Feeling the pressure

Everyone has the right to work in a healthy environment free from illness. Given the nature of the NHS, managers, supervisors and health and safety representatives should not only take the management of stress at work seriously but Trusts should be leading the agenda within their local area. There is a lot of good work going on within the NHS but much more can be done to improve standards.  
    
Stress at work is a big cost to the NHS. An estimated 442,000 people within the UK suffer from work-related stress, resulting in 13.5 million working days lost each year. Recent statistics show that NHS staff are almost four times as likely to be absent from work due to stress compared with people in other occupations – both public and private sector. But the real cost can often be staff coming into work and not performing to their true potential – an estimated £1,035 per employee per year is lost due to presenteeism1. With figures like these there is a clear need to drive forward stress management within the NHS.
    
Beyond the financial reasons for tackling stress at work, there are the moral and legal cases. Prolonged stress is likely to cause mental and/or physical illness and so there is a legal duty placed on managers to protect employees. Employers have a responsibility to protect the health, safety and welfare of their employees according to the Health and Safety at Work etc Act 1974. There must also be a risk assessment carried out for workplace hazards, which include work-related stress, under the Management of Health and Safety at Work Regulations 1999.

Management standards
Helping employers fulfil their legal and moral duties is The Management Standards approach, recognised and used within both the public and private sector for several years. It can be extremely effective in managing and reducing work-related stress.
     
The six Management Standards focus on:

• demand, ie workload, work patterns and the work environment
• the amount of control a person has over their work
• support, ie how much encouragement, sponsorship and resources are provided by the organisation, line manager and colleagues
• relationships at work, ie how well colleagues promote a healthy working environment, conflict, etc
• whether employees fully understand their role and how they fit in to an organisation 
• change, ie how it is managed and communicated.

Each standard describes an area of work, which, if not properly managed, can lead to stress at work. HSE’s Management Standards suggest that employers should:

• use existing absence data along with a survey of the workforce to decide who is affected by stress at work
• use focus groups to evaluate the data and create action plans
• monitor and review findings and create action plans.

Northumbria Healthcare NHS Trust decided to use HSE’s Management Standards with some real benefits, including a reduction in sickness absence; a decline in self-reported stress levels; a decline in claims of bullying and harassment; and a reduction in levels of staff turnover.
    
“The NHS is a public emergency service which can place high demands on the resilience of its staff,” said Ann Stringer, director of HR and OD at Northumbria Healthcare NHS Trust. “We already provide good support services for staff to help them cope with these pressures but it is also very important that we have processes in place to identify and reduce stress at source.”

Commitment from the top
Some of the challenges Northumbria faced during the process included securing management commitment and interest.

It is important that senior managers are committed to the process from the very start and this often requires a business case. Employees are only likely to take part if senior managers demonstrate their commitment to managing the causes of work-related stress.

If you can successfully secure senior management commitment, you should be able to show that:

• senior managers are visibly demonstrating support and participating in communication activities
• resources are being allocated, eg extra funding or time 
• authority is being delegated to relevant groups, eg a steering group.

Clear communication is a major factor in preventing stress at work. When employers, managers and employees know what areas they are responsible for, there is far less confusion about who should deal with certain situations, and in fact how they should be dealt with.
    
Furthermore, the Management Standards act as a form of training. They provide information about stress triggers and encourage line managers to look out for signs of stress.
    
HSE has jointly sponsored research into the competencies required for managers to tackle stress. These competencies have been mapped against the Management Standards and include being respectful and responsible; managing and communicating existing and future work; managing the individual within the team and effectively dealing with difficult situations.
    
This research has resulted in a number of tools to help managers identify symptoms of stress. A particularly useful tool is the team stress risk assessment questionnaire, which can be found at: www.hse.gov.uk/stress/pdfs/teamquestionnaire.doc.

Bullying and harassment
Bullying and harassment have also been identified as causes of stress. The responsibility for dealing with a case of bullying lies solely with the organisation and its managers.
    
Things to look out for in these situations include:

• a change in a group’s behaviour
• different members of a group appearing anxious
• an increase in sickness absence
• difficulty attracting new staff
• disputes, and/or
• an increase in staff turnover.

Managing and preventing stress is not only the responsibility of managers, or others directly responsible for health, safety and wellbeing, everyone has a role to play. It is up to employees and their representatives to ensure they are not working in an environment that causes excessive pressure. Employees should report any symptoms of stress, which are caused by the demand put on them.
    
To tackle work-related stress, employees can work with their employer, manager, health and safety representative or occupational health department to agree realistic ways of dealing with problems.
    
“The big challenge is not seeing it [the stress risk assessment] as one sector owned thing. It is not just an HR issue, it is not just an OH issue, it is an issue for the whole organisation. Everyone has a responsibility,” explains Teresa Jennings, a occupational health psychologist.
    
To ensure that health, safety and wellbeing are protected, employees should:

• familiarise themselves with HSE’s Management Standards
• be active in helping those directly responsible for health and safety to put effective plans in place
• attend group discussions, complete questionnaires and generally provide feedback at any given opportunity
• read all communications, and
• attend any stress management training courses that are made available.

Involve staff
Stress-related illness and the general health, safety and wellbeing of staff within the NHS are concerns. In order to tackle problems and improve the level of care provided to employees and in turn patients, the NHS and Department of Health have initiated a review on the health and wellbeing of NHS staff.
    
An NHS staff survey provides employees with an opportunity to have their say about the management of health and wellbeing. One of the other reasons for this is to find out what triggers could be causing stress within the NHS. For example, excessive working hours, lack of breaks, experience of bullying, and so on.
    
The survey will highlight and provide solutions to problems such as who is responsible for driving health and wellbeing within the NHS; inequalities that exist between different staff groups and their access to health and
well-being resources; and how any measures can be sustained. NHS employees who wish to have their say about their health and wellbeing can take part in the survey at www.nhshealthandwellbeing.org.
    
Interim findings will be published in the summer and final recommendations will be made available by the end of 2009.
    
Using the Management Standards can provide a range of benefits, not just a boost to employee morale. If these standards are achieved within the NHS, the benefits will be amplified, having a significant impact on the level of care that members of the public receive.
    
There is growing evidence to show the link between improved worker wellbeing and increased productivity, as well as reduced sickness absence and greater staff retention.

For more information
For more information on HSE’s Management Standards, visit: www.hse.gov.uk/stress/standards.

Notes
1. The 2007 Sainsbury Centre for Mental Health report, Mental Health at Work: Developing the business case.