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3
An Operational Definition of Resilience
In response to the project’s statement of task, the workshop series
explored the issue of how to define long-term resilience for the
Department of Homeland Security (DHS). Experts from different fields
of research were brought together to discuss resilience and its relevance
to the DHS workforce. The multidisciplinary panel of experts were
drawn from the fields of community resilience, individual resilience, and
resilience from an occupational health and safety perspective. Fran
Norris, an investigator at the National Consortium for the Study of
Terrorism and Responses to Terrorism and a professor at Dartmouth
University, is an expert in community resilience. She presented findings
from a comprehensive interdisciplinary literature review that sought to
identify common threads across different ecological levels and to draw
some conclusions for the emerging field of community resilience. Robert
Ursano is the chair of the department of psychiatry and founding director
of the Center for the Study of Traumatic Stress (CSTS) at the Uniformed
Services University of the Health Sciences; he is also a leading expert in
individual psychiatric responses to trauma, particularly within the first-
responder community. Dori Reissman is a senior medical advisor at the
National Institute for Occupational Safety and Health and is an expert in the
integration of behavioral health and resilience into occupational safety and
health policy and practice. Each speaker presented his or her perspective on
the issue and then participated in a panel discussion.
Although each speaker presented a nuanced perspective on resili-
ence, there were several common themes that emerged across disciplines
(see Box 3-1).
43
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44 BUILDING A RESILIENT WORKFORCE
BOX 3-1
Themes from Individual Speakers on Operational Definition of
Resilience
Resilience is a multi-component process
Resilience is affected by professional and personal factors
Organizational and individual resilience
Critical incident-specific and long-term resilience
Barriers to utilization of services
The role of leadership
The use of evidence in developing interventions
DEFINING RESILIENCE FOR COMMUNITIES AND
ORGANIZATIONS
The basic notion of resilience is the capacity to bounce back from
stress, pressure, or disturbance. Fran Norris proposed that resilience is
more than simply a capacity; rather it is a process through which, after a
disturbance, a set of adaptive capacities is linked to a positive trajectory
of functioning and adaptation. She suggested that the advantage of this
definition is that it emphasizes process, patterns of change, and adapt-
ability. Additionally, it works across different ecological levels, such as the
community, the organization, and the individual, because it is not context
specific. With this definition, the associated outcomes, adaptive capacities,
and interventions may vary, but the focus remains on functioning and
process.
Norris’s process-oriented definition of resilience includes three layers—
adaptation, adaptive capacities, and intervention—and is applicable to
individual, community, and organizational resilience (see Figure 3-1). The
first layer of the process details the predisaster level of functioning or
adaptation and the occurrence of a stressor. Within this model, there are
two pathways. Either there is resistance, and in turn, stability and no
change, or there is transient dysfunction. Over time, the model shows
that, when transient dysfunction occurs, there is either a readaptation, a
return to baseline levels of functioning, or continued dysfunction, which
indicates some vulnerability to longer-term problems.
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45
AN OPERATIONAL DEFINITION OF RESILIENCE
Predisaster Postdisaster Postdisaster
Adaptation Adaptation Adaptation
Resistance
T0 T1 T2
Resilience
Transient Continuing
Dysfunction Dysfunction
Vulnerability
Predisaster Postdisaster
Adaptive Adaptive
Capacities Capacities
Primary Prevention Secondary Prevention
(Predisaster, Universal) (Population at Risk)
Time
FIGURE 3-1 Proposed model of resilience.
SOURCE: Norris et al., 2008.
The second layer of this model includes the adaptive capacities. These
capacities are the focus of much ongoing resilience research. This
research seeks to determine which resources, characteristics, and condi-
tions influence the resilience process and affect the trajectory toward
postdisaster adaptation described in layer one. Figure 3-2 maps the adap-
tive capacities for community resilience.
