NIH director Dr. Elias Zerhouni (l) thanks steering committee members who just completed their rotation as of FY 2007. They are (from l) NIAMS director Dr. Stephen Katz, whose term was extended through FY 2008, NIA director Dr. Richard Hodes, NIDCR director Dr. Larry Tabak and NIDA director Dr. Nora Volkow. Photo: Hilda Schulke

Taking into account his prior experience with such organizational issues, and after getting advice from several experts, Zerhouni proposed a slimmed-down model for governance—the steering committee. Now, some 6 years later, the SC is moving nimbly into its fifth year.

“Overall it’s been a great success,” says NIH deputy director Dr. Raynard Kington, ex officio SC member. “It was a natural step in the growth and maturation of a large organization. Governance is deciding how complex decisions are made and who makes them. The goal of this committee structure was to allow a transparent, deliberative process in which there was input from diverse leadership of the agency for formulating policies on matters that affected the entire agency.”

Ten IC directors comprise the committee, in addition to chair Zerhouni and Kington. Directors of the three largest institutes budget-wise—NCI, NIAID and NHLBI—are permanent members; the other slots rotate in staggered 3-year terms among the remaining ICs. Senior Office of the Director staff also participate, serving on topic-specific fact-finding SC work groups.

Less Is More

Inaugural committee member NIAMS director Dr. Stephen Katz, who is serving a fifth year on the committee at Zerhouni’s request following the initial “trial-run year” and a 3-year appointed term, remembers the pre-SC days.

“Decision-making and information-gathering have become more ordered processes during the last few years,” he says. “The steering committee makes recommendations to the director of NIH who also actively participates in discussions. Candor and debate are essential ingredients that lead to crystallization of the issues at hand. In the past, issues may have been debated at length at meetings, and then punted back to the same or other committees for further debate. Now, there is a clear understanding that issues brought to the [SC] have already been discussed at the relevant stakeholder group meetings—so options presented to the committee are for final discussion and adjudication. Thus, decision-making has been enhanced, accelerated and expedited.”

Zerhouni agrees that having the SC helps put matters to rest more quickly. “My biggest contribution is that I believe once the decision is reached,” he says, “we have to stick to it. There is empowerment now. There’s no second-guessing afterwards, whether it’s difficult or politically unpopular—whatever—we’ll stick to it.”

NIDCR director Dr. Lawrence Tabak, whose SC rotation recently ended after 4½ years, marvels at the levels of expertise. “The approach has also engaged many more persons,” he notes. “Often issues are first examined by one or more working groups; highly talented people across NIH populate these subcommittees. The net effect is to have the input of many persons inform decision- making.”

Tabak, who co-chaired an IT work group, recalls pondering the start of electronic submission of grant applications. “Many persons—with expertise ranging from computer technology, programming, grants management, grants policy and communications—needed to weigh in,” he says. “In the end we were able to provide a ‘go’ recommendation that considered the multiple dimensions of this activity. Due to the hard work of many persons across NIH, the launch was remarkably smooth.”

Kington remembers how the committee dealt with a mandate handed down by HHS. “At the core of that decision were fundamental policy and scientific questions about how you treat people with addiction,” he explains. “Here was this mundane topic—how do we create a smoke-free campus?—that hit up against a scientific body of evidence on how we view this condition. Everything was discussed about the practical implications of creating a smoke-free environment: Do you have smoke-free sections of the buildings, outside the buildings, how far away, in central places? At what point does it become punitive to people with a health problem?

“I think we ended up with a reasonable, fair policy,” he continues. “It was a good example of having a smaller, representative group of individuals who are informed of the facts prepare briefings and put forth a proposal. Every year we have a similar thoughtful process for determining the budgets for central services—activities funded jointly by the institutes.”

Growing Pains Addressed

That’s not to say the SC was a universal hit at first. An early review of the SC found that some IC directors not on the committee felt left out of the process.

“There are challenges,” Zerhouni says. “You don’t want to create people that are ‘in the know’ and ‘not in the know.’ We’ve had to make sure that everyone is informed and is aware of what goes on in the steering committee. I’m against top-down management, so I always try to engage people.”

A big problem with governance everywhere is determining where governance stops and management begins, Kington explains. “Governance is about the overall rules and policy. Actually implementing those rules are management decisions. It’s a big challenge in any organization…Before, it was a committee of the whole, in essence, with all of the institute and center directors. But we could not maintain that approach. We’ve overcome some growing pains by tweaking the process.”

