Beacon of Hope: Founding Years
Framing Organizational Roles
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Founding Years 1944-1953
Growth Years 1953-1969
Years of Change and Renewal 1969-1993
Footnotes
About the Author

A series of legislative enactments beginning with the National Heart Act in June 1948 had pluralized the NIH administrative structure, creating five autonomous research institutes modelled on NCI. The Heart Institute, backed by a $5 million special appropriation and inheriting ongoing cardiovascular projects, began to reorganize the entire intramural program after Dr. James Shannon was appointed scientific director in April 1949. Shannon, who formerly led a highly regarded pharmacology clinic at the Goldwater Hospital, aggressively recruited key staff for newly vacated laboratories in Building 3.24 He also presented Heart’s expansion program to a gathering of institute directors in late October,25 touching off two months of extended discussions, which produced an organizational model for clinical research still in use today.

An early version of the Easton retreats for key NIH staff in the present era, the Institute Directors’ Conferences in December 1949 drew lines of authority strongly favoring the new research institutes over centralized hospital services. Apart from conducting laboratory investigations, institutes were made responsible for providing medical care to patients from admission to discharge, for professional supervision of nursing staff, and for staffing and fiscal support of centralized services such as surgery, clinical pathology, and outpatient services.26 The directors stopped short of recognizing “six autonomous hospitals” within the Clinical Center, but they decentralized authority to the point where even laboratory services such as housekeeping and fire protection were kept out of the director’s hands.27

The result was an extremely flexible administrative structure designed to maximize “the effective conduct of experiments,” subject to patient welfare as a “controlling factor.”28 The institute directors were careful to separate special clinical services such as surgery, pathology, and radiology from research functions usually available to specialists in these areas, but they were also very supportive of dietary, social work, and employee health service departments as centralized services. Shannon also gained acceptance for a single model of institute administration giving precedence to laboratory heads over administrators.29 The upshot was a pragmatic compromise reflecting the working requirements of clinical research, particularly the scientific investigator’s need for freedom from administrative restraint.

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