programs are organized by mechanism (such as grants and contracts). Although the latter was typical 15 years ago, today program branches in the extramural programs have subject matter rather than mechanism titles. Also, a typical institute today has an epidemiology and biometry component, which is neither extramural nor intramural. SOURCE: NIH Peer Review of Research Grant Applications, January 1983.

80 seven years. The NIH intramural program c laims four Nobe 1 Prize recipients within the last 15 years. A constant informal review of research in process is conducted and a formal review is made by the outside Board of Scientific Counselors. However, a virtue of the intramural program is the ability of Its scientists to undertake initiatives which offer no immediate short-range payof f . Today there are approximate ly 2, 700 separate pro jects in process, a catalog of which is published periodically. With limitations of both space and funds, the intramural program is projected to remain at its current level of effort. The Extramural Program. The extramural program involves the "research management and support" personnel in the Institutes plus the Division of Research Grants (DRG), the Division of Research Resources (DRR) and the Fogarty International Center (FIC). (Certain components of FIC also support the NIH intramural program.) The Institutes, DRR and FIC are the final award authorities and monitoring agencies for over 23,000 research and research training grants and contracts. The FY 1983 award projections (in millions of dollars) were: Research Projects Research Centers Other Research Training Awards R&D Contracts $2,096.0 373.4 218.2 164.7 320.3 $3. 1 72. 6 How Are Grants Processed? In the opinion of a majority of the people that were interviewed, the NIN peer review process for grant awards is among its most "brilliant achievements." It is a two-level review as illustrated in Figure 6. Applications are received and recorded by the Division of Research Grants (DRG), a central operating organization which decides on the referral of the application for review and maintains the Study Sections which conduct the initial review of research project applications. DRG itself is manned by a group of- 100 Ph.D.s and H.D.s who are experts in their particular subject matter. The Study Sections, of which there are currently 64, are structured to provide the highest level of scientific competence in their area of coverage. The Study Sections are primarily establishes along lines of scientific disciplines ant with very few exceptions are not captives of the individual Institutes. Applicat ions are re ferred concurrent ly to the Ins t instep or Research Divisions, which have the final authority for awarding grants. The second level of review is performed by that unit's National Advisory Council, which must approve applications before they can be funded. For the most part ~ the institute or division selects applications for funding based on priority scores assigned to each application by the Study Sections. Project periods of competing

81 research project grants averaged 3.2 years in FY 1982 (67 percent of research grant awards were for three years, and 20 percent were for five years), and competing research training awards 5.0 years. The one deviation from the above process occurs in connection with center grants, program project grants, and research training awards where the Institute establishes its own "Review Committee" of experts to conduct the first level of review. The rationale here is that multidiscipline committees are required and are better selected and maintained by the Institutes themselves. There are approximately 36 such committees active at the present time. In view of the differing bases of organization among the Institutes, there are frequent interfaces among them on individual applications. Similarly, the Study Sections typically review grant applications for In' - don and Review of ~ Grant Applicadon Type of Submitted Scientific Second Lead Inithdon Appl - don To MerIt Review Revlon l 1 Investigator(s) · Research Grant · Individual National Research Service (Fellowship) Award. · Research Career j Development Award · Program Project 1. Institutional National Research Service (Training) Award I · Center 1~ ~ · tines not require council review. ~ . _ | DRG study Section | Council I nstitute S RG _ 1 FIGURE 6 Initiation and review of a grant application. SOURCE: Orientation Handbook for Members of Scientific Review Groups, August 1982.

82 several Instituter. In order to obtain insights into the extent of such interfaces, several preliminary studies were conducted, using data provided by the Division of Research Grants, which revealed: 1. Study Sections Typically Review Grant Applications for Several Institutes. In FY 1983 there were 33 Study Sections which reviewed 200 or more applications for ROTS (investigator- initiated grants). The number of Institutes was: No. of Institutes Primarily Served by Top 33 Study Sec t ions* Number Study Sections Referring of Study 5 or more Applications Sec t ions t o an Ins t i Lute One Only 3 -Experimental Therapeutics -Radial ion -Visua 1 Sc fence s Two On ly 5 -Chemic a 1 Patho logy -Experimental Immunology -Neurolog ical Sc fences -Pa tho logy B -Re produc t ive B io logy Three On ly 1 Four On ly 4 Five Only 4 Six or More 16 TOTAL 3 3 =~ -Pathology A -A 11 e ray and I=nuno 1 ogy -Neuro logy A -Vi ro logy -Respiratory & Appl fed Phy s io logy -Biomedical Endocrinology - I=nunob io logy -Phys iology -Surgery ) Anesthesiology Trauma *Supported is defined as meaning that an institute received 5 or more applications from a study section in FY 1983.

