Advancing Workforce Health at the Department of Homeland Security Protecting Those Who Protect Us (2014) / Chapter Skim
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3 A Comprehensive Framework for Ensuring the Health of an Operational Workforce
3 A Comprehensive Framework for Ensuring the Health of an Operational Workforce
Pages 63-114
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From page 63... ...
This chapter delineates a comprehensive framework for ensuring the health of an operational workforce. It then details in turn the key functions that support the two pillars of this framework -- medical readiness and medical support for operations.
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From page 64... ...
A FRAMEWORK FOR ENSURING THE HEALTH OF AN OPERATIONAL WORKFORCE In its statement of task, the committee was asked to identify the key functions of an integrated occupational health and operational medicine infrastructure. It did so by examining and identifying commonalities in the major elements of employee health protection and promotion programs of public and private organizations.
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From page 65... ...
Without measurement and evaluation, the medical readiness and medical response capability of the DHS workforce cannot be assessed, reported, or improved. A unified strategy for workforce health protection will integrate and therefore ensure coordination of the nine key functions, resulting in • a prevention-focused approach to workplace injury and illness that creates a safe, supportive working environment; • ongoing readiness assessment to ensure an individual's continued ability to carry out his/her responsibilities fully and safely;
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From page 66... ...
Injury and Illness Prevention In the Occupational Safety and Health Act of 1970, "Congress declares it to be its purpose and policy … to assure so far as possible every working man and woman in the Nation safe and healthful working conditions ... by encouraging employers and employees in their efforts to reduce the number of occupational safety and health hazards at their places of employment, and to stimulate employers and employees to institute new and to perfect existing programs for providing safe and healthful working conditions." To achieve this purpose, it has since 1970 been customary and expected practice for all but the smallest public and private employers to establish and implement comprehensive occupational safety and health programs.
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From page 67... ...
Requirements for Federal Agency Occupational Safety and Health Programs Section 19 of the Occupational Safety and Health Act of 1970 requires that all federal employees be provided with "safe and healthful places and conditions of employment." To this end, the act assigns responsibility for establishing and maintaining "an effective and comprehensive occupational safety and health program" to heads of federal agencies. Further roles and responsibilities for federal agency occupational safety and health programs are delineated in Federal Executive Order 121963 -- Occupational Safety and Health Programs for Federal Employees (1980)
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From page 68... ...
All of the items delineated in that executive order bear on the subject of the present analysis, but two specific requirements placed on federal agencies merit special mention: "designate an agency official with sufficient authority to represent the interest and support of the agency head to be responsible for the … program," and "operate an occupational safety and health management information system." As required by Executive Order 12196, the Code of Federal Regulations, Title 29, part 1960 (29 CFR 1960) specifies the basic program elements that all federal agency occupational safety and health programs should encompass.
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From page 69... ...
. The importance of these elements to the effectiveness of occupational safety and health programs is supported by research on the characteristics of an occupational safety and health management system that appear to lead to the greatest improvement in safety and health outcomes (Shannon et al., 1997)
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From page 70... ...
These criteria are identified through a job task analysis, which can be conducted internally or contracted out and ideally involves human resources and medical personnel, as well as individuals currently employed in that occupation. The California Commission on Peace Officer Standards and Training recommends a variety of techniques for conducting job task analyses, including "review of current job descriptions, interviews with supervisors and employees, development and administration of questionnaires, use of daily job diaries by employees, [and]
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From page 71... ...
of setting standards and lead to increased uniformity. For example, the FBI and the National Park Service have already developed medical standards for federal law enforcement officers that could be adapted by other agencies.
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, that agency may establish medical standards for the position without OPM approval. An example of the latter is the border patrol agent job series (GL-1896)
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From page 73... ...
For example, the National Fire Protection Association 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments6 requires that candidates undergo a medical evaluation (to include a medical history, medical examination, and laboratory testing) prior to employment and annually thereafter, the purpose of which is to identify medical conditions that may interfere with the individual's ability to perform the essential job tasks safely.
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From page 74... ...
, and after occupational or personal injury or illness that may temporarily or permanently affect an employee's ability to perform essential job functions safely. The latter case provides a good reason for ensuring that fitness-for-duty and disability management activities are integrated.
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Concerns Regarding Medical Standards and Fitness-for-Duty Evaluations Throughout its information-gathering process, the committee heard of several concerns regarding fitness-for-duty evaluations from both organization and employee perspectives. Medical and administrative personnel often are concerned about the constraints and liabilities associated with the Americans with Disabilities Act (ADA)
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From page 76... ...
