Advancing Workforce Health at the Department of Homeland Security Protecting Those Who Protect Us (2014) / Chapter Skim
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6 Organizational Alignment and Coordination
6 Organizational Alignment and Coordination
Pages 165-200
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From page 165... ...
DHS operates using a matrix management approach whereby functional leaders (e.g., human resources) in the components receive direction both from component line leadership and from the functional leader at the DHS headquarters level (e.g., the DHS Chief Human Capital Officer)
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From page 166... ...
, the committee concludes that (1) the fragmentation of workforce health protection functions and the lack of sufficient delegation of authority to the Chief Medical Officer (CMO)
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From page 167... ...
.2 Similarly, at NASA, safety falls under the Safety and Mission Assurance Directorate, but all other employee health protection and promotion functions (e.g., occupational health, environmental health, health physics, physical fitness and health promotion, workers' compensation, and employee assistance) 2 The health system at P&G is organized similarly to that of J&J.
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From page 168... ...
. Neither DOI nor the Smithsonian has a designated CMO or medical director, although both organizations employ physicians to direct occupational health programs that are part of the aligned health protection reporting structures.
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From page 169... ...
Briefly, health protection responsibilities under the CMO encompass primarily medical quality management, medical support for operations, medical countermeasures, employee resilience programs, and medical readiness functions, whereas programs located within OCHCO include occupational safety and health, workers' compensation, disability management, and health promotion. This organizational and authority structure most closely resembles the segregated model described above, although the division of health and medical functions between offices is a notable difference (for example, medical surveillance and medical case management are overseen from within OCHCO, but other medical functions are the responsibility of the CMO)
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From page 170... ...
For example, health promotion is listed as an OHA responsibility, but policy and guidance for health promotion currently are led by the Human Capital Policy and Programs Division within OCHCO.6 A revision process was initiated but was interrupted by management turnover within OHA.7 The memorandum of understanding lists several functions for which the CMO has primary responsibility in an oversight role, but the provision of services themselves may be carried out through OCHCO (OCAO and 4 Under Directive 066-01, the DHS Safety, Health, and Medical Council was to be co-chaired by the CMO and the Chief Administrative Officer, who initially served as the DASHO for the department. When the DHS occupational safety and health program was detailed from the Office of the Chief Administrative Officer to OCHCO, the Chief Human Capital Officer assumed the title of DASHO and the attendant responsibilities.
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From page 171... ...
. Reliance on contracted medical support for functions that could be overseen by in-house medical authorities contributes to a lack of role clarity for the CMO, diminishes the authority of the position, and poses a barrier to ensuring integration of outsourced functions into an overarching DHS health protection strategy and system.
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From page 172... ...
leaving health protection responsibilities segregated but reorganizing reporting structures such that someone with sufficient authority would have responsibility for ensuring coordination between the CMO and the Chief Human Capital Officer; or (2) aligning all workforce health protection functions into a single reporting structure.
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From page 173... ...
The segregated approach could be successful only if formal and regular coordination mechanisms were established at the senior leadership (i.e., CMO and Chief Human Capital Officer) and program (e.g., occupational health)
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From page 174... ...
. Creating a single reporting structure and consolidating responsibility for all workforce health protection functions under a single leader would better ensure functional integration and would affirm and empower an enterprise-wide approach.
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From page 175... ...
, and DHS lacks the systems for data integration that would enable evidence-based adjustments to the design of benefits, so the degree of synergy that could be achieved with alignment under the Chief Human Capital Officer is limited. In addition to the human resources aspects of health protection functions, medical and operational aspects must be considered in determining the organizational context for an aligned reporting structure.
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From page 176... ...
Recommendation 2: Align and integrate all occupational health and operational medicine functions under the Chief Medical Officer. The Secretary of the Department of Homeland Security (DHS)
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From page 177... ...
. Separating these two interconnected functions would be at cross purposes with the committee's task to advise on the creation of an integrated health protection infrastructure; thus, inherent in the committee's recommendation to integrate disability management with other health and safety functions is the alignment of all elements of workers' compensation programs, including the administration of workers' compensation benefits, under the CMO.
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From page 178... ...
• Tactical Emergency Medicine: Training and experience in working with law enforcement or military operational personnel in delivering operational medical support, including sick call, urgent, and emergency health care in field or austere conditions. • Occupational and Operational Medicine-Related Law and Regulations: Knowledge and skills necessary to comply with regulations important to occupational health and operational medicine.
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From page 179... ...
• Medical System Management, Administration, and Control: Administrative and management knowledge and skills to plan, design, implement, man age, and evaluate comprehensive occupational and environmental health and operational medicine programs and projects. Included in these skills should be the ability to communicate effectively regarding health-related issues to both internal leadership and the public.
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From page 180... ...
Additionally, the title and responsibilities of the DASHO would have to be reassigned to ensure that the person with those responsibilities and authorities would be in the same reporting structure as the CMO and the safety program manager. According to 29 CFR 1960, Basic Program Elements for Federal Employee Occupational Safety and Health Programs and Related Matters, "the headquarters [safety and health program]
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From page 181... ...
In the 2008 Delegation to the Assistant Secretary for Health Affairs and Chief Medical Officer, the Secretary delegated to the CMO the authority to exercise oversight over all of DHS's medical and public health activities. In the course of this study, however, it became apparent that, in practice, the CMO lacks the authority to exercise oversight over all medical and public health activities for DHS.
