The more than 200,000 men and women that make up the Department of Homeland Security (DHS) workforce have been entrusted with the ultimate responsibility - ensuring that the homeland is safe, secure, and resilient against terrorism and other hazards. Every day, these dedicated individuals take on the critical and often dangerous challenges of the DHS mission: countering terrorism and enhancing national security, securing and managing the nation's borders, enforcing and administering U.S. immigration laws, protecting cyber networks and critical infrastructure, and ensuring resilience in the face of disasters. In return, DHS is responsible for protecting the health, safety, and resilience of those on whom it relies to achieve this mission, as well as ensuring effective management of the medical needs of persons who, in the course of mission execution, come into DHS care or custody.

Since its creation in 2002, DHS has been aggressively addressing the management challenges of integrating seven core operating component agencies and 18 supporting offices and directorates. One of those challenges is creating and sustaining a coordinated health protection infrastructure. Advancing Workforce Health at the Department of Homeland Security examines how to strengthen mission readiness while better meeting the health needs of the DHS workforce. This report reviews and assesses the agency's current occupational health and operational medicine infrastructure and, based on models and best practices from within and outside DHS, provides recommendations for achieving an integrated, DHS-wide health protection infrastructure with the necessary centralized oversight authority.

Protecting the homeland is physically and mentally demanding and entails many inherent risks, necessitating a DHS workforce that is mission ready. Among other things, mission readiness depends on (1) a workforce that is medically ready (free of health-related conditions that impede the ability to participate fully in operations and achieve mission goals), and (2) the capability, through an operational medicine program, to provide medical support for the workforce and others who come under the protection or control of DHS during routine, planned, and contingency operations. The recommendations of this report will assist DHS in meeting these two requirements through implementation 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.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON DEPARTMENT OF HOMELAND SECURITY OCCUPATIONAL HEALTH AND OPERATIONAL MEDICINE INFRASTRUCTURE
• Reviewers
• Preface
• Acronyms and Abbreviations
• Glossary
• Summary
  • A FRAMEWORK FOR WORKFORCE HEALTH PROTECTION
  • WORKFORCE HEALTH PROTECTION AT DHS
  • OPPORTUNITIES TO ADVANCE WORKFORCE HEALTH AT DHS
  • CONCLUDING THOUGHTS
  • REFERENCE
• 1. Introduction
  • BACKGROUND AND RATIONALE FOR THE STUDY
  • STUDY CHARGE AND SCOPE
  • STUDY APPROACH
  • TERMINOLOGY USED IN THIS REPORT
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. The DHS Workplace and Health System
  • A BRIEF HISTORY OF DHS
  • DHS MISSION AND ORGANIZATION
  • HEALTH AND SAFETY CHALLENGES AT DHS
  • THE HEALTH PROTECTION MISSION AT DHS
  • ORGANIZATION OF THE DHS HEALTH SYSTEM
  • REFERENCES
• 3. A Comprehensive Framework for Ensuring the Health of an Operational Workforce
  • WORKFORCE HEALTH PROTECTION AND MISSION SUCCESS
  • A FRAMEWORK FOR ENSURING THE HEALTH OF AN OPERATIONAL WORKFORCE
  • ENSURING MEDICAL READINESS
  • PROVIDING MEDICAL SUPPORT FOR OPERATIONS
  • MEASUREMENT AND EVALUATION
  • INTEGRATION OF ESSENTIAL WORKFORCE HEALTH PROTECTION FUNCTIONS
  • REFERENCES
• 4. The Current State of Workforce Health Protection at DHS
  • ENSURING MEDICAL READINESS
  • PROVIDING MEDICAL SUPPORT FOR OPERATIONS
  • INTEGRATION OF WORKFORCE HEALTH PROTECTION FUNCTIONS AT DHS
  • OPPORTUNITIES TO ADVANCE WORKFORCE HEALTH AT DHS: GAP ANALYSIS
  • REFERENCES
• 5. Leadership Commitment to Workforce Health
  • THE NEED FOR COMMITTED LEADERSHIP
  • THE CURRENT STRATEGIC APPROACH TO WORKFORCE HEALTH AT DHS
  • A COMMITMENT TO WORKFORCE HEALTH
  • REFERENCES
• 6. Organizational Alignment and Coordination
  • ALIGNMENT OF HEADQUARTERS OVERSIGHT FUNCTIONS
  • ALIGNMENT WITHIN AND AMONG OPERATIONAL COMPONENTS AND VERTICALLY WITH DHS HEADQUARTERS
  • A GOVERNANCE FRAMEWORK FOR ENTERPRISE-LEVEL INTEGRATION
  • REFERENCES
• 7. Functional Alignment
  • THE NEED FOR FUNCTIONAL ALIGNMENT
  • ENSURING THE MEDICAL READINESS OF THE DHS WORKFORCE
  • MEDICAL SUPPORT FOR OPERATIONS
  • CENTRALIZING HEALTH SERVICES
  • REFERENCES
• 8. Information Management and Integration
  • INFORMATION AND KNOWLEDGE MANAGEMENT
  • THE NEED FOR A DHS MEASUREMENT AND EVALUATION FRAMEWORK
  • A SYSTEMS APPROACH TO DATA COLLECTION
  • ENABLING HEALTH SYSTEM INTEGRATION AND CONTINUOUS IMPROVEMENT THROUGH INFORMATION MANAGEMENT SYSTEMS
  • REFERENCES
• 9. Considerations for Implementation
  • IMPACT OF AN INTEGRATED HEALTH PROTECTION INFRASTRUCTURE
  • PRIORITIES FOR IMPLEMENTING AN INTEGRATED HEALTH PROTECTION INFRASTRUCTURE
  • CONCLUDING THOUGHTS
  • REFERENCES
• APPENDIXES
  • Appendix A Department of Homeland Security Component Agency Health Protection Program Descriptions
  • Appendix B Referenced Policy Documents
  • Appendix C Performance Measure Framework and Balanced Scorecard Example
  • Appendix D Questions for the Department of Homeland Security Components
  • Appendix E Public- and Private-Sector Approaches to Workforce Health Protection
  • Appendix F Committee Meeting Agendas
  • Appendix G Committee Biosketches

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.

Suggested citation:

IOM (Institute of Medicine). 2014. Advancing workforce health at the Department of Homeland Security: Protecting those who protect us. Washington, DC: The National Academies Press.

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.