83 2. Most Institutes Must Look to Several Study Sections to Review and Rate Their Applications a' The 8 t = Institute' ~ relations with all Study Sections during FY 1983 ant identified each case in which an Institute received 5 0 or more applications from a single Study Section: Number of Study See t ions Reviewing 5 0 Ins t i Cute or More App 1 icat ions Comment . . . NIA 1 NLKID 9 NLADDK 15 NCI NIEHS 17 NIGHS 18 NET 3 NHLBI 10 N INCDS NIDR 2 NICHD 6 Human Development and Aging Study Section. Also supports NICHD. Widely spread Widely spread Widely spread Toxicology Study Section. Serves six. Widely spread Visual Sciences Study Sections Widely spread Widely spread Oral Biology and Medicine Study Sections Widely spread The above-would suggest that there are only four institutes with close attachments to a few study sections: Aging, Eye, Dental, and Environmental Health. But even here, many other Study Sections may review small numbers of applications.

84 3. About 19% of all Research Project Applications Interest Two Institutes. Another way of looking at the crosscutting interactions of NIH Institutes is the number of research applications that are given ~^~ ^ ~~:~^~~~ ~-~ referral by the Division of Research Grants. In FY 1982-1983, there were 40, 656 applications referred to NIH Instituter, 18.9: of which were of "dual interest. " Thi indicates the degree to which Institutes have potent ia 1 overlapp ing interes t s: ~ ~ . _, . both a primary and a secondary Research Grant ~ TO FY Tota 1 Primary Institute Total Primary Applicat ions Also Applications Referred to Another Percent 1982-83 Institute 1982-83 Referred NIA 1, 975 616 31. 2% NIAID 3, 465 1, 213 35. 0 NIADDK 4, 940 939 19.0 NCI 7,410 1, 060 14.3 NIEHS 715 283 39.6 NIGHS 4, 722 652 13 8 NET 1,710 122 7 1 NHLBI 5, 614 972 17. 3 NINCDS 4,117 756 18.4 NIDR 1, 091 114 10.4 NICHD 3,599 789 21.9 DRR 1,136 . 127 11.2 NLM 162 35 21.6 Total 40,656 7,678 18.97: In addition to NIH Institutes, DRG processed applications for several PHS organizations, including the National Institute of Mental Health which had 2,897 applications, 313 of which were referred to other institutes including NIA, NICHD, and NINCDS. 4. high I~rrals, There is Relatively Little Joint Funding of Grants by the Institutes. For f iscal years 1982-1983 ~ through August 15, 1983) there were approximately 300 jointly funded projects totaling 344.4 million. All Institutes were represented. Examples of such projects inc luded: Hypertension in the Elderly, six projects funded jointly by NIA and NHLBI. Numerous workshops and c onference s . Numerous minority student training and biomedical research programs.

85 How is Program Planning Being Approached by the Institutes? Program planning and evaluation techniques have become act ively used tools in the past decade , part ly in response to congressional requirements (as in the case of NCT, NIADDK, NIA). Today an NIH-wide Research Plan and Evaluation Plan in prepared by the Office of Program Planning and Evaluation (OPPE) based on inputs from the In8titute8, with whom OPPE is cons tantly working. Some Institutes use special advisory groups to develop plans and make annual or periodic updates with budget forecasts. Institutes doing the most intensive planning involve the scientific community extensively. Most published plans are presented with high skill to attract wide readership. The National Eye Institute has one of the most vigorously applied planning programs, which covers five component five-year plans and sets out areas in the intramural and extramural programs to be held level and those to be expanded during the planning period. On the other hand, there are those who are skeptical as to the value of such comprehensive efforts other than to report on "where science in going." These officials stress that the course of research is driven by the individual investigator and that the keys to real progress are: (l) keeping only superior people in the intramural program; (2) attracting the best applications for grants and selecting only the best of these for award; (3) monitoring the research results carefully, and (4) acting promptly on findings. In a phrase: "Excellence is the watchword." The challenging question is the extent to which such planning tools can assist in setting priorities and guiding budget decisions. The opportunity for Trans-NIH program planning, evaluation and coordination is illustrated by the large number of areas of cross- cutting activity among the Institutes. Examples of some of the major cross-cutting areas are listed below: Number o f Ins t itutes and Cros s -Cut t ins Areas - Res earch Divis ions AIDS Arthrit is 11 Cy ~ t ic F ibro~ i s 6 Diabetes Immunology Research Nutrition Prevent ion Smoking and Health 12 12 12 13 5 SOURCE: Data from NIH Office of Administration. FY 1983 Actual (in millions) . S 21 e 7 75.5 11~3 165~3 406~9 164~3 957~2 19~7 Summing up the Bureaus and Institutes The highly effective research programs of NIH are carried out by a system of autonomous Institutes whose structure has grown over the years in response to public and