, 5 CFR 339 grants federal agencies the authority to require medical evaluation and clearance prior to deployment for disaster response and recovery work and other planned or contingency operations. For some positions, medical clearance may be a condition of employment, but predeployment clearance programs can also be instituted and applied to employees whose positions are not subject to medical standards.10 The Department of State, for example, has a medical clearance program that determines the posts to which members of the Foreign Service can deploy, but does not have medical standards per se (Rosenfarb, 2013)
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Any "yes" response is referred to a reviewer who conducts a health interview with the responder; the responder may then be cleared for deployment or denied for medical reasons. In May 2010, Federal Occupational Health (FOH)
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The Federal Employees' Compensation Act (FECA) provides workers' compensation benefits (including wage-loss benefits and vocational rehabilitation)
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From page 79... ...
The last four of the seven performance areas under POWER relate to workers' compensation and return to work: increasing the timely filing of workers' compensation claims, increasing the timely filing of wage-loss claims, reducing lost production day rates, and speeding employees' return to work in cases of serious injury or illness (Obama, 2010)
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From page 80... ...
Health Promotion A medically ready workforce must start with employees who are fit and healthy, both physically and mentally. The process of ensuring a fit and healthy operational workforce begins prior to employment with the setting of expectations and, when appropriate, through physical fitness testing, and continues until retirement through organizational health and wellness programs.
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From page 81... ...
as including the following elements: • health education that focuses on skill development and lifestyle behavior change in addition to information dissemination and awareness building, preferably tailored to employees' interests and needs; • supportive social and physical work environments, including estab lished norms for healthy behavior and policies that promote health and reduce the risk of disease, such as worksite smoking policies, healthy nutrition alternatives in the cafeteria and vending services, and opportunities for obtaining regular physical activity; • integration of the worksite program into the organization's admin istrative structure; • related programs, such as employee assistance programs; and • screening programs, preferably linked to medical care service de livery to ensure follow-up and appropriate treatment as necessary and to encourage adherence. Health screening programs, which may include a health risk assessment,15 identify an individual's health risks based on physiological data (e.g., weight, blood pressure, cholesterol)
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From page 82... ...
Although stress is not considered a mental health disorder, it, too, can impact productivity, morale, and engagement. Employee stress or work-life management and resilience programs, including employee assistance programs, can help employees manage stress and find additional professional help as needed.19 16 The Substance Abuse and Mental Health Services Administration (SAMHSA, 2012)
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From page 83... ...
. Financial constraints often are cited as a major barrier to the establishment of workplace health promotion and wellness programs, but such rationales are short-sighted; the return on investment in worker health can more than justify the costs.
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Workplace Health Promotion Programs in Federal Government Settings Federal employees can choose from among more than 200 health plans under the Federal Employees Health Benefits (FEHB) Program.
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From page 85... ...
Activities of the employees of an agency or private organization that are conducted in areas remote from conventional medical support raise the issue of how to provide those services in the event of a work-related illness or injury. Operational medicine programs make occupational safety and health and medical services available to workers operating outside conventional workspaces, and they are essential to mission readiness.
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From page 86... ...
. embedding medical support within operational units has been adopted in several civilian settings, most notably law enforcement.
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Like tactical law enforcement teams, rescue teams may have embedded staff to provide medical support to team members and members of the public in emergency situations (see, for example, the description of the National Park Service's operational medicine program in Box 3-2)
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grants NPS the authorities to provide emergency services to visitors and employees. Approximately 75 percent of NPS law enforcement personnel are rangers, whose official job duties include not only law enforcement but also search and rescue and emergency medical services (EMS)
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123-124) contend that "the withholding of adequate medical care may be viewed as excessive force, an unconstitutional act in violation of the Fourth Amendment right to be free of unconstitutional seizure." NOTE: The definition of operational medicine adopted by the committee encompasses health and medical support provided to persons in DHS care and custody during routine, planned, and contingency operations.
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From page 90... ...
Operational medicine programs often include specialized training in preventive and nonemergency medical care functions because EMS providers traditionally are not trained in these areas. Routine medical problems such as gastrointestinal illnesses, bronchitis, and sports-type injuries (e.g., sprains and strains)
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From page 91... ...
If impact is not measured, success cannot be distinguished from failure. Spanning both pillars of the framework outlined in this chapter, measurement and evaluation is essential to developing, implementing, and continuously improving programs designed to address the other eight key functions of an integrated workforce health protection framework (see Figure 3-1)
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From page 92... ...
Within the field of occupational safety and health, a common approach to measurement has focused on lagging and leading indicators. Lagging indicators are retrospective measurements of system performance linked to outcomes; these are the traditional measures of safety performance, such as OSHA statistics and costs (Manuele, 2013)
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From page 93... ...
Attempts to evaluate individual performance based on lagging indicators may create perverse incentives, encouraging individuals to make outcomes look good and not necessarily to improve underlying performance (for example, an objective to decrease the number of workers' compensation claims may lead to claim suppression)
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INTEGRATION OF ESSENTIAL WORKFORCE HEALTH PROTECTION FUNCTIONS Most large employers have programs that address many of the key functions discussed in this chapter. Often, however, these programs operate in silos, divorced from each other both organizationally and strategically.
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From page 95... ...
