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Integrating Employee Health: A Model Program for NASA Executive Summary The National Aeronautics and Space Administration (NASA) employs a highly skilled workforce accustomed to working under high pressure, short deadlines, and limited budgets. Despite these challenges, it has turned the vision of space exploration into a reality in fewer than 50 years. This legacy of exploration and discovery is a hallmark of national pride. NASA’s achievements in air and space exploration, research, and development are integrally woven into the American experience. The high profile of the agency’s activities has led to public celebration of its mission successes as well as intense public scrutiny during times of tragedy. NASA’s cultural tradition of believing that its workers can overcome complex technical challenges is reflected in its stated core values: safety, people, excellence, and integrity. As a result, NASA’s manned space flight and the unmanned space probe missions alike have produced many successful, leading-edge programs. In large part, the success of these programs is the result of a highly motivated and resourceful workforce that embraces highly visible challenges during intense periods of exceptionally high demand. However, the very same cultural traits and organizational practices that have fostered mission success can also affect employee well-being. The success of NASA’s missions has always relied heavily on both the health and productivity of its workforce. Today, NASA has an aging workforce that may be at risk for the same chronic diseases facing America’s aging population as a whole. These chronic diseases, including heart disease, hypertension, obesity, diabetes, and cancer are frequently associated with negative lifestyle behaviors such as physical inactivity,
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Integrating Employee Health: A Model Program for NASA poor eating habits, and tobacco use. In addition, the NASA work environment is highly variable, and some workers are subjected to unusually hazardous and stressful conditions. NASA was one of the first federal agencies to recognize the importance of occupational health and wellness programs for the well-being of its employees. NASA has invested in health promotion research and established preventive employee health programs such as nutrition education and one-on-one counseling for employees with cardiac and other chronic diseases. Today, NASA offers a broad scope of employee health and wellness options, including programs in areas such as employee assistance, environmental health, health promotion, and occupational medicine. Individual centers within NASA incorporate these agency-wide programs into their own occupational health activities. These programs, managed by NASA’s Division of Occupational Health, are described further on the agency’s occupational health information web site, http://www.ohp.nasa.gov, and in Chapter 2 of this report. NASA’s Office of the Chief Health and Medical Officer (OCHMO), which administers the Division of Occupational Health, works to ensure that every NASA employee will, on leaving or retiring from the agency, be healthier than the average American worker as a result of his or her experience with NASA’s occupational and preventive health program system. In support of this goal, the Institute of Medicine’s Committee to Assess Worksite Preventive Health Program Needs for NASA Employees was charged to review existing preventive health programs, assess employee awareness of and attitudes toward occupational health programs, and determine whether there are any special risks unique to NASA work environments. The committee further was asked to prepare a report that evaluates and recommends specific options for future worksite preventive health programs, focusing on, but not limited to, nutrition, fitness, chronic disease prevention, and psychological well-being; incentives or methods to encourage employees to voluntarily enlist and sustain participation in worksite preventive health programs; ways to create healthier workplace environments that are conducive to more active lifestyles; intervention options to reduce risk factors for chronic disease; and ways to evaluate the effectiveness of such programs. PRIMARY FINDINGS The committee derived four primary findings from information obtained from observations made by committee members at site visits to six
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Integrating Employee Health: A Model Program for NASA NASA centers,1 published reports about NASA, and reviews of literature. Specific recommendations for addressing these findings appear in the following sections of this summary. FINDING 1: The occupational health mission statement at NASA is designed and directed to meet the health needs of NASA employees; however, there is a need to bring this mission statement into alignment with a mission-driven vision for the NASA organization. FINDING 2: Most organizations, public and private, follow a traditional model for providing health care to employees in which the focus is on disease status rather than health status, treatment rather than preventive care, an individual medical model rather than population-based health model, and single- rather than multiple-risk interventions, with segregated rather than integrated management systems. NASA is similar in its current approach to occupational and preventive health care. Although there is collection of information on employee health and program use, the data collected lack uniformity and consistency within and between NASA centers. In addition, there is a need to strengthen communication lines between NASA’s Headquarters and centers. FINDING 3: The traditional approach to occupational health care leads to segregated rather than integrated health programs (Table ES-1). The needs of the modern knowledge-based workforce in a high-performance organization require an approach beyond those traditionally used in occupational health. As currently implemented at NASA, such an approach is not conducive to meeting the health care needs of employees in a large, decentralized organization. FINDING 4: There is a need for more effective, coordinated, and data-driven health program policy development to support the agency’s mission and goals. THE CASE FOR CHANGE NASA serves as an excellent prototype for the twenty-first-century organization, challenged with increasing demands and a changing American workforce. Just as the agency’s scientific and engineering breakthroughs have improved everyday life, so too can NASA’s strategy for analyzing and improving the health and productivity of its workforce serve as a model for other U.S. employers. 1 Ames Research Center, Glenn Research Center, Goddard Space Flight Center, Jet Propulsion Laboratory, Johnson Space Center, and Kennedy Space Center.
