Government Executive - Authors - Christopher Connell

Down to a Science

Christopher Connell — Sun, 01 Jul 2001 00:00:00 -0400

These are heady days at NIH's leafy 300-acre campus in Bethesda, Md., as Congress pours more money into biomedical research. President Bush proposed a $23 billion NIH budget for fiscal 2002, a 13.5 percent, $2.7 billion increase that will nearly double NIH's 1996 funding level, if legislators approve it. The budget for Fauci's

NIAID is growing even faster. During Fauci's 17-year tenure, the $2.4 billion NIAID has grown from the sixth-largest NIH institute to the third, trailing only the National Cancer Institute ($4.2 billion) and the National Heart, Lung and Blood Institute ($2.6 billion). It now spends more than 10 percent of the NIH budget. When Fauci became director in November 1984, the institute had only a 7 percent share of NIH's $5.1 billion budget.

The dreadful AIDS virus, which has infected almost 1 million Americans and killed 430,000 of them, accounts for much of that growth. But so do exciting developments in understanding how disease spreads and a growing awareness that in this era of jet travel, no country is an island, immune from old scourges such as tuberculosis and malaria and newer, equally terrifying ones, from HIV and hepatitis C to hantavirus, Ebola virus, West Nile fever, mad cow disease and hoof-and-mouth disease. NIAID provides the major support for scientists developing better ways to diagnose, treat and prevent infectious immune system disorders and allergic diseases.

In the early days of the AIDS epidemic, Fauci and some colleagues (including Clifford Lane, the institute's longtime clinical research director; John Gallin; John La Montagne; and Margaret Johnston), retooled the institute's work, devoting major resources to understanding the virus and devising treatment protocols for a disease for which there remains no cure. The work of NIAID's own scientists, the extramural research at hundreds of sites across the country and now around the world, breakthroughs by the pharmaceutical industry and preventive efforts have cut the annual U.S. death toll from AIDS by two-thirds, from 50,610 in 1995 to 16,273 in 1999. And work continues apace on finding a way to block transmission of the virus, just as polio and other infectious killers were stopped in their tracks by powerful vaccines.

In addition to managing this burgeoning research enterprise and playing his very visible role as the government's leading authority on AIDS, Fauci still performs medical research and is chief of the Laboratory of Immunoregulation, one of the institute's 15 labs. He is shown not only atop NIAID's organizational chart, with an aerie in Building 31 where most of the institute directors hang their hats, but also on the staff of the Division of Intramural Research with an office in Building 10, where the scientists work. He still sees patients on rounds at NIH's Warren Magnuson Clinical Center at least once a week.

'Crazy' Pace

The 60-year-old Fauci maintains a schedule that even he calls "crazy." He arrives each weekday before 7 a.m. and routinely clocks a 14-hour day, leaving around 8:45 p.m. to pick up his daughters from gymnastics classes. He then sits down with wife Christine Grady and their three daughters (ages 9, 11 and 14) for dinner at 9:30 p.m. He calls it quits on Saturdays at 4:30 p.m. and tries to stay home on Sundays, although he is known to sneak back to work for a few hours if the girls are busy at gymnastics or track meets. It translates to an 80-hour workweek, and Fauci has kept up this pace for decades. He's also a main editor of Harrison's Principles of Internal Medicine (McGraw-Hill, 15th Edition, 2001), a top-selling textbook that he updates during "free" time at home at night and on weekends. "There are weeks when he has to go in on Sunday, like this past weekend when he just got back from Uganda and he really needed to catch up. He thrives on it," says Grady, his wife of 16 years, a former nurse and now a Ph.D. bioethicist who also works full time at NIH.

NIAID thrives on it, too. The allergy and infectious disease institute is considered a model of how a large and rapidly growing medical research program should be run. It moves adroitly in response to breakthroughs in research and creates robust new programs designed to speed development of vaccines. And it plays an expanding international role in the fight to stop the spread of infectious diseases. An NIH review panel in 1996 described Fauci as "the prototype of a highly effective institute director at the National Institutes of Health."

"NIAID is a leader among the institutes on strategic planning. It has moved very quickly to meet a large number of challenges and epidemics. That's one of Tony's strengths," says Barton Haynes, a Duke University immunologist and Fauci protégé who trained at NIAID a quarter-century ago. "He is a master organizer with a wonderful vision for how things could be."

'Iron Fist'

Fauci is famously productive, with an ability to move meetings along and cut to the chase, whether discussing scientific questions with laboratory fellows or building renovations at NIH. John La Montagne, NIAID's deputy director, who helped build the successful influenza vaccine program and was the first director of the Division of AIDS, calls Fauci "very much of a delegate-and-hold-accountable kind of executive" who gives a lot of latitude to his division directors.

