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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

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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.

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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.

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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

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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~.

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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

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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.

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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.

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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,

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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.

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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

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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.

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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

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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.

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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.

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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 .

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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.

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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.

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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 ~ .

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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

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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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