Responding to Health Needs and Scientific Opportunity The Organizational Structure of the National Institutes of Health (1984) / Chapter Skim
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2 Organizational Evolution
2 Organizational Evolution
Pages 10-23
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, others relate to stages in human development (Child Health and Human Development; Aging) and still others have broad themes (Environmental Health Sciences; General Medical Sciences)
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Before doing so, it is important to under Stand an fully as possible the effect of organizational change on research budgets and research programs. Overall NIH Appropriations Since the 1930s, NIH has seen the establishment of many new institutes and divisions.
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Appropriations for the Affected Instituter The committee has examined whether there is a cause and effect relationship between creation of new institutes or elevation to bureau status ant funding patterns. While we could not find conclusive evidence of sloth a relationship, we report the following observations.
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13 2.0 1.8 1.6 1.4 o z 1.0 o < 0.8 0.e 0.4 1.2 0.2 ~ ~ 0~ O it_ ~ 11340 1~5 1 9S0 1~6 .
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The Ef f ec t on Sc fence and Management The remaining question is the extent to which different organizational forms facilitate the NIH objectives of maintaining scientific excellence ant being responsive to the needs of society. It is extremely difficult to assemble objective data on the impact of new institutes or other organizational changes on the scientific productivity and the generation of health research in these fields.
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50r 40 30 3 In us lo: . ~ o a UJ cut -20 at: flu ILL 20R -10 ~ · NIA ~ NICHO O NICHD ~ NIA t972 1974 1916 1978 1~ 1982 YEAR FIGURE 3: Di f ferent is l growth rates of congres a tonal appropriat ions for the National Institute of Child Health and Oman Development (NICHD)
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Through a series of actions taken to increase the visibility of and resources for this area, lung research wee transformer from a relatively undeveloped area into a thriving one that underwent a scientific revolution in the 19708.16 Frommer characterizes this as a shift from "studying the lung simply as a bellows and gee exchange organ to Studying it as a complex physiological organ involved in numerous other processes and to studying it at the cellular and subcellular levels and also by biochemical, immunological, and other techniquea.''l7 In the case of the Lung Division, a major reason for the successful outcome was the active cooperation of institute leadership with the forces urging greater attention and resources for lung research. What both of these cases had in common was a scientific readiness for major advances and dynamic leadership from committed individuals with a vision for the field.
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But partly as the result of an internal study completed in 1973, most institutes have since adopted a program-orientet structure.23 The National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases, for instance, now has divisions corresponding to each of the disease groups in the title, and under them nine branches in rheumatic diseases, musculoskeletal diseases, skin diseases, diabetes, endocrine ant metabolic diseases, digestive diseases, nutrition, kidney and urologic diseases, and blood diseases. This program orientation enables coordinated efforts in identified research areas, committed ant accountable program leadership, and organizational responses below the institute level.
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The individual or office charged with this surveillance function should keep track of scientific developments ant public perceptions 80 as to alert the Director when strategies of response are required. This mechanism would allow NIH to seize the initiative in interacting with the external world, rather than simply reacting to its pressures.
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publicizing what scientific research has accomplished, and the status and promise o f current research in the area; disseminating the resules of research widely to centers that can make immediate clinical use of them; . accelerating research by such means as soliciting applications for grants, schedul ing spec is 1 peer review sessions, appointing special study sections, and utilizing "high relevance ~cores" for applications in the area concerned; holding major conferences of the leaders of the scientists and practitioners concerned to exchange ideas and discuss future actions, and in appropriate situations, creating such groups by action of the Secretary, or the White House, or by joint action with Congress; naming special panels or subcommittees of the national advisory councils , boards of Scientific counselors, review committees, and study sections, as appropriate, to examine both extramural and intramural programs and opportunities; forming an NlH-wide or inter-agency committee, preferably led by an institute director, to coordinate and develop research in the area; providing higher visibility and stronger leadership over the area of concern by organizational upgrading; for example, elevating sections to branches, branches to programs, or programs to divisions.
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A Process to Assess Proposed Organizational Changes The committee recommends: There should be a formal process to assess proposed major organizational changes in NIH. This process must involve the entire range of interested parties.
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No single agency, or advisory board associated with a single agency, would have the broad perspective and the public credibility that are needed to address transfer issues. Criteria to Assess Proposed Organizational Changes The criteria described below identify a set of issues to be addressed in the discussion about the need for a new institute or other major organizational change in NIH.
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Critical mass arguments cut both ways. In the case of vision research, proponents of a new eye institute claimed that the scientific personnel and research ideas already existed, but were not getting enough attention.25 The National Institute on Aging, on the other hand, was established, in part, in order to develop a cadre of researchers on aging, and personnel development continues to be one of the institute' s top priorities.26 The committee feels that the research area to be emphasized must have a potent ial for growth, both in terms of the underly ing sc fence and in the number of scientists whose efforts could prof itably be directed toward the area.
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From page 23... ...
In this respect, an organizational change is an improvement if it leads to a more appropriate set of trade-offs, for instance, one in which the alternatives are different scientific approaches toward the same health goals. In addition, because institute appropriations are determined outside of NIH, narrowly defined institutes may lead to excessively detailed external control.
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