The SC instituted several adjustments including a principals-only briefing for IC directors held the week following an SC meeting, and an intranet site developed so IC directors can get documents on deliberations. In addition, an outside consultant was contracted to help evaluate the SC process. Another similar assessment is under way for SC’s work groups.

Some IC directors also worried about the additional scheduling burdens a formal steering mechanism might require. “Initially directors were very concerned about the time it would take,” Zerhouni says. “Was this new thing going to be just another bureaucratic thing? Over time, those who have participated have become fans of the process. What I hear is that it is an enriching experience, something that will last.”

Who Are the Deciders?

“The reality is the IC directors and the NIH director are held accountable,” Kington says, noting that ultimately decisions are made by those who will have to answer for any problems that may result. “We also recognize that we need to tap into the knowledge, expertise and experience of leaders at multiple levels. I think we have a system that allows that. What the SC process does is make recommendations to the NIH director, who then makes the final decisions. Having said that, though, it’s interesting that the difficult decisions have almost always had consensus. It’s rare that someone won’t feel comfortable.”

NINDS director Dr. Story Landis, who has served for 18 months, acknowledges the SC’s impact on decisions. “[There] was a proposal from the extramural activities work group (EAWG) that I presented,” she recalls. “The proposal was based on 2 years of work by a trans-NIH work group to develop principles for determining where grants should be reviewed. EAWG recommended that all unsolicited applications be reviewed in CSR while applications that were solicited—request for application or program announcement with set-aside—could be reviewed in ICs. There was a very lively discussion—mostly negative—and in the end the recommendations were not implemented. Since then EAWG has made sure that the steering committee has endorsed projects before they are initiated.”

NIH deputy director for intramural research Dr. Michael Gottesman says IC directors do a lot of the groundwork on most topics. “Some of the most important policy issues that come before the [SC] are deliberated extensively by the IC directors in their regular meetings and at special retreats such as the annual leadership and budget conferences, so that the steering committee begins with a good sense of the community of IC directors.” In addition, he points out, SC members “are in constant contact with their colleagues, and many topics that need resolution by the committee are brought to the IC directors as a whole for further input.”

A Lasting Organizational Legacy

Katz says SC members prize their posts at the policymaking table. “Everyone on the steering committee considers it an honor to serve and takes on the responsibility with great commitment. Since no substitutions are allowed for these meetings, members may call in from all over the world, wherever they may be. The importance of these meetings is reflected by ‘attendance by phone’ at 2:30 or 3:30 a.m. local time. This is what I would call real commitment.”

It’s also important for NIH’ers to know the SC doesn’t sit around conjuring up ways to make work life challenging for employees. Each topic the group tackles, Kington concludes, is in response to “some external pressure or internal force” that demands an answer.

“Decisions on policies that affect all of NIH are not just made in a vacuum,” he emphasizes. “They’re made in a very thoughtful way. People spend a lot of time bringing many different perspectives to bear in developing a policy. This is a way to have the leadership buy into the result.”

Ever planning for the future, Zerhouni says governing by way of the SC offers benefits not only for today, but also for tomorrow.

“The other reason I think creating the steering committee has been important is that it has helped develop more effective leadership across NIH—not just among IC directors either,” he says. “By employing work groups that report from the scientific community as well as the administrative community, we have enhanced the ability to develop fresh leadership. Members have grown and matured positively through their experience with this governance mechanism, so the steering committee is also a way of doing on-the-job training for management and leadership skills, promoting collegial citizenship.”

In many ways, Zerhouni concludes, there’s nothing like actual experience to prepare you for making critical decisions.

“Because I was a scientist and never went to any business schools,” he explains, “I learned it on the job—first and foremost through my being director of a large research division. First question you have to ask yourself is, if you get run over by a car tomorrow, would things continue to work well? Not only do you have to have the right team of people, you need the right organizational structure to make decisions as a community of colleagues. I think the steering committee provides that. Now there’s an institutional way for leaders to tackle the issues of the agency. Eventually all the directors will rotate through the committee.

“When an organization is based on knowledge and high-quality people, my experience is that, if you share information reliably and transparently, 95 percent of the time reasonable people will come to similar conclusions. It fosters a spirit of collegiality and synergy. I think that’s what the steering committee has accomplished over time.”