Standards for stress

Chris Dyer reports on the HSE's plans to publish management standards for work-related stress.

The HSE has announced a three-month consultation on management standards being developed to help employers gauge and address levels of stress in their workforces. Managers and employees are being asked for their views on proposals to reduce workplace stress following the completion of a pilot study that tested the standards in various workplaces.

Work-related stress (WRS) 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 stress, anxiety or depression related to work. This resulted in an estimated 13.4 million days lost to industry and costs to society of about £3.7 billion (Work-related ill health 2001/02 ). The estimated prevalence rate of WRS and related (mainly heart) conditions has been increasing over recent years and is now around double the level it was in 1990.

Recognising this situation, the HSC dedicated one of eight priority programmes in its Strategic Plan 2001/04 (HSC strategic plan 2001/04 ) to reducing the high incidence rate of work-related illness caused by stress. The HSC is aiming for a 20% reduction in incidence of WRS and a 30% reduction in number of working days lost from WRS by 2010.

Partnership, advice and standards

In September 2000, the HSC rejected for the time being the need for specific legislation or an Approved Code of Practice (ACoP ) on WRS (HSB 291). Instead, it decided to develop initiatives based on partnership, advice and management standards. In May 2001, the HSE published Tackling work-related stress: a managers' guide to improving and maintaining employee health and well-being¹, which set out a risk assessment approach to tackling WRS. This guidance identified seven broad categories of risk factors, or "stressors", for WRS:

culture - of the organisation and how it approaches WRS;

demands - such as workload and exposure to physical hazards;

control - how much say the person has in the way they do their work;

relationships - covering issues such as bullying and harassment;

change - how organisational change is managed and communicated within the organisation;

role - whether the individual understands their role in the organisation and whether the organisation ensures that the person does not have conflicting roles; and

support, training and factors unique to the 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: demands, control, support, relationships, role and change were then used to develop management standards that would enable an organisation to assess its performance in managing WRS.

The first draft of the management standards was published on the HSE's website in 2003², along with several tools to help assess levels of WRS in an organisation (Stress pilot takes off ). The standards are based on the HSE's belief, backed by research (HSB 324), that WRS is best tackled by primary or organisational level interventions rather than by interventions at secondary or tertiary levels, which focus on the individual (see box 1). This approach centres on managing WRS by prevention rather than treatment.

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 assumes that the same proportion of employees in an organisation will be very or extremely stressed by work, and for each of the six selected stressors it proposes a standard based on the percentage of workers exposed to that stressor in the workplace. For demand, control and support, the standard was set at 85% - an organisation would only meet the standard if at least 85% of employees were satisfied with the management of these elements, whereas for relationships, roles and change the standard was set at 65% because evidence linking these to health outcomes is not so robust.

The HSE has also developed a methodology that organisations can use to gauge their success in managing stress, which includes questionnaires - "filter tools" - and supporting materials directly related to the management standards (see box 2). The HSE stresses that the tools are provided for assistance only, that organisations are in no way obliged to use them and that they are free to use their own or commercially provided products. However, it warns that research suggests that many "off the shelf" products for measuring WRS may be of dubious worth.

As every organisation is different, the HSE has avoided prescribing solutions, although it has published guidance containing case studies to help employers and employees tackle WRS (see box 3).

Pilot study

The HSE developed the standards in conjunction with partners drawn from a range of organisations and as part of the development process some of these organisations agreed to pilot the standards and the methodology. Twenty-two organisations took part in the pilot study, which started in April 2003.

Pilot organisations included one charity and 14 public sector organisations, comprising four government departments, six city and metropolitan borough councils, two educational establishments, an NHS Trust and a police force. Private sector pilot organisations included two manufacturing companies, two companies involved in energy production and supply, one company from the railways sector and two financial services companies.

