ADVANCING WORKFORCE
HEALTH AT THE DEPARTMENT
OF HOMELAND SECURITY

Protecting Those Who Protect Us

Committee on Department of Homeland Security Occupational Health
and Operational Medicine Infrastructure

Board on Health Sciences Policy

INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

THE NATIONAL ACADEMIES PRESS    500 Fifth Street, NW    Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract/Grant No. HSHQDC-11-D-00009/HSHQDC-12-J-00188/P00003 between the National Academy of Sciences and the Department of Homeland Security. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

International Standard Book Number-13: 978-0-309-29647-2
International Standard Book Number-10: 0-309-29647-1

“Knowing is not enough; we must apply.
Willing is not enough; we must do.”      

                                                —Goethe

INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.

COMMITTEE ON DEPARTMENT OF HOMELAND SECURITY OCCUPATIONAL HEALTH AND OPERATIONAL MEDICINE INFRASTRUCTURE

DAVID H. WEGMAN (Chair), Professor Emeritus, Department of Work Environment, University of Massachusetts Lowell

EDWARD BERNACKI, Professor of Medicine and Director, Division of Occupational Medicine; Executive Director of Health, Safety and Environment, Johns Hopkins University, Baltimore, Maryland

LESLIE BODEN, Professor, Department of Environmental Health, Boston University School of Public Health, Massachusetts

TOM CAIRNS, Principal, Cairns Blaner Group, LLC, Valencia, California

RICHARD H. CARMONA, 17th Surgeon General of the United States; Distinguished Professor, University of Arizona, Tucson

CHERRYL CHRISTENSEN, Corporate Medical Director, The Procter & Gamble Company, Cincinnati, Ohio

DON E. DETMER, Professor of Medical Education, University of Virginia, Charlottesville

ELLEN P. EMBREY, President/CEO, Stratitia, Springfield, Virginia

WILLIAM FABBRI, Medical Director, Office of Medical Services, Federal Bureau of Investigation, Washington, DC

JANIE GITTLEMAN, Chief, Occupational Safety, Health & Environmental Compliance (FAC-3A), Mission Services Office of Facilities and Services, Defense Intelligence Agency, Washington, DC

WILLIAM L. LANG, Senior Physician, Owl’s Nest, Inc., Arlington, Virginia

MICHAEL A. SILVERSTEIN, Clinical Professor of Environmental and Occupational Medicine, University of Washington School of Public Health, Olympia

DAVID N. SUNDWALL, Professor of Public Health (Clinical), Division of Public Health, Department of Family and Preventive Medicine, University of Utah–School of Medicine, Salt Lake City

W. CRAIG VANDERWAGEN, Senior Partner, Martin Blanck and Associates, Columbia, Maryland

Study Staff

AUTUMN S. DOWNEY, Study Director

FRANK VALLIERE, Research Associate

Y. CRYSTI PARK, Senior Program Assistant

BRUCE ALTEVOGT, Senior Program Officer

ANDREW M. POPE, Director, Board on Health Sciences Policy

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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Jeannie Cimiotti, Rutgers University College of Nursing

Scott Deitchman, Centers for Disease Control and Prevention

Elaine Duke, Elaine Duke & Associates

Pamela A. Hymel, Walt Disney Parks and Resorts

Jeffery Lowell, Washington University School of Medicine

William S. Marras, The Ohio State University

Robert K. McLellan, Dartmouth-Hitchcock Medical Center

C. Crawford Mechem, Pennsylvania Hospital of the University of Pennsylvania

Richard J. Miller, Federal Occupational Health

Dean Smith, U.S. Department of State

Terri Tanielian, RAND Corporation

Mark Tedesco, NextCare Urgent Care

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the report’s conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Ellen Wright Clayton, Vanderbilt University, and Georges C. Benjamin, the American Public Health Association. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Preface

The creation of any new institution or agency can be expected to entail a phase of growth and development. When a new agency is formed in a time of crisis, its evolution is further complicated by circumstance. Furthermore, if the agency is constructed from previously existing components along with newly created entities, both designers and new leadership face major challenges, and many roadblocks can be expected. This was the context for the Department of Homeland Security (DHS) when the nation responded to the harrowing events of September 11, 2001, by forming this new cabinet secretariat. Over the past decade, the agency has been learning and evolving slowly into its adolescence, and in the course of this evolution, it recognized a need to focus special attention on its most valuable asset—its employees.

Health and medical leadership in the department’s Office of Health Affairs (OHA) recognized that balancing the need for centralized authority and component agency autonomy in carrying out the full measure of its responsibilities posed particular challenges. It was critical to respect the prerogatives and character of the components while striving to instill a department-wide ethos through commonality of purpose. This balance was deemed critical to building and maintaining the quality and morale of the workforce.

With this need for balance in mind, OHA sought assistance from the Institute of Medicine (IOM) regarding how best to organize, across the department, the varied and complex programs and services designed to protect the occupational health of the DHS workforce and prepare it to fulfill its many operational missions. The committee empaneled to respond

to this request comprised 14 members selected to represent a broad range of expertise that included occupational and environmental health, health systems management, health economics, health information technology and data management, metrics/measurement/program evaluation, workers’ compensation/liability, human resources, and operational medicine. This broad range of backgrounds was necessary to bring proper attention to the task. During the course of this study, the members worked diligently to bring their expertise to bear, learning from and assisting one another to appreciate the complexity of the committee’s charge. As a result, the committee was able to develop recommendations that reflect and respect the needs of the agency and the complex, multidimensional missions with which it is tasked.

It should be noted that several committee members have had previous experience serving in leadership roles within DHS. This experience proved invaluable in grounding our work. We are particularly grateful to Dr. Jeff Runge, who served as liaison from the IOM Committee on Department of Homeland Security Workforce Resilience and shared his wealth of experience from his tenure as the DHS Chief Medical Officer.

Throughout our deliberations, we sought a common understanding of the full range of responsibilities faced by the department both within and across its many component units. We examined the work of other federal agencies as well as institutions in the private sector with reasonably analogous organizational challenges. In so doing, we came not only to better appreciate the difficulties faced by DHS but also to understand a variety of ways in which the same objectives might be met. Early on we received valuable input from Dr. J. D. Polk, Acting Chief Medical Officer at DHS, who provided his insights into the problems and challenges that represent the primary needs to be addressed by OHA. Our efforts were further enhanced by input from many researchers, agency personnel, and representatives of interested groups who graciously dedicated their time to responding to our inquiries and provided their insights and perspectives during our deliberations. Appreciation also is extended to those individuals who served as reviewers of this report.

Chairing this committee has been an education and a rewarding experience, the task made much easier by the friendly and supportive atmosphere of the committee meetings. Over the course of the study, we depended greatly on the high-quality intellectual and administrative skills of the IOM staff, under the able direction of study director Autumn Downey and her colleague Frank Valliere. Their energy and commitment were evident from the outset. Their tireless efforts in developing the necessary background information, undertaking a variety of research tasks, and regularly interacting with the committee members are reflected throughout the report. Their work was ably supported by project assistant Crysti Park. Additional

thanks are owed to Rona Briere for carefully editing and improving the structure of the report.

Finally, I wish to offer thanks and acknowledgment to my fellow committee members, all of whom gave generously of their time in addressing a stimulating and challenging task. I am confident that our conclusions and recommendations will help DHS achieve its overarching goal of a healthy, safe, ready, and resilient workforce, regardless of where they serve and what their missions may be.

David H. Wegman, Chair
Committee on Department of Homeland Security
Occupational Health and Operational Medicine Infrastructure

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Contents

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