Work Related Stress Frances Bailey HM Inspector of Health and Safety Executive Work Related Stress Frances Bailey HM Inspector of Health and Safety I am a stress partner – and have detailed training to help organisations through the stress management process Visit the Management Standards website at: www.hse.gov.uk/stress/standards

Why manage stress? Legal Requirement to assess Stress costs the UK economy £3.7-3.8 billion per annum 13.4 million working days lost in 2001 due to stress, depression and anxiety 1 in 5 people find work either very or extremely stressful Sectors with highest incidence are: health & social services, education, local government, central government and financial services. Legal Requirement to assess These data are drawn from various national surveys they indicate the high cost of WRS to UK plc; a cost that the government believe is unsustainable. The sectors with the highest incidence are those that will be targeted for improvement as part of the Sector Implementation Plan, the details of which we will discuss shortly. Working with the public is highly stressful And lets not forget, it is a legal requirement under the Management Regs. It is regulation 3 MHSWR (Health and safety arrangements) that requires a duty holder to carry out suitable and sufficient assessments and to record the significant findings. Regulation 5 of MHSWR requires the duty holder to ‘make and give effect to such arrangements as are appropriate’ to manage health and safety through the preventative and protective measures identified in the risk arrangement (Regulation 3 MHSWR). The action the duty holder chooses to take to comply with Regulation 5 is dependent on the findings of the risk assessment in Regulation 3.

The Management Standards 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 The Management Standards Gathering information Linking to problems Communicating the results These are the standard five steps to risk assessment – any risk assessment. The relevant stress-related tasks associated with those steps. Action planning Evaluation / Continuous Improvement

The Management Standards Before you start: Secure commitment from senior management; Secure commitment from employees and their representatives; Understand your legal duties; and Have a clear understanding of what stress is:- HSE definition of stress: Stress is the adverse reaction people have to excessive pressure or other types of demand placed on them. Some Pressure is necessary and can be beneficial Experience/research has shown that organisations that have the commitment of both senior management and employees get better results in tackling work related stress. There is a clear difference between stress and pressure, pressure can help motivate, give a buzz, whereas stress can have adverse effects on health. Some earlier work on stress, Lazarus & Folkman (1984) for example, talked about good and bad stress. However, later definitions only talk about good pressure, stress always being seen as bad.

Project Planning Things to consider: Who will act as the project manager Project steering group/ membership The importance of employee involvement throughout the process What activities can be done in parallel Interdependency of activities Who will be responsible for each activity Deliverable from each activity What resources are required Communication strategy. It is suggested that the application of the MS process is subjected to the same planning process as any other project. The headings here are just a summary of some of the issues that need to be considered. Your organisation may have its own project planning procedures, if so, then these should be used. Treating the Management Standards risk assessment in this way can increase the likelihood of success as it help focus on the deliverables, namely improved organisational performance through improved employee well-being; this will have a positive impact on Key Performance Indicators (KPI). There will be a number of decisions to make during the process. The process will proceed more smoothly if there is a steering group that comprises, a Director, HR officer, H&S advisor, Occ Health, representative from different staff ‘levels’ eg Senior management, middle management, supervisors, staff.

The Management Standards 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 The Management Standards Gathering information Linking to problems Communicating the results These are the ‘Five steps to risk assessment’ included in the majority of HSE publications relating to effective management of risk. This was chosen as a structure for the Management Standards as it well understood by our target audience, health & safety and HR professionals. We will quickly run through each of the Steps so we get a feel for the tasks involved. Action planning Evaluation / Continuous Improvement

Step 1 – Management Standards The six areas are: Demands: workload, work patterns, and the work environment Control:  How much say the person has in the way they do their work Support: encouragement, sponsorship and resources provided by the organisation, line management and colleagues Relationships: promoting positive working to avoid conflict and dealing with unacceptable behaviour Role: Whether people understand their role within the organisation and whether the organisation ensures that they do not have conflicting roles Change: How organisational change (large or small) is managed and communicated in the organisation. What are the hazards? These are essentially the six areas identified in the Management Standards. In earlier HSE publications on stress their was a seventh stressor, culture, statistical analysis has shown that this factor appears in the six main stressors so is no longer considered as a separate item. The way these six stressor areas are managed help describe the culture of an organisation.

