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Introduction and Overview*

The Institute of Medicine (IOM) hosted a two-workshop series titled Workforce Resiliency Programs in September and November of 2011. The workshops were sponsored by the Department of Homeland Security’s (DHS’s) Office of Health Affairs (OHA). The workshops were designed to aid DHS in the development of a strategy to build a long-term resilience initiative for the DHS workforce. The statement of task requested that the workshops provide a forum to examine the following topics:

  1. defining workforce resilience and its benefits such as increased operational readiness and long-term cost savings for the specified population;
  2. identifying work-related stressors faced by DHS workers, and gaps in current services and programs;
  3. prioritizing key areas of concern; and
  4. identifying innovative and effective worker resilience programs that could potentially serve as models for relevant components of the DHS workforce.

Resilience is generally defined as the ability to rebound after adversity. DHS is concerned that long-term exposure to stressors reduces individual resilience and negatively affects employees’ physical and mental well-being. In turn, the organization’s level of operational

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*The planning committee’s role was limited to planning the workshops, and the summary has been prepared by the rapporteurs as a factual summary of the presentations and discussions that took place at the workshops.



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1 Introduction and Overview* The Institute of Medicine (IOM) hosted a two-workshop series titled Workforce Resiliency Programs in September and November of 2011. The workshops were sponsored by the Department of Homeland Security’s (DHS’s) Office of Health Affairs (OHA). The workshops were designed to aid DHS in the development of a strategy to build a long-term resilience initiative for the DHS workforce. The statement of task requested that the workshops provide a forum to examine the following topics: 1. defining workforce resilience and its benefits such as increased operational readiness and long-term cost savings for the speci- fied population; 2. identifying work-related stressors faced by DHS workers, and gaps in current services and programs; 3. prioritizing key areas of concern; and 4. identifying innovative and effective worker resilience programs that could potentially serve as models for relevant components of the DHS workforce. Resilience is generally defined as the ability to rebound after adversity. DHS is concerned that long-term exposure to stressors reduces individual resilience and negatively affects employees’ physical and mental well-being. In turn, the organization’s level of operational * The planning committee’s role was limited to planning the workshops, and the summary has been prepared by the rapporteurs as a factual summary of the presentations and discussions that took place at the workshops. 1

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2 BUILDING A RESILIENT WORKFORCE readiness is potentially reduced. The September workshop focused on DHS’s operational and law enforcement personnel. The November workshop concentrated on DHS policy and program personnel with top secret security clearances. Law enforcement personnel are defined as individuals who carry a weapon and are charged with enforcing the law. Operational personnel include a wide range of emergency responders such as firefighters, federal emergency responders working in the field, and emergency medical staff. Many positions within DHS require employees to have a security clearance. Employees with high-level security clearances are often exposed to traumatic and disturbing information as part of their jobs. DHS is concerned that individuals will not seek assistance because of fears of jeopardizing their security clearance. In planning the workshops, the committee noted resilience research and interventions are an emerging area of study, and many factors appear to influence both individual and organizational resilience. As a result, they reached out to a broad array of experts from various fields including resilience research, occupation health psychology, emergency response, performance measurement, high-reliability organizations, law enforcement, work design, and private-sector programs, to name a few. Although the two workshops focused primarily on specific groups of personnel, many of the issues discussed were relevant for all DHS employees. Throughout the workshops, themes emerged in the individual presentations and participants’ comments (see Box 1-1). The themes listed are the most frequent, cross-cutting topics that arose during the workshops, but they do not constitute a full or exhaustive overview of the field. The planning committee’s role was limited to planning and convening the workshops. This summary has been prepared by designated rapporteurs as a factual summary of what occurred at the workshops. Opinions and comments contained in the summary are those of individual workshop participants and do not necessarily represent the views of all workshop participants. Statements in the summary should not to be construed as findings, conclusions, or recommendations of the planning committee or the Institute of Medicine.

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3 INTRODUCTION AND OVERVIEW BOX 1-1 Themes from Individual Workshop Speakers  Resilience as a process rather than a state or personal trait  Links between individual, family, organizational, and community resilience  Connections between physical and mental well-being including resilience  Relationships between leadership and resilience  Balance between personal and professional obligations  Disincentives for seeking assistance such as stigma affect resilience  Role of evidence and performance measurement in developing and improving interventions  Role of organizational diversity and culture in developing and implementing resilience interventions  Factors influencing program utilization and outcomes include o leadership buy-in and support, o alignment of programs with organizational culture, o communications, and ongoing performance measurements o ORGANIZATION OF THIS SUMMARY This summary encompasses more than 20 hours of presentations and discussions from the two workshops. Many of the sessions touched on more than one of the topics within the statement of task listed above. Given the overlap in the issues and topics discussed at the workshops, this summary is organized topically rather than chronologically. The agendas from the workshops and a complete listing of the speakers, panelists, and planning committee members are included in the Appendixes.  Chapter 2 includes presentations from both workshops. The presentations provide background information about DHS, work- related stressors, gaps in current services and programs, as well as overviews of DHS’s human capital framework, internal resilience efforts, and security clearance requirement.

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4 BUILDING A RESILIENT WORKFORCE  Chapter 3 consists of a session focused on developing an operational definition for long-term resilience that is relevant to DHS. The presentations examine definitions of resilience from various perspectives such as individuals, communities, organizations, and occupational health and safety.  Chapter 4 explores various factors that influence workforce effectiveness and resilience. The chapter includes presentations from both workshops. These presentations cover discussions of sleep and fatigue, common issues within high-reliability organizations, employees’ ability to balance their professional and personal obligations, teams under stress, and the role of leadership. The chapter also includes descriptions of a federal wellness program and a military framework for resilience.  Chapter 5 includes an overview of different resilience programs and interventions. The presentations include overviews of the Army’s Comprehensive Solider Fitness Program, perspectives on other military resilience research, as well as interventions with firefighters and other private-sector programs.  Chapter 6 includes descriptions of employee wellness and employee assistance programs (EAPs) and how they might be leveraged to support DHS’s resilience efforts.  Chapter 7 is a discussion of the various individual and organizational measures of resilience, engagement, burnout, and job-fitness, as well as an example of a successful private-sector employee satisfaction assessment.  Chapter 8 includes a multidisciplinary panel of experts discussing the key points of the September workshop, as well as perspectives on resilience from representatives of DHS component agencies. BACKGROUND Alexander Garza, Assistant Secretary for Health Affairs and chief medical officer for DHS, and Kathryn Brinsfield, director of the Workforce Health and Medical Support Division within the Office of Health Affairs (OHA), presented background information on DHS at the workshops. Their comments have been summarized below. At the September workshop, Garza stated that DHS was birthed in the aftermath of the 9/11 terrorist attacks and was charged with a 21st- century mission of protecting the homeland. Twenty-two preexisting

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5 INTRODUCTION AND OVERVIEW federal agencies were brought together along with several new groups under one umbrella to create DHS. The current structure of DHS includes the following components:  Directorate for National Protection and Programs (NPPD)  Directorate for Science and Technology  Directorate for Management  Office of Policy  Office of Health Affairs  Office of Intelligence and Analysis (I&A)  Office of Operations Coordination and Planning  Federal Law Enforcement Training Center  Domestic Nuclear Detection Office  U.S. Immigrations and Customs Enforcement (ICE)  Transportation Security Administration (TSA), which also houses the Federal Air Marshal Service (FAMS)  U.S. Coast Guard (USCG), except under Title 10 where it becomes part of the military  U.S. Secret Service (USSS)  U.S. Customs and Border Protection (CBP)  Federal Emergency Management Agency (FEMA)  U.S. Citizenship and Immigration Services (USCIS) The structure under which these components existed before the crea- tion of DHS varies widely. For example, USSS was created in 1865 as a division of the Department of Treasury tasked with suppressing counter- feit currency. Over time, the mandate grew to include protection of the President of the United States and other government officials. USSS re- mained a component of the Treasury until the creation of DHS. USSS was restructured and experienced a large expansion of its mandate under the USA Patriot Act as part of the move to DHS. USSS now investigates a wide array of security threats, including threats to cyber security and financial transactions. USSS is a component with a long-standing history and culture. Alternatively, the TSA was created in 2001 in response to 9/11. Initially under the Department of Transportation, it became a com- ponent of DHS in 2003. As a relatively new organization, it is in the ear- ly stages of developing a structure and organizational culture. DHS employees bring a broad range of skills, organizational cul- tures, and backgrounds to their diverse and difficult responsibilities.

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6 BUILDING A RESILIENT WORKFORCE Within DHS, the largest group of employees are law enforcement personnel. Almost 50 percent of the department’s personnel serve in a law enforcement role. Another large group of employees are policy personnel who carry high-level security clearances. Although these groups may share a common mission to protect the homeland, each of their roles carries different tasks and stressors. To add to the complexity, DHS and its component agencies are geographically diverse. DHS personnel are stationed around the country with only 20 percent located in the national capital region. Approximately 20 percent of DHS’s law enforcement personnel work in some of the most remote regions of the United States. In some cases, they are 4 to 6 hours away from any health care facility. RESILIENCE WITHIN THE DEPARTMENT OF HOMELAND SECURITY Brinsfield noted that in response to an increase in suicide rates within the department, Deputy Secretary Jane Hull Lute tasked the OHA to develop a department-wide employee resilience program in October 2009. The deputy secretary also tasked the new program with making the department one of the “best places to work in the federal government” as measured by the Office of Personnel Management’s annual Employee Viewpoint Survey. The OHA started the DHSTogether program to address this charge. Brinsfield noted that the initial research gathered to support the DHSTogether program found that DHS’s suicide rate was equivalent to the national suicide rate. However, when they drilled down to the different components within DHS, some law enforcement components had rates that were significantly higher and in some cases were much closer to those seen in the military. Given the two goals of the program, DHSTogether staff decided not to focus solely on suicide prevention but instead to look broadly into stress and resilience in the workforce. More detailed information about the DHSTogether program is included in Chapter 2. Over the past 2 years of the DHSTogether resilience program, the OHA has learned that resilience is not a single-solution problem given the diversity of people, positions, and mission sets within DHS. The issues are multifactorial and require many different skill sets and complementary strategies to address resilience. Garza added that some of the more

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7 INTRODUCTION AND OVERVIEW complex issues to be addressed are the social, cultural, and stigma barriers related to seeking help. Whether the barriers to seeking help are concerns about jeopardizing security clearances, cultural norms within the law enforcement community, or stigma associated with mental health problems, these issues are significant problems in developing an effective resilience program. DHS is not alone in tackling these issues. The Department of Defense (DOD) is dealing with these same issues in its resilience and suicide prevention programs. The DHS workforce is stressed by challenging work and exposure to multiple critical incidents. DHS needs to find a way to encourage members of the workforce to seek help in order to better deal with those challenges. Garza asserted that in order for DHS employees to meet the demands of their important mission, they have to be effective, mission- oriented, and in peak condition every day. This requires that they be resilient. Garza stated that DHS employees have dedicated their lives to protecting this nation, and they should have a work environment that helps them with the challenges they face, whether they are work related or family related. The DHSTogether program is working to provide a cohesive strategy for all the components to demonstrate that the department cares about its people and is trying to break down those cultural barriers. Brinsfield mentioned that although the program has been unfunded since its inception, it will potentially be funded starting in 2012. As the program moves forward, the staff is looking at the initiative’s work to assess its effect. She added that the good news is that the suicide rate within the department has dropped dramatically since the program started. Unfortunately, she cautioned that it is not possible to determine if this drop is related to the efforts of the resilience program. The DHSTogether team is now focused on identifying what is working, what is not working, and how to reinforce what already has been done. Given the limited amount of the potential funding for the program, it is essential to ensure that resources are spent wisely.

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