86 congressional interests in specific diseases, organs, and other criteria including life stage and fields of science. To cope with the lack of perfect logic from a scientific and medical point of view, the Directors have developed success ful techniques of communication to resolve cross-cutting interests. Furthermore, the 64 Study Sections, which are independent of the Institutes, constitute a powerful "organizational overlay" that brings the logic of science and medicine to the vital peer review process. :r Issues Regarding Organization: Can this effective, decentralized mode of organization be preserved? What would be the impact of statutory mandates to establish a separate Arthritis Institute or a Nursing Research Institute; and to transfer into NIH the National Center for Health Services Research (NCHSR), the National Center for Health Stat is ~ ice ~ NCHS ), and the Nat iona 1 Ins t ituee for Occupat ions 1 Safety and Health (NIOSH) ? Should relationships between the Intramural and Extramural Research Programs be reviewed? Some observations on these questions will be offered in Part III of this paper. The NIH Research and Central Services Divisions The seven remaining components of NIH comprise shone activities that not only engage in research programs themselves, in varying degrees, but also provide the professional facilities, tools, and resources needed by the Extramural community and the Intramural organizations to conduct scientific research. They are thus both unique and indispensable. Most are supported by reimbursements from the Institute budgets, but two have separate appropriations. These organizations include the divisions shown in Figure 7 plus the Office of Research Services (located in the NIH Director's Office). They have the following responsibilities: The Clinical Center. The Center is staffed by 2,300 personnel and had a budget of t92.4 million in FY 1983. It is a 54 - bed hospital and contains 40% of all the hospital beds in the U. S. devoted exclusively to clinical research. It also houses the new Ambulatory Care Research Facility and some Institute laboratories.

87 lithe D ivis ion 0 f Computer Research and Technology . Thi 8 Division is a unique scientific research support and computer service organization. With its staff of 345 personnel and a budget of 343.6 million in FY 1983, it serves 2, 000 terminals and 200,000 databases. Its research staff engages in collaborative pro jects with the Intramural scientists, bringing expertise in the mathematical and physical sciences. The Computer Center serves al 1 NIH act ivities, not just the Intramural, and the NIH Administrative management information system is cons idered to be in the forefront of management technology . The Division of Research Services. With a staff of 496 and a FY 1983 budget of S28.0 million, this division provides scientific and technical support for Intramural research with animals, equipment, engineering and instrument fabrication, graphics, visual aids, and library services. High profession- alism pervades all- of these staffs. Biomedical engineers participate as collaborators with peer scientists in the laboratories and its members do some self-initiated projects. They also participate in training personnel from other countries. The Veterinary Resources Branch maintains a major facility for large animals and handles primates, livestock, and fox hounds. This branch also furnishes 700, 000 rodents annually for research uses. There is international interest in the 25 0 s trains o f rodents produced . THE NIH R ESEARCH & SUPPORT DIVISIOhIS CLINICAL ~ // FOGARTy CENTE R _ _ , r ~ CENTE R _ R ESEA RC~ GRANTS COMPUTE R RESEARCH & _ TECHNO LOG Y R ESEA R CH SER~iCES FIGURE 7 The NIH research and support divis ion. R ESEA R CH R ESOU RCES : ~- SOURCE:: NIH Peer Review of Research Grant Applications ~ January ~ 1983.