"Tony's tough. He's not an easy person at times. He's demanding. He's exceptionally intelligent. He's a very good judge of character," says La Montagne. And he attracts "very original people" drawn to the challenge of working for someone who sets the bar high. When Varmus, in his first year as NIH director, remarked to a New York Times reporter that Fauci ran his institute "with an iron fist," Fauci canvassed his staff members to ask whether they felt that was true. "Most giggled nervously and said variations of, 'Well, yes, but you're always fair,'" Times science writer Natalie Angier recounted in a 1994 profile.

Douglas Brust, a fellow in Fauci's Laboratory of Immunoregulation, says Fauci "usually knows about stuff before we do because he sees everything. He writes articles. He reads the same journals I read. He's brilliant at taking a very complex scientific question and breaking it into its essential components. He's famous for saying, 'What is the question?' If it's not important, we stop right there." Lynn Hellinger, who was NIAID's director of human resources for five years and recently became associate director for management and operations, says NIAID's 1,600 workers thrive on the challenge of working "for someone who is passionate about what they are doing. The research that we're doing here is important. It's easy to get caught up in what's going on, even if you're just supporting the science."

Donna E. Shalala, Fauci's boss for eight years as Secretary of Health and Human Services in the Clinton administration, calls the NIAID director "a Renaissance man, a world-class scientist and a world-class human being. NIAID may rank third in size among the NIH institutes, but "not in prestige," says Shalala, now the president of the University of Miami. "It's first among equals. It's an extraordinary place." Shalala continues, "Tony Fauci is one of the great scientists of this world, and I treated him accordingly. Tony did not go through [NIH Director Harold Varmus] to talk to me . . . . He's been a close scientific adviser to every Secretary that I've known of and certainly was a close friend and an adviser to me." For his part, Varmus, who left NIH in 1999 to become president and CEO of Memorial Sloan-Kettering Cancer Center in New York, calls Fauci "an exceptionally organized, energetic, dedicated person. He runs not just a lab, but a very large lab; he manages one of the biggest institutes. He also is a leading spokesperson on AIDS research in the country, has a lot of dealings with the press and advocacy groups, and is in the middle of a politically turbulent landscape. And he makes rounds." Varmus believes that "being involved in the day-to-day science is extremely good for someone trying to manage a scientific program. NIH would go downhill if we didn't have good scientists running the programs. Management there is developing scientific programs and overseeing the grants that are funded. It's not bean counting; when you have bean counters, it's all over."

Would NIAID be better off if its director were not also a full-time researcher and part-time clinician? It's hard to argue with Fauci's success at wearing all these hats. "The evidence would be that none of them suffer, that they all seem to prosper," says La Montagne. Fauci says seeing patients is "part of my identity. That gives me a lot-to see the HIV-infected patients and the problems they have, and what they are facing, and then to go back into the lab and tell my basic scientists, 'You know, this is the critical question we need to answer. Let's design some experiments to take a look at that.' And then I put my administrator's hat and now I have this $2.3 billion armada that I'm steering here [he simulates turning a helm], and it's 'We really need to torque it a little bit this way, because that's where the field is going.' So doing all these three things I think makes me a much better person at each. I am totally convinced of that." Far from being surprised when the famous Fauci turns up at their bedsides, the AIDS patients "expect it," says Cliff Lane. "It's been that way since the beginning of the epidemic. It's like, 'Well, where is he? I was hoping to see Dr. Fauci.'" Fauci weathered personal attacks in the late 1980s from AIDS activists who criticized the government for a lack of urgency in its response to the epidemic, but he won them over. He gave AIDS patients a voice in the NIAID advisory process and set an example that other institutes now follow with patients with breast cancer, prostate cancer, Alzheimer's disease and other debilitating illnesses.

NIAID's official goals, under the 1993 Government Performance and Results Act, include helping researchers find an AIDS vaccine by 2007. Fauci increasingly is setting his sights on fighting this plague abroad, especially in Africa and Asia, where the lethal virus has claimed most of its 20 million victims, prevention is weak and drugs are unavailable or too expensive.