The third layer of the model is the interventions. An intervention pri-
or to an event can target boosting adaptive capacities for resistance. Ad-
ditionally there are interventions at the time of the event/stressor or
afterward. Interventions after the event do not boost resistance but they
can support resilience. Norris indicated that there is a longer version of
the model that includes longer-term issues and tertiary interventions for
recovery that she did not present at the workshop.
Drawing on her research on community resilience and the model de-
scribed above, Norris outlined several items she felt could contribute to
DHS’s definition of organizational resilience. DHS leadership should
first identify the desired outcomes. For example, is the department con-
cerned with burnout, absenteeism, and other typical workforce issues, or
are there more comlex issues to consider? Secondly what are the primary
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46
Responsible Skills and
media infrastructure
Trusted sources of
Narratives
information
Information and
Communication
Community action
Fairness of risk and
vulnerability to hazards
Problem-solving
skills
Economic Community
Level and diversity of
Development Competence
resources
Flexibility and
creativity
Equity of resource
Collective efficacy
Social
distribution
Empowerment
Capital
Received (enacted) Attachment to place
support
Perceived (expected) Sense of community
support
Social Organizational
Citizen participation
linkages
embeddedness
FIGURE 3-2 Adaptive capacities for community resilience.
SOURCE: Norris et al., 2008.
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AN OPERATIONAL DEFINITION OF RESILIENCE
stressors of concern? Has DHS examined what resources matter in these
settings? What are the adaptive capacities of the various groups within
DHS? Finally, Norris suggested considering what interventions influence
each of those adaptive capacities, which in turn may influence the
outcomes.
Norris gave examples from the literature of the definitional process
for individual and community resilience. The outcome of interest for
individual resilience could be wellness. Wellness goes beyond the
absence of psychopathology. It also means good behavioral health,
quality of life, and effective functioning in role performance. For
communities, the primary outcome of interest is population wellness.
Population wellness is defined as high and nondisparate levels of mental
and behavioral health in the community with good quality of life, as well
as effective role functioning and performance.
The research on individual and community resilience can inform
DHS’s definition of organizational resilience. Norris suggested that a
starting place would be to consider workforce wellness and its similarity
to individual wellness and community wellness. Workforce wellness
could imply things such as low turnover and absenteeism, and effective
role functioning and performance. She pointed out that the basic
questions for organizational resilience remain the same as in individual
and community resilience. What are the desired outcomes? What are the
adaptive capacities in organizations that produce the desired outcomes?
What are the interventions that support these adaptive capacities?
Lessons Learned from Community Resilience Research
Norris highlighted several components of community resilience that
would be applicable to organizational resilience. One such component is
social capital, including social support and social participation.
Social Support
In terms of social support, she pointed to the importance of
“buddies” within military communities for social support and wellness.
Norris also noted the importance of social participation or the sense of
being imbedded within the organization. Social participation can be seen
in terms of bonds, roots, and commitments. For an example, she
mentioned that although she had not lived there for many years, she still
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48 BUILDING A RESILIENT WORKFORCE
felt a deep sense of attachment to her hometown of Louisville, Kentucky.
In a similar vein, individuals can also have attachments to their
organizations.
Communication
Norris suggested that another potentially applicable component is
information and communication. This is an area of tremendous importance
to communities. When building community resilience, there is an emphasis
on “trusted sources of information,” and Norris proposed that the same
applies within organizations.
Competency
Community competency is the ability of people to work together, use
information, and then make decisions and act. Community competency is
dependent on leadership. The leadership on which it is dependent is not
just hierarchal leadership—it includes collective action and participatory
decision making.
Beyond Psychopathology
Norris emphasized the need to stop thinking of resilience as a
personal trait but rather as a process. This shift in thinking has occurred
in the field of mental health and has broadened the perspective on
resilience beyond psychopathology; the role of stressors and the impact
they have on individuals and organizations is important.
