2
Occupational and Preventive Health at NASA

This chapter provides an overview of occupational and preventive health programs at NASA, beginning with a historical perspective. The administrative structure of Occupational Health is described, including the departmental locations of various occupational health-related programs. The chapter closes with a summary of committee member site visits to observe occupational health programs and activities at selected NASA centers.

DEVELOPMENT OF PREVENTIVE HEALTH PROGRAMS

NASA was one of the first federal agencies to recognize the importance of occupational and preventive health programs to the overall health and productivity of its employees. In addition, safety was early on instituted as a core value among the NASA workforce—vital to the success of NASA missions. In 1972, NASA commissioned the Durbeck study, which showed a relationship between worksite exercise programs and improved health, particularly cardiac health (Durbeck et al., 1972). In 1976, NASA established and implemented a standardized set of criteria for Employee Assistance Programs (EAP). By 1977, preventive health programs based on nutrition education and counseling had been established within the agency. In the subsequent three decades, NASA took additional steps to institute preventive health programs agency-wide. Between 1977 and 1997, NASA initiated several nutrition programs, including one-on-one counseling about cardiac and other chronic diseases. In 1989, the agency commissioned a study on implementation of the Healthy People 2000



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Integrating Employee Health: A Model Program for NASA 2 Occupational and Preventive Health at NASA This chapter provides an overview of occupational and preventive health programs at NASA, beginning with a historical perspective. The administrative structure of Occupational Health is described, including the departmental locations of various occupational health-related programs. The chapter closes with a summary of committee member site visits to observe occupational health programs and activities at selected NASA centers. DEVELOPMENT OF PREVENTIVE HEALTH PROGRAMS NASA was one of the first federal agencies to recognize the importance of occupational and preventive health programs to the overall health and productivity of its employees. In addition, safety was early on instituted as a core value among the NASA workforce—vital to the success of NASA missions. In 1972, NASA commissioned the Durbeck study, which showed a relationship between worksite exercise programs and improved health, particularly cardiac health (Durbeck et al., 1972). In 1976, NASA established and implemented a standardized set of criteria for Employee Assistance Programs (EAP). By 1977, preventive health programs based on nutrition education and counseling had been established within the agency. In the subsequent three decades, NASA took additional steps to institute preventive health programs agency-wide. Between 1977 and 1997, NASA initiated several nutrition programs, including one-on-one counseling about cardiac and other chronic diseases. In 1989, the agency commissioned a study on implementation of the Healthy People 2000

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Integrating Employee Health: A Model Program for NASA goals, and from 1990 to 2000 it developed and implemented a 10-year, agency-wide competitive plan to meet the Healthy People goals. It was the first federal agency to achieve Voluntary Protection Program (VPP) Star Status, and was recognized by the American Productivity and Quality Center (APQC) for its programs in 1999. Today, NASA offers a broad scope of health and wellness support options to employees. In addition, a NASA Health Promotion and Wellness Team (HPWT) was established in 2000 to standardize the delivery of health promotion across the agency. The HPWT, comprising Occupational Health Program professionals from each NASA center and facility, meets quarterly (Probst, 2004). All of the occupational health-related programs and activities offered by NASA are linked to the NASA Occupational Health website (http://www.ohp.nasa.gov/). This website can be accessed by all NASA employees, as well as by viewers outside the agency. The site informs employees of relevant events such as the Healthier Feds campaign (http://www.healthierfeds.gov/) and topics such as flu vaccines, and it serves as a vehicle to facilitate employee participation in personal health care by offering health information, links to outside health sites, and notification to employees of health screening, physical exams, and other health programs offered by NASA (NASA, 2004). THE OFFICE OF THE CHIEF HEALTH AND MEDICAL OFFICER The Office of the Chief Health and Medical Officer (OCHMO) was created to undertake responsibility for the health of the NASA workforce in areas such as policy, medical guidelines, best medical practices, professional development and training, and medical quality assurance. (Refer to Chapter 1, Figure 1-2 for the NASA organizational chart, including the OCHMO.) Specifically, the office is responsible for policy and oversight for occupational health, aerospace medicine, medicine in extreme environments, protection of research subjects and patients, quality assurance, public health issues, and professional health education and development. The OCHMO administers a broad range of health, wellness, and environmental programs and is headed by the Chief Health and Medical Officer (CHMO). Figure 2-1 shows the organizational chart for the OCHMO. Program Administration at NASA Centers Occupational Health at NASA is decentralized (see Figure 2-1), with each center administering its own programs. The total FY 2002 budget dedicated to occupational health across all centers was $45,042,553 (Probst, 2004). A breakdown of the Occupational and Environmental Health budget for this year by center is shown in Table 2-1. Each center is unique, and