Around 11,000 employees participated, ranging from 26 in one organisation to 6,000 in another. Pilot organisations reported response rates to questionnaires ranging from 30% to over 80%, and 95% in one part of a public sector organisation. The two organisations with the highest response rates were both public sector and had both implemented an electronic questionnaire. Feedback from the pilot organisations was collected through emailed questionnaires, face-to-face interviews, telephone interviews and the organisations' own in-house reports.

General reactions to the draft management standards were largely positive. One organisation said it had not known where to begin in conducting a risk assessment for WRS and that the standards and associated process had helped it to get started.

Some organisations, while endorsing the general management standards approach, expressed reservations about the amount of work in the pilot process, and the length of time the process took. The relative simplicity of the process also caused some problems; having used a simple process some organisations were then surprised to find it raised complex issues.

Preparation

The HSE's methodology suggests that organisations prepare to use the standards by gaining organisational commitment and selecting sample groups (see box 4). In one organisation the simplicity of parts of the methodology made it more difficult to secure senior management commitment because it was regarded as being too simple.

Nearly three-quarters of the pilot organisations said that senior management supported the use of the standards because of an existing commitment to tackle WRS in their organisation and the desire to be recognised as a good employer.

Just over half said that other reasons the standards were piloted was because of:

the HSE's reputation and regulatory role;

the simplicity of the draft standards; and

the package of risk assessment tools provided for pilot organisations.

The offer of external support from the HSE was a significant factor for one-third of the pilot organisations. Information on costs and benefits was not a significant consideration for the majority of the organisations.

Filter tools

Three-quarters of the pilot organisations used the HSE's first pass filter tool to assess their organisation's performance against the management standards, while the others used their own questionnaires. Several of the organisations developed electronic versions of the HSE's questionnaires.

Asked if the percentage statement in the management standards was helpful in deciding whether the standard had been met, most pilot organisations said it was. Most said that having used the process, they had found it easy to know if they had met the standards.

Nevertheless, there were significant criticisms. Pilot organisations expressed a range of views on the accuracy of the supporting tools in identifying critical risk areas. Some organisations thought they were accurate, but several expressed reservations about the reliability of the process and the accuracy of the tools. Some felt that some of the questions contained in the tools were ambiguous, misleading, badly phrased or failed to address the relevant stressor.

Several organisations questioned whether the findings on the first pass filter tool were a true reflection of WRS within their pilot group, in that the standards seemed to be met too easily in groups where higher levels of WRS might be expected.

There was also criticism of the lower-level percentages (65%) for three of the stressor areas: relationships, roles and change. Trade unions and others were particularly critical of the lower percentage for relationships, their argument being that it was unacceptable for one-third of an organisation's staff to have poor workplace relationships.

During the pilot exercise, the organisations discussed the advantages and disadvantages of having separate first pass and second pass tools, the latter being a more detailed questionnaire used to define problem areas. The advantages were expressed in terms of convenience and ease of use, disadvantages included a lack of sensitivity of the first pass tool. While some organisations found that first pass and second pass results were consistent, others reported that first pass results were potentially misleading.

Despite these reservations, most of the pilot organisations thought that the management standards approach was consistent with, or integrated well with, their existing human resources policies, such as health and safety, performance management, bullying and risk assessment processes.

Engaging with employees

Pilot organisations used a range of approaches to consult with employees on agreeing the problems and actions to be taken. These included:

training sessions;

debriefing sessions;

internet and poster briefings;

information cascaded from senior management briefings;

presentations to staff;

team meetings;

one-to-one discussions; and

working parties set up to address specific topics.

Pilot organisations said that efforts to engage with staff had been largely successful. Focus groups were used by 10 organisations to engage with their employees and five had focus groups planned. The reactions to the experiences of running focus groups were generally positive, although several pilot organisations emphasised the need for trained facilitators to run focus groups. One organisation said that people who had been trained in the traditional occupational health route, such as nursing staff, were more likely to focus on the individual rather than the organisational issues.