Building on Existing Research
Norris also noted that although this workshop series focuses on DHS
organizational resilience, it is not necessary for scholars and practitioners
in the realm of organizational resilience to start from scratch. They can
build on progress in the realms of individual and community resilience.
Additionally, there is the long-standing field of organizational
psychology and other areas that have performed a great deal of research
and have background knowledge, yet they may have never used the word
resilience in the literature. Researchers have studied resilience for
decades; however, terminology differs across fields.
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AN OPERATIONAL DEFINITION OF RESILIENCE
THE RESILIENT ORGANIZATION
In his remarks, Robert Ursano agreed with Norris’s assertion that
resilience is a process with multiple factors. He identified the four
primary factors within the process as (1) mission, (2) organizational
function, (3) individual, and (4) time.
Ursano suggested that these factors form a matrix in which all four
are interrelated and that a comprehensive program for resilience requires
consideration for each section of the matrix. For example, within DHS
there are operational and law enforcement missions. Imbedded within
each mission there may be response teams, decontamination teams, or
administrative tasks such as budgeting. Each of these roles requires
different types of personnel and operates on varying timelines. All of
these factors vary between missions, and all influence the specific
situation.
When considering the four quadrants within the resilience matrix,
several significant mediators can serve as risk or protective factors for
building resilience. Three of these mediators are leadership, family, and
sleep.
Ursano stated that leadership should be considered at all levels and can
be a tool for overcoming stigma within law enforcement communities.
Leadership also is a means for teaching individuals how to ask for help.
Strengthening families is key to sustaining a resilient workforce. Sleep
patterns could play a significant role in resilience.
Ursano observed that the type of critical incident that occurs affects
the resilience process. He commented that it is always a challenge in
first-responder communities to think about fostering operations before an
incident versus dealing with the consequences after the fact. To illustrate
the effects of critical incidents, Ursano discussed a study of responders to
an airplane crash. A month after the crash, the rates of acute stress
disorder, post-traumatic stress disorder (PTSD), early dissociative
symptoms, depression, and health care utilization among the responders
were examined. These rates were compared to a similar group of
responders located 90 miles away who were not involved in the incident.
The study group of responders experienced higher rates of emotional
problems and physical problems, and they were more likely not to obtain
needed medical care than the comparison group (Fullerton et al., 2004).
Other studies have looked at similar populations (Fullerton et al., 2004;
McFarlane and Papay, 1992; North et al., 2002). These studies indicate
that first responders develop disaster-specific disorders. First responders
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50 BUILDING A RESILIENT WORKFORCE
seek care for emotional problems at higher rates. Interestingly they also
report needing medical care but not seeking it. These studies are
informative, but they do not explain the full picture because they only
examined psychiatric disorders and did not include distress or sleep
disorders.
Ursano suggested that a key component of DHS’s mission is
continuity. Continuity has three Rs embedded in it—redundancy,
reliability, and resilience—and specific policies are necessary to sustain
all three. An example of redundancy is using three computers instead of
one. To ensure reliability, people back up those computers, and people
are usually more resilient than organizations. Therefore, it is necessary to
sustain individuals because individuals will sustain the organization
when all else fails.
When building resilience in individuals, mental and behavioral
health issues must be considered. The following list from a 2002 Institute
of Medicine (IOM) report illustrates issues related to critical incident
responses of individuals (IOM, 2002):
Mourning
PTSD
Depression
Unexplained somatic symptoms
Sleep disturbances
Increased use of alcohol and cigarettes
Traumatic/complex grief
Increased family violence and conflict
Over-dedication to the group
Helplessness and guilt
Identification with the victim
Ursano suggested that, when planning to sustain the surge capability
in responders, this list also provides insight into individual responses and
possible areas to target, such as psychiatric health and behavioral health.
One behavioral health problem specific to DHS that was mentioned by
multiple workshop speakers and participants was over-dedication. Over-
dedication is an issue in nearly every workforce and is a particular issue
in DHS and the military. Organizations such as DHS foster over-
dedication. Ursano observed that it might be more productive for the
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AN OPERATIONAL DEFINITION OF RESILIENCE
organization to help personnel achieve more balance between their work
and personal lives.