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Integrating Employee Health: A Model Program for NASA TABLE ES-1 Current Trends in America for a Healthy and Productive Workforce Perspective Current State Desired State Function Absenteeism Performance Cost Metrics Medical Costs Economic Outcomes Care Model Treatment Focused Prevention and Behavior Change Focused Medical Model Individual Population Health Metrics Disease Status Health Status Interventions Single-Risk Focused Multiple-Risk Focused Health Framework Employer-, Condition-, and Program-Centric Employee-Centric Management Systems Segregated Programs Integrated Systems A “healthy workforce” is characterized by four key attributes, consistent with the World Health Organization (WHO) definition of health, which can be analyzed and improved to promote personal and organizational “well-being.” Specifically, for both individuals and organizations to achieve optimal performance, they must be healthy—demonstrating optimal health status as defined by positive health behaviors; minimal modifiable risk factors; and minimal illnesses, diseases, and injuries; productive—functioning to produce the maximum contribution to achievement of personal goals and the organizational mission; ready—possessing an ability to respond to changing demands given the increasing pace and unpredictable nature of work; and resilient—adjusting to setbacks, increased demands, or unusual challenges by bouncing back to optimal “well-being” and performance without incurring severe functional decrement. The twenty-first-century American workforce is characterized by increasing demographic diversity, as workers perform a greater number of multidisciplinary jobs with higher degrees of collaborative work and reliance on technology, around-the-clock operations, an accelerated work
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Integrating Employee Health: A Model Program for NASA pace, and more flexible work patterns. In addition, workplaces in America now rely more heavily on information technology and use highly variable work arrangements, employing teams composed of members from different employers, or from the same employer but with different terms of employment; creating and dissolving work groups and employment around specific projects; and employing global work teams using technology to perform work in “virtual” environments of electronic team rooms and Web-hosted meetings. Within the workforce itself, there is greater uncertainty about employment, with people having many more employers during their working careers, being required to become continuous learners to enhance or expand skills, and experiencing the movement of work and jobs to other countries. Previous reports addressing relevant health, health care, occupational health, and American workforce issues provide important information that can inform and guide NASA’s efforts to achieve its broad goal of creating a comparatively healthier NASA workforce. Interest in worksite initiatives integrating occupational health and safety with health promotion and disease prevention efforts is on the rise among the research and business communities as well as labor groups, as evidenced by the recent National Institute for Occupational Safety and Health (NIOSH) Steps to a Healthier United States Workforce Symposium (Goetzel, 2005; Seabury et al., 2004; Sorensen and Barbeau, 2004). Additional evidence supporting the potential impact of an integrated approach is emerging in a growing literature reporting results of studies that have systematically assessed the efficacy and effectiveness of integrated interventions (Sorensen and Barbeau, 2004). For example, Hunt et al. (2005) reported greater participation in preventive health programs by both employees and managers when an integrated approach was used. The Steps to a Healthier U.S. Workforce Initiative (STEPS) was developed by NIOSH from an initiative in the U.S. Department of Health and Human Services (USDHHS), called Steps to a Healthier U.S. (NIOSH, 2004). Concordant with this committee’s study charge to evaluate options for preventive health programs, incentives to encourage employee participation, and methodologies to longitudinally track employee health at NASA, the STEPS initiative seeks to improve the dissemination, acceptance, and effectiveness of activities directed at improving worker health through integrated approaches to health protection and health promotion. The vision of the STEPS initiative is to integrate occupational safety and health protection with health promotion activities into a coordinated system that addresses both workplace and worker health. STEPS strongly supports the view that all illness and injury should be prevented when possible, controlled when necessary, and treated where appropriate, and