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Integrating Employee Health: A Model Program for NASA FIGURE 2-1 Occupational Health Organizational Chart, NASA Headquarters. although the offices are separate, they are mutually supported and cooperative. The centers are encouraged to communicate with Headquarters, and feedback mechanisms include biannual outbrief/inbrief surveys, news sheets disseminated via e-mail from Headquarters to the centers, an annual occupational health conference, the annual health and safety meeting, biweekly continuing professional education videoconferences, for centers, and an OH website (see above). The range of occupational health services offered to civil servants and contract employees varies between centers, depending on the proportion of contract and civil servant employees at the site, as well as on contract specifications. Every site offers some level of preventive health including fitness centers, stress management, diet/nutrition, and so on, as well as Employee Assistance Programs (EAPs). Occupational Medicine Strategic Planning Strategic planning within NASA gave rise to the development of specific outcome metrics for the OCHMO that focused on the objective that

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Integrating Employee Health: A Model Program for NASA TABLE 2-1 Occupational Health Budgets for Selected Sites in Millions of Dollars (2002)   Occupational Medicine Environmental Health Total Ames $1.2 $1.2 $2.4 Dryden $.9 $.5 $1.4 Glenn $.9 $2.0 $2.9 Goddard $1.4 $1.1 $2.5 Headquarters $.8 – $.8 JPL $2.4 $2.8 $5.2 Johnson $5.5 $2.5 $8.0 Kennedy $7.4 $8.8 $16.2a Langley $1.2 $.6 $1.8 Marshall $1.8 $1.0 $2.8 Stennis $.6 $.6 $1.2 Total $24.1 $21.1 $45.2 aIncludes support of the Cape Canaveral Air Force Station through the Joint Base Operations Support Contract. SOURCE: Probst, 2004. employees who join NASA should end their careers healthier than the average American worker. There were several documents that helped transform this outcome objective into a vision for the OCHMO. These included the Institute of Medicine (IOM) report, Safe Passage (IOM, 2001), which helped develop a focus on prevention, and the Healthy People 2010 report, which served as a model for an occupational health approach to preventive health and provided benchmarks for programs (USDHHS, 2000). There are impediments, however, to the implementation of the OCHMO’s vision. First, safety is historically a core element of most engineering cultures, whereas health is not; and second, occupational health and safety are each managed in separate NASA offices. Both of these factors affect development and implementation of programs offered through the OCHMO. ORGANIZATION OF OCCUPATIONAL AND PREVENTIVE HEALTH PROGRAMS Occupational and preventive health programs at NASA are carried out by over 400 health professionals across the 14 centers (Probst, 2004). They provide comprehensive support to NASA’s diverse and highly technical workforce, which includes both federal employees and contractors.

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Integrating Employee Health: A Model Program for NASA The primary program elements making up NASA Occupational Health and administered through the Office of the Chief Health and Medical Officer (OCHMO) are: Occupational Medicine Medical Clinics Health Education and Wellness Programs EAP Environmental Health Health Physics (HP) Industrial Hygiene (IH) Sanitation Federal Workers’ Compensation Physical Fitness Occupational and Preventive Health Programs Occupational Medicine Figure 2-1 shows the organizational chart for Occupational Medicine at NASA Headquarters, and Table 2-2 depicts the office’s developmental timeline. The primary objectives of the Occupational Medicine program are to improve health through prevention, ensure fitness for duty, and minimize absenteeism and reduced productivity resulting from injury, illness, short- or long-term disability, or premature death (http://www.ohp.nasa.gov/index.html/). The program components offered through OCHMO include: Acute Medical Care Certification Examinations Clinical Care Electronic Health Record System (EHRS) EAPs Health Maintenance Examinations Medical Monitoring Examinations Nutrition Services Physical Fitness Programs Traveler Health Federal Workers’ Compensation Services Environmental Health The Environmental Health program at NASA is dedicated to the identification, evaluation, and control of occupational and environmental haz-

