PUBLIC HEALTH: Gerberding Defends Her Transformation of CDC
Science Magazine, Oct 13, 2006
By Jocelyn Kaiser and Jennifer Couzin

The director denies that a reorganization is weakening the public health agency

Hopes were high 4 years ago when Julie Gerberding, a respected infectious-disease researcher, took the helm of the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. Following the post-9/11 anthrax mail attacks the year before, some in Congress had criticized the nation's premier public health agency for an uncoordinated response. Gerberding, who as CDC acting deputy director for science had emerged as a polished spokesperson for the agency during the crisis, resolved to revamp an organization seen as moving too slowly to address health threats.

She's certainly stirred things up--including some vocal opposition. In 2003 after bringing in management consultants, Gerberding began a reorganization called the Futures Initiative, creating new "coordinating centers" to oversee CDC's existing centers and drawing howls of protest within CDC. The unrest, simmering for years, drew new public attention in September when the Atlanta Journal-Constitution ran a lengthy story quoting disgruntled former and current CDC scientists. The article suggested that the turmoil has contributed to the departures of the heads of six of CDC's eight original main centers, such as James Hughes, director of the National Center for Infectious Diseases, as well as other seasoned scientists. The story also revealed that last December, five former CDC directors sent Gerberding a letter expressing "great concern" about "low morale" and "losses of highly qualified and motivated staff."

In press reports, an Internet blog (cdcchatter.net), and conversations with Science, CDC staffers have complained that the Futures Initiative has dragged on too long, sapped their time, and added layers of bureaucracy that impede their independence. "There's been a deterioration in our capacity coincident with the deterioration in morale," says Stephen Cochi, a senior researcher in CDC's National Immunization Program. "Something has gone terribly wrong."

Researchers also worry about how Gerberding's still-developing plan to align CDC's budget to match a set of "health protection goals," such as increasing older adults' life spans, will affect research priorities. To her credit, says David Sencer, CDC director from 1966 to 1977 and one of the letter signers, Gerberding has increased efforts to communicate with staff in recent weeks and has announced plans to appoint two ombudsmen: "I think she's trying," Sencer says.

In an hourlong interview last week with Science, Gerberding defended her plan to transform CDC and said the mood of many in the agency is upbeat. She pointed to her efforts to branch into new scientific areas such as climate change, expand CDC's extramural grants program, and begin outside peer review of intramural programs. She praised as "extraordinarily gifted" the leaders she's recruited, such as Kevin Fenton, who runs CDC's National Center for HIV, STD, and TB Prevention, and Lonnie King, who directs a new center on zoonotic, vector-borne, and enteric diseases. "There's a difference between our performance in the scientific arena and people's discomfort with some of the things that are going on," Gerberding said, while acknowledging that her radical overhaul of CDC's operations is inevitably prompting "anger" and "grieving."

"There's a difference between our performance in the scientific arena and people's discomfort with some of the things that are going on,"

Q: Are there areas of research at CDC that you're cutting back on to accommodate some of the expansion?
Not at this time. Our budget is very constrained by very strict budget lines that basically dictate, you spend your money for this.

Q: So you're 3 years into the reorganization. As you know, CDC staff members are saying, "Yeah, we have to change, but let's get it over with." How long do you think this reorganization should take? Has it taken longer than you expected?
Absolutely not. Anybody who's gone through a major organizational transformation knows that you measure the timeline in years.

Q: We hear from people at CDC saying, "I'm still not sure how my job is going to change." When will they be able to say, "Okay, now I know how my job has changed, and it's not going to really overhaul much more?"
Many of the hard pieces are done. As of October 1st, the management priorities of the year are number one: stability. The main structural reorganizations are approved and in place. It's really time to say, "Let's take a breath, and let's really think about now how do we make the promise that we had when we started this really come true."

Q: Are you concerned that so many senior scientists have left CDC in the last couple of years?
First of all, it's not an unprecedented rate of departures. We have been tracking the attrition rate of scientists, and there's absolutely no change in the trend whatsoever.

Q: What about if you just looked at the number of center directors who left from 1996 to 2001, versus from 2001 to 2006?
I haven't looked over time at the historical attrition of center directors per se. Some of our center directors were no longer in what I would consider to be the most productive phase of their career, and that was something that, you know, is difficult to point out in a public environment. Being a center director is not a life sentence. But we also have some excellent center directors who were recruited to terrific jobs elsewhere, and we were sorry to see them go, believe me. CDC is a good place to recruit from. We've had a wonderful influx of new, brilliant people who are leading our centers.

Q: In the letter from the former CDC directors, they express concern about how many senior people are leaving and about morale. It seems fairly unusual that five directors would send a letter like that. What do you make of this?
I think [the former directors] weren't conducting a poll of CDC. They were talking to people they respected and they trusted, and they took it very seriously, as I hope I would if I were in their shoes. You know, Dr. [William] Foege [CDC director from 1977 to 1983, a letter signer] was the last person to try to initiate any kind of organizational change at CDC. And when he was going through it, the entire laboratory division of the agency threatened to resign.

We recognize that a change process for a center as large and as successful as CDC is a very difficult undertaking. When you ask people to be more collaborative, or you're asking people to more formally work together for a common goal, it's a new way of working, and not everyone's comfortable with it.

Q: What we've heard is that while that [working together] may be a stated goal, it's not really happening. People feel that because there's additional bureaucracy, it's actually harder to work together.
I think you probably need to talk to more people.

Q: You've said the news reports reflect symptoms of a "disease" at CDC. What do you mean by this?
There are a small number at CDC who are intent on continuing to be critical and are not really willing to say, "How can we help?" or "How can we step up to the plate?" In my opinion, the solution to solving organizational problems is to speak up, not necessarily out.

We're trying to do more to make it safe for people to speak up at every level of the organization, because if we know we've got problems, we can fix them. We're going to try our own blog and really create a system where people can bring their own questions to me anonymously or otherwise, so that we have an informal way of saying, "Gee, how come I can't hire?" or "What is this about performance awards? Let's get the story straight."

Q: Another complaint is that scientists felt, especially early on, that they spent a lot of time on these work groups, and yet in the end, it seems like their advice was ignored.
I completely disagree with that. The people who designed the organizational structure at CDC were scientists [who] came up with three organizational designs, there was lots of conversation about it, and ultimately, you have to pick one. There's no perfect organizational structure in any agency, but we took their advice.

There's a difference between our performance in the scientific arena and people's discomfort with some of the things that are going on. We are performing with excellence, and I cannot find any evidence of any faltering of CDC's performance in the last 3 years. We are the most credible governmental organization if you believe the Harris opinion poll--and we continue to strive to improve even more.

Q: When you look back at your tenure as director so far, are there any mistakes you feel you've made, things you'd do differently in the future, going forward?
I'm kind of a speed-oriented person, and this [the transformation] has taken longer than I wish. But I'm counseled by wise people who have done this kind of thing many times that it always takes years. And I wish that we had been clearer about that expectation at the beginning--that people had been more prepared for the fact that organizational transformation takes a long time, and it's really hard.

Q: How long are you planning to stay [at CDC]? Until the transformation is complete?
I have absolutely no plan to leave right now. [And] I don't think that the transformation will be complete for many years. People who are scientists of organizational design say you check at the 10-year point about your success or failure of the enterprise.