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Integrating Employee Health: A Model Program for NASA an integrated approach serves to enhance the effectiveness of programs designed to promote and protect worker health. The STEPS initiative has created an opportunity for the occupational safety, occupational health, and health promotion communities to develop and implement a comprehensive set of programs aimed at improving integrated health and productivity in the workplace. Further, the STEPS project is pertinent to meeting the needs of public-private partnerships such as NASA, which include a mixed workforce of civil servant and private-sector employees, technically-focused products designed for specific outcomes, and major research needs. As discussed above, employers and relevant federal agencies have demonstrated that multifactor determinants of health and productivity must be addressed using new perspectives, metrics, and models. Table ES-1 outlines current trends toward achieving a healthy and productive workforce on the basis of determinants of health and productivity. The traditional “occupational” and “nonoccupational” dichotomy stemming from regular shifts and the 40-hour workweek is being increasingly blurred by the changing demands of the contemporary American workplace. Employers who have traditionally been responsible for safety, environmental, and occupational health concerns will, by necessity, become more involved with worklife issues, health behaviors, and social factors affecting their employees. NASA and other employers, who must support a mission-directed, healthy, and optimally productive workforce, will have to articulate a new vision, develop new strategies, and employ new tactics to meet this challenge. Recommendation 1: A New Vision The committee recommends that the administrator of NASA adopt a new vision for worker health, readiness, and resilience that directly links to NASA’s mission and includes health as a core NASA value that is implemented through an integrated health and systems approach. This vision should extend and apply to the entire NASA workforce and should clearly articulate a broader perspective of health and how it advances NASA’s core mission; be adopted and adapted by each center director to maximize the alignment with each center’s mission and workforce composition; be promoted and implemented vertically and horizontally within NASA, using participatory strategies to ensure sustained senior management and organizational commitment and total workforce engagement.
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Integrating Employee Health: A Model Program for NASA ACHIEVING A NEW VISION FOR NASA WORKER HEALTH The success and sustainability of an integrated health process must first and foremost begin with a clear understanding of the organization’s mission. The organization’s senior leadership must directly communicate the critical importance of policies, programs, and practices designed to optimize the health and productivity of the workforce, promoting an organizational culture that values worker well-being. Senior leadership also must ensure that human resource activities, personnel benefit designs, occupational health and safety policies, environmental health, wellness programs and practices, and disability management are integrated and coordinated. Senior leadership must further ensure that all relevant stakeholders participate in and provide input to the planning process. Roles and responsibilities of key functional area leaders can be defined in the context of their contribution to the broader organizational mission. All individual and organizational factors contributing to the health and productivity of the workforce must be addressed, monitored, and improved over time. The current health vision for NASA employees (i.e., achieving an improved level of health status as a consequence of employment at NASA) does not establish a clear link to the larger organizational mission. As a consequence, it does not provide NASA leadership with a compelling reason to commit resources and management attention to employee health needs beyond hygiene components such as injury prevention, exposure and occupational hazard control, regulatory compliance, and emergency response. A mission-driven vision for health should articulate why investment in health and employee-integrated health helps NASA achieve its core mission on time, under budget, and better than expected. A management systems approach for NASA would serve as a means to establish and achieve specific integrated health priorities for its knowledge workforce. Benchmark management systems, available both in the private and public sector, could serve as useful models for design and implementation insights. Such a quality systems-based approach can be an effective mechanism for targeting increasingly scarce resources on higher-value initiatives related to the physical and psychological fitness and resilience of a high-performance workforce; fostering engagement and accountability; focusing on specific outcomes, and discipline to measure and improve employee health by integrating people, processes, and resources toward specific common goals and objectives. Figure ES-1 shows the components of a Health and Productivity Management System (HPMS) that can be adapted by NASA. The integrated HPMS works by first ensuring that the program is tied, if possible, to the design of the federal health benefits provided to NASA employees. Not
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Integrating Employee Health: A Model Program for NASA FIGURE ES-1 An integrated and sustainable approach for Total Health Management. SOURCE: Personal communication, D.W. Edington [Modified from Florida Power & Light], February 2005.
