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Government Leader home > November 2005 issue
November 2005; Vol. 1 No. 4
Prescription for Progress: Dr. Julie Gerberding believes in connecting, not busting, silos to keep CDC in good health
By Trudy Walsh
Other stories on the E-Government Payoff are:
If there’s one characteristic that Dr. Julie Gerberding has shown as director of the Centers for Disease Control and Prevention, it’s that she keeps a cool head in a crisis—23 crises, to be exact.
Since 2001, CDC has weathered 23 emergency situations ranging from anthrax attacks to severe acute respiratory syndrome and avian influenza. During each emergency, Gerberding and her team had “to bring people from a lot of silos together: communications, health informatics, all areas throughout the agency,” she said.
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| | THROWING DISEASES A CURVE: CDC’S new $1.5 billion campus in Atlanta includes a $214 million laboratory devoted to studying infectious diseases such as smallpox and Ebola.
(Image: Ken Hawkins) | |
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But at CDC, silos aren’t necessarily a bad thing. The agency’s scientists are “some of the nation’s most important national treasures,” Gerberding said. “They need to go very deep into their field,” and they find it distracting to look outside their scientific specialty. “CDC developed extraordinary silos, but it didn’t connect them.”
Now, though, that science—and the world—has become more connected, CDC has had to link the silos.
“We don’t talk about silo busting,” Gerberding said. “We talk about silo connecting, because we still need that silo, we still need that depth.”
CDC had to “recognize that one of the key elements of success is how to improve that connectivity but still preserve and protect the depth of the science, which is the foundation of everything we do,” she said.
For example, CDC discovered it had 18 divisions doing critical work related to adolescent health, but those divisions hardly talked to one another. A first step in connecting the silos was the creation of a link between a program supporting advice about adolescent tobacco use and another program that dealt with other kinds of healthy choices for adolescents.
Creating clusters. CDC also restructured some program areas by creating what Gerberding called clusters. For example, the agency put three infectious-disease centers into one management cluster. Most of the clusters are programmatic, but in the case of infectious diseases, the cluster is geographic as well. All of CDC’s infectious-disease research activities except for HIV and sexually transmitted-disease research were moved to the same physical location.
Another part of the silo-connecting process is developing better internal communication processes, Gerberding said.
“We’ve done more to improve internal communications in the past two years than in the past 20 years combined,” she said. The agency also launched CDC Connect, an intranet that explores events of importance to the health community.
Managing scientists poses some special challenges, Gerberding said. “By nature of their discipline, they’re relatively autonomous. They need that protected space, and they function best when they can focus on that.”
But a large part of CDC’s mission is to “disseminate what we learn so people can make health decisions. It’s sometimes been challenging to convince our scientists that dissemination is as important as creation.”
The agency paired scientific experts with people who were experts in management. That way, “the scientist isn’t running around trying to figure out our management process,” Gerberding said. “The scientists can do science, and the managers can manage.”
Fast forward. When Gerberding took CDC’s helm in July 2002, the agency had a strategic plan that dated back to 1970. Back then, the agency’s budget was about $300 million; now it’s $8 billion.
“It’s clear the agency had undergone extraordinary evolution, but management had undergone very little evolution in the past few decades,” she said. “We made a conscious decision that we needed to improve our management structure.”
CDC decided it needed a chief operating officer. This decision was not made lightly, Gerberding said. After much study, Gerberding and her team decided they needed to empower their COO with sophisticated management support. The CDC recruited seven “extraordinary leaders” for the newly created clusters. All seven were CDC experts who were good at collaboration and thrived on innovation. “I like to think of them as the dream team,” she said.
Thus far, the restructuring has paid off handsomely. CDC’s performance metrics have improved significantly, and the agency has achieved five green lights on the President’s Management Agenda scorecard.
Gerberding also is leveraging technology to boost the agency’s efficiency. CDC was the first Health and Human Services Department agency to implement the Unified Financial Management System, HHS’ centralized financial management system. The system lets managers drill down to find specific information such as how much the CDC spent last quarter on programs that support adolescent health. It also helps the agency manage grants, payments and cost accounting.
To keep CDC’s day-to-day operations running smoothly during emergencies, the agency has had to employ some unusual staffing techniques.
First, the agency hires people who have multiple talents and skills. They come on board with the expectation that they will have to pitch in during a crisis, even if it’s not in their job description.
Second, CDC had to employ “the principle of parsimony,” Gerberding said. “By that I mean we don’t send every good person out into the field all at once. We pace them. They come home and rest, and then we rotate them in a planned way as we go forward.”
Third, the agency always has “a second bench,” Gerberding said. “Even if we’re wrapped up in Hurricane Katrina, we’re ready with a second bench. Then when Hurricane Rita came along, we luckily had a third bench. We could reach out to retired people, former CDCers and the private sector so we didn’t detract from our core mission.”
Although CDC has been around for almost 60 years, Gerberding is its first woman director. The agency is working with the National Academy of Public Administrators, which did a comprehensive study of diversity at the agency. “We’re taking steps on that, to increase diversity regarding age, race, gender,” Gerberding said.
