2. Organisational Stress – a management model Dil Sen, Clinical Senior Lecturer in Occupational Medicine Centre for Occupational & Environmental Health, University of Manchester, UK EASOM Aug.2015 Lake Bled, Slovenia

3. “Hard work never killed anybody… but why take a chance?” Charlie McCarthy (Edgar Bergen,1903-1978)

5. Agenda l Definitions l Some myths & confusions l Facts & figures l Core features l A management model

6. Hazard & risk mechanisms (ILO) "Psychosocial hazards are those which relate to the interaction between job content, management systems, environmental control on the one hand, and workers' competencies and needs on the other."

7. è “a natural reaction to excessive pressure” (HSE) è not a disease…till it’s excessive/goes on for long time, è can lead to physical & mental ill harm (evidence base) è PRESSURE is the stimulus in the STRESS equation - STRESS is a negative imbalance in the system (transactional model of Cox & Mackay or Selye’s model of psychological strain) è when perceived DEMAND(s) exceed ability to COPE (job demands – control model) è pose an important problem via the negative impact on work capacity & productivity What is stress ?

8. è "managers only get stressed" - not so è "it's my own fault" - predisposition ? è "it's good for you" - arousal "yes"...stress "no" è same as job dissatisfaction, BUT people with high level of job satisfaction can also be greatly stressed è can be used to define cause…or effect (confusing?) Some myths...

9. Facts & figures è total number of cases of stress in UK in 2011/12 was 428 000 (40%) out of a total of 1 073 000 for all work-related illnesses (LFS) [Slight decrease!] è on average each case lead to 24 working days lost (10.4 million days lost in total, 2011/12) [UK] è industries reporting highest rates of total cases of work-related stress (three- year average) were human health and social work, education and public administration and defence [UK] è occupations reporting highest rates of total cases of w-r stress (3-year average): health professionals (in particular nurses), teaching and educational professionals, and caring personal services (eg. in welfare and housing ) è European Agency for S&H at Work - ~28% affected in EU è E20billion/year è second biggest OH problem in EU after back pain…. è 11% of all disease claims (Nat.Council of Compensation Insurance)

10. è stress is a process that happens over time and to people è individual perception & cognition very important (perception of control ?) è Imbalance 1 - demand v coping capacity (Karasek & Theorell) è Imbalance 2 - effort-reward paradigm (Siegrist) è other influences: “flexible workforce” & “short term contract” culture è consequences è consequences are physiological;behavioural; cognitive;emotional Core features

11. PHYSIOLOGICAL PHYSICAL HEALTH PSYCHOLOGICAL HEALTH BEHAVIOURAL TYPE A PERSONALITY PSYCHOLOGICAL Individual characteristics Symptoms DiseaseSources of stress Physical & Mental ill health Career development Intrinsic to job Role in org Relationships at work Org structure/climate Personal PHYSICAL (CONTROL) (SUPPORT) (CHANGE management) (DEMAND v CONTROL)

12. Some organisational "symptoms" Physiological - not applicable Behavioural -high absenteeism/sick leave -high staff turnover -poor industrial relations -increased acc/illness rates -poor quality/productivity -increased claims Cognitive - not applicable Emotional -low morale -loss employee contributions to planning/process improvements

13. Some 'Stressors' l Workload l long workhours ( >45hrs) [Kecklund G. Scand J Work Env Health 2005;31(5):325-327 Milner A et al. Occup and Env Medicine 2015;72(8):573-586] l OR not enough work l monotonous work l Physical environment - hot/cold; noisy; bright/dark….. l Relationships - with boss, colleagues, subordinates - problems with delegation l "Work-life balance" - personal crises (money, health...) - work v family demands

14. Managing 'stress' at work è Step 1-"Do we have a problem?"(Recognition & Acceptance). Initiate risk assessment.... è Step 2-”How bad ?” Analysis of work situation & identification of likely organisational risk factors è Step 3-”What do we need to do?” ACT on it.. è Step 4-”Has it worked?” Monitor/audit what has been done and evaluate long term impact

15. Prevention Organisational approaches Preventive strategies - job redesign/worker management training/better org.communications Timely reaction- early recognition/management, group problem solving/ reward orientated mgt style Support strategy - treatment, rehabilitation & counselling Hard to do Easy to do

16. Managing 'stress' - 5 steps l policy and procedures l organisation of staff l planning and setting standards l measuring performance l audit and review

17. Auditing The HSG 65 Model http://www.hse.gov.uk/pubns/books/hsg65.htm Information link Control link Policy Development Organisational development Feedback loop to improve performance Developing techniques of planning, measuring & reviewing

18. l Is there a clear 'stress' policy & is it written down ? l Does it specify who is responsible and the arrangements for identifying org.stressors, assessing risks and controlling them ? l Do employees (& managers) know....are they involved ? l Is it up to date ? Is there a policy ?

19. Acknowledges that work-related stress is primarily an organisational, not individual, issue Allocates roles and responsibilities (and explains the responsibilities of managers and staff) Recognises that stress is a health and safety issue which can be integrated into existing arrangements Has an emphasis on prevention; lighter emphasis on provision of training/support services Has in-built review mechanisms Is applicable to all staff Has been created in partnership with employees and is not ‘owned’ by the organisation Characteristics of a good stress policy

20. Organisation of staff ? -competence, control, cooperation, communication l specific people for specific H&S tasks ( especially managers) l consultation with staff & representatives l inform staff about risks & preventive measures l expertise and training as appropriate l specialist support ( OHS, counselling)

21. l setting of objectives to manage stress l the hazards/organisational stressors? l what are the risks? l are there standards (measurable, achievable, realistic ) for people and processes? Planning ?

22. l Active monitoring ( before things go wrong) - are standards being implemented ? - are they effective (check ill health data) ? l Reactive monitoring ( after things go wrong) - investigating incidents, complaints - why was 'performance' sub-standard? Measuring performance

23. l focus on the concerns of the majority of employees l developed through work with partners l applied & considered across “high-risk” sectors l health, education, finance, social care…. l covers the main stressors: l Demand l Control l Support l Relationships l Roles l Change Management Standards [MS]

24. remains popular across all employment sectors website receives over 25,000 visits per month many organisations have adapted MS tools for use with individuals for RA and as part of r.t.w procedures the most effective interventions have been those designed & implemented jointly (management, workers, TU) www.hse.gov.uk/stress Management Standards

25. Management Standards Process The Management Standards Who can be harmed & how? Step 1: Identify the hazards Step 2: Decide who might be harmed and how Step 3: Evaluate the risk and take action Step 4: Record your findings Step 5: Monitor and review Gathering information Linking to problems Communicating the results Action planning Evaluation / Continuous Improvement

26. l HSE Stress management Standards: l Making the Management Standards work - pdf l HSG218 – managing the causes of WRS l Management standards tools & downloads l Case studies l COEH teaching modules: l Mental ill health & Stress at Work [Module 2F online] l Common Mental Health problems and the Workplace [Module 3J] Resources ?

27. l by own staff, different department or outsiders l to check effectiveness of 'Stress' policy - degree of compliance with standards - areas where standards need review - stress case data, possible causes, trends.... Is there a review process ?

28. So who’s stressed then? Any questions? http://www.coeh.man.ac.uk/