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Integrating Employee Health: A Model Program for NASA TABLE 2-2 Developmental Timeline for Occupational Medicine at NASA 1972 U.S. Public Health Service Health Evaluation and Enhancement Program at NASA (Durbeck Study) linked a worksite exercise program with improved cardiovascular health. 1976 Standardized criteria for Employee Assistance Programs was established at NASA. 1977 Preventive health programs on nutrition education and counseling were developed and implemented. 1989–1999 NASA conducted a Cardiovascular Risk Reduction Program. 1989 NASA commissioned a study to examine which Healthy People 2000 goals could be implemented in the worksite. From 1990-2000 NASA implemented a plan to meet the Healthy People 2000 goals. mid-1990s Agency-wide downsizing reduced the occupational health function from eleven FTE civil servants to three FTE civil servants. 1996 Two of three remaining billets and existing budget were transferred to the Kennedy Space Center. Two existing civil service positions were filled, one additional civil service position was hired, and a contractor workforce was hired. 1997 NASA funded a study by the Health Enhancement Research Organization (HERO) examining the modifiable health risk factors of coronary artery disease, and related expenditures and hospitalizations. 1998 LifeSkills, Inc. conducted focus groups to determine sources of stress at NASA. 2000 Office of the Chief Medical Officer (OCHMO) was established. Separate divisions for Occupational Health, Medicine of Extreme Environments, and Bioethics and Transition to Practice were created. 2002 Responsibility of four civil service FTEs was transferred to NASA Headquarters following an independent review of effectiveness of the lead center concept for occupational health. 2003 OCHMO moved from the Administrator’s Office and was reorganized as the independent Office of Health and Medical Systems. 2004 OCHMO was returned to the Administrator’s Office as a result of the President’s Commission for the Exploration Vision. ards or stresses that may adversely affect the well-being, work environment, or performance of the workforce. The program components offered through Environmental Health at NASA include: Health Physics Industrial Hygiene

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Integrating Employee Health: A Model Program for NASA Environmental Sanitation Pesticides Food sanitation OSHA Compliance. Components of NASA Occupational Medicine The NASA Occupational Health website (http://www.ohp.nasa.gov/) provides employees with information on environmental health programs and weekly health topics. Acute Medical Care Occupational Health clinics provide emergency first aid and medical care to employees who experience a medical emergency while at work. Occupational and Health Maintenance Examinations Clinical Care. NASA Occupational Medicine’s policy is to minimize sick absences and reduced productivity resulting from partial physical disability, permanent disability, or premature death. NASA centers provide acute medical care for first-aid care and other services to maintain health, improve morale, control costs, and reduce lost time resulting from injuries and illness. Electronic Health Record System. In an effort to improve the longitudinal understanding of the health status of the workforce, NASA Occupational Health has planned to implement an EHRS. This system would replace the traditional paper medical record and afford NASA clinics the opportunity to facilitate identification of critical health issues in real time, reduce the chance of medical errors and improve reporting, assess the effectiveness of health improvement programs, and advance collaboration between centers to provide an overall employee health status. In addition to enhancing the day-to-day delivery of occupational health services, the EHRS would allow the measurement of health outcomes compared to career-long exposures and employee-focused health care. The EHRS project is a major initiative of the OCHMO. An Agency Task Force, comprising individuals from each of NASA’s 14 centers and facilities, and crosscutting many professional disciplines, is currently focusing on the generation of technical and functional requirements necessary for such a system to operate successfully in NASA’s environment. The results of this endeavor will drive the development of an agency-

