Managing work-related stress - the HSE sets its standards

Chris Dyer examines the development of the HSE's stress management standards launched in November.

National Stress Awareness Day, the first Wednesday in November, was marked this year by the launch of the HSE's new management standards for work-related stress¹.

The day, the seventh day of its kind to be organised by the International Stress Management Association (see box 1 ), saw new HSE material published to help organisations meet their existing duty of care and their newly-defined duty to assess the risk of work-related stress. The management standards define the characteristics or culture of an organisation where stress is being managed effectively. Accompanying the standards is a toolkit, comprising a survey and a continuous improvement model, which enables organisations to compare themselves with others.

The management standards are not new Regulations; employers already have a duty under the HSW Act to ensure, as far as is reasonably practicable, the health, safety and welfare of their employees at work, and to assess health and safety risks under the Management of Health and Safety at Work Regulations 1999. These duties cover work-related stress.

The evolution of the management standards has taken place over more than 10 years. In 1991, the HSE commissioned a review of the scientific literature to assess the nature of work-related stress and to provide information on ways to tackle the problem. This resulted in the publication in 1993 of Professor Tom Cox's seminal review of work-related stress (HSB 220 and HSB 222), which found that:

there was evidence that the experience of stress at work was associated with changes in behavioural and physiological function, both of which may be harmful to employees' health;
only a minority of organisations were purposely practising stress management;
most stress management interventions were individually focused;
stressor reduction/hazard control is the most promising avenue for intervention; and
measurement of work-related stress and the effectiveness of an intervention require a standard or target to be meaningful.

A critical argument for tackling stress at work under the remit of UK health and safety law is that it must be risk-assessed and managed like any other hazard. Cox and his colleagues advocated a risk assessment approach to managing work-related stress. Research from other academics, published in 1997, concluded that EU health and safety authorities should be providing appropriate advice and support to organisations to enable them to perform their own risk assessment as an effective strategy for managing work-related stress.

Although EU and UK health and safety legislation generally sets out minimum acceptable standards, Cox noted that organisations that actively monitored stress tended to be more aspirational in their targets, preferring to evaluate their performance against standards of excellence. This suggested that a standard for assessing psychosocial risk factors associated with work-related stress should be much more informative than merely being a pass/fail marker. To be in line with the HSE's notion of effective stress management, a standard that acted as a yardstick to enable organisations to plot and target progress was likely to be most effective.

First talks

In April 1999, the HSC issued a discussion document, Managing stress at work, seeking views on the best way to ensure the control of risks from work-related stress (HSB 278). Nearly all respondents (98%) thought that more needed to be done to tackle stress, and 94% thought that stress at work was at least partially a health, safety and welfare issue. Respondents broadly supported the concept that it was better to prevent stress before it occurred, through the adoption of good job design and good management practices, in line with a risk assessment approach.

There was no clear consensus on the action that the HSE might take; the HSC's options had included Regulations, an Approved Code of Practice (ACoP) and targeted, but informal guidance. Equal proportions of employers and employees were in favour of an ACoP. Of those calling for something else, employees preferred stronger action (ie Regulations), while employers preferred weaker action (ie guidance).

Following from the discussion document, the HSC agreed in 2000 to the development of a plan, involving partners, to tackle work-related stress. This plan included work to develop clear, agreed standards of good management practice for stressors, with the option of developing an ACoP later being kept under review (HSB 291). The HSC also dedicated one of eight priority programmes in its Strategic plan 2001/04 to reducing the high incidence rate of work-related illness caused by stress (see HSC strategic plan 2001/04). The HSC is aiming for a 20% reduction in the incidence of work-related stress and a 30% reduction in the number of working days lost by 2010.

Seven risk factors

In May 2001, the HSE published a manager's guide that sets out a risk assessment approach to tackling work-related stress. This guidance identified seven categories of risk factors for work-related stress or "stressors":

culture - organisational culture and how it approaches work-related stress;
demands - such as workload and exposure to physical hazards;
control - how much "say" workers have in the way they do their work;
relationships - covering issues such as bullying and harassment;
change - how organisational change is managed and communicated in the organisation;
role - whether individuals understand their role in the organisation, and whether the organisation ensures that workers do not have conflicting roles; and
support, training and factors unique to each individual - covering support from peers and line management, training for the person to be able to undertake the core functions of the job, and factors unique to a person that need to be catered for individually.

Six of these stressors - all but culture - were then used to develop the management standards that would enable an organisation to assess its performance in managing work-related stress. For each standard, "states to be achieved" were given that demonstrated good management of the control of risks from work-related stress.

The HSE published the first draft of the management standards on its website in 2003, along with tools to help assess levels of work-related stress in an organisation (see Stress pilot takes off). In research commissioned by the HSE, as many as one in five employees reported that they were either "very" or "extremely" stressed by their work (HSB 296). In setting the management standards, the HSE assumed that the same proportion of employees in an organisation would be very or extremely stressed by work, and for each of the six selected stressors it proposed a standard based on the percentage of workers exposed to that stressor in the workplace:

for demands, control and support the standard would only be met if 85% of employees were satisfied with the management of these standards; and
for relationships, roles and change the percentage level was set at 65%, as evidence linking these stressors to health outcomes is less robust.

The HSE also developed a methodology for organisations to use to gauge their success in managing stress, including questionnaires (filter tools) and supporting materials directly related to the management standards (see Standards for stress). The standards and tools were tested in a pilot study by 22 organisations, with the results of that experience being fed back to the HSC in April 2004. It was agreed that the HSE should consult more widely on the development of its proposals. A public consultation exercise was run through the summer and the results of the consultation have been fed back into the development of the standards.