Pilot organisations reported few barriers or concerns around ensuring employee involvement. While some reported a relatively low response rate to questionnaires and invitations to attend focus groups, others reported high response rates and groups of employees volunteering to take part in the pilot exercise.

Many of the pilot organisations said that they had involved trade unions in the process. Some had encountered initial reservations on the part of trade unions, though these had subsequently been resolved. Most reported that those consulted were satisfied with the process or, at least, had not raised any major issues.

Actions and interventions

While several organisations had followed up their focus groups by identifying interventions and developing action plans, few had yet reported on this stage of the process and a significant number of the pilot organisations were at earlier stages. One pilot organisation, which had used focus groups to identify interventions, noted that many of the interventions were not what were often thought of as WRS interventions: "A lot of the interventions were not . . . particular "stress" interventions in the sense that . . . we'll bring in a lifestyle coach or whatever. It was about undoing some of the blockages that meant they could get on and do some of the work faster." This would seem to indicate the process is identifying organisational, rather than individual, interventions.

Work in progress

Evaluation of the pilot project began in December 2003 and continued into early March 2004. An evaluation report of the work to date has been published³, and evaluation will continue and be updated to reflect feedback from pilot organisations that are currently taking forward important aspects of the pilot process. The evaluation so far is that most of the organisations rated the draft management standards as seven or eight out of 10 in terms of how helpful they had been.

The HSE has also held a series of stakeholder workshops with the pilot employers, academics, human resource specialists, trade unions and others to refine and develop its approach. The findings from the pilot exercise and the workshops were presented to the HSC in April 2004, and it was agreed that the HSE should consult more widely on the development of its proposals. The HSE has revised its draft management standards (see table 1) and a public consultation exercise on the standards and the HSE's approach to managing WRS is running until 27 August 2004. The HSE will evaluate the outcome of the consultation in the autumn and will seek the HSC's agreement to launch management standards based on all these experiences at the end of 2004.

Announcing the consultation, head of the HSE's better working environment division Elizabeth Gyngell said, "Work-related stress is not the reasonable pressure that is part and parcel of all work and that helps to keep us motivated. It is the kind of excessive pressure that undermines performance, is costly to employers and can make people ill.

"We are working hard to help tackle the issue through good job design and people management. The HSE cannot do this alone. We need employers, employees, and their representatives to visit our website [http://consultations.hse.gov.uk/consult.ti/StressManagementStandards] and participate in this consultation."

The website contains a video explanation of the proposals, with the consultation available online or on CD-ROM; it is not available in print. This has caused concern at the TUC. The TUC's senior health and safety policy officer Hugh Robertson says that the HSC consultation process "will disenfranchise many thousands of safety representatives who do not have access to the internet or a computer". He added that the approach "treats consultation as some kind of ballot. This is totally at odds with the TUC's view of how consultations should be carried out and the role of unions and employers organisations in consulting their membership groups and responding appropriately."

Chris Dyer is editor of HSB and a freelance journalist

¹ "Tackling work-related stress - a managers' guide to improving and maintaining employee health and well-being", HSG218, HSE Books, £7.95.

² www.hse.gov.uk/stress.

³ "Evaluation of the management standards pilot study", Health and Safety Laboratory, http://consultations.hse.gov.uk/consult.ti/StressManagementStandards, free.

BOX 1: TREATING CAUSES NOT SYMPTOMS stress prevention and management interventions in the workplace can be broken down into three broad groups. Primary interventions attempt to eliminate the sources of stress by focusing on changing the physical or socio-political environment to match individual needs - examples include improving communication, redesigning jobs or involving employees in the decision-making process. Secondary interventions help individuals manage stress without trying to eliminate or modify workplace stressors - examples include stress management programmes, which assist individuals in identifying stress symptoms and help them acquire coping skills. Tertiary interventions aim to rehabilitate people who have been unable to cope - they seek to assist individuals who are experiencing ongoing problems emanating either from the work environment or their work lives and they focus on adapting individual behaviour and lifestyle without much reference to changing organisational practices.