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Integrating Employee Health: A Model Program for NASA wide system capable of standardizing an improved level of health care for all employees. Health Maintenance Examinations. NASA centers offer physical exams to civil servant employees on an age-based schedule. Additional testing is offered on the basis of age and risk criteria. Employees in positions with potential toxic exposure are required to undergo occupational physical exams. The requirements for such testing are determined by state and federal regulations. All examination protocols include a health risk counseling component. In addition, numerous preventive medicine services are available to employees, including physical exams, health education, screening programs (e.g., mammography and screening for skin cancer, prostate, and colon cancers) and cardiovascular risk reduction programs. Employee Assistance Programs The NASA EAP is one of the constituent Occupational Medicine programs within the agency. All NASA centers offer an EAP that provides employees with short-term counseling or referrals to community resources. Features of the EAP include employee stress management; Web-based training services for employees experiencing emotional stress, mental health disorders, family or relationship difficulties, financial or legal concerns; and alcohol or drug abuse problems. Participation is voluntary, though services may be initiated by supervisor, medical, or other referral. The training programs include a stress-level questionnaire with immediate feedback and after-hours EAP coverage. Nutrition Services It is NASA Occupational Medicine policy to promote healthy behaviors by creating a work environment supportive of healthy choices, advanced by providing to the employees sound and safe nutrition services to assist with proper diet, meal planning, and weight and disease management. Physical Fitness Programs NASA provides employees with fitness facilities at all centers, staffed to offer counseling and individualized training and offering a variety of exercise classes and equipment. Some centers also provide orthopedic and cardiac rehabilitation services, directed by qualified professionals. Be-

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Integrating Employee Health: A Model Program for NASA tween 1990 and 2000, in collaboration with the President’s Council on Physical Fitness and Sports, NASA engaged employees in an intercenter competition called “Exercise for the Health of It” to raise awareness of the benefits of regular exercise, based on the fitness objectives of Healthy People 2000. Traveler Health It is NASA’s policy to offer a comprehensive health services program for international travelers to safeguard the health and productivity of its employees on international travel and duty assignments. NASA Occupational Health clinics follow the guidelines set by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) when providing health evaluations, immunizations, and information on diseases, food and water, and personal safety in foreign countries. In addition, any employee, including contractors, traveling to a medically underserved area is provided with contract arrangements for emergency evacuation. Federal Workers’ Compensation Programs NASA’s goal is the prevention of occupationally related injury and illness. However, it is agency policy, as directed by the Federal Employees’ Compensation Act, to provide compensation benefits to civilian employees of the U.S. government (civil servants) who are injured, become ill, or die while in the performance of duty. Occupational Health Website The Occupational Health Website, http://www.ohp.nasa.gov/, provides employees with information on occupational medicine and environmental health programs and provides a single point of access to all programs, and a large inventory of resources and tools. Environmental Health Programs Health Physics Licensed radiation protection programs are in place at every center where radiation hazards are present. These programs comply with the regulations established by the Nuclear Regulatory Commission, and qualified staff provides training and evaluation to employees. Laser Safety

