Integrating Employee Health A Model Program for NASA (2005) / Chapter Skim
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3 Workforce Health, Performance, Readiness, Resilience: The Case for Change
3 Workforce Health, Performance, Readiness, Resilience: The Case for Change
Pages 53-76
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From page 53... ...
agencies and corporations, NASA is challenged with both increasing productivity demands and a changing American workforce. Just as the agency's scientific and engineering breakthroughs have improved everyday life for Americans, so too can NASA's pioneering effort in other aspects of its mission be harnessed as an opportunity to improve the health and performance of its own workforce and serve as a model for other "knowledge worker" employers whose workers are highly educated and whose work products are complex problem solving and solutions rather than service delivery or product manufacture.
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From page 54... ...
A "healthy workforce" is characterized by four key attributes, consistent with the World Health Organization (WHO) definition of health, that can be analyzed and improved to promote personal and organizational "well-being." Specifically, for both individuals and organizations to achieve optimal performance, they must be · healthy -- demonstrating optimal health status as defined by positive health behaviors; minimal modifiable risk factors; and minimal preventable illnesses, diseases, and injuries; · productive -- functioning to produce the maximum contribution to achievement of personal goals and the organizational mission; · ready -- possessing an ability to respond to changing demands given the increasing pace and unpredictable nature of work; and
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From page 55... ...
Adverse effects on employers of high health care costs and tight labor markets, particularly in engineering, create employer imperatives for engaging health beyond traditional occupational health and safety. Employers, including NASA, who must support a mission-directed, healthy, and optimally productive workforce will have to articulate a new vision, develop new strategies, and employ new tactics.
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From page 56... ...
The health goals that were established for the nation in the Healthy People series serve as a framework for NASA's Occupational Health programs; however, as the focus of occupational health at NASA is its workforce, the agency's focuses for action and the benchmarks are necessarily somewhat different from those established for the entire American population. Specific application of these goals to an integrated preventive health care program is discussed further in Chapter 5.
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From page 57... ...
These indicators are anticipated to facilitate health promotion and disease prevention, encourage participation in health improvement efforts, and increase the effect of Healthy People on improving quality and length of life and eliminating health disparities (USDHHS, 2000)
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From page 58... ...
It may also serve as a guide to integration of training and education for worksite health professionals into agency-wide occupational health and safety programs. Guide to Community Preventive Services Employers can exercise many environmental and population-based interventions to improve the health and productivity of employees and their families.
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and are also published in supplements to the American Journal of Preventive Medicine. Quality Chasm NASA is both a purchaser of health care insurance and a provider of health care services for its employees and their families.
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The study panel proposed a broad agenda for improving and redesigning the current health care system in the United States, which included the following: all health-care constituencies, including policy makers, purchasers, regulators, health professionals, health-care trustees and management, and consumers, should commit to a national statement of purpose for the health care system as a whole and to a shared agenda of six aims (see Box 3-1) for improvement that can raise the quality of care to unprecedented levels; clinicians and patients, and the health care organizations that support care delivery, adopt a new set of principles to guide the redesign of care processes; the USDHHS identifies a set of priority conditions on which to focus initial efforts, provides resources to stimulate innovation, and initiates the change process; health care organizations design and implement more effective organizational support processes to make change in the delivery of care possible; and purchasers, regulators, health professionals, educational institutions, and the USDHHS creates an environment that fosters and rewards improvement by creating an infrastructure to support evidence-based practice, facilitating the use of information technology, aligning payment incentives, and preparing the workforce to better serve patients in a world of expanding knowledge and rapid change.
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From page 61... ...
. Concordant with this committee's study charge to evaluate options for preventive health programs, incentives to encourage employee participation, and methodologies to longitudinally track employee health at NASA, the STEPS initiative seeks to improve the dissemination, effectiveness, and acceptance of activities directed at improving worker health through integrated approaches to health protection and health promotion.
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From page 62... ...
workforce are affected and predicted by many and various factors, including individual health status (e.g., disease incidence and prevalence) , health care access and quality, occupational health and safety efforts, employer-specific culture and organizational factors, and community-wide (demographic or geographic)
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(2001) showed that reductions in health risk factors including stress resulted in decreased medical care costs.
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Isolating the components of absenteeism, disability, workers' compensation, and presenteeism has enabled employers to more closely examine the effect of health risks on overall productivity (Edington, 2001)
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NASA, like all federal agencies, obtains civil service employee health care through the Federal Health Employee Benefits Program (FEHBP) , centrally administered through the Office of Personnel Management (OPM)
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From page 66... ...
While it is unclear from these data whether the non-occupational health benefits data are for the employee only or the employee plus dependents, even at one third the cost reported, assuming the reported costs reflect a conservative allocation of cost at one third employee/one third spouse/one third children, the conclusion is unchanged. Care Model: From "Treatment-Focused" to "Prevention and Behavior Change-Focused" The leading causes of premature morbidity and mortality in the United States have consistently been shown to be modifiable health behaviors (McGinnis et al., 2002; McGinnis and Foege, 1993)
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From page 67... ...
A similar population health-based approach to effectively alter individual health behaviors is needed to address large preventable burdens such as disease and lost productivity. Employers are more likely to improve their employees' health and productivity using multiple strategies and tactics at the population level than by focusing on individual medical or clinical programs to address risk factors, disease, and injuries as they occur.
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. Overall health status might be thought of as the sum, among others, of risk factors and disease state, and it is influenced by lifestyle choices, genetics, and workplace environmental factors.
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. Because multiple behavioral risks are present simultaneously among most people, addressing these risk factors in combination rather than singly is warranted, but requires more effective models, tools, strategies, and systemic support for integrated health behavior change efforts (Orleans, 2004)
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From page 70... ...
This method of service delivery is highly vulnerable to program segregation, and it tends to diminish opportunities for crossprogram synergy and reinforcement of health objectives which occur at each encounter, irrespective of the specific program triggering the encounter. Outsourced occupational health programs under very large sitewide contracts, for which the occupational health team at NASA has little direct oversight, create obstacles to vendor collaboration and efficient integration of interventions.
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From page 71... ...
Adapted from Dahlgren and Whitehead, 1991. The dotted lines between levels of the model denote interaction effects between and among the various levels of health determinants (Worthman, 1999)
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From page 72... ...
employers, are currently organized as a programcentric model with a focus on disease status rather than health status; treatment and traditional physical health risk factor modification, with relatively less emphasis on mental health and behavior change; an individual- rather than population-based medical model; and a program-byprogram approach to risk factor remediation rather than an integrated multiple-risk approach (see Table 3-1)
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2004. Physician screening for multiple behavioral health risk factors.
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From page 74... ...
. Examining the Value of Integrating Occupational Health and Safety and Health Promotion Programs in the Workplace.
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2004. Addressing multiple behavioral health risks in primary care; Broadening the focus of health behavior change research and practice.
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1991. Associations between employee health-related mea sures and prospective medical insurance costs in a manufacturing company.
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