88 The Office of Research Services. Thin office, officially part of the Office of the Director, NIH, and headed by a scientist administrator, supports the entire campus complex with safety programs, engineering and facilities services, and administrative services including purchases of supplies and equipment, transportation, and communications. like Divis ion of Safety, headed by a Phi. engineer, is pushing the state of the art in areas such as environmental protection, chemical waste disposal, radiation safety and occupational safety in the research environment. The total staff number 1,636 with a FY 1983 budget of 6114.0 million, which in reimbursed by the users. The above four organizations provide campus and Intramural support as their primary mission, and are self-supporting through reimburse- ments. The remaining three organizations are predominantly Extramural: Divis ion of Research Grant s. As previous ly described, the DRG handles the receipt and referral of all grant applications and operates the 64 Study Sections. Its FY 1983 budget 617.3 million. Its staff of 427 includes about 100 Ph.D.s and M.D.s to undertake the rigorous effort involved in substantive examination of 26,000 applications annually, and the prepara- tion of the findings of the Study Sections. The peer review process is not just a "service" function, but an important part of the "quality control" management of the Extramural program, assuring objectivity and high competence in the examination and rating of applications. Division of Research Resources (DRR). This division is a major grant~aking organization, larger in fact than several of the Institutes. Its 1983 budget was $214 million, which Congress increased to $243 million in FY 1984. The stat f is small at 127, but this is because the division has no Intramural program. The DRR' 8 role to support recipient institutions of NIH grants and contracts with essential clinical facilities (74 now financed), animals (such as the 7 National Primate Centers currently being funded), development of advanced information processing and instrumentation technology (such as Nuclear Magnetic Resonance , Art if ic ial Intelligence, and High Voltage Electron Microscopy). In addition, the grants program provides seed money to research institutions to finance pilot projects and provide financial f legibility. These supports are in the forefront of research support and indispensable to the scientific community. A special program for the support of minority biomedical research support is conducted in collaboration with the Institutes .

89 The Fo~arty _Internationa1 Center (FIC). With a staff of 64 and a FY 1983 budget of $10 million, the FIC awards research fellowships and conference grants; has authority to award other grants and contracts; coordinates scientist exchanges foreign visitors, and bilateral activities (with PHS-wide responsibility for some of these); manages the NIH International Visiting Scientists Program; and organizes and manages international scientific meetings. The FIC is also the funding channel for the Gorgas Memorial Laboratory in Panama. ~ These last two organizations, DRR and FIC, have autonomous research programs and direct congressional appropriations, and are known as research divisions. The majority of their budgets are devoted to extramural grants and contracts, for which DRR and FIC have final authority, and for most purposes they are treated as research institutes. Unlike the institutes, however, their missions primarily involve the support of research, through the development and support of research resources (DRR) and international research collaboration (FIC). In total, the supporting organizations have a staff of 5,395 full and part-time personnel and annual expenditures of approximately $526 million, of which about $302 million is reimbursed by the Institutes. Interviews were conducted with Branch level supervisors in most of these organizations and one is impressed both'with their technical competence and with their superior motivation to support the biomedical revolution" of which they are an integral part. One is also impressed with the comprehensiveness and excellence of a major study which has recently been conducted for the Director of NIH, on the basis for charging the Institutes for these services, case by case, in the interest of cost control and equity. Some of the people that were interviewed raises the question as to whether tighter management of these supporting activities would be beneficial in the interest of cost management--but not to sacrifice in any way their excellent morale and high quality of performance. This question will also be considered in Part III. In Part III of this paper, some of the questions posed in this section will be assessed and possible courses of action considered.

PART III AN EXAMPLE OF POSSIBLE NEAR-TERM REFINEMENTS IN ORGANIZATION After considering the findings and observations resulting from this-opportunity to view NIH through direct observation and discussion with its leaders, one is impressed with those features of its organization and culture which make it highly.manageable today: The stress on performance, at every level , sweeps aside the bureaucratic struggles which usurp the time of supervisors in many organ~zat ions . The practice, almost subconsciously, of the best tenets of participative management is closely allied to the first attribute. It makes collaborators out of the entire workforce and encourages new leve Is of achievement in virtually every field. Tolerance for overlapping interests is perhaps the most --remarkable attitudinal factor. The fact that the Institutes experience a high degree of dual interest in areas and applications, but yet are able to resolve such overlaps with a neutral party in the Division of Reseach Grants, is a brilliant achievement. Excellence of communications and documentation goes hand-in-hand with the above characteristics, and in many ways is both cause and e f feet . It is the purpose of this chapter to examine the proposition that without impairing these virtues, benefits might accrue from assuring greater attention to the day-to-day management and cost-effectiveness of the seven research and central services activities discussed in the preceding chapter. The chapter discusses one example of how this could be done. To Accomplish This, Certain Responsibilities Could be More Sharply De f ined Among the Deputy Directors of NIH The concept suggests that the "front office" partnership employ two functional deputies with line authority over central service functions outside of individual institutes and staff responsibility for extramural and intramural research programs: one for Intramural Programs and Campus Services; one for Extramural Programs and Training.

