Absence essentials: using focus groups in stress management

Focus groups form a vital part of the HSE's management standards approach to tackling stress. But how can employers make them more than another talking shop?

Employee focus groups represent a central plank of the Health and Safety Executive's (HSE) recommended approach to tackling work stress. But they need to be well planned and run if they are to fulfil their primary purpose - supporting or refuting data revealed in staff stress surveys, and helping to move the organisation towards consensual action plans on stress.>

The HSE stress management standards describe focus groups as a "good way" of deciding what needs to be done about stress, once the baseline data on stress and, in particular, any "hot spots", have been collected in a stress audit or other survey.

Its management standards toolkit recommends that employers should bring together groups of about six to 10 employees. It suggests that talking to a selection of employees from a specific work group or site - perhaps one where a survey reveals there are particular stress issues - should allow these matters to be explored in more detail.

However, the focus group is not only useful in following up the results of a stress survey. For example, Carol McCloskey, director of The Focus Group UK - a consultancy offering focus groups and other qualitative research methods - says that it may not be necessary to carry out a major organisation-wide employee survey to gather the baseline data in a smaller organisation. A series of focus groups might provide the information equally well.

Relatively low response rates to employee surveys might also make it difficult for small and medium-sized enterprises to use the results of a survey in a valid way, making qualitative data collection from a focus group the only real option, she adds.>

Even some larger organisations find that they only need to conduct full stress surveys once every two or three years, and hold a series of focus groups between survey years to provide qualitative data on progress in the intervening period.

A stress audit at Somerset County Council in 2001 highlighted hot-spot areas, together with information on the specific nature and level of stressors experienced by staff. A number of staff focus groups were held to provide feedback on the results of the audit and identify solutions. Organisations with the most proactive approaches to stress management tend to use this mix of quantitative audits and qualitative focus groups, according to an HSE research report (Beacons of excellence in stress prevention, HSE research report 133, 2003, www.hse.gov.uk) identifying beacons of excellence in stress prevention. The HSE recommends that targeting employees working in hot spots for inclusion in focus groups is worthwhile, as these are the people best placed to address any issues flagged up by an audit.

Benefits

Focus groups produce a sense of participation among employees, in addition to creating greater ownership of the process. Employees feel as though they have the opportunity to express their opinions directly, the HSE-backed research concludes.

This participative approach helps to produce high-quality data, as staff involvement levels are usually high, with most people valuing the opportunity to be consulted on stress. Focus groups draw on local understanding and knowledge, and can provide information that is not easily measured in a survey. This can include examples of stressful situations, details of organisational culture and management styles in different parts of the business, and the nature of relationships between people.

The London Borough of Hounslow used focus groups to gather information about workplace stress in late 2000. The discussions were led internally by the principal employee counsellor and coordinated by the two people with organisational responsibility for stress - the organisational development manager and the occupational health and safety manager. The groups of council employees considered three key questions:

• What do you see as the causes of pressure?
• What do you see as the signs of stress around you in the workplace?
• What could the following parts of the organisation do to help cut workplace pressure: occupational health; employee counselling; training; personnel; managers and senior managers; and elected councillors?

The HSE says that organisations should start planning to hold focus groups as soon as they embark on the process of collecting baseline data on stress, as part of stress risk assessments. This recommendation is supported by McCloskey. She believes that employers should have realistic ambitions for focus groups. They should not see them as the answer to everything, but as part of a broader approach to stress. Organisations need to work through what they want to know well in advance, and be clear about how the results of focus group discussions will be fed back to employees.

In her 20 years of working with focus groups, McCloskey recognises that there is often "lots of anti-management feeling" in an organisation with high levels of work-related stress, and suggests that quick fixes based on the results of focus group discussions without feedback to participants will not succeed.

Confidentiality is key

Ensuring confidentiality and participants' anonymity is crucial to the success of the focus group approach. Some stress risk assessment is essentially management-driven, but Somerset County Council sought to make its process more participative by protecting confidentiality. For example, external consultants were the only people involved in identifying appropriate employees to take part in the focus groups and in conducting those meetings.