 

BOX 2: STRESS MANAGEMENT METHODOLOGY The HSE' s methodology has six stages: preparation; using the first pass filter tool; using the second pass filter tool; consultation;   taking action; and review . The first pass filter tool consists of six simple one-line questions, one for each of the stressors, distributed to each of the employees in the study. It is designed to give an indication of how well the workforce thinks an organisation is managing WRS and will highlight any problems. The second pass filter tool is used to analyse the results and to decide which stressors might require more investigation. It comprises a brief questionnaire for each of the stressors and is designed to indicate where problems lie. It is issued to all of the employees in the areas needing further investigation. Another tool provides analysis of the results from the second pass and indicates those aspects of each stressor that are likely to be a problem. The methodology then envisages a consultation phase, during which employees are asked what the problems are. The HSE recommends making use of local arrangements to encourage consultation. It also suggests that focus groups are a good source of ideas for potential interventions, which are likely to comprise a blend of "quick fixes" and longer-term solutions. The HSE suggests that, in the long term, a positive change in organisational culture is likely to prove the best way of preventing WRS. In the short to medium term, it is likely to be more productive to set up realistic interventions that are achievable rather than trying to change ingrained aspects of organisational culture. Employees often have a good understanding of sources of stress and what their employer might do, but the HSE warns that once employees are asked about these they will then expect action to be taken. Interventions must be evaluated and the results of the evaluation fed back to all employees.

 

BOX 3: STRESS MANAGEMENT KIT The HSE guidance pack1 contains a range of case studies designed to support the stress management standards, along with practical prompt cards for managers, information on how to use the case studies, and an action plan to record and monitor what needs to be done. The guidance is based around examples of good practice gathered by the HSE's Stress Priority Programme team and the findings of HSE-funded research that identified UK organisations exemplifying excellence in stress prevention (HSB 324). It builds on, and complements, Tackling work-related stress - a managers' guide to improving and maintaining employee health and well-being, HSG218, which is included in the pack. The 18 case studies are chosen to illustrate good practice for each of the HSE's six categories of risk factors for work-related stress: demands, control, support, relationships, role and change. There are examples from a variety of organisations, including schools, hospitals, retailers, small and medium-sized enterprises, manufacturing companies, construction firms and local authorities. 1 "Real solutions, real people - a managers' guide to tackling work-related stress", ISBN 0 7176 2767 5, HSE Books, £20.

 

BOX 4: SELECTING STAFF FOR STUDY Pilot organisations chose which parts of their organisation would take part in the study. These included: a mixture of business units from across a whole company; a manufacturing plant; offices in large government organisations; all the teachers within a local authority education sector; first and second line management; front desk staff and social services staff of a local council; and a range of line operative, office-based and supervisory staff. Two organisations (with 145 and 488 staff) ran the pilots across the whole of their organisation. Participants in the pilot included supervisors, managers, factory operatives, administrative staff, front line office staff, teachers, lecturers, doctors, nurses, council employees and police officers. The pilot organisations each took a different approach to selecting the groups to take part in the pilots. Some asked for volunteers, one selected parts of the organisation to give a cross-section, and some selected a part of the organisation that represented a self-contained unit. One organisation selected first line staff, as they "would be most affected by stress issues"; another selected staff "based on identified areas where staff are known to have a varied and busy workload". Interest of senior managers was quoted as a reason by three pilot organisations and one of these also cited pressure from local trade unions. Two pilot organisations selected parts of the organisation because they were currently going through, or had recently experienced, significant organisational change, while one pilot organisation selected a part of the organisation because there were no major changes happening at the time of selection. One organisation selected an office where staff were all located in one building, since this "helped the logistics, ie handing out the paper questionnaires, communications, etc"; while another chose an office partly because it was a multi-site operation and "the satellite office offered the opportunity to explore physical remoteness from the senior managers." One of the two smaller organisations that had included all staff noted that they did not wish to leave any part out, "to prevent suspicion".