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Integrating Employee Health: A Model Program for NASA only must the programs be integrated and sustainable, but data must be integrated into the measurement and evaluation systems as described below, under “Data Integration and Management For Better Health.” Recommendation 2: NASA’s Health Vision To achieve an integrated health program, grounded in a management systems approach to health and safety, NASA should (1) recast its employee health vision to improve linkage and support for NASA’s core mission and goals; (2) integrate workplace safety with the occupational health function; (3) establish specific interfaces or linkages between health benefits design and administration in Human Resources and Occupational Health for analytic, intervention, and outcome assessment purposes; and (4) adopt a management systems approach to actualize, sustain, and improve NASA’s commitment and performance in employee health, safety, and wellbeing. Recommendation 3: Consolidation and Consistency To the extent possible, NASA Headquarters should encourage consistency between core occupational health programs, health data collection, impact assessment, and program evaluation. A management systems approach that consolidates local with NASA-wide health priorities can ensure harmonization. In addition, consistency in programs and data collection, assessment, and evaluation should be endorsed by the center directors and become a component of full-cost accounting. Recommendation 4: Program Integration To achieve the integration required, NASA should incorporate those components of an integrated system most appropriate to its organizational needs, including: Develop a data-based approach to policy, planning, programming, budgeting, implementation, operations, evaluation, and management. Such an approach will serve to ensure agency-wide deployment of an integrated health program; Create a standardized “health and performance” full-cost accounting framework to define, standardize, prioritize, fund, and evaluate resource allocation for human-related mission performance and workplace safety, health, and productivity. Incorporate mission-essential elements of integrated health programs in contracting requirements. In addition to ensuring basic health insurance coverage to all employees and access to preventive services and core fitness and health promotion programs, such ele-
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Integrating Employee Health: A Model Program for NASA ments should include management of short-term disability, Federal Workers’ Compensation, family medical leave, and other applicable leave policies. Resourcing and cost sharing should be considered within the legal and regulatory practices of NASA and the federal procurement rules. Recommendation 5: Manager Education NASA should provide education and training to first-line managers and supervisors that focus on the relationship between health and productivity and the linkage to NASA- and center-specific missions. This should include evaluation of common core program elements across sites; reevaluation of current training programs for the prevention, detection, amelioration of risk factors; and integration of content related to risk reduction across program components. UNDERSTANDING INTEGRATED HEALTH PROGRAMS An integrated approach to improving the health of employees involves going beyond traditional medical or occupational health to include a variety of fitness and wellness programs as integral components to a comprehensive well-being approach. Such a strategy can be targeted on multiple levels, according to a social ecological approach that provides guidelines for thinking about health decisions as being determined by multiple, including environmental and behavioral, systems. These systems are organized and combined in a variety of ways, depending on the research objectives, and have been successful in explaining and changing behavior. The committee found variability, from center to center, in support for health programs at the level of individual work units in some settings or for some job classifications. The committee also found significant variability between civil servant and contractor access to some health programs. A common finding among large, decentralized organizations that also appears to be true at NASA is communication gaps between the centers and Headquarters, as well as between managers and employees, resulting in a lack of integration among programs designed to optimize health, safety, and productivity. This, coupled with a segregated approach to program administration without integration across functions at large organizations such as NASA, results in a less effective health care system. The committee also found that methods for collecting health metrics varied among NASA centers. Without uniform metrics to inform program planners of the needs of participants, it is difficult to design and implement preventive health care programs that optimize health outcomes for participants.