Ursano asserts that the key points for DHS to consider in developing
its resilience program are defining DHS’s mission in terms of resilience,
thinking about organizational versus individual resilience, and considering
employee work-life balance needs.
INTEGRATING RESILIENCE INTO
HEALTH AND SAFETY
The capacity of individuals to be resilient is tied to the organization’s
mission success and productivity and is an element of organizational
culture. Dori Reissman suggested that resilience is the ability to adjust
rapidly to adversity in a healthy manner and is an integral component of
occupational health and safety. She agreed with many of the previous
speakers’ comments including concepts such as resilience as a process
with a trajectory. She further elaborated on the previous definitions by
stating that resilience is connected with preventing injury and illness and
making sure individuals are functioning well on the job. This type of
public health prevention is much more than a focus on suicide prevention,
which represents the most extreme end of the spectrum.
Reissman noted that almost all definitions of resilience are anchored
in stressors, and almost all resilience programs target stressors. She noted,
however, that certain types and levels of stress can sometimes be helpful
when it reasonably motivates individuals to get their work done and to be
productive. However, along the concept of continuum, at some point
stress levels or types of distress may become pathological and need
intervention. In 2002 the National Institute of Mental Health (NIMH)
defined stressors as events or conditions that may cause physiological
and behavioral reactions and present coping difficulties for the individual
experiencing them (NIMH, 2002).
Reissman suggested that work stress must be viewed in context to the
employment environment and the psychological fit between worker and
supervisor or manager. Therefore, it is intimately tied to the organization’s
mission success and productivity. There are several factors in how a job,
tasks, or negotiating position are organized that are associated with job
stress:
Job design (task complexity, skill/effort, worker control)
Scheduling (work-rest schedules, hours of work, shift work)
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52 BUILDING A RESILIENT WORKFORCE
Career concerns (job security, growth opportunities)
Management style (participatory management practices, team-
work)
Interpersonal relationships (with supervisors and coworkers)
Organizational characteristics (climate, culture)
Job design is central to many of these factors. Reissman suggested
that organizations should consider how they are matching individuals to
the tasks, the requirements, pressure, and resources needed to do their
job.
Scheduling is an important component of job design, and it not only
includes the hours individuals are at work but also the time they spend
away from work to recover. Some individuals choose to work long hours
because they prefer to and have developed coping skills to deal with the
overtime. However, individuals’ coping mechanisms can be overwhelmed
by the amount of shift work or high-intensity project work that they have
to respond to on an ongoing basis without time to recover.
Reissman noted that career concerns are also an important
contributor to job stress. In the current economic climate, job security as
well as growth opportunities are primary concerns of many employees.
Management style and interpersonal relationships at work matter. If
employees dislike their supervisor, they tend to work around them. When
employees step outside the lines of command, it creates an environment ripe
for scapegoating. Leaders set the tone for resilience for the workforce, and it
is important that the tone is in line with workforce needs.
Organizational characteristics, such as climate and culture, should
be assessed to find out what workers think about safety and employee
support, and whether appropriate policies are in place to protect and
support workers. As mentioned by the previous speakers, DHS operates
under many different types of situations. The department responds to
events such as extreme weather, man-made disasters like the Deepwater
Horizon accident, terrorists’ actions, and calls from concerned citizens.
Because of the diversity of activities to which DHS is required to
respond, there are two distinct cultures within the department—the law
enforcement culture and the emergency management culture. She noted
that in order to address resilience for DHS as a whole, it is necessary to
consider the different operating principles and values of these two very
different cultures.
