Commission on Review of I.H.D.
Program Committee
Members
Dean William I. Myers, Chairman
Dr. Kenneth F. Maxcy
Dr. Dean A. Clark
Dr. Robert F. Loeb
Dr. Alan Gregg
Dr. Paul C. Mangelsdorf
Dr. Lowell T. Coggeshall
1. Program on International Health Division
2. Control and Investigation of Specific Diseases and Deficiencies
3. Laboratories of I.H.D.
4. State and Local Health Services
5. Medical Care
6. Public Health Education
a. Schools and Institutes of Hygiene and Public Health
b. Schools of Nursing and Public Health Nursing
c. Fellowships and Travel Grants
7. What disciplines should be represented on IHD staff?
a. At administrative level
b. At field staff level
Confidential
From: Dr. Alan Gregg
To: Mr. William I. Myers
My first three years in The Rockefeller Foundation were spent as a member of the International Health Board in Brazil. Then came two years, 1922-23, in the New York office in the newly-formed Division of Medical Education where as Dr. Pearce's assistant and especially during his absences I had direct contact with the principal officers of both the GEB and the RF and a scant but vivid impression of the Trustees of that day. Consequently, I cannot claim the detachment or the unfamiliarity with the IHD that would have some advantages in approaching the present problems of its program and organization.
But if the IHD were a part of some other foundation and I were asked to comment upon its program and organization, I would make the observations that follow because I think they reach behind or beneath the more immediate issues to aspects that are more important.  I hope that this memorandum even if it goes beyond the immediate issues of program will justify itself. It views the IHD in a long perspective of future time. Deliberately it challenges certain things we tend to take for granted. It relates not merely to the choice of program but also to what would help to make the future choices of program more flexible and to bring to more prompt and certain realization the programs that are adopted.
I would not agree that the only end of the present review of the IHD program and organization is to select programs for it to follow. More important is the effort to find a policy which will favor, or even guarantee, flexibility, adaptability and enthusiasm in the task of finding programs later on as well as now.
Though the remark may smack of psychiatric introspection, the first thing for us to do is to wonder whether we have any blind spot as we look at the IHD. I think we do and that it is this: we ignore the personal and individual contribution that the Divisional Director makes to the work of the Foundation. There are ample, cogent and constant reasons for so doing. Personal vanity and extreme individualism threaten any organization, always. Modesty becomes the directors of large sums of any kind of money but particularly of philanthropic funds that must call forth genuine, and enthusiastic hard work by the recipients. We have to merge ourselves in the organization. I doubt if the RF would have its present status if the officers had either claimed or admitted the grants of the Foundation to be their individual triumphs. Our insistent reticence has made it easier for the recipients to assume both the responsibility and the credit for what they have accomplished with our funds. Nor would any "Santa Claus Complex" long survive questioning by the Trustees. In any event, the officers have steadily attempted to disclaim, both inside the organization and to the outside, the credit for their successes. This attitude should continue.
But in a temporary access of objective realism let us not avoid the fact that as long as it is the duty of the officers to devise or find, and propose programs or projects to the Trustees, the cardinal factor in the Foundation's success is to be explained by the quality, ability and character of its officers. It has got to be their work whether they admit it or not. The Trustees cannot wisely assume any such responsibility. As a corollary, the future of the Foundation depends on its chief officers and the same goes for the future of any division. Therefore, if it could be shown that not enough care and reflection have been given to the procedure in selection of the divisional officers, a reasonable case would exist for better selection.
What is the policy of the Foundation in the selection of divisional directors? I have never heard or seen it formulated. What does the record show?  In the IHD all the successors of Rose have been promoted from within the organization, in the MS I succeeded Pearce after sight years as his subordinate. In the SS Willits was brought in from the outside without previous experience in the RF. Weaver and Spoehr came into the NS without previous experience. Stevens, similarly coming from the outside, succeeded Capps, but Fahs was promoted, and Embree was made Director of the Division of Studies as a promotion.  Obviously, the first appointments of Rose, Pearce, Day, Capps and Mason were not from within the organization, though Mason's appointment, as I remember it, was based upon his stipulation that he would succeed Vincent as President. The record is clear but variant. It is not uniform. No declared policy has been followed as between promotion from inside and deliberate going outside for a new director.  In an organization like the Foundation what are the pros and con$ of each system - or of having no system at all?
When it is expected that the director of a division will be promoted from within, appointments to junior staff must be affected by the criterion "Is this man of really high quality and not merely a convenient assistant with obvious limitations?"  (Getting rid of assistants with obvious limitations has proven peculiarly difficult in Foundation experience.) The policy of promotion from within certainly stimulates the general morale of staff members but it should call for administrative measures to train and test them. Lacking such measures, it invites inevitable results. More explicitly, promotion from within runs the risk of appointment to the directorship of a subordinate, who unless he has represented the Foundation abroad, and so in some measure had some experience in being thus alone, has had little stimulus for the independence, originality and freedom of his convictions and the breadth of his horizons. In the aggregate and the long run, promotion from within favors routine thinking, tenacity of purpose, getting things finished rather than finding entirely new things to do. It rewards efficiency and loyalty to the traditions of the organization rather than alertness to new problems and to pioneering.  Promotion from within, if it arrives only after 55 or 60, cheats the organization of the chance of young and enthusiastic leadership in new departures. There isn't time before retirement - and there are existent claims to carry on what is already under way but not finished. These considerations are not unfamiliar to those who have watched academic life or the Army and Navy in almost any country.  I would therefore underscore the question whether promotion from within is appropriate to the most distinctive functions of a foundation, even if as a policy it works reasonably well in an operating organization.
