Abstract of the EfH Conference Publication

Managing stress at work through work organisation and job design

John Griffiths and Ava Fine
work2health, Cardiff (United Kingdom)
www.work2health.org.uk

Introduction
This paper was presented at the Enterprise for Health (EfH) Network meeting in Munich in April 2008. It is given from the perspective of a consultancy team who work on a day to day basis with organisations who are trying to tackle the issue of work related stress. Our work involves us in identifying the causes of stress within an organisation, department or team and then in working with the organisation to identify and implement ways of reducing and managing the pressure that workers face and consequently the amount of stress that they experience.

This paper briefly identifies the scale of the problem and describes in greater detail the actions taken by the UK's Health and Safety Executive to enable and support organisations in their efforts to reduce the causes of stress at work. The paper will also show how employers have addressed the need to examine the way in which work is organised and jobs are designed as a means of tackling the problem of work related stress.

Stress at work
With several hundred definitions of stress in every day use, employers might wonder which one is relevant to the workplace. However several themes emerge from the definitions which are of help: the key one being that stress is associated with feelings of not coping. In other words when the demands faced by an individual, be they work related and / or emanating from other aspects of their life, exceeds that individual’s ability to cope (or be in control), the person feels stressed. At such times their ability to concentrate on their work, their enthusiasm for their job and their confidence in their ability to perform their role can all be adversely affected.

While there is no such disease in the Clinical Diagnostic Register as 'stress', it is well recognised that prolonged exposure to stress can lead to anxiety / clinical depression or physical symptoms and, as the evidence set out below reveals, the impact on the UK workforce is considerable.

The scale of the problem
In the UK in 2006 work-related stress, depression or anxiety were responsible for the loss of almost 14 million working days, or 45.9% of the total number of working days lost due to illness. Taken on a case by case basis, the estimated average number of days lost per year per case is 30.2 – the highest cause of long term absence by some distance! (1)

In 2005/6 work related stress, depression and anxiety cost Great Britain in excess of £530 million (€662.5 million) and the number of workers who sought medical advice for what they believed to be work related stress increased by 110,000 to an estimated 530,000. (2)

These figures reveal the scale of the problem, the impact of which is felt by employers, co-workers and the individuals themselves. In addition considerable costs are borne by society – e.g. NHS treatment costs together with the costs of social security benefits e.g. incapacity benefit

The costs borne by employers should provide the raison d'etre for taking action, yet unfortunately this is not always the case. The loss of productive work due to work related stress, the impact on output and service delivery, the effect on the quality of employees working lives – all directly or indirectly have an effect on the balance sheet, and yet stress – its causes, outcomes and implications is either not recognised as being important to the running of the organisation, or managers concerned about the issues it raises, the obligations it places upon them, and their own ability to act, choose to ignore the problem.

It is also important to recognise that when an employee is stressed and their ability to do their work is compromised, the impact of this is also borne by co-workers who have to carry out at least some of the tasks previously done by their colleague. In turn, this increase in workload increases the pressure they are facing and may lead to them becoming stressed. Levels of resentment (against the employer) may rise and as a consequence morale within the team falls.

Employers and managers should also be cognizant of the fact that people working under high pressure are more likely to make mistakes and be involved in accidents.

We ask ourselves 'should employers take the issue of stress at work seriously?', and conclude that of course they should! The question is what can be done, who should do it and what support is available to employers to help them in this process?

The Health and Safety Executive (HSE)
The HSE is the UK's national regulatory body responsible for promoting the cause of better health and safety at work. It seeks to ensure that 'risks to people's health and safety from work activities are properly controlled' and that people are protected against 'risks to health or safety arising out of work activities'. The changing nature of work is reflected in the HSE's mission statement which states that, 'Our mission is to protect people's health and safety by ensuring that risks in the changing workplace are properly controlled'.

The impact of stress in the workplace was recognised by HSE more than a decade ago, with specific guidance first being issued in 1995, and since then the agency has published a number of very practical resources for employers and staff on stress related issues. The 1974 Health and Safety at Work Act does imply psychological health in its definitions, and so it could be argued that mental health and well being has been on the health and safety agenda for sometime.

2004 saw the publication of the HSE's Management Standards on Work Related Stress (see also: www.hse.gov.uk/stress/standards/index.htm), and there can be no doubt that the introduction of these standards provided employers with a framework around which to build a corporate response.
Perhaps for the first time the need to prevent stress occurring within the workplace (primary prevention) was fully recognised and the role of tertiary interventions (treatment, counselling, employee assistance programmes etc) was given its correct place as a necessary final step for those for whom work remained stressful, rather than being the sole action in place.