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From page 182... ...
This arrangement may help promote integration between health and human resources activities, which is essential to the effective management of integrated workforce health programs (McLellan et al., 2012)
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From page 183... ...
. As suggested by the Chief Human Capital Officer, ensuring that health protection functions remain closely linked to related human resources functions such as benefits and labor relations enables a desirable synergy.15 This arrangement would not only ensure close coordination between the CMO and Chief Human Capital Officer but would also facilitate increased engagement of other relevant line-of-business chiefs (e.g., Chief Human Procurement Officer, Chief Financial Officer, Chief Information Officer)
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From page 184... ...
As discussed previously, the committee believes that organizational alignment of workforce health protection functions into one reporting structure would ensure effective coordination, collaboration, and accountability. While acknowledging that other options for coordination of these
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From page 185... ...
Not only does fragmentation of workforce health protection functions at the component level impact intracomponent coordination, but oversight from the headquarters level also is more challenging when there is no single responsible leader or even consistency in what are considered medical, occupational safety and health, and human resources functions. Vertical integration has been less of a problem for occupational safety and health functions because well-established processes for oversight are in place to ensure compliance with regulations for federal agency occupational safety and health programs.
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From page 186... ...
The Secretary of the Department of Homeland Security (DHS) should direct each component agency head to design and implement a single reporting structure that effectively aligns and integrates all compo nent occupational health and operational medicine functions and as sign oversight responsibility for these functions to a Component Lead Medical Officer.
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From page 187... ...
would need to lead the development and coordination of the full spectrum of occupational health and operational medicine programs, encompassing health promotion, occupational safety and health, occupational and operational medicine, and disability management, the same core competencies described in Box 6-1 for the CMO should be represented on their team. Initially, as the CLMOs work to become established and address pressing gaps, it will be important for the CMO to ensure that they have adequate reachback support (program management staff and subject-matter experts)
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From page 188... ...
advise on the allocation of adequate financial and other resources, (2) advocate within the component for health protection as essential to mission readiness, and (3)
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From page 189... ...
Challenges Associated with Dual Reporting Regardless of which of the two above options were chosen, the CLMOs, by design, would have a dual reporting relationship under the DHS matrix management authority structure. For component operational matters, they would report to the component leadership, but for medical matters, their implementation of health and medical programs, guidelines, and practices would fall under the oversight of the CMO.
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From page 190... ...
The committee noted significant reliance on outsourced providers for occupational health and medical services (e.g., fitness-for-duty evaluations, health promotion services, ergonomics assessments, medical surveillance services)
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From page 191... ...
To ensure that such services are integrated into the larger DHS health protection infrastructure, technical oversight of outsourced services should be delegated to DHS medical officers at the component level. An example of these activities is monitoring revalidation of licensure for contracted medical practitioners (ICE, 2013)
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From page 192... ...
Other DHS Management Chiefs lead a council of representatives from each component that meets regularly for these purposes (e.g., the DHS Chief Human Capital Officer meets regularly with a council of Human Capital Officers from component agencies)
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From page 193... ...
For example, participation and regular briefings by OHA Branch Chiefs and the DHS Safety Manager could help ensure that all OHA activities are supportive of and complementary to, but not redundant with, CLMO-led activities. The committee believes that, to promote the continued maturation of the DHS health protection infrastructure and ensure that the CMO and CLMOs have the knowledge and experience required to provide occupational and operational health leadership to DHS, the CMO and CLMOs would benefit from regular peer review and input.
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From page 194... ...
Portfolio-Level Governance of Health, Safety, and Medical Programs The committee is unclear as to whether or how workforce health protection programs would be managed within the DHS governance structure shown in Figure 6-1 but identified a need for portfolio-level governance20 of such programs to ensure alignment and efficiency. Multiple headquarters offices and component agencies have shared responsibilities for the complex programs supporting the health, safety, and mission readiness of the workforce.
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From page 195... ...
Many workforce health protection functions span the intersection between health and human resources and therefore also require the involvement of the Chief Human Capital Officer. Input from other
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21 The management team (located within the Management Directorate) consists of the Chief Human Capital Officer, Chief Financial Officer, Chief Procurement Officer, Chief Information Officer, Chief Security Officer, and Chief Administrative Services Officer and is led by the Under Secretary for Management.
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From page 197... ...
ORGANIZATIONAL ALIGNMENT AND COORDINATION 197 FIGURE 6-2 A proposed tiered governance framework. aExchanges with the Health, Safety, and Medical Council would flow through the proposed Health and Safety Informatics and Information Technology Governance Board (see Recommendation 11)
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From page 198... ...
. Enabling a Coordinated Approach to a Unified DHS Workforce Health Protection Strategy A reinvigorated Health, Safety, and Medical Council would be instrumental in the coordinated development of the department-wide workforce health protection strategy discussed in Recommendation 1.
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From page 199... ...
Presentation at IOM Committee on DHS Occupational Health and Operational Medicine Infrastructure: Meeting 2, June 10-11, Washington, DC. DHS (Department of Homeland Security)
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From page 200... ...
Presentation at IOM Committee on DHS Occupational Health and Operational Medicine Infrastructure: Meeting 2, June 10-11, Washington, DC. NASA (National Aeronautics and Space Administration)
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