The mission of the NCI is scientific discovery about all aspects of cancer toward the ultimate elimination of cancer from our lives. As our understanding of cancer has grown and our capacity to attack it has blossomed, NCI has recognized a need to re-examine and revise its organizational structure to ensure a cohesive, efficient approach to the myriad initiatives and programs the Institute brings to bear on the cancer problem.
The new NCI leadership initiated a major reorganization and significant management improvements, based on recommendations of the Ad Hoc Working Group of the National Cancer Advisory Board and NCI streamlining workgroups and quality improvement teams. These changes, including decentralized authority for many operating decisions, reflect NCI's recognition that programmatic and cost efficiencies were both possible and would best realize the Institute's mission by enhancing scientific program management, reducing duplication, fostering a uniform standard of intramural research excellence, improving communication among scientists working in related areas, improving and simplifying administrative functions, and optimizing the use of information technologies.
To achieve these efficiencies and better align the organization's structure with evolving scientific priorities, the extramural programs have been regrouped to reflect current scientific knowledge and to co-locate certain clinical grant programs for more efficient scientific management. All intramural laboratory, clinical, and population-based research has been consolidated under three new divisions. The Office of the Director has been restructured and now includes the Office of Science Policy to ensure continuing surveillance of opportunities to improve planning, management, and efficiency.
Moreover, the reorganization makes real NCI's dedication to stronger participation in decision-making by the cancer research community while at the same time streamlining the advisory committee structure. A single Board of Scientific Counselors (BSC), reviewing and advising on intramural research, replaces the four Boards previously addressing activities of each of the four program divisions. Similarly, one Board of Scientific Advisors (BSA) will appraise and make recommendations for the extramural programs. Both Boards include members of the lay community in addition to leading scientists. Advisors will now be able to consider the programs of the NCI as a whole, rather than only the type of science funded by a single division.
Steps have also been taken to solicit advice from the community of NCI intramural scientists and the scientific and administrative staff responsible for the review, award, and scientific management of the grant programs. The Intramural Advisory Board (IAB) and Extramural Advisory Board (EAB) within the NCI meet regularly to advise on policy and process and serve as information conduits back to the staffs they represent.
There is no question that the NCI's greatest challenge is to reduce
the burden of cancer. The Institute needs to find ways both to maintain
the spectacular progress in basic research discoveries and to bridge this
progress into improved prevention and treatment for the many different cancers.
Successfully meeting these challenges involves the ability to respond to
needs and scientific opportunities, to articulate priorities and create
the structures to support them, and to evaluate how we are doing.
During the past three years, NCI has undertaken several evaluations and
reviews to focus on progress against cancer, what the Institute is doing
now, where we should be heading, and what the collective programs of the
cancer effort should look like in the next five to ten years. In 1993, an
assessment of the achievements of the National Cancer Program (NCP) identified
the gaps, shortfalls, and opportunities in the cancer effort and made recommendations
for future research and program directions. Cancer At a Crossroads: A
Report to Congress for the Nation, authored by the NCAB Subcommittee
to Evaluate the National Cancer Program, integrated information on the past
progress and the current state of the NCP and included viewpoints of a variety
of constituencies having a stake in the cancer research enterprise. Also
under the auspices of the NCAB, a working group of pre-eminent researchers
was formed in 1994 to review the NCI Intramural Research Program (IRP).
The group examined the overall mission, quality, size, and organization
of the IRP; whether its major research areas were in proportion to the overall
priorities of the NCI; and the morale and working conditions within the
IRP. The review culminated in a report known as the Bishop-Calabresi Report
that summarizes findings and makes recommendations for a stronger IRP. Recommendations
from these assessments have already been implemented by the new NCI leadership.
NCI has started intensive reviews of four of its major programs--Clinical
Trials, Cancer Centers, Developmental Therapeutics, and Prevention. For
this purpose, our Board of Scientific Advisors has assembled a group of
distinguished scientists, clinical investigators, and consumers for each
review group. We expect each review to take several months and provide a
top-to-bottom evaluation of each program and recommendations for how we
should successfully structure these programs for the future. Deliberations
of these reviews will figure importantly in our planning for the future
of the NCI.
The NCI Executive Committee, which meets weekly to make major policy and operating decisions for the Institute, has been newly reconstituted to include the chairs of the IAB, EAB, BSC, and BSA. In this way, the extramural community and the internal working scientists and scientific administrators inform and influence key NCI policies and actions.
The NCI recognizes its responsibilities to function as efficiently as possible and make hard decisions about redirecting funds to reflect priorities and scientific opportunities. Over the past ten months, 8 programs, 8 branches, and 18 sections have been abolished, and 6 administrative branches have been merged into 2 organizational components. Information management and support services have been consolidated from 7 divisions and 8 offices into a single management structure.
Streamlining has allowed us to do our business faster and at lower administrative cost. For example, the cost for our contract review process was reduced 40 percent, and the time for review was shortened by more than one-third.
Over $30 million were reprogrammed from contracts by closing or scaling down programs of lower priority. Major shifts of funding totaling over $60 million have allowed us to increase by about one-third the number of new, investigator-initiated single project research grant applications that receive funding. These funds also are being used to strengthen clinical research and our clinical trials program. For the first time, our intramural research programs have been managed using zero-based budgeting and strict cost management principles.
All of these changes, and more, allow us to move ahead as an efficient and effective organization as we seek to invest new monies in new opportunities to reduce the burden of cancer.
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