Deep roots. A South Dakota native, Gerberding had strong role models in both her mother and grandmother. “The truth is, I was clueless about some of the obstacles women faced,” she said. “Throughout my career, I’ve been extremely fortunate to have leadership positions. I didn’t see the challenges some women face until I was a junior professor at the University of California, San Francisco.”
At UCSF, one of the leaders of the department told Gerberding that despite the fact she was doing great work, epidemiology wasn’t really a science. “If I wanted to be a professor, he said I should switch to something like laboratory science. That woke me up [to the fact] that the playing field wasn’t level for all people. I became interested in proving this person wrong.”
Since the start of her medical career, Gerberding has not shied away from crisis.
“In my heart and in my mind, I’m always first and foremost a doctor,” said Gerberding, who earned her M.D. at Case Western Reserve University in Cleveland.
As an intern and a resident, Gerberding worked with AIDS patients in the early days of the epidemic in San Francisco. Listening to the stories of those patients “convinced me that prevention is primary.”
This conviction about prevention is what ultimately led Gerberding to CDC, which she joined in 1998 as director of the Division of Healthcare Quality Promotion for the National Center for Infectious Diseases.
The other major lesson Gerberding learned from her work with AIDS was more scientific. “AIDS taught us all in the medical community to avoid dogma. It took a long time for us to realize that AIDS was an infectious disease,” she said. Medical researchers spent too much time looking for environmental toxins as a possible cause of the illness, she said. “The notion that a brand new and completely deadly disease could emerge and spread so rapidly—the dogma then was that it couldn’t happen. Now I’m mindful of [avoiding] acting on assumptions rather than data.”
To ensure the agency avoids placing too much faith in dogma, the CDC developed “Team B,” a special group of scientists who step away from the agency’s operations. They watch out for places where the CDC is “not being objective or not digging deeply enough into the scientific literature,” she said. “They can recognize when we are being dogmatic or missing the boat.”
Gerberding is also convinced of the importance of the private sector to public health. “We must engage the business community,” she said. “So much is in the hands of the employees and employers in this country.” CDC is directing research to improve workplace health promotion. For example, the agency is funding research to find out what small employers can do to promote the health of their employees.
Change is never easy. “Organizations, particularly government organizations, change very slowly,” Gerberding said. “But individual people can adapt and change very quickly. The trick is to get the people with that kind of flexibility to be part of the larger changes, the champions, if you will.”
And not everyone has gone along entirely with the recent changes at the CDC. “It’s a process. You have to be thinking in terms of a five-year plan. We’re just in Year One. A healthy organization is in a constant state of change.”
Higher standard. “You can’t run government like a business,” Gerberding said. To lead a government agency requires “everything a CEO needs plus some additional accountabilities. You’re held to a higher standard.”
Under Gerberding’s leadership, CDC is positioning itself to better handle public health crises as they arise. And one thing is certain: New public health emergencies will arise. The biggest health challenges of this century will be “the ones we can’t forecast now,” Gerberding said. That’s why the center has had to learn to be so adaptable.
One recent health challenge that has caused worldwide concern is avian influenza, also known as bird flu, which Gerberding called “a very serious threat. We have every signal indicating the eventual development into a pandemic except for the last signal—efficient transmission from one person to another. If you were checking off boxes for a pandemic, every box has been checked except that last box.”
Since January, Gerberding has met weekly with HHS secretary Mike Leavitt to discuss the avian flu. They and other officials last month traveled to Asia to meet with ministers of health. “If ever there was a metaphor for public health as a network, it’s the avian flu,” she said.
Indeed, CDC itself is much like “a high-speed network. It’s a very global, very connected operation,” she said. And the days of being able to micromanage every hub in the network are “long past,” Gerberding says. Everyone has to be free to use their creativity and innovation to make their unique contribution to the mission.
Not only does this high-speed network require effective, vertical integration, “but you also need to have a much greater ability to act between agencies, between public and private sectors, and in the case of CDC, between nations.”
Having dealt with the public health aftermath of hurricanes Katrina and Rita this year, Gerberding wonders if a situation could arise that would tax the agency to the point at which it couldn’t carry out its public health mission. Even with all the changes the agency has made to handle emergencies, CDC is still making changes so it can assure response capability.
“Planning is everything,” she said.
Take five:
leadership lessons from CDC’s chief
Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, offers five guiding principles for government managers:
1 Learn to adapt, experiment and adjust. “A leader must be open to new experiences.”
2 Focus on the future. Keep your sights on that future space you’re trying to achieve, “but be sure that you accept the accountability for anything that doesn’t go well.”
3 Celebrate successes. Make sure to celebrate these successes with the people who are achieving them.
4 Leadership is a privilege. Gerberding keeps this phrase on a notecard on her desktop.
5 Communication, both within and without an organization, is of the utmost importance. Gerberding relies on a simple but effective communications strategy: Tell the truth. “Every time I feel discombobulated about what to say, I rely on that, and I never go wrong.”
Other stories on the E-Government Payoff are:
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| Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention
(Image: Ken Hawkins) |
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