While it is important to consider the differences between organizational
and individual resilience, Reissman emphasized that workforce resilience
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AN OPERATIONAL DEFINITION OF RESILIENCE
feeds into the resilience of the organization. These stressors and
subsequent issues with long-term resilience of the workforce can affect
DHS at several levels. Long-term exposure to certain types of stressors
may not only have negative consequences for the health and welfare of
the workforce, but also affect their performance, morale, and motivation
as well. The resilience of the workforce can affect the success of the
mission.
Reissman suggested that workers’ compensation claims could result
from employees working too much and becoming stressed out. For
example, cardiovascular complications or accidents can arise from fatigue,
and these problems can create cascading effects for years.
Emergency Responder Communities
The National Institute for Occupational Safety and Health (NIOSH)
created a logic model for researching work stress that can be applied to
homeland security and emergency response entities (see Figure 3-3). The
items on the left are inputs into the system. To the right are groups
representing work organization and potential exposures. The work
organization grouping attempts to capture the stress related to the job and
how the work is designed. Reissman modified the model to include issues
related to critical incidents and stressors. Although traumatic exposures
and experiences appear to be straightforward, in reality, they are not
always obvious. There are several important questions to consider: What
constitutes psychological trauma? Does this include ongoing exposure to
routine everyday stress, or is it narrowly defined as a sudden critical
incident? Where do you draw the line?
Riessman suggested that there are many potentially traumatic
experiences for first responders and law enforcement personnel. There
are threats to personal safety, the inability to control or predict their
circumstances, and incongruent events such as witnessing death,
mutilation, mass casualties, and violence. There are also personal factors
such as the loss of personal attachments, loved ones, a job, or home.
These exposures are compounded by sensory overload and sometimes
information overload or conflict. Sensory overload can happen if workers
are exposed to things that are not typical. For example, at the 9/11 World
Trade Center disaster construction workers had to pick up body parts
(human remains), which was extremely taxing, outside their occupational
training or experience, and resulted in higher rates of PTSD.
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54 BUILDING A RESILIENT WORKFORCE
The mechanisms included in Figure 3-3 are all interactive. To
explain the differences between resistance and resilience, Reissman uses
the metaphor that resistance is like a steel bar that is stiff enough to
overcome most things until it is broken; resilience is a rubber bar that can
be bent out of shape and snap back. The NIOSH model attempts to look
at resilience, resistance, and recovery in the face of all the other out-
comes related to normal functions of health, illness, injury, dysfunction,
and disease.
Reissman noted a couple of resources that have been developed to
broaden the understanding of the role of resilience in emergency
responder communities. The IOM’s 2002 report on the psychological
consequences of terrorism inspired a further evolution of thinking by a
federal interagency group considering impacts of an influenza pandemic,
which includes building blocks for improving disaster response, mental
health, and human behavior. For instance, people’s distress response may
be buffered by their resilience capabilities. Those capabilities can depend
on (1) how their employer prepares them for success and (2) learning
how to help themselves.
Although it is not always possible to prevent mental illness, there are
things that can be done to maximize coping and reduce the severity of
mental distress and stress-related disorders. From the human behavior
side, resilience can affect the productivity of the individual. NIOSH de-
veloped the Emergency Responder Health Monitoring and Surveillance
Guidebook to implement enhancements for monitoring emergency
Work Organization
Worker Mechanisms Illness
Organizational Job
Demographics
Practices Design
Injury
Biological
Labor Supply
Traumatic Experience Behavioral
Dysfunction
Cognitive
Technology
Disease
Resistance
Economy Physical and Chemical
Exposure
Recovery
Resilience
FIGURE 3-3 Causal pathways affecting worker safety and health.
SOURCE: Adapted from NIOSH, 2009.
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AN OPERATIONAL DEFINITION OF RESILIENCE
workers. The guidebook contains lessons learned from large disasters
and their affect on workers (NIOSH, 2011). This may be useful for DHS.
Although the guidebook is based on lessons from emergency responders,
it looks at many issues that are relevant for the entire workforce. These
include factors such as the status of an individual, if they are medically
fit for the job, and types of services that can support them, such as an
employee assistance program.
