Advancing Workforce Health at the Department of Homeland Security Protecting Those Who Protect Us (2014) / Chapter Skim
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One of those challenges is creating and sustaining a coordinated health protection infrastructure. Seeking strategic advice on how to strengthen mission readiness while better meeting the health needs of its workforce, DHS's Office of Health 1 DHS operating component agencies include U.S.
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Meeting these two requirements necessitates implementing an overarching workforce health protection strategy encompassing occupational health and operational medicine functions that serve to promote, protect, and restore the physical and mental well-being of the workforce. To guide such a strategy, the committee developed a workforce health protection framework in which the essential and interconnected functions necessary to support an operational workforce are defined within two pillars: 1.
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that enable mission capability. WORKFORCE HEALTH PROTECTION AT DHS With its strong focus on securing national borders and protecting critical infrastructure against acts of terrorism and other hazards, DHS often is referred to as a "guns, guards, and gates" organization -- about half of its workforce is made up of law enforcement and security personnel.
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Although some components, such as the Coast Guard, have a comprehensive occupational health and operational medicine infrastructure, others have not dedicated sufficient resources to providing their employees with even the most basic occupational health support services, let alone what is required to carry out the functions necessary to ensure mission readiness. Given the myriad potential impacts of this shortfall -- mission failure, employee turnover and low morale, high health-related costs, liabilities -- strengthening workforce health protection is critically important to achieving readiness and meeting mission requirements.
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At the same time, however, there is a need and clear role for an empowered centralized health authority at DHS, with continuing support from the Secretary, to provide for and oversee the implementation of policies, standards, and programs designed to protect employee health and safety, promote efficiency and interoperability, and achieve cost savings. This authority also needs to serve as an advocate for workforce health protection, communicating clearly that these health- and safety-related functions are essential to mission readiness.
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Thus, the committee believes there would be significant benefit to having a CMO, supported by a multidisciplinary team with collective backgrounds spanning occupational health, operational medicine, and health systems management, lead an aligned health protection infrastructure. Although the Secretary has delegated authority to the CMO for exercising oversight over all medical and public health activities for DHS, the CMO lacks visibility and strategic input on workforce health protection functions currently
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to the Designated Agency Safety and Health Official.5 Responsibilities for the CMO in this aligned reporting structure should include but are not limited to • promulgating department-wide policies and standards for inte grating and coordinating all occupational health and operational medicine functions, including occupational safety and health, fit ness for duty, disability management, and health promotion; • developing a process for ensuring the implementation of DHS-wide health, safety, and medical standards; • providing advice and guidance to the Secretary and component agency leadership on all matters related to health, safety, and medicine; • overseeing component agencies' medical quality assurance pro grams and ensuring that all DHS and outsourced providers of med ical services are appropriately educated and trained and routinely 5 The Designated Agency Safety and Health Official is designated by the head of a government agency as the individual responsible for its occupational safety and health program. As specified by Executive Order 12196 (1980)
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With the notable exception of the Coast Guard, however, component agencies lack a single point of accountability for all health, safety, and medical activities. Fragmentation of workforce health protection functions at the component level not only limits intracomponent coordination but also poses challenges for oversight at the headquarters level.
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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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should establish and chair a Medical and Readiness Committee with membership comprising the Compo nent Lead Medical Officers to promote information sharing and inte gration. Responsibilities of the proposed committee should include but not be limited to • recommending and validating department-wide health and med ical standards; • providing briefs on the specific health and medical issues/needs of the components; • identifying best practices and sharing lessons learned; • advising the CMO on resource needs for program implementa tion and execution; • contributing subject-matter expertise to aid the CMO in pro viding medical guidance to the Secretary and component leadership; • identifying and sharing education and training resources to help all component agencies achieve strategic goals; • identifying opportunities to achieve efficiencies through con solidation and centralization of common services, including out sourced services (see Recommendation 9)
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Many workforce health protection functions span the intersection of health and human resources and therefore require coordination between the CMO and the Chief Human Capital Officer. Input from other members of the DHS management team6 may be required to ensure appropriate resourcing and management of occupational health and operational medicine programs.
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Although variability is not unexpected for such a large and diverse organization, the committee identified the paucity of global health and medical policies and standards designed to set clear expectations and ensure that core quality and performance requirements are met by all components as a major barrier to the realization of an integrated health protection infrastructure. A Common Approach to Ensuring Medical Readiness Mission readiness depends on a workforce that is medically ready.
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A Comprehensive Capability for Providing Medical Support for Operations Federal agencies are equally responsible for the health and safety of workers operating in the field and those stationed in more conventional workspaces. Operational medicine programs are a means by which occupational health and medical services are made available to those operating outside of conventional workspaces, and are essential to mission readiness.
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The Chief Medical Officer (CMO) , with input from the Medical and Readiness Committee, should establish a coordinated, department-wide operational medicine capability to ensure that timely and effective preventive and responsive medical services are available to all compo nent employees and others under Department of Homeland Security (DHS)
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Although responsibility for execution of the operational medicine program should be delegated to Component Lead Medical Officers, the Secretary should hold component agency heads accountable for the effectiveness of such programs and their compliance with department-wide policies and standards. Centralization of Common Services Because of the wide variation among their missions, each of the component agencies has specific needs that are best served by support programs tailored to its operational functions.
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Health and Safety Information Management The CMO must be able to brief the Secretary regarding the health, safety, and readiness of the DHS workforce and to advocate for needed investments in prevention and health protection programs. Requisite to carrying out this charge is the capability to maintain situational awareness regarding the health and medical status of the DHS workforce and the major health and safety risks that impede readiness.
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The Health, Safety, and Medical Council should charter a Health and Safety Informatics and Information Technology Governance Board to develop and oversee the implementation of a strategic plan for building a health and safety informatics and information technology infrastructure. The Governance Board should be led by a Chief Medical Information Officer designated by the Chief Medical Officer (CMO)
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4. Establish Component Lead Medical Officers to align and integrate occupational health and operational medicine functions.
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, the committee has attempted to provide a foundation and a path forward for an integrated health protection infrastructure encompassing the programs, tools, and resources needed to enable the DHS workforce to fulfill the homeland security mission. In essence, the goal is to do on a smaller scale what the Homeland Security Act sought to accomplish more than 10 years ago -- to weave the key functions and activities entailed in protecting the homeland into a unified, cohesive enterprise.
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