Deliberately going outside for a new divisional director of course involves the new director in two or three years of bewilderment and hard work. He ought to be young enough to stand that and yet old enough to remain true to his own convictions, unfamiliar as they may be at the outset to subordinates, colleagues and trustees. Though my withers are wrung in saying it, I think that thus far the outsiders appointed as divisional directors have brought more that was progressive, original and alertly adaptive than has come from directors appointed from within. Going outside for divisional directors involves lost motion while they learn their new job, but I would prefer lost motion in a foundation to the loss of challenging new ideas. As Elton Mayo used to insist, we are living in an adaptive civilization. Right there lies the raison d'etre for a foundation. I would not refuse to consider as a candidate anyone who had ever been in the Foundation, but he ought to get out of the Foundation in order to run the chance of being brought back. Such a realization would do much to remove the obloquy of ever leaving the Foundation, and thus quicken the pace and the interchange and the experience of our personnel. Such a policy would have the disadvantage of increasing the salary scale necessary to attract men to jobs that were likely to be impermanent instead of being only nominally so. Our one-year appointments are only nominally impermanent.
The absence of any declared policy seems to ne to secure the advantages of neither system. As long as we never endow any institutions and so get free from their dependence, our RF obligation to continue support indefinitely or be accused of letting institutions down (cf. the National Research Council) exerts a very considerable pressure on any incoming director to keep on with existing program. The juniors in a division are more uncertain of their chances when there is no defined system. Having no defined policy ends in the temptation to promote a man who knows all the ropes and "the Foundation way of doing things;" to take a known good man rather than the risk of a better or worse outsider. And as long as we make repeated short-term grants rather than endowment we shall tend conservatively and continually to prefer promoting someone familiar with the past. The easiest way, i.e. , making an internal promotion, dulls the urgency of looking for a first-rate outsider.  Yet the chance that it my not be an internal promotion disturbs the morale of subordinates.
In the experience I have had in the Foundation few aspects of its work, its public status and its uniqueness have impressed me more than the results of putting large sums of money in the hands of men of imagination, sensitiveness and conviction provided they could transmit the last of these, conviction, to a discriminating and thoughtful board of trustees. I doubt if an uninterrupted career within a money-granting organization is the ideal circumstance for developing the sensitiveness, the originality and the convictions appropriate to the peculiar opportunities of a newly-appointed divisional director. Is there any other course open?
As early as 1925 it seemed to me that when the Foundation finds or creates an activity of apparently permanent importance, and especially when it has found and trained within its own staff the persons to carry on the work well, there could be no valid objection to separating the activity form the Foundation by means of endowment, a separate board of trustees and separate status. In this way could be avoided the conflict and anomaly of an operating organization within a non-operating one. The China Medical Board, begun as a Foundation enterprise and later given a partial endowment, was in 1946 finally given an adequate endowment for functions that had proved a constant source of anomalies, exceptions, indecision, administrative embarrassment and large expense to the Foundation. It was simply no longer a program. But it was too nearly our own creature to be discontinued - and too valuable.
For such present functions of the IHD as appear certain to have another fifty years of valuable operation, I would think that a plan for the endowment and  eventual separation of such activities from the pioneering and exploratory work that the IHD also does would deserve careful consideration.  Anything else that I can see will miss the reason underlying the present review.
In this present memorandum, however, I would want to make only this point: attention should now be made to the policy of selecting the director to follow the present excellent nominee. One or the other of the policies discussed, i.e., internal or external recruitment, produces a better result than no declared policy at all. Nothing would tend more to make the IHD organization as a whole adaptable, supple and pioneering than the knowledge that, with due warning, the director of the IHD to be chosen I believe as of 1957 will be taken from the outside and that this will be the explicit policy thereafter.
One more point: I think that more attention should be given to the advantages of expecting the IHD director to designate and propose, and the Committee to dispose of, his own program of future divisional activity. I say this because ever since the reorganization of 1929 the officers have felt less and less free to take full responsibility for the choice of divisional programs. At the same time the Trustees, without realizing that their influence is so great, have added to their proper function of approving or disapproving that of choosing and proposing programs. This leads, and in the past has frequently led, to a constant exaggeration of "program." In obedience to program definitions the officers have exaggerated a rigidity of program to a degree that has at times puzzled even the Trustees. Furthermore, such Trustees' programs, reviewed only at widely separated periods, have lost a considerable measure of the adaptability which could be our unique characteristic and satisfaction.
As a possibly effective measure I would suggest that our subcommittee recommend that the whole Committee present a series of questions to Doctor Warren such as, "what do you propose in the field of malaria?  What use do you see in the maintenance of staff members in foreign countries even if not much money is to be spent under their direction?  What do you propose in the field of medical care?  What fields that the IHD has never worked in invite IHD interest now?" For the program committee and even more for the entire Committee to choose what he is to take as fields for the IHD runs a larger risk than I think is realized if relieving him of complete responsibility by putting blinders on his angle of vision.  Wickliffe Rose was wise, I think, in saying, "I cannot say what the Trustees will do or will not do. I can only tell you what they have done."
I should regret and disclaim any inferences of a personal nature in this memorandum. I have tried to be detached, impersonal and clear.
Alan Gregg