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A MODEL PROGRAM FOR NASA
Copyright © 2005 National Academy of Sciences
All right reserved.
The National Aeronautics and Space Administration (NASA) employs a highly skilled workforce accustomed to working under high pressure, short deadlines, and limited budgets. Despite these challenges, it has turned the vision of space exploration into a reality in fewer than 50 years. This legacy of exploration and discovery is a hallmark of national pride. NASA's achievements in air and space exploration, research, and development are integrally woven into the American experience. The high profile of the agency's activities has led to public celebration of its mission successes as well as intense public scrutiny during times of tragedy.
NASA's cultural tradition of believing that its workers can overcome complex technical challenges is reflected in its stated core values: safety, people, excellence, and integrity. As a result, NASA's manned space flight and the unmanned space probe missions alike have produced many successful, leading-edge programs. In large part, the success of these programs is the result of a highly motivated and resourceful workforce that embraces highly visible challenges during intense periods of exceptionally high demand. However, the very same cultural traits andorganizational practices that have fostered mission success can also affect employee well-being.
The success of NASA's missions has always relied heavily on both the health and productivity of its workforce. Today, NASA has an aging workforce that may be at risk for the same chronic diseases facing America's aging population as a whole. These chronic diseases, including heart disease, hypertension, obesity, diabetes, and cancer are frequently associated with negative lifestyle behaviors such as physical inactivity, poor eating habits, and tobacco use. In addition, the NASA work environment is highly variable, and some workers are subjected to unusually hazardous and stressful conditions.
NASA was one of the first federal agencies to recognize the importance of occupational health and wellness programs for the well-being of its employees. NASA has invested in health promotion research and established preventive employee health programs such as nutrition education and one-on-one counseling for employees with cardiac and other chronic diseases.
Today, NASA offers a broad scope of employee health and wellness options, including programs in areas such as employee assistance, environmental health, health promotion, and occupational medicine. Individual centers within NASA incorporate these agency-wide programs into their own occupational health activities. These programs, managed by NASA's Division of Occupational Health, are described further on the agency's occupational health information web site, http://www.ohp. nasa.gov, and in Chapter 2 of this report.
NASA's Office of the Chief Health and Medical Officer (OCHMO), which administers the Division of Occupational Health, works to ensure that every NASA employee will, on leaving or retiring from the agency, be healthier than the average American worker as a result of his or her experience with NASA's occupational and preventive health program system. In support of this goal, the Institute of Medicine's Committee to Assess Worksite Preventive Health Program Needs for NASA Employees was charged to review existing preventive health programs, assess employee awareness of and attitudes toward occupational health programs, and determine whether there are any special risks unique to NASA work environments.
The committee further was asked to prepare a report that evaluates and recommends specific options for future worksite preventive health programs, focusing on, but not limited to, nutrition, fitness, chronic disease prevention, and psychological well-being; incentives or methods to encourage employees to voluntarily enlist and sustain participation in worksite preventive health programs; ways to create healthier workplace environments that are conducive to more active lifestyles; intervention options to reduce risk factors for chronic disease; and ways to evaluate the effectiveness of such programs.
The committee derived four primary findings from information obtained from observations made by committee members at site visits to six NASA centers, published reports about NASA, and reviews of literature. Specific recommendations for addressing these findings appear in the following sections of this summary.
FINDING 1: The occupational health mission statement at NASA is designed and directed to meet the health needs of NASA employees; however, there is a need to bring this mission statement into alignment with a mission-driven vision for the NASA organization.
FINDING 2: Most organizations, public and private, follow a traditional model for providing health care to employees in which the focus is on disease status rather than health status, treatment rather than preventive care, an individual medical model rather than population-based health model, and single- rather than multiple-risk interventions, with segregated rather than integrated management systems. NASA is similar in its current approach to occupational and preventive health care. Although there is collection of information on employee health and program use, the data collected lack uniformity and consistency within and between NASA centers. In addition, there is a need to strengthen communication lines between NASA's Headquarters and centers.
FINDING 3: The traditional approach to occupational health care leads to segregated rather than integrated health programs (Table ES-1). The needs of the modern knowledge-based workforce in a high-performance organization require an approach beyond those traditionally used in occupational health. As currently implemented at NASA, such an approach is not conducive to meeting the health care needs of employees in a large, decentralized organization.
FINDING 4: There is a need for more effective, coordinated, and datadriven health program policy development to support the agency's mission and goals.
THE CASE FOR CHANGE
NASA serves as an excellent prototype for the twenty-first-century organization, challenged with increasing demands and a changing American workforce. Just as the agency's scientific and engineering breakthroughs have improved everyday life, so too can NASA's strategy for analyzing and improving the health and productivity of its workforce serve as a model for other U.S. employers.
A "healthy workforce" is characterized by four key attributes, consistent with the World Health Organization (WHO) definition of health, which 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 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
resilient-adjusting to setbacks, increased demands, or unusual challenges by bouncing back to optimal "well-being" and performance without incurring severe functional decrement.
The twenty-first-century American workforce is characterized by increasing demographic diversity, as workers perform a greater number of multidisciplinary jobs with higher degrees of collaborative work and reliance on technology, around-the-clock operations, an accelerated work pace, and more flexible work patterns. In addition, workplaces in America now rely more heavily on information technology and use highly variable work arrangements, employing teams composed of members from different employers, or from the same employer but with different terms of employment; creating and dissolving work groups and employment around specific projects; and employing global work teams using technology to perform work in "virtual" environments of electronic team rooms and Web-hosted meetings. Within the workforce itself, there is greater uncertainty about employment, with people having many more employers during their working careers, being required to become continuous learners to enhance or expand skills, and experiencing the movement of work and jobs to other countries.