A key point in Reissman’s presentation was that when the
requirements of a job are a poor match to the capabilities, resources, or
needs of the worker resilience is compromised. Reissman reiterated that
safety and resilience have to be a part of work design and is ultimately a
function of leadership.
DEFINING LONG-TERM RESILIENCE
PANEL DISCUSSION
At the conclusion of the individual presentations, the speakers
participated in a panel discussion. Planning committee member David
Sundwall moderated the panel discussion. Questions and comments were
taken from all of the workshop participants including the planning
committee, summary panelists, and audience members.
Long-Term Resilience Versus Incident-Specific Resilience
Summary panelist Joseph Hurrell suggested that focusing on specific
events or disturbances makes it possible to miss the bigger picture. He
asked the panelists to comment on resilience in terms of adaptation to
disturbances compared to resilience in the context of chronic exposure to
stressors on the job. Norris responded that, to some extent, there is an
ongoing level of adaptation to the environment that is always stressful. In
the field of community resilience, the primary focus is understanding
what happens when the environment suddenly and dramatically shifts
and the types of stressors change. Ursano added that in the study on
critical incidents, ongoing daily hassles, adversities, and disrupted
resources contribute to stress in a workplace. Reissman commented that
these are all issues that have been examined in other fields of study,
including work organization and design, and the problem is that the
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56 BUILDING A RESILIENT WORKFORCE
different fields often have subtly different jargon, which can create issues
finding and translating the information.
Workforce Capacity
Sundwall asked the panelists to comment on the adequacy of the
workforce, especially in the treatment of resilience or disaster problems.
Reissman agreed that the adequacy of the workforce is a huge issue, and
that ongoing demands are taxing the existing staff. She suggested
leadership needs to think about workforce adequacy at an organizational
level in order to protect the workers. At the basic level, this means
understanding what the work demands are, intelligently reformulating
how teams meet the demands of the job, and being more flexible in job
assignments. Additionally, to avoid silos within the organization, it is
good to bring individuals from different teams together for a project.
This can be very productive, but it is often problematic because agencies
assign people to tasks but then do not relieve them of existing
responsibilities. Management of these issues requires effective leadership.
Expanding View of Workforce Supports
There is the perception that there is a grave problem with the
adequacy of the workforce, noted Norris. She believes this is largely
because people are only thinking about psychiatrists and psychologists.
There are other groups who can support individuals, the workforce, and
communities. For example, the FEMA-funded crisis counseling program
is a step-care model that includes not only professional providers but also
peers and others who can provide various types of emotional support.
The logic of the model is that resilience requires different levels of
interventions, and early intervention can decrease the likelihood that
professional interventions are needed later.
Stigma
The issue is not always the availability of services but getting people
to utilize the resources, noted Norris. She commented that each of the
speakers discussed the problem of stigma and how it affects utilization of
mental health and related services. It is important to make sure that the
services provided fit the way individuals view their health care needs.
Ursano mentioned there are several new programs looking at how to embed
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AN OPERATIONAL DEFINITION OF RESILIENCE
mental health care within primary care, which may help to alleviate the
stigma as well.
Work Rewards
Most of what is written about resilience is centered on stressors.
Ursano liked that Norris’ presentation and comments shift the resilience
discussion out of the pathology mode and asked the panelists to discuss
the role of work rewards. Reissman and Norris both felt that work
rewards are a valuable component. As an example, Norris discussed a
study of individual resilience and the key role of meaning. Being part of
an event because you have a role in that event and can make a difference is
very different from being part of an event in which you feel victimized by
your presence there. Law enforcement or public health personnel know from
the outset of an event that they are there for a reason and generally believe
they can make a difference. Ursano discussed the concept of “mattering,”
which asks “Do I matter to my organization, and does my work have
meaning for me?”