Fleeting Fame

Fauci has 1,008 scientific articles to his credit. He has a knack for explaining complex scientific topics in language that nonscientific people can understand. When the press or television calls, he handles the interviews himself. Fauci often credits the Jesuits who taught him at Regis High School in New York City and the College of the Holy Cross in Worcester, Mass., with teaching him to value "precision of thought and economy of expression. I think the Jesuits played a major role in helping to formulate what I am and what I do now, my modus operandi as a scientist, as a clinician, as an administrator, as a leader," says Fauci. "I never took any management or business courses. But I strive for excellence, and I demand that. We have a lot of responsibilities. We're in the health professions. We're dealing ultimately with the lives and deaths of people. We are public servants. We are consuming tax dollars. We've got to be excellent. That's the first thing. And the second is I surround myself with the best people I can find," he says. "I've been here a long time and virtually everybody that's here-in fact, the second generation in some jobs-was picked by me."

The other thing he learned from the Jesuits was "the discipline. It was tough love and gentle disciple. You were expected to do something, and there was no excuse if you didn't. I liked that. The Jesuits expected you to be excellent. If you goofed off, they just didn't tolerate it. You knew who the boss was."

Fauci came to NIH as an infectious disease specialist in 1968 after receiving his M.D. degree from Cornell University Medical College (he was first in his class) and completing a two-year residency at The New York Hospital-Cornell Medical Center. He tells of hearing then-U.S. Surgeon General William Stewart say that it was time to "close the book" on infectious diseases and concentrate on chronic ailments, and wondering whether he had chosen the wrong specialty. He needn't have worried.

"The NIH is a very, very unique and wonderful place to be," says Fauci. "With the breakthroughs that now are coming with sequencing the genomes of microbes, not to mention the human genome, and with all the recent emphasis on international health, particularly with HIV/AIDS, malaria and tuberculosis, it's a very exciting place to be. In many areas, our work has just begun . . . . In my life, it's never 'Miller time.' There's always something to do." But from another perspective, it's all Miller time for Tony Fauci-his work is his play. He enjoys the celebrity of his position, from the television appearances to the cocktail parties at ABC news correspondent Sam Donaldson's house to strangers asking for his autograph or spontaneously giving him a hug and a "God bless you."

"The fact that you're known by Presidents and by Cabinet members-that feels good, obviously. It's crazy to say that it doesn't," says Fauci. "But it's for a purpose and to me that purpose-and I don't care how corny it sounds-is public service. Whenever they are making me up for McNeil-Lehrer or This Week, I'm always saying to myself: Sic transit gloria mundi. I know that this is transient. The real substance is going into the patient's room and figuring out what's wrong and how you can move some projects to not only make them better, but make a lot of other people better. The stuff you do in the lab, the stuff you do at the institute level. That's the thing that's nontransient. That other stuff is going to go away."

Christopher Connell is a Washington journalist and editor who spent 25 years with the Associated Press before launching his writing and consulting business. ]]>

The problem solver

Christopher Connell — Sun, 01 Apr 2001 00:00:00 -0500

The experience confirmed for Hoenig that he had a flair for business, and it taught him something more. At first he'd attributed difficulties in getting Dutch employees to collaborate to language differences. But once he spoke the language, he realized that was not the root cause. "The problem was much more their vocabulary, their mind-set, their experience base. It was how they communicated and thought," says Hoenig, who left the growing transport information venture, Transpotel BV, for graduate school-first at Cambridge and then the Fletcher School of Law and International Diplomacy-where he ruminated on what three years in The Hague had taught him.

Hoenig, at 24, had found his mission: creating a lingua franca for problem solvers.

"I got the idea that there had to be a way to capture some of the common elements of how people really solve problems and work things through together," recalls Hoenig. He spent a decade putting his ideas into practice with McKinsey and Co., a firm that specializes in corporate trouble-shooting around the globe, and the General Accounting Office. Now Hoenig is an entrepreneur and author, spreading his gospel of problem solving through a start-up company, Exolve Inc. The firm provides software, training, business strategies and a new book, The Problem Solving Journey: Your Guide for Making Decisions and Getting Results (Perseus Publishing, 2000).

Hoenig launched Exolve two years ago with a straightforward business plan: to sell government and private sector clients software tools and expertise that they can use to unravel problems. His book offers seasoned advice drawn from the examples of dozens of diverse achievers from the worlds of business, finance, government, the military, science, literature and even sports. Hoenig's paragons run the gamut from Paul Kaminski (who managed the Stealth bomber program for the Pentagon) to the director-less Orpheus Chamber Orchestra to Reinhold Messner (who scaled Mount Everest alone) and Ron Barbaro (who devised viatical insurance payoffs for AIDS patients) to the NASA team that put man on the moon to Microsoft's Bill Gates and former Georgetown coach John Thompson (who hugged a player who had just thrown away a shot at the NCAA basketball championship).