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Integrating Employee Health: A Model Program for NASA To establish a system in which health data are collected in a consistent and useful way that will contribute to the design and implementation of health and safety programs that meet the NASA vision for a healthy workforce, the committee makes the following recommendations. Recommendation 6: Health Care Cost and Utilization Data NASA should obtain health care cost and utilization data for its civil service employees enrolled in the Federal Employee Health Benefit Program (FEHBP) to inform, target, and optimize agency benefits, policies, and workplace interventions as private-sector employers do. Ideally, these data could be analyzed and reviewed at the directorate level to further inform and optimize local programmatic efforts. Recommendation 7: Health Risk Appraisal A basic health assessment tool such as a health risk appraisal (HRA) should be selected from those available in the marketplace and offered to all NASA workers. For contract employees, NASA occupational health leaders should identify ways to channel HRA information back to the contracting companies for their use in designing and implementing uniform health care programs, and prioritizing and monitoring longitudinal health and performance status that is consistent with the NASA vision. The HRA can be used as a basic component to build an agency-wide database of aggregate health data that will inform the design, development, implementation, and evaluation of health programs to meet the needs of NASA employees. The subsequent recommendations flow from this vision for a uniform database. Recommendation 8: Integrated Health Policies and Programs NASA should offer coordinated and integrated individual- and environmental-level health promotion policies and programs that promote worker health across content areas including diet, exercise, job stress, tobacco use, alcohol and substance abuse, and control of worksite hazardous exposures to meet the health needs of a diverse workforce. All programs should include program promotion strategies and financial and benefit-designed incentives to foster program participation across the diverse NASA workforce. Examples of policies and programs include: Developing policies for making healthy food options available throughout the workplace for all shifts through a combination
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Integrating Employee Health: A Model Program for NASA of cafeteria and vending options, and offering a variety of nutrition education programs targeting both healthy workers and those with nutrition-related diseases; Ensuring a physical activity–friendly atmosphere and environment that is supportive of employees’ efforts to achieve physical activity guidelines for health benefits as outlined by national policy, including Healthy People 2010 and the Dietary Guidelines for Americans; Providing support for nonsmoking employees by uniform adoption and enforcement of tobacco control policies and through a broad spectrum of tobacco use cessation programs for tobacco users at varying stages of readiness for change; further, review the medical benefit screen for tobacco cessation counseling and pharmacological support; Implementing an approach to reducing stress and building resilience that focuses on increasing output through enhancing organizational health-focused productivity. Perceived stress and job control and strain should be screened as part of the Health Risk Appraisal and further assessed, if needed, through referral to appropriate follow-up programs. Individual programs should be made available to employees with stress concerns that address both resilience through integrated health promotion and reduction of individual stress reactions. At the organizational level, managerial training should be organized within NASA and for contractors and civil servants. This training should address communication and job control issues that affect both stress and productivity. Training should also include how to recognize and handle the stressed or mentally ill individual in conjunction with EAP personnel; Developing financial- and benefit-designed incentives to encourage employee participation in health promotion and disease management programs. Recommendation 9: Periodic Health Examinations NASA should reexamine the allocation of resources at the center level for periodic health examinations, in consideration of an integrated risk factor reduction program, and evaluate the data requirements, periodicity, and effectiveness of existing occupationally related medical screening examinations. To achieve this goal requires a clear rationale, policy, and practice that drive accomplishment and resource allocation at the center level. The committee recommends the following strategy:
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Integrating Employee Health: A Model Program for NASA Establish appropriate databases to provide health metrics to inform the evaluation process; Define desired goals for periodic health examination programs and medical surveillance data requirements; Stratify health and safety requirements into occupationally mandated standards rather than general risk factor identification; Link health promotion and disease prevention examinations, if and when uniformly performed, through a standardized process, to the employee’s primary health provider and the HRA. Recommendation 10: Program-Specific Evaluations NASA should conduct program-specific evaluations to ensure the effectiveness and appropriate use of available resources. Ideally, each program should include some level of evaluation integrated into the program implementation process that will inform program staff about reach, participation, acceptability, and effectiveness. DATA INTEGRATION AND MANAGEMENT FOR BETTER HEALTH In an organization such as NASA, where measurement and evaluation is a cultural norm, a data-driven decision-making system is a prerequisite for success. However, observations made by the committee at site visits to selected NASA centers indicate that this type of system is not uniformly in place across the agency or in complete form at the observed centers. Data management is a key concept in the successful implementation, conduct, and measurement of any occupational health program. Programs that experience long-term success and are consistently recognized as “best practice” are those that incorporate integrated management and evaluation efforts where program information is collected in a systematic manner that allows for data integrity and consistency. An effective data management and measurement system can support organizational objectives such as decision making; accountability; improvement; and surveillance and longitudinal analyses and knowledge discovery. A systematic approach, incorporating these “four faces of measurement,” described in the quality improvement literature, can serve as an organizing framework for data management- and measurement-related
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Integrating Employee Health: A Model Program for NASA objectives. Such a framework adds to the realities of the business setting that demands an approach to data-driven decision-making processes. This framework also serves as a paradigm that encourages managers to explicitly recognize various approaches to data collection and use, measurement, and reporting, and subsequently provides support for the reporting needs at the various levels within the NASA organization (i.e., intracenter-, intercenter-, and headquarter-specific needs). The data collected are used for a variety of purposes—to create reports that are presented to top management as well as to employees, ensuring that the program staff is accountable for the program’s performance, and to support ongoing improvement of the program, allowing for an assessment of need at baseline that may inform program staff on necessary actions to take, identify barriers to opportunities, and quantify results following the implementation of change in programming. Finally, the program design is based on scientific theory. The reporting of the program’s performance may, in fact, aid in the generation of new hypotheses that could be tested in a research setting or context and, in return, may benefit the field of worksite health promotion. To determine the success of each health programmatic component, data systems must be able to reflect an “employee-centric” perspective rather than a program-centric focus (see Chapter 6). A comprehensive data management system vision should not deter facility-specific linkages of databases or incremental improvements in capability. The infrastructure, broadly defined as the personnel, technology, and information needed to support the integrated health programs, should be defined and appropriately supported as a critical requirement for maintaining the value of an optimally functioning workforce. Observations of occupational health programs at NASA, findings from the literature, and comparisons with “best practice” models in the private sector indicate a need for data-driven integration and health management capabilities across NASA and within its centers, so that a truly integrated health management program can be implemented. Consistent with many organizations that follow a traditional approach, occupational health programs and initiatives at NASA tend to be program specific, and although readily available to the centers, the selection of such programs and initiatives does not appear to be based on health-related, employee-based, NASA-wide data or center-specific analyses. The health improvement data at NASA that are available for program planning, prioritization, and resource allocation tend to be fragmented and sparse. Because NASA is interested in moving forward with a world-class integrated health program, it is imperative that a robust, agency-wide, center-specific, and employee-centered data management system be implemented. With this aim in mind, the committee recommends the following.