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Integrating Employee Health: A Model Program for NASA and Ground Nuclear Safety training programs are available on the SOLAR Website. Industrial Hygiene Hazardous Material Exposure. Every NASA center has a Hazardous Material Program designed to identify, evaluate, and control potentially hazardous materials to which employees may be exposed (NASA, 2004). A Material Safety Data Sheet (MSDS) inventory is maintained on all potentially toxic substances and hazardous physical agents. Employees participate in special programs to manage unique hazardous materials and processes and receive special training in handling such materials. Annual inspections are conducted at each center, and personal exposures are monitored. NASA industrial hygienists are available to respond to all spills and accidents involving hazardous materials, conduct on-site evaluations, and answer employee questions (NASA, 2004). Proactive reviews are made of all engineering drawings of new and renovated buildings and of all contract and purchase requests before the initiation of new research and development programs. These reviews serve to identify and control potential exposures to hazardous materials and processes to prevent such occurrences (NASA, 2004). Employees are trained in hazard recognition, proper use and care of personal protective equipment, and proper handling of harmful substances. Training is conducted through a multimedia approach called the Site for On-line Learning and Resources (SOLAR). Web-based training is also available on Bloodborne Pathogens and Hearing Conservation. The NASA Safety Training Center (NSTC), near Johnson Space Center, Houston, offers course development and deployment through a catalog of safety and health courses which are updated annually and offered agency-wide. Ergonomics. The NASA Ergonomics Program uses a multidisciplinary approach to evaluating workers and the workplace to prevent work-related musculoskeletal disorders (MSD). At least one center has an on-site physical therapy and rehabilitation group; however, ergonomic hazard awareness and training programs have been instituted and engineering controls used to abate ergonomic hazards wherever they are encountered. Agency-wide, a compendium of informational materials and links to ergonomic information is made available through the Occupational Health Website. Indoor Air Quality. The Indoor Air Quality (IAQ) Program focuses on the four basic causes of “sick building syndrome”: inadequate ventilation, inside contamination, biological contamination, and outside source con-

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Integrating Employee Health: A Model Program for NASA tamination (NASA, 2004). Investigations into air quality problems are made on a case-by-case basis by Occupational Health personnel. IAQ takes a proactive approach, including a review process to evaluate any new construction for air intake and exhaust locations, ventilation rates based on occupancy, and a review of operations to determine the need for local exhaust ventilation to control emissions of potential contaminants. IAQ courses, an in-house training video, and IAQ-related websites are available to employees. Food and Sanitation All centers operate a Food Sanitation Program that addresses issues of food safety. Food sanitation and inspection programs are in place to prevent foodborne illness, poisoning, and contamination of food. Food handlers are trained in proper food handling procedures, use of equipment, and personal hygiene. OBSERVATIONS OF OCCUPATIONAL HEALTH PROGRAMS AT SELECTED NASA CENTERS The Office of the Chief Health and Medical Officer is staffed at NASA Headquarters in Washington, DC, and at a tenant office at Kennedy Space Center (KSC) in Florida. NASA Occupational Health consists of approximately 400 occupational health professionals distributed across 14 NASA centers and facilities. These professionals provide comprehensive support to NASA’s diverse, highly technological workforce. Headquarters maintains oversight of the Occupational Health program and is responsible for ensuring compliance with programmatic, statutory, and regulatory guidelines and policy implementation. NASA center directors and the Assistant Administrator for Institutional and Corporate Management have the responsibility to ensure that the NASA Occupational Health program is effectively implemented and operated at their respective center and component facilities (refer to Chapter 1, Figure 1-2). Site Visits to Review Health Programs, Employee Attitudes and Awareness, and the NASA Work Environment A component of the charge to the study committee was to gather data to assess employees’ awareness of and attitudes toward preventive health care programs and the support facilities offered in their worksite. Limitations in time and budget precluded the conduct of a formal research survey of the NASA workforce; however, the committee did conduct infor-

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Integrating Employee Health: A Model Program for NASA mal voluntary interviews and focus groups with employees and managers at selected NASA worksites. Six NASA centers were selected for site visits by the study committee during the summer of 2004. These sites (Kennedy Space Center, Goddard Space Flight Center, Jet Propulsion Laboratory, Ames Research Center, Glenn Research Center, and Johnson Space Center) were visited by three to five committee members and project staff. The sites visited were selected on the basis of the following criteria to ensure as representative a sampling of sites as possible: Site mission and function, Geographic location, Workforce size, and Mix of civil servant and contract employees. Typical activities on each itinerary included (a) tours of the site, including the fitness facility and health unit; (b) interviews with one or more upper-level administrators (usually a deputy center director), the division chief for Occupational Health, union representatives, and a representative from human resources; and (c) focus groups composed of male and female employees and supervisors. Although there are differences among the sites visited, committee members noted recurring themes at all sites. These major themes are described below. The site visits allowed committee members to make observations and interact directly with employees at all levels from administrative to nonsupervisory workers. Major categories of NASA-identified concerns and program areas were specifically reviewed by the committee, using the best available data, site visits, and interviews. Focus groups of 6-10 individuals were arranged to include either all male or all female employees and either all supervisory or all nonsupervisory employees whenever possible at each center. Though the content of the focus group discussions varied between sites, the following topics were included to the extent possible: Use of fitness facilities, Attendance and valuing of other programs, Health/Nutrition environment, Overall health of employees and value of health, Stress environment, and Group interactions. On the basis of the information provided and collected, the committee formed its assessments, findings, and recommendations.