These are odd bedfellows, to say the least. But this list is not surprising, considering that Hoenig is an amateur poet as well as an expert in harnessing technology to solve business problems. He grew up in a California home where his parents bridged the divide between science and art: his father, a Ph.D, was a scientist who spent his career at the Lawrence Livermore National Laboratory, and his mother was a homemaker and artist who created woodblock prints and quilts. Hoenig got an early introduction to technology and computer programming by noodling around on a Digital Equipment Corp. PDP-11, the first 16-bit computer. "I grew up idealizing people who solved big problems. People who won Nobel Prizes and solved big problems were heroes in our household," he says. And, as a high school swimmer, Hoenig came within three one-hundredths of a second of making the U.S. team for the 1976 Olympics in Montreal. In those days, he'd spend seven hours a day in the pool, seven days a week.

Today, the 42-year-old Hoenig confines his workouts to hiking, cycling and the gym and channels his competitive drive into his problem-solving ventures. He managed to launch Exolve while writing The Problem Solving Journey, which is dedicated to his wife, Susan Riker, the director of editorial projects at U.S. News & World Report, and their young daughter, Sophia. He had some help from Washington journalist Karen Ball in researching and writing the dozens of abbreviated case studies spliced through the book, but did the final composing and editing himself. He also writes a bimonthly column on leadership for CIO magazine.

Hoenig and colleagues W. Scott Gould and Andrea H. Weiss have gotten Exolve out of the gate on a pay-as-you-go basis, securing contracts with the Defense and Commerce departments for their suite of problem-solving software and techniques and turning a profit in its first 18 months. Exolve also is working with Arthur Andersen on software to solve problems for new residents of San Jose, Calif. The firm's revenues quintupled last year to $3 million, and its staff has grown to 16. One of its biggest projects is building a World Wide Web portal the Pentagon calls IKE-Information Knowledge Exchange-to link the U.S. military's 152,000 information technology professionals worldwide.

"We're not a group of executives who are sending out at 2 a.m. for pizza and Coke, breathlessly trying to meet the next deadline," says Gould, the company's chief operating and financial officer. He is a former CFO for the Commerce Department and a captain in the Navy Reserve. Weiss left a post as corporate vice president and chief information officer at MITRE Corp. to help launch Exolve and become its chief information and technology officer. While at MITRE, she oversaw its work with federal CIOs, which grew from $1 million in 1997 to more than $18 million in 1999.

The Path to Solutions

Hoenig's career has zigzagged between the private and public sectors. He did a stint in 1987 as a volunteer for Missouri Democratic Rep. Richard Gephardt's short-lived presidential campaign. "I became disillusioned with Washington pretty quickly, maybe because I wasn't very good at the politics, but . . . [also] because I felt the people I was working with were talking about problems, but they weren't defining them or solving them very well," he says. "That intensified my desire to get career experience in actually solving big problems."

So off Hoenig went to the Swiss Alps with McKinsey and Co., which runs a mini-MBA boot camp for new hires. He spent the next three years traveling around the world tackling problems for corporate clients, including a European software maker, an aerospace manufacturer and a telecommunications firm. "The goal at McKinsey was to add 15 times your value as a multiple of your fees on every engagement," says Hoenig. "You are hired not just to come in and write a report; you are hired to make change happen."

In 1991, Hoenig made plans to join the General Accounting Office, but they were put on hold when he ran into Sen. Bill Bradley, D-N.J., on a plane. Hoenig, who had taken out conventional student loans to help pay his Yale tuition, pitched the senator an idea for a new type of income- contingent loan. Bradley invited Hoenig to join his staff instead of GAO and put the concept into law. Hoenig spent a year on Capitol Hill, where Bradley got a pilot test of the concept included in the 1992 reauthorization of the Higher Education Act. Hoenig took on even bigger trouble-shooting challenges at GAO, where he worked from 1992 to 1997. He began as an assistant director and within two years was promoted to director of information technology. "I was hired as a quiet revolutionary, to rethink the way GAO did business from the ground up," says Hoenig. GAO afforded a bird's-eye view of a host of problem-solving efforts on an even larger scale than those at McKinsey. "The federal government has the largest organizations on the planet just in terms of size. No matter how big the issues get in business, they don't get as big as they get in government," says Hoenig.

To the newcomer, GAO seemed to be working on low priority issues, spotting problems too late, and not working with the top decision-makers at the agencies they critiqued. Also, says Hoenig, "they didn't eat their own dog food, so to speak. Theydidn't apply the principles in their own organization they were telling other people to apply.

"I turned all those things on their head and asked, 'What if we got out in front, worked with the top decision-makers, were proactive, identified best practices and tried to actually help proactively solve problems?' " he says. "We engineered and designed a whole new way of working with agencies, which was self-assessment as opposed to GAO's assessing them.