The Management Standards 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 The Management Standards Gathering information Linking to problems Communicating the results This step is important as the data gathered feeds the rest of the process which effectively performs a gap analysis between the Management Standards and the information you gather on your organisation. Action planning Evaluation / Continuous Improvement

Step 2 – Gathering Information Who can be harmed? Work-related stress can affect any employee, even though some may cope better with work pressures than others At particular times, individuals may be more vulnerable to work-related stress How? Exposure to the six areas covered by the Standards can affect employees in different ways Finding out how the factors are affecting your employees requires a partnership approach based on openness, honesty and trust. An important point to reinforce here is that stress can affect anyone that includes employees from the shop floor to the boardroom, remember senior managers are employees too; all employees need to be included in the risk assessment. It is important to manage home related stress, in a similar manner to managing a broken leg – even if the leg was broken playing football

Step 2 – Gathering information Sources of information include: Sickness absence data Employee turnover Exit interview Productivity data Performance appraisals Informal talks with employees Focus groups Surveys Return to work interview Some or all of this data may be available, however, it may not have been considered as a source of data related to stress. What is important is not to rely on a single source of data, such as surveys, analysis of a number of data sources may reveal important corroborating information. What are we looking for in the data? Use all available sources of data Correlations between data sources Look for ‘hot spots’ to focus resources Areas of good performance Map the issues in the data to the Management Standards

Step 2 – Gathering information HSE Indicator Tool 35 item questionnaire Validated in a large organisation and in a national household survey Questions are designed to look at the six areas of work related stress A user manual download is provided on the website The HSE Indicator Tool can be used in a stand alone survey or as part of a wider staff survey. However, it is important that the questions, their response options or order are not modified. This is to ensure that your results can be compared with other organisations and benchmark data. Also, to ensure the HSE Analysis Tool can be used to generate results for use in the rest of the risk assessment process.

Step 2 – Gathering information HSE Analysis Tool: Presents a summary of the data in graphical form Colour coding helps to identify hotspots Interim and longer term targets suggested A user manual download is provided on the website The HSE Analysis Tool has been designed specifically to help you analyse the data from the HSE Indicator Tool. It provides descriptive data on each of the six stressor areas as well as data on the response to each question. In addition, by collecting demographic data such as location, job grade etc, you can use the functions of the analysis tool to identify hot spots within the organisation. The outputs from the analysis tool can also be used as an input to Focus Groups discussed in Step 3. Demonstrate the use of the Indicator and Analysis Tools.

The Management Standards 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 The Management Standards Gathering information Linking to problems Communicating the results As with most risk assessments this step forms the heart of the process as it is concerned with identifying interventions to address the issues identified by the data gathered in the previous step. Action planning Evaluation / Continuous Improvement

Step 3 – Linking problems to solutions Focus groups: Consider desired state retrieved from standards Confirm / challenge current state from Indicator Tool and other data sources Discuss / agree how to make practical improvements Agree next steps and timings. As stated previously, we recommend that any findings from analysis of data or results from surveys are discussed with employees in focus groups. For small/parts of/ organisations it may be appropriate to use a focus group as a means to identify problems and solutions. The reason for this is that a key issue with the use of a survey is the anonymity of the respondent, obviously with small groups this is difficult to maintain. The survey will have identified stressors that are a problem for example bullying; or ‘too much work’. But it won’t identify the reasons – ie who is bullying (and why); or too few staff, wrong equipment, confusion over objectives etc. Hence a focus group will be usually needed. The ‘How To Run Focus Groups guide’ on HSE’s website discusses some important issues about the membership, size, structure and facilitation of focus groups that should be considered before proceeding. As with any focus group the competency of and the confidence in the facilitator are key to its success. If members of the group do not feel comfortable with the facilitator and other group members they may not participate fully in the activities of the group. For this reason it is often preferable to have a ‘neutral’ facilitator, such as from another department or outside organisation. It is usual to have 10 to 15 participants, who are of the same/similar job type. It is not usually a good idea to have managers in the same focus group as their staff. Consideration should be given to how the output from focus group(s) will be used i.e. completed action plans. It may not be possible or desirable to implement all suggested interventions; so manage expectations. Whatever arrangements are made to prioritise or filter interventions should be made clear to focus group members and communicated to employees. If the survey shows many stressors causing problems, use focus groups to identify the top three/five etc, and concentrate on resolving those issues only. You may consider using the standards as a prompt or basis for discussion to structure the focus groups. When considering interventions some useful questions are: Can you tackle the source of this problem? What are the options? How workable is this option? What are the cost/benefits of this option? What are the advantages/disadvantages of this option? Consider what has been done elsewhere….is there anything you could learn from this?