Surveillance and Measuring Resilience
Sundwall asked about the role of surveillance and measurement in
developing a resilience program, and how to build baseline measures of
resilience. Ursano suggested health surveillance in primary care is
intended to be a health intervention model. This model is in contrast to
models for embedded mental health care within primary care. He went
on to say that health surveillance falls into two different categories. One
category is the dashboard or the elements of health surveillance
information to which an individual already has access. There are a
number of items to consider, including accident rates, the number of
health visits, absenteeism, and suicide. The other category is active
health surveillance that spans everything from postdeployment health
assessments to survey health assessments, and from interviews to
requiring annual physicals. The World Trade Center is one of the largest
health surveillance activities, as is the Deepwater Horizon oil spill. The
question of instituting mental health surveillance is on the cutting edge.
There are all kinds of health surveillance programs for a variety of
conditions, but health surveillance for depression is different. Health
surveillance for smoking is linked to smoking cessation programs.
Although the Department of Defense is able to do health surveillance for
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58 BUILDING A RESILIENT WORKFORCE
PTSD, other organizations probably cannot. In addition, primary care
providers need to be trained to identify resilience-related health needs
and be aware of resources that are available.
Norris commented it is necessary to differentiate between the
individual and organization and then the variables or outcomes that can
be changed. For instance, self-reported stress is a good marker and could
capture information from both individual and collective levels.
Reissman commented that, from an organizational perspective, a key
piece to surveillance is management. At the management level, it is
possible to get at the presenteeism/absenteeism ratio. However, some of
the other metrics mentioned earlier are more difficult, such as disability
and injury, because these are typically paid by workers’ compensation.
They are important and should be part of the dashboard used by
leadership to understand their workforce. On top of that, some issues
might happen outside of a formal survey. For instance, do they have
management team meetings to raise awareness? What’s the tension
level? Is productivity dropping off? Are groups meeting deadlines? It is
also important to compare the views of leaders to workers to see if they
are concordant. Additionally, there is a program sponsored by the
Washington Business Group on Health that puts together an index for
corporations assessing health care at work and the kinds of resources
required.
REFERENCES
Fullerton, C. S., R. J. Ursano, and L. Wang. 2004. Acute stress disorder, post-
traumatic stress disorder, and depression in disaster or rescue workers.
American Journal of Psychiatry 161(8):1370-1376.
IOM (Institute of Medicine). 2002. Preparing for terrorism: Tools for evaluat-
ing the Metropolitan Medical Response System Program. Washington, DC:
The National Academies Press.
McFarlane, A. C., and P. Papay. 1992. Multiple diagnosis in posttraumatic stress
disorder in the victims of a natural disaster. Journal of Nervous and Mental
Disease 180:498-504.
NIMH (National Institute of Mental Health). 2002. Post-traumatic stress
disorder (PTSD). Washington, DC: U.S. Department of Health and Human
Services.
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AN OPERATIONAL DEFINITION OF RESILIENCE
NIOSH (National Institute of Occupational Safety and Health). 2009. Causal
pathways affecting worker safety and health. Modified from Steering
Committee on Work Organization and Health. http://www.cdc.gov/niosh/
programs/workorg/ (accessed February 16, 2012).
NIOSH. 2011. Emergency responder health monitoring and surveillance.
http://www.cdc.gov/niosh/docket/review/docket223/ (accessed February 16,
2012).
Norris, F., S. Stevens, B. Pfefferbaum, K. Wyche, and R. Pfefferbaum. 2008.
Community resilience as a metaphor, theory, set of capacities, and strategy
for disaster readiness. American Journal of Community Psychology
41(1):127-150.
North, C. S., L. Tivis, J. C. McMillen, B. Pfefferbaum, E. L. Spitznagel, J. Cox,
S. Nixon, K. P. Bunch, and E. M. Smith. 2002. Psychiatric disorders in
rescue workers after the Oklahoma City bombing. American Journal of
Psychiatry 159(5):857-859.
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