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Integrating Employee Health: A Model Program for NASA Employee Training Programs The committee site visit teams did not obtain specific information on these programs, although some observations by committee members indicated that the skills taught by outside contractors were typically too generic and failed to adequately address the actual problems present at NASA. Employees expressed concerns that supervisory training did not include the identification of stress in the workplace and that inadequate management education may have exacerbated or created unnecessary stress among employees. In at least some cases, such training seemed available only to civil service employees. Further observation by committee members indicated that training was not appropriately integrated into management career paths and did not reach those that needed it most. Preventive Health Programs All NASA centers offer preventive health programs to employees; however, the range of options varies by site. The following observations describe the variability in range and depth of preventive health care across centers. For most centers, safety and health do not appear to be integrated: Safety and health are often located in different divisions, if not different directorates, which can inhibit effective coordination of programs, and There appears to be relatively little attempt to integrate the variety of preventive health programs that are offered at the various centers. These programs are often driven by perceived employee desires rather than a strategic analysis of employee health needs. There are inconsistencies across the centers with respect to contractor access to preventive health programs. There appears to be consensus that contractors and civil servants are “on the same team,” and that both groups need to function optimally for a project to succeed. However, many centers do not allow contractors access to health services, preventive health programs, or fitness facilities. This can lead to feelings of resentment and inequity, which may be exacerbated by the knowledge that some centers do allow contractor access. Evaluation of Stress at NASA NASA can be compared to a large corporation that faces unique and competitive challenges and attempts to adjust its management and work-

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Integrating Employee Health: A Model Program for NASA force to meet these challenges. As a federal agency, NASA experiences significant stress because of the high visibility of its major programs, and a number of NASA operations are not error tolerant—seemingly minor mistakes can have major negative consequences. The committee’s evaluation of chronic and acute stress was limited to observations at site visits and site-specific, small data sets. Its conclusions about stress at NASA, however, were similar to those observed in prior surveys such as those described above. An exact assessment of chronic stress would require appropriate sampling of stress measures and risk factor measurements that were not available at NASA. The committee did not seek out high-stress occupations or attempt to assess peak levels of stress. Stress resulting from the public visibility of NASA and its often hazardous missions appeared to be most evident among the upper levels of management. Discussion with employees did not elicit any voiced concern about public exposure, mission events, or long-term psychological reactions to mission events. Importantly, the response from upper-level management to stressful exposures did appear to frequently translate into reorganization or policy changes that then posed significant daily challenges to employees. In general, the committee observations of the NASA work environment, along with findings from the previously described reports, indicate that deficits in managerial training and the design of work/communication flow at NASA create acute stresses, which may affect both employee health and employee productivity. Specific observations on the NASA work environment are that: Job stress levels were reported as comparable to those in private industry. Although employee stress is clearly an issue among NASA employees, it did not appear to the committee that the absolute level of stress was significantly different than that experienced by employees in the private sector. The major sources of and trends related to job stress consistently noted by employees and management are: The recent initiation of a “full-cost accounting” approach has caused considerable stress among civil servant and contract employees. There are peak and valley times of stress and increased workload. However, the most stressful times are also the most exciting times. Employees who had worked in both sectors believed there were no significant differences, whereas NASA civil servants generally perceived more workplace stress.