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Integrating Employee Health: A Model Program for NASA Recommendation 11: Data Management NASA should implement a systems-based approach to data management that includes the following components: data collection, management, and reporting according to agreed-on protocols and standards; consistent data practices across all NASA centers; and longitudinal tracking of data across all centers and the agency as a whole. Recommendation 12: Data Access NASA should adopt a framework for measurement that will allow the agency direct access to data collected for the purposes of decision making, accountability, improvement, surveillance, longitudinal analyses, and knowledge discovery. Recommendation 13: Intra-agency Collaboration NASA should create and initiate a data-management collaborative that includes representatives from all centers as well as Headquarters who are trained and well informed about measurement and evaluation. At a minimum, the objectives of the collaborative would include generation and ongoing monitoring of performance data measures; Initiation of a data-driven exchange of improvement strategies and tactics for practitioners at the centers; Provision of input and feedback to center- and agency-specific health initiatives; and Provision of specific recommendations for data management-related resource needs, training, and integration. Recommendation 14: Data Architecture and Technology NASA should establish agency-wide data architecture and technology, that may or may not include a comprehensive electronic medical record, to support its operational goals. Clarification of occupationally related, compared to general health, promotion and disease prevention and management data requirements is an essential first step in defining agency-wide technology solutions. Recommendation 15: Research Opportunities NASA should use the opportunity of building such new programmatic endeavors to contribute to knowledge about program effectiveness, cost benefits arising from these programs, and factors that can contribute to the success of these programs. Implementation of a standardized methodology using NASA’s full cost accounting ap-
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Integrating Employee Health: A Model Program for NASA proach for a health and productivity element (see Recommendation 4 above) would greatly assist in this regard. In this way, NASA’s experiences can help to inform the directions taken by other worksites. Specifically, the Committee recommends that NASA consider research in program outcomes (including improved health outcomes for workers and overall cost savings), factors that contribute to program success (e.g., as measured by employee participation rates, or behavior change), barriers and facilitators that contribute to worker participation in programs—and how these barriers and facilitators differ by type of worker, center, and other factors—and factors that contribute to each center’s ability to initiate, implement, and sustain integrated health programs. CONCLUSION Well-being programs can reach large numbers of employees with information, activities, and services that enhance occupational health and encourage the adoption of healthy dietary and physical activity behaviors. Moreover, these programs may reduce health care costs, including employer costs for insurance programs, disability benefits, medical expenses, and employee sick leave. Implementation and ongoing evaluation of effective programs at all NASA worksites may provide significant improvements in the employees’ physical and psychological well-being, benefiting the agency with a more productive workforce, and be more cost effective than the current, traditional program. Such measures, supported by the committee’s examination of “best practice” programs and relevant published research, stand to confer similar benefits if adopted by other public- and private-sector organizations. In addition, opportunities exist for further research that will help inform future program and policy development. REFERENCES Goetzel RZ. 2005. Examining the Value of Integrating Occupational Health and Safety and Health Promotion Programs in the Workplace. Paper presented at the National Institute of Occupational Safety and Health (NIOSH) Steps to a Healthier U.S. Workforce Symposium (2004), Washington, DC. [Online]. Available: http://www.cdc.gov/niosh/steps/2004/whitepapers.html [accessed May 12, 2005]. Hunt MK, Lerman R, Stoddard AM, LaMontague AD, McLellan D, Combe C, Barbeau E, Sorensen G. 2005. Integrating occupational health and health promotion in the WellWorks-2 worksite intervention study: Process evaluation results. Health Education and Behavior 32:10–26.
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Integrating Employee Health: A Model Program for NASA NIOSH (National Institute of Occupational Safety and Health). 2004. Steps to a Healthier U.S. Workforce. [Online]. Available: http://www.cdc.gov/niosh/steps/ [accessed December 9, 2004]. Seabury SA, Lakdawall D, Reville RT. 2004 (October 26-28). The Economics of Integrating Injury Prevention and Health Promotion Programs. Paper presented at the National Institute of Occupational Safety and Health (NIOSH) Steps to a Healthier U.S. Workforce Symposium, Washington, DC. [Online]. Available: http://www.cdc.gov/niosh/steps/2004/whitepapers.html [accessed May 12, 2005]. Sorensen G, Barbeau E. 2004 (October 26–28). Integrating Occupational Health and Safety and Worksite Health Promotion: State of the Science. Paper presented at the National Institute of Occupational Safety and Health (NIOSH) Steps to a Healthier U.S. Workforce Symposium, Washington, DC. [Online]. Available: http://www.cdc.gov/niosh/steps/2004/whitepapers.html [accessed May 12, 2005]. Websites: www.cdc.gov/niosh/steps/ www.cdc.gov/niosh/steps/2004/whitepapers.html www.ohp.nasa.gov
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Representative terms from entire chapter: