THE CLINICAL CENTER REVIEW: WHAT'S REALLY HAPPENING

John Gallin

I am sure that most of you have read or heard about the recent news articles in Science, Nature, and Nature Medicine about stress at the Clinical Center stemming from the HHS proposal to contract out all, or a portion, of the Clinical Center's operations as part of phase two of Vice President Al Gore's Reinventing Government initiative, or REGO II. I am also sure that many of you who saw the May 12 article in the Washington Post, which was headlined "Administration Unveils Proposal to Cut 2,400 HHS Jobs in 5 Years," were disturbed to read that "HHS sources said ... 1,000 or so jobs could turn out to be positions at NIH's Clinical Center ... ." In my conversations with Health Care Financing Administration Deputy Administrator Helen Smits, who is charged with overseeing the review of the Clinical Center for HHS Secretary Donna Shalala, it is clear that no decision has been made to contract out the entire Clinical Center. The purpose of this column is to bring you up to date on my understanding of what is happening.

Smits, who has an office near mine on the second floor of the Clinical Center, is here every Wednesday. She is anxious to learn about the Clinical Center and soon expects to be joining patient rounds and visiting operating rooms. She has assembled an "Options Team" charged with identifying obstacles to conducting clinical research and evaluating options to ensure that the Clinical Center runs as efficiently as possible. The members of the Options Team, which is chaired by Smits, are Alan Brier, NIMH; Greg Curt, NCI; Michael Goldrich, NIAID; Christine Grady, NINR; David Henderson, CC; Steven Holland, NIAID; Walter Jones, CC; Ruth Kirschstein, OD (ex officio); Harvey Klein, CC; Francine Little, OD; Kathy Montgomery, CC; Griffin Rodgers, NIDDK; Judith Vaitukaitis, NCRR; and myself. Additionally, the following external advisers will provide periodic consultation to the Options Team: John Finan Jr. of Barnes Hospital in St. Louis; William Kerr of the Medical Center at the University of California at San Francisco; Gloria Opirhory of John Dempsey Hospital, University of Connecticut at Storrs; John Rowe of Mount Sinai Medical Center in New York; Steve Shimpf of the University of Maryland Medical Center in Baltimore; Ralph Snyderman of Duke University in Durham, N.C., and Samuel Thier of Massachusetts General Hospital in Boston.

The goal of the Options Team is to identify mechanisms for making the Clinical Center more efficient and a better place to conduct clinical research. The goal is not to save a certain number of full-time employees (FTEs) through costly and inefficient contract mechanisms. Specifically, the Options Team will be divided into groups to look at the Clinical Center's governance, information and reporting, budgeting, benchmarking, and options as a federal entity and at the possibility that the center could become a reinvention laboratory. As a result of the retreats held by the Medical Board and the Clinical Center department heads early this fiscal year, several groups have already started working independently on related issues and these groups will merge their work with the Options Team's efforts. The Options Team is addressing specific questions in these areas:

• Governance. How can the governance system of the Clinical Center best ensure its successful function? Is the Clinical Center capable of responding quickly to change and dealing effectively with difficult decisions? Does the current governance structure serve the interests of intramural clinical investigators?

• Information needs and reporting mechanisms. What kinds of information, training, and administrative systems are needed to ensure cost-effective performances?

• Budgeting mechanisms. Are there other medical research institutions similar enough to use for comparisons of efficiency? If so, in what functional areas?

• Flexibility. What are the most serious problems posed by federal rules dealing with personnel? Purchasing? Contracting?

Smits has asked the Options Team to describe a full range of options that could be used to enable the Clinical Center to operate with maximum effectiveness. She has also asked the team to weigh the relative merits, including the cost-effectiveness, of each option.

The Options Team will spend May through August gathering data and visiting other hospitals. In September or October, the team will hold a retreat to develop recommendations, and those recommendations will be submitted to an outside consultant for cost-benefit analyses. Throughout November and December, the team will review draft reports and present its conclusions to the NIH leadership, including the External Advisory Committee to the NIH Director. The final report will be delivered to Assistant Secretary for Health Philip Lee by Jan. 1.

From my vantage point, the Options Team's objectives appear compatible with NIH's long-standing objectives of efficiency in clinical research, training, and patient care. I am confident that the review process will result in an improved Clinical Center, and I urge clinical researchers to make their views and priorities known during this time of transition. Smits welcomes your comments and can be reached by e-mail (smits@qmgate.cc.nih.gov).

John I. Gallin, M.D.
Director
Warren Grant Magnuson Clinical Center
Associate Director for Clinical Research