With regulatory reform again on the presidential agenda, the history of the Office of Information and Regulatory Affairs (OIRA) provides a useful case study of organizational effectiveness. In 1981, President Ronald Reagan charged OIRA with imposing cost-benefit analysis on agency regulations, formalizing a new process of centralized regulatory review. But OIRA’s effectiveness flowed less from a single executive order than from the previous decade of presidential experimentation with regulatory review and Reagan’s continued investment in its institutionalization. This article draws extensively on archival documents to understand how regulatory review established itself as a constant of presidential management through the development of attributes such as staff capacity, organizational complexity, bureaucratic leverage, and reputation. Today’s policymakers should heed broader lessons for enhancing organizational effectiveness: singular structural and procedural changes are necessary, but not sufficient, for achieving reform.