Step 3 – Linking problems to solutions Risk Assessment - risk assessment form Similar to focus group, less formal Briefing/training for risk assessors Careful if bullying identified as an issue Must include consulting employees A risk assessment template form should be drawn up – a standard risk assessment form is not usually sufficient. The form should be in six sections – one for each of the stressors. To carry out an assessment, the assessor should consider each stressor in a similar manner to focus groups, but possibly less formal, ensuring that the persons that are affected by the assessment have input into the assessment, particularly in identifying control measures. Where the organisation has an embedded system for assessing standard risks, experience has shown that ‘competent risk assessors’ need additional training or briefing to carry out a stress risk assessment. Where there has not been additional training or briefing, the results have not delivered the required outcomes in terms of stress reduction. Care needs to be taken where previous information (surveys/ exit interviews etc) identify bullying as an issue, as the perpetrator may be the assessor. Moreover, if the individual designated as a stress assessor does not understand the benefits of the process, the results can be counter-productive.

Step 3 – Linking problems to solutions Identifying control measures 3 levels of interventions - hierarchy Primary- organisational factors eg management training Secondary- individual work load management, time management training Tertiary- Occupational health, Counselling, individual RA When sources of stress have been identified, it is important to involve staff in identifying suitable control measures. This is often done at the same time as the risk assessment/focus group is carried out. Most organisations are now good at the tertiary levels with employee assistance schemes/counselling, occupational health and case management when individuals who have suffered stress return to work. It should be clear in the stress policy who (managers and/or occupational health) should carry out and document a Risk Assessment for all those returning to work after any stress episode, (whether home-related or work-related). Some organisations are looking at control measures for those who have identified (themselves) as being stressed (home or work), such as flexible work patterns for that person, individual work load management etc What the law requires is that organisations identify organisational stressors and implement control measures that control stress for all staff. This could be flexible working as standard for all staff, management training for middle managers, (on how to manage!) etc Front line staff are at high risk. There should be organisational systems in place to ensure that everyone is trained in handling the public, including refresher training. More about the environment, systems as well as training in the violence bit.

Step 3 – Communicating the results Provide feedback : Survey findings Agreed solutions Action plans Timetable. Individual concerns: Develop ways for employees to raise concerns Provide employee assistance programmes Use mentoring or other forms of co-worker support Encourage employees to talk about concerns to managers, union representatives, HR etc. An effective communications strategy, one where all employees are kept up to date on the progress of the of intervention on a regular basis, is critical to the success of the process and to the realisation of the benefits. It is recommended that communication should be given due consideration at the project planning stage. Although the HSE approach is a primary intervention, prevention rather than cure, we appreciate there is a need to deal with the concerns of the individual. There may be a need to deal with employees who are currently suffering from a work related stress condition, the needs of these employees should to be considered. If individuals do take sick leave because of stress don’t forget the return to work interview and individual risk assessment (before returning to work) -Welcome back -Do not re-expose to stressors -Make alterations to the work that caused the stress, seek advice from Occupational Health -Give full range of duties but reduce those causing the illness -Offer to reduce hours, responsibilities

Individual signs Body language, hesitant speech Blank, sad expression Drinking alcohol Disorganisation, errors Irritability, tiredness, outbursts, Repeated absence, unpunctuality, late starts Working longer, reduced output The organisation should not wait until signs show before tackling stress, but if a person is suffering stress (home or work related) how does it show? To deal with individuals who have stress you should Develop skills needed to deal with staff; Don’t be panicked by emotion; Do not penalise;Encourage staff to manage own well being; Ask how you can help the employee; Ensure staff know about support; Create a culture where staff to seek help If individuals do take sick leave because of stress don’t forget the return to work interview and individual risk assessment (before returning to work) -Welcome back -Do not re-expose to stressors -Make alterations to the work that caused the stress, seek advice from Occupational Health -Give full range of duties but reduce those causing the illness -Offer to reduce hours, responsibilities