Previous reports addressing relevant health, health care, occupational health, and American workforce issues provide important information that can inform and guide NASA's efforts to achieve its broad goal of creating a comparatively healthier NASA workforce. Interest in worksite initiatives integrating occupational health and safety with health promotion and disease prevention efforts is on the rise among the research and business communities as well as labor groups, as evidenced by the recent National Institute for Occupational Safety and Health (NIOSH) Steps to a Healthier United States Workforce Symposium (Goetzel, 2005; Seabury et al., 2004; Sorensen and Barbeau, 2004).
Additional evidence supporting the potential impact of an integrated approach is emerging in a growing literature reporting results of studies that have systematically assessed the efficacy and effectiveness of integrated interventions (Sorensen and Barbeau, 2004). For example, Hunt et al. (2005) reported greater participation in preventive health programs by both employees and managers when an integrated approach was used.
The Steps to a Healthier U.S. Workforce Initiative (STEPS) was developed by NIOSH from an initiative in the U.S. Department of Health and Human Services (USDHHS), called Steps to a Healthier U.S. (NIOSH, 2004). 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, acceptance, and effectiveness of activities directed at improving worker health through integrated approaches to health protection and health promotion.
The vision of the STEPS initiative is to integrate occupational safety and health protection with health promotion activities into a coordinated system that addresses both workplace and worker health. STEPS strongly supports the view that all illness and injury should be prevented when possible, controlled when necessary, and treated where appropriate, and an integrated approach serves to enhance the effectiveness of programs designed to promote and protect worker health.
The STEPS initiative has created an opportunity for the occupational safety, occupational health, and health promotion communities to develop and implement a comprehensive set of programs aimed at improving integrated health and productivity in the workplace. Further, the STEPS project is pertinent to meeting the needs of public-private partnerships such as NASA, which include a mixed workforce of civil servant and private-sector employees, technically-focused products designed for specific outcomes, and major research needs.
As discussed above, employers and relevant federal agencies have demonstrated that multifactor determinants of health and productivity must be addressed using new perspectives, metrics, and models. Table ES-1 outlines current trends toward achieving a healthy and productive workforce on the basis of determinants of health and productivity.
The traditional "occupational" and "nonoccupational" dichotomy stemming from regular shifts and the 40-hour workweek is being increasingly blurred by the changing demands of the contemporary American workplace. Employers who have traditionally been responsible for safety, environmental, and occupational health concerns will, by necessity, become more involved with worklife issues, health behaviors, and social factors affecting their employees. NASA and other employers, 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 to meet this challenge.
Recommendation 1: A New Vision
The committee recommends that the administrator of NASA adopt a new vision for worker health, readiness, and resilience that directly links to NASA's mission and includes health as a core NASA value that is implemented through an integrated health and systems approach. This vision should extend and apply to the entire NASA workforce and should
clearly articulate a broader perspective of health and how it advances NASA's core mission;
be adopted and adapted by each center director to maximize the alignment with each center's mission and workforce composition;
be promoted and implemented vertically and horizontally within NASA, using participatory strategies to ensure sustained senior management and organizational commitment and total workforce engagement.
ACHIEVING A NEW VISION FOR NASA WORKER HEALTH
The success and sustainability of an integrated health process must first and foremost begin with a clear understanding of the organization's mission. The organization's senior leadership must directly communicate the critical importance of policies, programs, and practices designed to optimize the health and productivity of the workforce, promoting an organizational culture that values worker well-being.
Senior leadership also must ensure that human resource activities, personnel benefit designs, occupational health and safety policies, environmental health, wellness programs and practices, and disability management are integrated and coordinated. Senior leadership must further ensure that all relevant stakeholders participate in and provide input to the planning process. Roles and responsibilities of key functional area leaders can be defined in the context of their contribution to the broader organizational mission. All individual and organizational factors contributing to the health and productivity of the workforce must be addressed, monitored, and improved over time.
The current health vision for NASA employees (i.e., achieving an improved level of health status as a consequence of employment at NASA) does not establish a clear link to the larger organizational mission. As a consequence, it does not provide NASA leadership with a compelling reason to commit resources and management attention to employee health needs beyond hygiene components such as injury prevention, exposure and occupational hazard control, regulatory compliance, and emergency response. A mission-driven vision for health should articulate why investment in health and employee-integrated health helps NASA achieve its core mission on time, under budget, and better than expected.
A management systems approach for NASA would serve as a means to establish and achieve specific integrated health priorities for its knowledge workforce. Benchmark management systems, available both in the private and public sector, could serve as useful models for design and implementation insights. Such a quality systems-based approach can be an effective mechanism for targeting increasingly scarce resources on higher-value initiatives related to the physical and psychological fitness and resilience of a high-performance workforce; fostering engagement and accountability; focusing on specific outcomes, and discipline to measure and improve employee health by integrating people, processes, and resources toward specific common goals and objectives.
Figure ES-1 shows the components of a Health and Productivity Management System (HPMS) that can be adapted by NASA. The integrated HPMS works by first ensuring that the program is tied, if possible, to the design of the federal health benefits provided to NASA employees. Not only must the programs be integrated and sustainable, but data must be integrated into the measurement and evaluation systems as described below, under "Data Integration and Management For Better Health."
Excerpted from INTEGRATING EMPLOYEE HEALTH Copyright © 2005 by National Academy of Sciences. Excerpted by permission.
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|1||The NASA worksite||19|
|2||Occupational and preventive health at NASA||34|
|3||Workforce health, performance, readiness, resilience : the case for change||53|
|4||Organizing and managing employee-integrated health programs and policies||77|
|5||Implementing integrated health programs||102|
|6||Data integration and health management||150|