91 Assign the Deputy for Intramura 1 Programs ant Campus Services Line Responsibility for the Major Supporting Activities As envies toned, this would be the biggest operas ing management " responsibility in NIH, and it would require a leader devoted first to the scientific research mission of NIH on campus and second to assuring that the supporting stat fig, facilities, tools, and services are provided in a high-quality, cost-effective manner. The motto should be: "The dollar we save on support services can be inves ted in direct research. " The methodology should be one of periodic cost- benefit analysis in collaboration with the Scientific and Clinical Directors. A possible organization is shown below: Total Positions: 4, 777 Total Budget: S278 million plus including GSA, Facilities and F inane ial Management pos: 1,6 Of ~ ice of Research Serv ices L ine . _ Pos: 496 1 S28 Div is ion of Research Serv ices · Safety ~ Animals · Facilities ~ Instruments · Administrative ~ Library Services ~ Graphics _ Deputy for Intramur al Programs and Campus ierv ices. Rcapons ib i 1 i TV . Pos: 2~300 1 S92 Pos: 345 1 S44 Clinical Division of Computer Center Research ~ Technology · Clinical Services · Ambulatory Care NIH-Wide Coordination of Intramural Programs Computer Center Research supper t: computers ~ matte r physical sciences It is believed that the most useful approach to managing this huge c luster would be to form task teams, over time, around a series of pre-planned projects. Examples of near-term issues which might be examined are: Operation and utilization of the Clinical Center. Today beds are specifically assigned to and controlled by individual Institutes. Utilization ranges from 32: to 80: with an average of 62%. Should higher utilization rates be sought? Similarly, should cons iteration be given to utilization of surgical and related facilities on more than one shift? *This expanded title seems appropriate. Budget data are FY 1983 actuals, as reimbursed by the Bureaus and Ins titute ~ .

92 The~NIH-wide responsibility for library services is another area which might be assessed for cost-effectiveness. Should NLM be given this miss ion? Should individual DRS and Institute libraries (and/or journal subscription services ) be coordinated to obtain des irable economies? Organization for oversight of the Office of Research Services and the Divis ion of Research Services: Should one management be established at an appropriate time? Is there any value in closer coordination between the in-house support services and the Extramural programs? For example, does the DCRT computer capability and state of the art expertise offer value to the extramural community, and vice versa? It is recognized that issues of competition with private sector organizations must be carefully considered. Some may challenge the wisdom of assigning such detailed management responsibilities to an executive whose main purview today is one of intramural research policy. This is a good question to consider, and a separate executive to specialize in support services management is certainly a proper alternative. The question may be whether a policy or a management orientation is most desired. On balance, the policy orientation has been chosen but with a strong and · . pressing mission to pay more attention to the managerial, - cost-effectiveness aspects of these activities. Assign to the Deputy for Extramural Programs and Training Line Re s pans ib i 1 i ty for the Maj or Suppor t ~~ Organizat ions A pos s ib le c lus ter is shown on the fo l lowing page: r . l Positions: 618 plus ' Budget: S241 Allison ~ Deputy for Extramural Programs and Bra I n i ^^ 1 , .... , 1 Line ~ Respor IS:bi1~t~ 1 1 Pos: 427 1 S17 Pos: 127 1 S214 Pos: 64 S10 Division ~ I Division ~ l Fogart Office for ' of | of l Ineernatronal ~ Protection from I Research Grants ~ Research Resources| Center Research Risks I _ · Applications · Primate Centers international · Guidelines for Receipt, · Clinical Centers · Fellowships Human and Animal Referral · Computers and · Conferences Subjects · Peer Review - instrumentation · Seminars · M:noc~ty Research | · Exchange. · Seed Money j l NIH-WIde Coordination of Extramural Programs

93 This arrangement is less of a change in the present organization than the one proposed for Intramural Programs and Campus Services. But the principle is the same--namely, to assure a clear line responsibility for those support organizations which are clearly relevant to the Extramural Program; and to see that they relate in the most cost-effective manner to the Bureaus ant Institutes. Among the questions encountered which would affect this cluster are: Should the Grant Application Review process give more weight to program priorities ~ as in the case of the Eye Institute? Should the Director of DRG have a coordinating role over all f irst level peer review groups ~ inc. luding the Review Cormittees, on behalf of the Deputy Director for Extramural Programs ?* Should Intramural projects be subjected to the same peer review mechanisms? Should closer relations exist between the programs of the Institute for General Medical Sciences and the Division of Research Resources, particularly in the field of minority programs, and possibly computer/equipment development projects . Should the DRR, whose programs are excellent and strongly supported by Congress ~ be retitled the L Institute for Research Resources?" Should a more formalized program of research into research support be instituted to assure that these grants are meeting the most significant needs of investigators and institutions in the most cost-effeceive manner? Such an effort might be entit led Research Program on Research Support . flight it be 1 inked a lso to the proposed evaluat ions to be carried out by the Deputy for Intramural Programs and Campus Services? *It is noted that the Deputy Director has established an Extramural Programs Policy Staff which may accomplish this objective in part.

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