However, the option of using external facilitators to run focus groups is not likely to be one that is open to many smaller organisations seeking to manage stress, and these employers need to ensure that the in-house person they choose is seen as being neutral. Often, HR specialists are considered to be the obvious choice to lead focus groups, but McCloskey warns that this might not be the case if the HR function is closely involved in stress grievances or cases, as this may inhibit open discussion.

Facilitators

The facilitator does not need to be a manager, and could be a trainer or other person with good, active listening skills. It is most important that whoever is chosen is not involved too heavily in the stress issues to be discussed by the focus groups.

Roger Mead, who has eight years of stress management experience and until recently was on the executive committee of the International Stress Management Association, agrees that general trainers can run stress focus groups. However, he advises that there are legal issues surrounding risk assessment for workplace hazards - for example, the person conducting stress focus groups must be "competent" in the legal definition of the term. There are also ethical issues surrounding supporting individuals if issues are raised during a focus group, and he argues that this makes a professional stress manager the best choice for facilitator.

Facilitators should be seen as independent and, if internal, from a different part of the organisation to that of the focus group participants. Facilitators should take care not to defend organisational policy or demonstrate inside management knowledge during discussions.

"In-house facilitators commonly make the mistake of defending or refuting a comment made by a group member," McCloskey says. "This immediately stops discussion as people become wary of sharing their views if they believe the facilitator will disagree with them."

Gordon Tinline, a director of the business psychologist Robertson Cooper, agrees that confidentiality is a potential issue in focus groups, especially "when you start drilling down to ever smaller groups of workers". Robertson Cooper uses focus groups as part of its ASSET programme for stress risk management. Its consultants rehearse what the report of a particular focus group is likely to say with the group at the end of a discussion to give them an opportunity to question anything they are uncomfortable with.

Robertson Cooper never gives the names of those taking part in focus groups to the organisation, although Tinline accepts that a worker's absence from duty signals to a manager that they are taking part in a discussion.

It becomes easy to breach confidentiality in reporting back on focus group discussions in small companies, according to Mead. He believes that the solution for smaller firms lies in training line managers to recognise stress and talk regularly about pressure with team members, so that all team briefings can perform the function of a focus group. The aggregate data gathered from stress audits cannot be confidential if it is part of proper risk assessment, he points out.

Running the groups

The HSE's recommended group size of six to 10 participants is designed to enable a wide enough range of viewpoints to be aired without the participants having to compete to be heard. This size of group should be used to explore sensitive issues highlighted by surveys so that all participants get a chance to speak. However, it is possible for larger focus groups to work if the object is to gather a large number of brief views or suggestions. But most experts agree that it is preferable to run a higher number of smaller groups rather than a couple of large ones.

The HSE suggests that organisations and facilitators prepare a schedule of questions to be discussed by the focus group. Most of those with experience of the focus group approach argue that a meeting lasting between one-and-a-half to two hours will not have time to consider more than four or five key questions. Time must also be set aside for summing up, and explaining what happens next, including how participants will be kept informed and how the discussion will be presented to the organisation. An HSE guide (How to organise and run focus groups, HSE management standards for tackling work-related stress, www.hse.gov.uk) contains a useful section on designing questions for stress focus groups, pointing out that there should be different types of questions at each stage of the discussion, and the need to avoid leading, loaded or double-barrelled questions.

Robertson Cooper tends to undertake workshops once the results of the employee survey on stress have been analysed. Focus groups are used to verify survey data and explore with employees the range of solutions that may be possible in the context of their own working environment.

Although groups tend to concentrate on hot-spot areas, Robertson Cooper will occasionally pick out groups where the results of a stress survey were particularly encouraging, especially if there is a similar part of the organisation where high levels of stress are reported. "The difference usually comes down to a question of people management," Tinline says.

He says that the focus groups he organises tend to consist of around eight people from a similar level in the organisation, "and not more than 12, as it then starts to break into two groups". Discussions as part of the Robertson Cooper programme last for around an hour, and start by presenting people with an opportunity to talk about the pressures they face at work.

Tinline and his colleagues will then provide feedback on the results of the preceding stress survey and give workers a chance to talk about what they see as the underlying causes of what the survey reveals about work stress.

Discussion then switches to developing "realistic and workable" solutions by encouraging people to think beyond the obvious, such as "we need more people" in the case of work overload, Tinline emphasises. Groups finish by talking about some of the positives of the job. Participants normally have access to the full report of the stress survey and the focus group exercise.

Mead also uses focus groups to explore, tease out and validate data revealed in a stress audit, and to move towards a solution. Focus groups can represent a form of participative risk assessment and he uses a two-stage approach when facilitating them.

The first session deals with what participants believe is causing stress. The second, which takes place after the facilitator has prioritised and linked issues, targets specific matters using open questions such as "what would you like to happen about X?". At this point, Mead argues, the line manager should be involved. He believes the key to a successful discussion is for the facilitator not to be judgmental and not to challenge the group's views, accepting that different people will be pressured by different aspects of working life.

Difficult situations

McCloskey recognises that some groups will be difficult, or hostile to the aims and objectives of the focus group, which some participants still see as a management exercise. "These happen", she accepts, but suggests that in these situations, facilitators should "ditch the script if necessary for a while, be firm but polite with the individuals who are dominating the group and try to explore underlying tensions".

Tinline believes that focus groups can sometimes distort the picture presented by a stress survey, and that you "will always get one or two people, perhaps with particular issues around stress, who try to dominate focus group discussions".

There will always be individuals with an axe to grind about a single issue who try to sway focus group discussions, according to Mead. In these circumstances, the facilitator needs to check and test what these people are saying. It sometimes works to list issues on a flipchart, and get participants to place stickers on their top three priorities: this often gives a truer picture, he finds. If an individual has a grievance, the organisation will need to act, but the whole point of risk assessment for stress is to consider what the organisation can do to remove the hazard from the system, looking at proactive, collective solutions for the organisation.

Developing solutions

Focus groups can help to initiate the process of developing stress solutions, but employers need to avoid the pitfall of groups becoming yet another talking shop. At the start of any new project, consultants at Robertson Cooper will make employers aware that stress is not an area where organisations can survey people and do nothing about the stress that the stress-audit questionnaire reveals.

"For a start, there is the legal issue surrounding foreseeability," Tinline points out. "We need to make sure that employers will see things through and act on the results of surveys and focus groups." He also says that senior management commitment is vital, particularly if the work on stress is being led by occupational health - in his experience, this is a function with a relatively low power base in most organisations.

Focus groups should take the "states to be achieved" (checklists of action points) in the HSE's stress standards as the starting point. They should consider whether the good practice outlined in the management standards is happening in the organisation and, if not, what needs to happen to move the organisation towards this point.

Managers, the HSE argues, need to ensure that employees participating in the focus groups are kept informed as action plans develop, suggesting that "it is unrealistic to expect employees to participate in focus groups to discuss problems without a commitment to at least share the outcome with them soon after."

Facilitators should write up summaries of focus group discussions as soon as possible after the meetings, and read all the summaries in one sitting to look for trends, the HSE suggests. The structure of the final report of focus group discussions is likely to vary between organisations, but it might include information on the purpose of the group, details of the sessions, themes and conclusions. The "biggest failure" of focus groups, according to the HSE, is not reporting on discussions to participants and failing to apply the results to develop action plans.

The HSE identifies possible ways in which the results of focus groups might be translated into action:

• hold a meeting to review the summaries and discuss the implications;
• analyse the focus groups' information in the context of other management information on stress gained from surveys;
• highlight the main themes and issues arising from focus groups and discuss and record how these will be tackled; and
• decide which issues can be tackled locally and which need addressing within the wider organisational context.

Mead believes organisations should identify a range of solutions, even if some might appear to be "pie in the sky". The key is to get the group to set out what they wish to see happen - moving towards the "desired states", in HSE management standards speak. He often splits his second session into two syndicates, which report back to each other with only light facilitation.

So does your organisation need focus groups on stress? Tinline believes focus groups are "nearly always helpful, but not always essential". If an organisation collects regular survey data and employs good people managers who pick up issues as they arise, it may not need focus groups, "but this is quite often not the case".

However, focus groups do raise expectations among those taking part, and participants need to know what participation will involve, how the information they provide will be used, and what management action will result.

In future, more emphasis should be placed on audit information flowing back to line managers, who must talk to teams and use the information from focus groups to develop action plans, to avoid the danger of these groups becoming "a way of reacting rather than acting", Mead concludes.