"We did a huge self-assessment with the IRS that involved hundreds of SESers across the country, and we used a set of best practices and diagnostic methodology that in a lot of ways was the first version of what ended up in [The Problem Solving Journey]," Hoenig says. "By the second year we set a goal to reform the way the entire government managed technology. We started with research and best practices and trying to influence and develop relationships with agencies and on the Hill and we were lucky enough to come across the people on Sen. [William] Cohen's staff . . . . Together we pulled off the Clinger-Cohen reforms and changed how the government managed technology."

A People Person

Hoenig is "one of the most effective senior executives that has worked at GAO," says his former boss, Gene Dodaro, GAO's chief operating officer. The Clinger-Cohen reforms, bundled into the 1996 Defense Reauthorization Act, established chief information officers across the executive branch and required agencies to make sure that their investments in technology improved performance. "That was Chris' crowning achievement," says Dodaro. Kim Corthell, a longtime lieutenant to former Sen. Cohen, says Hoenig "has a great deal of common sense and a great way of looking at problems and dealing with people."

"He does it with equanimity. He is not a yeller and a screamer. He's a relationship builder," says Hoenig's sidekick Gould. "He's got these world-class problem-solving skills combined with an iron will to get stuff done. He just has a huge capacity." You can almost sense "this sort of Cray computer constantly running in the background" whenever Hoenig is solving a problem, adds Gould, who picked up both an MBA and a doctorate in education while teaching Navy ROTC at the University of Rochester.

Hoenig and Gould first met through their wives in the late 1980s. Their paths crossed professionally in 1994 while they were both working on the Internal Revenue Service's tax system modernization-Hoenig from his vantage point at GAO and Gould as a deputy assistant secretary at Treasury. "We cut our teeth and broke a few teeth on the great beast," Gould says. "We got to go into the lion's den together and come out in one piece. That took a lot of trust, hard work and communication."

rets of Success

If Hoenig and his fledgling company purport to have found a common language that guides problem solvers from many fields, why have they been so open about it?

Hoenig thought about taking a proprietary approach to marketing his ideas and services, but instead chose openness, similar to the way programmers share their ideas and handiwork on the open source operating system Linux. Hoenig considers his book a work in progress that he hopes will be tested and improved by readers' critiques and experiences.

"In terms of building a business, there's no question that we're going to make some money on this, because there's a commercial aspect to it. But we could go about it commercially in a much more tightly closed way than we are," says the Exolve chairman. "In the end, the thing that allows me to really sleep well at night is to know that I have chosen something unique that I think I can contribute to the world."

Hoenig and his partners have applied for two patents on their problem-solving software and techniques. Hoenig also is laying the groundwork for a nonprofit foundation that will draw on "the brightest minds on the planet" to improve education on problem solving. This fits with Hoenig's belief that it takes a combination of "nonprofit, public and private sector approaches to really get something profound done."

Hoenig says his hope is that clients will turn to Exolve and its Solver Suite software to turn the Web "into a problem-solving tool as opposed to just a place where people do searching. Our goal is to help professionals get 80 percent solutions on the first search rather than 20 percent solutions after hundreds of searches."

"The idea of solutions-based government, where government can help citizens solve problems seamlessly for themselves using these kinds of tools and Web technologies more effectively," is critical to federal managers, Hoenig says.

What's in a name

The Oxford English Dictionary defines "exolve" as an obsolete verb meaning to slacken or dissolve. It's not a word likely to turn up anywhere outside of the most obscure crossword puzzles.

But these days it has a new lease on life, at least in the lexicon of Christopher Hoenig's start-up business.

When Hoenig was hunting in 1999 for a name for his new problem-solving venture, he encountered in the writings of Harvard naturalist Edward O. Wilson a longer word from the same root, "exolution," that means "loosening" or "setting free."

The eponymous company puts a bit of its own English on the definition posted on the Exolve Inc., Web site: "Exolve v. [ad. L. ex - out + solvere - loosen]

a. to evolve more intelligently, at a faster rate, and at a higher level,
b. to explosively liberate or set free from one's problems,
c. to realize and create new potential."

"We thought it looked quite good after we'd taken up, examined and discarded a thousand other names," says W. Scott Gould, Exolve's chief operating and financial officer.

The small, growing company dubs itself "the primary source for problem solvers" and says its vision is to become "the place where professionals go for tools and knowledge to improve their problem solving." Among its clients are the Defense and Education departments and the city of San Jose, Calif.

Christopher Connell is a Washington journalist and editor who spent 25 years with the Associated Press before launching his writing and consulting business. ]]>