The Management Standards 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 The Management Standards Gathering information Linking to problems Communicating the results Action planning Evaluation / Continuous Improvement

Step 4 – Action plans shared with staff What is the problem How the problem was identified What are you going to do in response How you arrived at this solution Key milestones and dates Provide feedback to employees on progress A date for reviewing progress against the plan. Ideally these will be prepared as a part of the output from the focus groups. A good action plan is a means of demonstrating you are taking practical steps to address any problems. SMART – specific (and by who), measurable, achievable, realistic and time bound

The Management Standards 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 The Management Standards Gathering information Linking to problems Communicating the results Action planning Evaluation / Continuous Improvement

Step 5 - Review dates set Monitor and review: This is not a one off process, review periodically Monitor against action plan Evaluate effectiveness of solutions Review if significant changes are planned Repeat process at agreed intervals. The aim is to improve your organisations performance in managing work related stress to be the same as the top 20% of best performers in 2004, our baseline. The Analysis Tool will calculate suggested interim targets based on your current performance with the aim of improving your performance in stages to reach the aspirational target also provided by the analysis tool.

The benefits A more content and effective workforce Reduced sickness absence Lower staff turnover Improved business image/reputation Improved financial performance And finally; Meet your legal obligations under the Health & Safety at Work Act and Management Regulations.

What worked in pilot studies Senior management commitment Employee involvement Managing expectations / communications Identify role of middle management Train middle managers To manage Understand stress and stress management Appraisal training Supervision Support 360 degree feedback Target hot spots Interventions include: general awareness raising for all employees on WRS; training managers to better manage pressure and stress within the workplace; a confidential listening service for employees to discuss work related problems; active absence management including how to carry out return to work interviews; training in conflict management for employees who deal with the public Ensuring staff are aware of what is achievable and realistic ensures expectations are not raised and not met – which would create more stress In the UK generally, Middle Managers are often referred to as the damp-proof course – nothing permeates up or down through them. Many organisations have not identified that Middle Managers are crucial to motivating and enabling front line staff to deliver targets set by senior management. Many British organisations have a ‘command and control’ senior management, who set strategies and targets. But front line staff need to be ‘touchy-feely’ managed. Hence it is the role of middle managers to translate and communicate between the two types of management styles. In Somerset CC they identified management training had the biggest impact. It was noted that the appraisal system had fallen into disarray, with only 50% of staff being appraised. Counter-intuitively it was the 50% that had received an appraisal that were suffering most stress. Looking deeper into this, it was shown that the appraisals were carried out by managers who lacked knowledge and skill to conduct a review interview with sensitivity. The Council overhauled the appraisal system, with 360degree feedback at all levels. Training managers to support staff and review performance and development. Also staff were trained how to get the best out of the review process. Other interventions included Leadership training Teambuilding Employee assistance programme/counselling services/listening service Occupational health Services – involved before sickness absence, greater feedback (anonymised) to organisation.

Why manage stress? Case study : Somerset County Council Cost of sickness absence £3.7m 2001/02 Wellbeing/Quality of Working Life initiative Stress audit carried out 50 Interventions aimed at the individual,team and organisation identified Reduction in cost of sickness absence £1.9m over two years. Net saving after costs of interventions etc. £1.57m For further details see Research Report 295 at www.hse.gov.uk Programme Costs around 1/2M pounds and included largest UK survey, 15,000 employees, Interventions included: general awareness raising for all employees on WRS; training managers to better manage pressure and stress within the workplace; a confidential listening service for employees to discuss work related problems; active absence management including how to carryout return to work interviews; training in conflict management for employees who deal with the public, lone workers and call centre staff. Sickness absence fell from 10.75 days in 2001/02 to 8.29days in 2003/4 I think you will agree that the financial saving realised are significant, representing a reduction of over 40% in the cost of sickness absence.

Stress Guidance HSG 218 Managing the causes of work-related stress Making the stress Management Standards work. How to apply the Standards in your workplace. MISC 714. MISC686 Working together to reduce work-related stress - A guide for employees INDG 406 Tackling Stress: The Management Standards approach Real Solutions, real people. A managers’ guide to tackling work-related stress. ISBN 0717627675. At this point, I have completed the stress management process, and will go on to Work Related Violence, does anyone have any burning questions that they would like clarification on before I move on