The Management Standards are developed around the six causes of work related stress which had been identified from previous research undertaken by HSE, namely:

Demands
workload, work patterns, and the work environment.

Control
how much say the person has in the way they do their work.

Relationships
includes promoting positive working to avoid conflict and dealing with unacceptable behaviour.

Change
how organisational change (large or small) is managed and communicated in the organisation.

Role
whether people understand their role within the organisation and whether the organisation ensures that the person does not have conflicting roles.

Support
includes the encouragement, sponsorship and resources provided by the organisation, line management and colleagues.

Within the documentation, the description of each of the standards follows the same pattern - the standard is described e.g. for demands the standard is that, 'Employees indicate that they are able to cope with the demands of their jobs and that systems are in place locally to respond to any individual concerns'. This last point features in the description of each of the six standards and emphasises the vital role that communication (both formal and informal) has on the prevention of work related stress.

The Guidance then explains what should be happening within the organisation and the position to be reached. For the section relating to demands, the expectations are, 'that the organisation provides employees with adequate and achievable demands in relation to the agreed hours of work; that people's skills and abilities are matched to the job demands; that jobs are designed to be within the capabilities of employees; and that employees' concerns about their work environment are addressed'.

The role of risk assessment in stress prevention
All employers have an absolute duty to carry out 'adequate' or 'suitable and sufficient' risk assessments of hazard that might cause harm to employees (Reg. 3 Management of Health and Safety Regulations 1999). Such risk assessment includes the risks to physical and psychological health, with work related stress falling into this latter category.

The approach suggested by the HSE consists of five steps, and is built on the standard approach to risk assessment.

Step 1: Identify hazards

Step 2: Decide who might be harmed and how

Step 3: Evaluate the risk and decide if enough is being done

Step 4: Record findings

Step 5: Review assessment and revise where necessary

It takes approximately 18 months for large organisations to work through the process of the risk assessment cycle. This includes time to implement the action plan and produce measurable outcomes. Small organisations may complete the process in a shorter timescale

Who should participate in the risk assessment?
In our work with organisations we strongly encourage them to see the risk assessment process as one which is led by line managers and supervisors who involve as many members of their teams or work groups as possible in the process, always remembering that risk assessment is a tool for managers to aid in preventing stress. It’s the actions taken as a result of the risk assessment process that can reduce stress at work not the risk assessment process itself.

Before undertaking the risk assessment the manager needs to talk to his or her team, brief them on what is going to happen and involve them in the process. Consideration should be given to determining the terminology that will be used. Use of the term stress in any context, especially that of a risk assessment can provide employees with an opportunity to 'off load' all their concerns and fears – both well founded and irrational, and may cause others to become introverted and reluctant to participate in the process for fear of being labelled or stigmatised. Managers may wish to refer to the process therefore as an assessment of pressure rather than a stress risk assessment.

At all times in the risk assessment managers must be prepared to listen to the thoughts and concerns of their staff and to create an atmosphere in which these views can be expressed.

Managers are also encouraged to group people by role, and undertake the risk assessment with as large a group as possible. An individual risk assessment should only be undertaken following an incident, on someone's return to work following a period of absence caused by stress (work or non-work related) or when someone has come forward to say they have difficulty in coping and managing their work. In addition to utilising information from team members, mangers should also consider any other information which becomes available to them, in particular sickness absence data for their team (and how it compares to other teams). Information on morale, relationships within the team and team performance should also be considered. At all times the manager is responsible for running the process and driving it forward, but the process itself should be fully participative, it is most certainly not the case of a manager 'doing' the risk assessment for the team!

At all stages in the risk assessment process reference must be made to the organisation's stress or pressure management policy and other policies which may have an impact on how the pressure / stress is moderated e.g. flexible working policy, work life balance policy, family friendly policy etc.

Step 1: Identify the stress factors
The risk assessment process should address each of the six main causes of stress at work. For each, staff should be asked to consider where the main sources of pressure for the team or a particular job role originate. Clearly in any team different people will bring different perspectives to the discussion – usually therefore it is the common pressures, those experienced by several member of the team, that are noted. But opportunity must be provided for members of the team with individual concerns to express those either in the group discussion or in private at a later time. As indicated earlier, all relevant sources of information should be utilised in both identifying the major risks and in determining their impact on the team members.