TABLE 1: WRS MANAGEMENT STANDARDS

The HSE describes its revised draft management standards on WRS as practical statements of good management practice that are supported by a body of research and by an ongoing dialogue with a range of businesses, professional bodies and unions. The standards are not new regulations: they aim to be a non-legislative yardstick to help organisations meet their existing duty of care and their duty to assess the risks from WRS. The HSE says that they, "highlight the components of good organisation, job design and management that keep stress levels in check and enhance productivity".

The standard is:	State to be achieved
DEMANDS - includes issues such as workload, work patterns, and the work environment
(At least XX% of)* 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. * A percentage figure of 85% was used for the pilot exercise.	The organisation provides employees with adequate and achievable demands in relation to the agreed hours of work. People's skills and abilities are matched to the job demands. Jobs are designed to be within the capabilities of employees. Employees' concerns about their work environment are addressed.
CONTROL - how much say the person has in the way they do their work
(At least XX% of)* employees indicate that they are able to have a say about the way they do their work; and systems are in place locally to respond to any individual concerns.     * A percentage figure of 85% was used for the pilot exercise.	Where possible, employees have control over their pace of work. Employees are encouraged to use their skills and initiative to do their work. Where possible employees are encouraged to develop new skills to help them undertake new and challenging pieces of work. The organisation encourages employees to develop their skills. Employees have a say over when breaks can be taken. Employees are consulted over their work patterns.
SUPPORT - includes the encouragement, sponsorship and resources provided by the organisation, line management and colleagues
(At least XX% of)* employees indicate that they receive adequate information and support from their colleagues and superiors; and systems are in place locally to respond to any individual concerns.     * A percentage figure of 85% was used for the pilot exercise.	The organisation has policies and procedures to adequately support employees. Systems are in place to enable and encourage managers to support their staff. Systems are in place to enable and encourage employees to support their colleagues. Employees know what support is available and how and when to access it. Employees know how to access the required resources to do their job. Employees receive regular and constructive feedback.
RELATIONSHIPS - includes promoting positive working to avoid conflict and dealing with unacceptable behaviour
(At least XX% of)* employees indicate that they are not subjected to unacceptable behaviours (eg bullying) at work; and systems are in place locally to respond to any individual concerns.   * A percentage figure of 65% was used for the pilot exercise.	The organisation promotes positive behaviours at work to avoid conflict and ensure fairness. Employees share information relevant to their work. The organisation has agreed policies and procedures to prevent or resolve unacceptable behaviour. Systems are in place to enable and encourage managers to deal with unacceptable behaviour. Systems are in place to enable and encourage employees to report unacceptable behaviour.
ROLE - whether people understand their role within the organisation and whether the organisation ensures that the person does not have conflicting roles
(At least XX% of)* employees indicate that they understand their role and responsibilities; and systems are in place locally to respond to any individual concerns.   * A percentage figure of 65% was used for the pilot exercise.	The organisation ensures that, as far as possible, the different requirements it places upon employees are compatible. The organisation provides information to enable employees to understand their role and responsibilities. The organisation ensures that, as far as possible, the requirements it places upon employees are clear. Systems are in place to enable employees to raise concerns about any uncertainties or conflicts they have in their role and responsibilities.
CHANGE - how organisational change (large or small) is managed and communicated in the organisation
(At least XX% of)* employees indicate that the organisation engages them frequently when undergoing an organisational change; and systems are in place locally to respond to any individual concerns.   * A percentage figure of 65% was used for the pilot exercise.	The organisation provides employees with timely information to enable them to understand the reasons for proposed changes. The organisation ensures adequate employee consultation on changes and provides opportunities for employees to influence proposals. Employees are aware of the probable impact of any changes to their jobs. If necessary, employees are given training to support any changes in their jobs. Employees are aware of timetables for changes. Employees have access to relevant support during changes.