Broad support

Respondents to the consultation supported all six of the draft standards, with a majority believing that each of the 30 states to be achieved in meeting the standards was achievable in their workplace. Asked to indicate on a scale of one to 10 how well they thought their organisation would currently perform against the states to be achieved for each of the six standards, most respondents rated their current performance at around six, with responses for the change standard rated slightly lower. Furthermore:

73% of respondents thought it would be useful to have a numerical target (for example a percentage) to assist in measuring progress towards the aims;
57% thought the target(s) should be included in the standard, while 43% opted for the supporting guidance; and
47% thought the target(s) should be an aspirational target, with 31% preferring a stepped approach, and 22% an absolute cut-off.

Responses to the consultation from the TUC and six unions indicate that:

the approach is broadly welcomed;
a legislative approach would have been preferred (an ACoP at the least);
an enforcement-led approach would be preferred;
a number of indicators are required to measure levels of stress within an organisation, not just the staff surveys that the HSE methodology uses;
sector-specific guidance is needed; and
the percentages used for the pilot exercise were unacceptable (they would prefer a model based on continuous improvement).

Responses received from the CBI and the Institute of Directors agreed that:

stress is an issue to be addressed and the management standards are an important milestone;
there is support for the non-legislative approach;
the approach should not be enforcement-led;
it is important to recognise that other tools and methods (other than the HSE tools) are available to measure work-related stress;
the standards may not always be achievable due to factors such as operational constraints; and
the percentage targets represent the weakest element of the standards, although some form of target would be useful to measure progress.

Responses received from individual organisations indicated that:

the view of the proposed standards varied from "the development should be welcomed and promoted as a management tool" to "the stressor [standard] headings are wrong and should be changed";
the non-legislative approach is supported and that this approach should be clearly expressed to avoid confusion;
there is some concern that benchmarks may be used as an enforcement tool;
there should be a greater emphasis on training (for employers and employees at all levels) in dealing with stress at both organisational and individual levels;
small and medium-sized enterprises (SMEs) may have practical implementation difficulties and specific guidance might be needed;
indicators other than surveys alone (the HSE tools) are required to measure the level of stress in an organisation; and
the percentage target as a "pass/fail" may not be achievable across all sectors. Emphasis should be on trends and continuous improvement.

All respondents expressed concern about the use of percentages, particularly in the form used for the management standards pilot, ie an absolute cut-off. There was a consensus that the most effective approach would be to promote best practice through continuous improvement and, as a result, the percentage targets have been dropped from the final version of the standards.

The end of the beginning

The HSE will now produce guidance for employers and employees (and their representatives) to support the chosen approach. The guidance will address concerns over the sole use of surveys and will suggest additional indicators. The HSE is also working in partnership with Health Scotland to develop guidance for SMEs.

In developing the standards, the HSE has used scientific principles to underpin standards that are practical and acceptable in the real world. Adopting the methodology of the management standards will normally mean that an organisation is doing enough to comply with health and safety law. Organisations are also likely to benefit from a reduced risk of work-related stress and improvements in the way its work is currently designed. This in turn is likely to have a positive impact on organisational productivity and performance.

The need for better management in this area is backed by statistics that show that work-related stress has overtaken musculoskeletal disorders as the biggest cause of working days lost through injury or ill health in Britain. In 2001/02, over half a million individuals in Britain reported suffering work-related stress, anxiety or depression. This resulted in an estimated 13.4 million days lost to industry and costs to society of about £3.7 billion (see Work-related ill health 2001/2002). The estimated prevalence rate of work-related stress and associated (mainly heart) conditions has been increasing over recent years and is now around double the level it was in 1990. A recent survey by the TUC suggests that the situation is not improving and may be getting worse (see next issue of HSB).

Responding to the publication of the standards, HSC chair Bill Callaghan said: "Pressure is part and parcel of all work and helps to keep us motivated. But excessive pressure can lead to stress, which undermines performance, is costly to employers and can make people ill."

Chris Dyer is editor of HSB and a freelance journalist.

1 "Management standards for tackling work-related stress", www.hse.gov.uk/stress/standards/index.htm.

2 "Tackling work-related stress: a managers' guide to improving and maintaining employee health and well being", HSE Books, HSG218, £7.95. Other HSE guidance includes "Real solutions, real people: a managers' guide to tackling work-related stress", HSE Books, ISBN 0 7176 2767 5, £25.

Box 1: the ISMA

The International Stress Management Association (ISMA)¹, a registered charity with a multi-disciplinary professional membership, exists to promote sound knowledge and best practice in the prevention, reduction and management of personal and work-related stress. It sets professional standards for the benefit of individuals and organisations using the services of its members. ISMA UK currently has almost 600 members ranging from professionals specialising in stress management consultancy, coaching, counselling and training to specialists in massage, hypnotherapy, aromatherapy and other complementary therapies.

The purpose of the ISMA's National Stress Awareness Day is to educate businesses and individuals about the positive steps they can take to reduce stress.

Together with the HSE and ACAS, the ISMA has developed a new leaflet² explaining the significance of the management standards for employees. ISMA operates a referral service for individuals or organisations wishing to use the services of ISMA members in their area, all of whom have been independently verified as providing a professional service.

1 www.isma.org.uk/help.htm.

2 "Working together to reduce stress at work: a guide for employees", www.hse.gov.uk/stress/standards/pdfs/leaflet.pdf.

Box 2: The HSE's stress management standards

Demands: includes issues such as workload, work patterns and the work environment.

The standard is that:

employees indicate that they are able to cope with the demands of their jobs; and
systems are in place locally to respond to any individual concerns.