Models for Integrating Workforce Health Protection Functions Integration of relevant systems is one of the "essential elements of effective workplace programs and policies for improving worker health and well-being" identified by the National Institute for Occupational Safety and Health (NIOSH, 2008)
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From page 96... ...
The IOM Committee to Assess Worksite Preventive Health Program Needs for NASA Employees recommended that NASA adopt an integrated management systems approach to employee health to support the agency's missions and goals. The National Business Group on Health, seeking to share the key findings and recommendations from that report
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From page 97... ...
. NIOSH defines TWH as a "strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being" (CDC, 2013)
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Because of similarities in organizational and operational challenges faced by DHS and the Department of the Interior, the committee examined in particular detail the means by which integration of workforce health protection functions across Department of the Interior bureaus is achieved; this case study is presented in Box 3-6. Requirements for Successful Integrated Employee Health Programs The committee was asked to examine occupational health and operational medicine infrastructures established within and outside of government; to identify key functions of an integrated infrastructure; and ultimately to provide recommendations on how infrastructures within
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From page 99... ...
. DOI also has taken steps to ensure horizontal alignment of all workforce health protection functions at the headquarters level, including placement of the Occupational Health and Medical Programs Division under the Office of Occupa tional Safety and Health, organizationally aligning these functions within a single reporting structure.
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From page 100... ...
A primary example of how DOI has approached integration across diverse components, and especially relevant to DHS, is the creation and enforcement of overarching medical standards and clearance processes. Similar to DHS, DOI employs a wide variety of operational staff, including approximately 7,000 law enforcement officers and 15,000 wildland firefighters.
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From page 101... ...
, Chief of the Division of Occupational Health and Medical Programs, provided the committee with two examples of alternative approaches to implementation. The National Park Service, which employs approximately 5,000 law enforcement officers, operates a central ized medical clearance program with a single national contract medical provider.
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From page 102... ...
. Leadership commitment is crucial to the creation, expansion, and sustainability of workforce health programs; without vocal and active leadership, such programs may not be viewed as a priority by management or the workforce as a whole.
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From page 103... ...
The Smithsonian Institution, the Department of the Interior, and Johns Hopkins all combined workforce health protection functions into a single reporting structure, while other organizations, such as NASA, P&G, and J&J, housed functions in separate reporting structures and instituted measures to ensure alignment through systematic communication and coordination. Successfully integrated programs provide avenues for ensuring appropriate communication and coordination.
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From page 104... ...
, information management has been critical to the success of the integrated employee health programs examined by the committee. The development of any new program should be based on organizational needs, as determined by metric-based assessments, so that programs and interventions can be appropriately designed and targeted.
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From page 105... ...
Given the multidisciplinary nature of workforce health protection programs and the complexity of the data that must be integrated to inform decision making, information management systems designed for interoperability are needed to drive coordination among functions and ultimately provide a means for managing and integrating organizational knowledge. For example, the National Park Service's electronic patient care record allows for system-wide epidemiological surveillance and real-time communication with other entities (e.g., public health, risk management)
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From page 106... ...
In 1995, J&J began to centralize health services in its U.S.-based companies, bring ing employee health, wellness, occupational medicine, disability management, benefit plan design, and employee assistance activities under a single umbrella: the J&J Health and Wellness Program (Isaac, 2013; Ozminkowski et al., 2002)
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From page 107... ...
The result was a single system that brings together occupational health and disease management, mental health and well-being, healthy lifestyle programs, and health education and awareness programs. J&J's integrated health program takes a multimodal approach, providing face-to-face support at the worksite or close to home, Web-based and telephonic tools and resources, and environmental support, thus offering a choice of value added services that meet people where they are in the health continuum.
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From page 108... ...
workforce health, organizational alignment and coordination, functional alignment, and information management -- can help create a common core culture dedicated to maintaining and improving employee health and safety across an organization. Such a culture will unite a workforce in striving toward a common goal: a safe, healthy, and resilient workforce that is physically capable, mentally prepared, trained, equipped, and adequately supported to achieve its mission.
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From page 109... ...
Presentation to IOM Committee on DHS Occupational Health and Operational Medicine Infrastructure: Meeting 2, June 10-11, Washington, DC. DFEC (Division of Federal Employees' Compensation)
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Presentation at IOM Com mittee on DHS Occupational Health and Operational Medicine Infrastructure: Meeting 2, June 10-11, 2013, Washington, DC. FOH (Federal Occupational Health)
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Presentation to IOM Committee on DHS Occupational Health and Operational Medicine Infrastructure: Meeting 2, June 10-11, Washington, DC. Minson, M
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Presenta tion to IOM Committee on DHS Occupational Health and Operational Medicine Infra structure: Meeting 2, June 10-11, Washington, DC. Rousseau, D
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Presentation to IOM Committee on DHS Occupational Health and Operational Medicine Infrastructure: Meeting 2, June 10-11, Washington, DC.
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