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Integrating Employee Health: A Model Program for NASA Employees appreciate the campus-like atmosphere and academic freedom. Employees recognize the benefits of working for NASA and appreciate the campus-like atmosphere. However, employees also exhibited a sense of entitlement to these benefits and desired additional “perks”. There are pervasive concerns regarding the Report of the President’s Commission on Implementation of United States Space Exploration Policy (Aldridge Report). There are significant concerns regarding job security. This was more apparent at some sites than others but was mentioned at all of them. Employees are concerned about the effects of potentially becoming a Federally Funded Research and Development Center (FFRDC), like the Jet Propulsion Laboratory. Relations between civil servant and contract employees are positive, but somewhat strained because of perceived inequities. For a variety of reasons, civil servants and contractors were not able to access all of the same health and wellness services (e.g., fitness center, health clinic, EAP) at all of the sites. Some sites allowed more equitable access than others. Some employees reported that contractors are treated like “second-class citizens”. Contractors noted the difficulties involved in reporting to two supervisors: the contractor supervisor and the project supervisor. Despite these issues, the overwhelming committee consensus was that stress did not interfere with productive and collegial working relationships. The stress concerns the committee observed closely echo those reported earlier in Stress at NASA (Williams and Williams, 1998). The Williams Report was commissioned to evaluate the employees’ level of concern associated with federal-wide downsizing so that NASA’s employee assistance programs would be better positioned to assist employees. Both report stressors at NASA that could have been observed in other large corporations; for example, effects of downsizing (Landsbergis et al., 1999), poor “people skills,” inadequate vertical communication, and problems with a mixed contractor/civil servant workforce. The 2004 survey of NASA by Behavioral Science Technology (BST) provides further confirmation of problems with communication and management style. A pilot program has been initiated with contractors hired by NASA to train managers in stress and communication management (BST, 2004).

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Integrating Employee Health: A Model Program for NASA Although the committee site visit teams did not obtain specific information on this program, its initiation seemed to be viewed positively by employees. Observations during the site visits, however, raised concerns about the implementation of this (and prior) programs. NASA staff discussions of programs indicated that the skills taught by outside contractors were typically rather generic and failed to engage successfully the actual problems present at NASA. In at least some cases, such training seemed available only to civil service employees. Further observation by committee members indicated that training was not appropriately integrated into management career paths and did not reach those that needed it most. The positive features present at NASA are echoed in committee observation as well as previous reports (CAIB, 2003; President’s Commission on Implementation of United States Space Exploration Policy, 2004; BST, 2004) that emphasize the strength of the NASA workforce in terms of skills, dedication, and in most cases, positive morale. An important function of EAP personnel that is well executed at NASA is crisis intervention. Acute stressors, such as occur in mission mishaps, affect large segments of the NASA community. In such situations, and in equally severe, but more local, crises, it is important for the community to recognize the effect of such stressors, provide social support, and enhance referral for those suffering severe symptoms. Overall, the committee impressions and these reports indicate (but cannot definitively prove) that deficits in managerial training and the design of work/communication flow at NASA create acute stresses, which may affect both employee health and productivity. The committee impressions further indicate that chronic stress at NASA was comparable to that at similar large workplaces. Such stress remains important to long-term health and productivity despite the possibility that NASA does not have a unique or remarkably greater level of stress relative to other worksites. Employee Utilization and Awareness of Occupational Health Programs In general, the committee observed employee appreciation for the variety of programs offered. As noted earlier, employees realize that working at NASA provides a lot of “perks,” and that they have a wide array of health and wellness programs offered to them. They appreciate the availability of services such as the fitness center and health unit, even if they do not necessarily use them. The following factors, however, affect the utilization and effectiveness of programs:

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Integrating Employee Health: A Model Program for NASA Communication regarding available health and wellness programs varies; Many employees noted that information regarding wellness programs is often lost in the volume of daily notices that employees receive. Flyers and e-mail notices are sometimes received after the fact or are buried in center-wide emails; There appears to be some dissatisfaction with the trend toward population-based health assessments; At some of the sites, the medical clinics have started to eliminate annual physicals and routine blood work in favor of population- and risk-based assessments. Employees were not generally aware of the rationale behind these changes and were not happy with the perceived reduction in services; and Attitudes toward the fitness center and health units are very personality dependent and center specific. In general, there were high levels of employee awareness regarding the medical clinics and fitness centers. However, attitudes appeared to vary depending on the contractor managing the facility. In addition, employees often cited barriers to participation in these programs (e.g., too much work, programs only offered for the already healthy, etc.). Metrics The committee reviewed health metric collection and management systems at the centers visited. They found that large amounts of data are collected; however, Metrics are collected and maintained by individual centers and are not consistently or uniformly coordinated between centers; and Utilization data generally tend to be collected, rather than health outcomes data. Another important observation made by the committee was that data are generally not used to inform decisions. It appears that data are often collected to verify that contractual requirements are being met, but these data do not appear to be used to influence future strategic planning, to assess the health effect of the programs that are being offered, or to assess the actual health needs of employees. As noted above, there is inconsistency from site to site regarding what is collected and how it is used. Specifically, there is a lack of consistently reported utilization data across centers. As an example of inconsistency, fitness center utilization may be tracked by “number of monthly visits,”

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Integrating Employee Health: A Model Program for NASA “number of active members,” “daily average visits,” or “number of employees with medical clearances.” Therefore, it is difficult to make comparisons across the different centers. FINDINGS The committee found that, overall, Occupational Health at NASA has established many of the elements of an integrated health program and has taken an important step toward incorporating its programs into an integrated system through its Occupational Health Website. Observations of committee members indicate that a stronger emphasis and greater visibility was given to safety over health, although that observation varied between centers. The committee believes, however, that safety and health should both be viewed as elemental components of an integrated health program. The committee further found, based on its observations and review of existing programs, that the current organizational status of Occupational Health programs is segregated and fragmented between and within centers. The lack of uniformity in these programs is largely a consequence of a decentralized system that results in variability and lack of consistency in the collection and reporting of health data and program use at the center level. REFERENCES BST (Behavioral Science Technology). 2004. Assessment and Plan for Organizational Culture Change at NASA. Ojai, CA: BST. CAIB (Columbia Accident Investigation Board). 2003. Report, Volume 1. Washington, DC: U.S. Government Printing Office. Durbeck DC, Heinzelmann F, Schacter J, Haskell WL, Payne GH, Moxley RT III, Nemiroff M, Limoncelli DD, Arnoldi LB, Fox SM III. 1972. The National Aeronautics and Space Administration-U.S. Public Health Service Health Evaluation and Enhancement Program. Summary of results. American Journal of Cardiology 30(7):784–790. IOM (Institute of Medicine). 2001. Safe Passage: Astronaut Care for Exploration Missions. Washington, DC: National Academy Press. Landsbergis PA, Cahil J, Schnall P. 1999. The impact of lean production and related new systems of work organization on worker health. Journal of Occupational Health Psychology 4(2):108–130. NASA. 2004. Report on Preventive Health Services. Washington, DC: NASA. President’s Commission on Implementation of United States Space Exploration Policy. 2004. A Journey to Inspire, Innovate, and Discover. Washington, DC: U.S. Government Printing Office. Probst TM. 2004 (March 25). Preventive Health at NASA: A Summary of Occupational Health Programs and Employee Utilization. Paper presented to the Institute of Medicine’s Food and Nutrition Board Committee to Assess Worksite Preventive Health Program Needs for NASA Employees, Meeting # 1.

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Integrating Employee Health: A Model Program for NASA USDHHS (U.S. Department of Health and Human Services). 2000. Healthy People 2010. Washington, DC: U.S. Government Printing Office. Williams RB, Williams VP. 1998. Stress at NASA: A Report to the NASA Occupational Health Program Summarizing Sources of Stress That Are of Major Concern to the NASA Work Force and Potential Steps That Can Be Taken to Address and Remedy These Problems. Durham, NC: Williams LifeSkills, Inc. Websites: www.healthierfeds.gov/ www.ohp.nasa.gov/