Step 2: Who might be harmed and how?
Having identified the sources of pressure the next question to be answered is who might be harmed and how? Managers should discuss with their teams the issues covered by this question – are any members of the team at particular risk, is the team as a whole at risk, are there specific times or circumstances where the risk increases?

Step 3: Evaluate the risk
The team should be asked to consider the action that is already being undertaken to reduce the risk of stress occurring. Is this action sufficient to control the risk and what else can be done? A second significant question that must be asked is could the risk be avoided altogether and what actions would need to be taken for this to happen?

When undertaking an evaluation of the risk of stress occurring and the actions required to reduce it or remove it altogether, an assessment of how risks can be combated at source should be completed. This could include determining whether work could be better adapted to the individual, whether the job should be redesigned and whether levels of training and instruction are appropriate.

Step 4: Record the significant findings
Significant findings from the risk assessment should be recorded on a risk assessment form. This sets out by cause of stress the actions already being taken, whether these are sufficient to control the risk, what other actions could be implemented to reduce the risk still further and the level of risk remaining (in some organisations this is simply quantified as high medium or low, in others a mathematical formula is used to give a numeric score). The documentation can also indicate who is responsible for implementing actions to reduce the risk of stress and who is responsible for evaluating these as well as when the evaluation will be undertaken.

Step 5: Review the assessment
Risk assessments should be reviewed whenever there is a change or a reason to consider the assessment is no longer valid e.g. when an employee who has been absent from work as a result of a stress-related illness, or following an accident or incident at work or a personal issue, returns to work.

In any case the initial risk assessment should be reviewed within six to twelve months and then, assuming no significant change, after every one to two years. Any review should involve the team members in the review process.

At a team / department level the results of the risk assessment should inform the way in which work is organised and jobs are designed. Corporately full support should be given to the risk assessment process with it becoming a corporate priority and with all managers trained in how to undertake one, and work with their teams in doing so.

Other tools that can be used to identify levels of pressure and stress within an organisation include stress audit tools. A number of these are available, but the one referred to hereafter is the HSE's own. Downloadable from the HSE website the 35 item questionnaire is completed by staff (either within a team, department, or if possible the whole organisation). The results of the questionnaire are fed into the HSE’s database and a comparison with other organisations, whose data is already in the database, is obtained. This is colour coded to enable the comparison to be made more easily.

The questionnaire was followed by a series of focus groups with managers and team members being kept separate. Trigger questions were developed to explore the issues raised by the results. Comments were recorded and analysed and used to provide additional information on the causes of the pressure and how these could be reduced. A report detailing all the information provided by the questionnaires and the focus groups was developed, and this included suggestions on how the team might deal with the issues it faced.

Having been presented with the report, the team and its managers developed an action plan to reduce the pressure that was being faced and bring about the achievement of the interim and long term targets suggested by the HSE. Ownership of this action plan by all the key stakeholders – the team members themselves, the managers and the corporate body was essential if progress was to be made.

The actions taken by the team included bringing about an improvement in the working environment, a more equitable sharing and allocation of work among team members and an enhancement of communication between managers and team members (and team members and managers), and subsequent feedback from the team indicates that improvements have been achieved. Ideally the stress audit tool will be used once again with this team in the near future to confirm this subjective feedback.

Conclusion
In order for an individual to be able to work without fear of a recurrence of work related stress, changes must be made to the source of the problem. Secondary interventions such as stress management training, awareness raising or tertiary interventions such as counselling and psychological support will have limited success if changes are not made at the organisational level. Adjusting working patterns, work volume or the nature of the work itself either permanently or on a temporary basis are essential if recovery is to be maintained.

In addition to the promotion of the risk assessment process and subsequent modifications to the design or nature of the job, the HSE have now developed a competency framework for managers whereby examples of positive manager behaviour are recommended in order to best manage each Standard topic. This enables and encourages managers to act positively in reducing and preventing stress in each topic area thus taking a further proactive approach to managing work related stress.

It is early days as yet to evaluate the impact the competency framework will have in further reducing stress at work. But the introduction of the framework highlights once again how important it is for senior management to take responsibility for, and lead the process of identifying the sources of stress within their organisation; putting in place positive steps to actively reduce it; and consistently monitoring the effects of their actions, making further changes when necessary. Only by such positive action at an organisational level will stress at work be successfully managed and hopefully reduced.

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