Stress pilot takes off

Chris Dyer reviews the HSE's newly launched standards for managing work-related stress.

In September 2000, the HSC rejected for the time being the need for specific legislation or an Approved Code of Practice (ACoP) on work-related stress. Instead, it decided to develop initiatives based on partnership, management standards and advice.

The HSE has now launched a pilot project to test draft management standards on work-related stress. The HSE's website1 has a dedicated area covering its "stress priority programme", where the management standards are set out. The HSE wants all sizes and types of organisations to apply the draft standards and to feed back the results so that the standards can be developed. The website contains software tools to help implement the standards and guidance on using the HSE's methodology.

When the management standards have been tested, the HSC will decide whether or not an ACoP is necessary. The standards have the potential to offer agreed levels of management practice against which an employer's performance can be measured; the absence of agreed standards has meant that an ACoP in the current circumstances would be unenforceable.

Management standards

The management standards cover the majority of the stressors that can lead to work-related stress: demands; control; support; relationships; roles; and change.

The standards are intended to be simple to understand and apply. For each stressor identified in the HSE's guidance on stress for employers (Unison slams HSE over stress advice),2 the HSE has proposed a standard based on the percentage of workers exposed to that stressor at the workplace. 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. In the pilot programme, the HSE has made an assumption that the same proportion of employees within an organisation may be very or extremely stressed by work.

To reduce workers' experience of work-related stress, the HSE has set cut-off points for the six stressors:

  • demands, control and support are set at 85%, ie an organisation will achieve the standard only if at least 85% of employees are satisfied with the management of these elements;

  • relationships, roles and change are set at 65%, because evidence linking these to health outcomes is not as robust (see table).

    Work is underway to refine the estimates of numbers and proportions exposed to risk from low job control, job demands and social support.

    Six-stage process

    The pilot project process has six stages:

  • preparation;

  • using the first pass filter tool;

  • using the second pass filter tool;

  • consultation;

  • taking action; and

  • review.

    Preparation

    The HSE warns that any organisation undertaking the stress pilot programme needs commitment from senior management, line managers, employees and safety representatives.

    It suggests that ethical, legal and economic arguments can all be deployed where a case needs to be made for the pilot:

  • work-related stress can lead to ill health and seriously affect the workforce's quality of life;

  • health and safety law requires organisations to tackle work-related stress; and

  • although the true cost is not known, the HSE estimates that 6.5 million working days were lost in 1995 as a result of work-related stress.

    The HSE also provides guidance to help an employer decide which groups it should test the pilot standards on, and what to look for.

    First pass tool

    The HSE has developed a methodology to enable organisations to gauge their success in managing stress. This comprises first pass and second pass filter tools and supporting materials that are directly related to the management standards. The questions in the filters are based on the best available evidence linking (poor) work design to ill-health outcomes.

    The first pass filter tool consists of six simple one-line questions, one for each of the stressors, distributed to all employees in the study. It gives a rough indication of how well the workforce thinks an organisation is managing work-related stress risks, and will highlight any problems.

    A second tool is used to analyse the results and determine which, if any, stressors require further investigation. The analysis indicates three alternative states:

  • "green" - the organisation is probably achieving one or more of the standards, but the HSE recommends that this is checked with staff;

  • "amber" - the majority of staff feels that a standard has been reached, but a significant number feels that it has not. This requires further investigation, and the HSE suggests using the second pass filter tool to identify the elements of the standard causing stress; and

  • "red" - the majority of staff feels that the organisation is not achieving a standard. This also requires further investigation using the second pass filter tool. Investigation of these sources of stress should have highest priority.

    Second pass tool

    Red and amber results may suggest that there are areas where an organisation is not meeting the standards. A second pass filter tool, comprising a brief questionnaire for each of the stressors, is designed to indicate where the problems may lie. It is issued to all employees in the areas needing further investigation. A further tool is provided to analyse the results from the second pass filter tool and determine which aspects of each stressor is the likely source of any problems.

    Consultation

    The next step is to consult with employees to find out what the problem is. The HSE recommends making use of local arrangements for encouraging participation and consulting with employees and their representatives. 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.

    Taking action

    Employees often have a good understanding of the sources of stress and what their organisation might do. For the pilot, the HSE urges employers to consider their employees' expectations. It will be more productive to set up realistic interventions that can be achieved in the short to medium term, rather than trying to change ingrained aspects of organisational culture. The HSE adds that, in the long term, bringing about a positive change in organisational culture may prove the best way of preventing work-related stress and ensuring a happy, healthy and productive workforce.

    Some sources of stress identified may not be completely eliminated because of the nature of the business. If this is the case, it is important that an employer explains clearly the rationale; employees are then more likely to understand why work is organised the way it is and be more able to make suggestions for interventions that fit with business realities.

    Even in the absence of significant changes, the organisation can offer simple solutions, such as practical support and acknowledging the challenges faced by employees.

    The HSE is currently developing more specific guidance on, and suggestions for, interventions that can have an impact upon the six stressors.

    Review

    Interventions must be evaluated and the results fed back to all employees. The timing of a review of an intervention will depend on its complexity and will range from a matter of days to several months. Employers should also bear in mind any changes that may introduce new stressors. If these are significant, consideration should be given to redistributing the first pass filter tool to highlight quickly any emerging stressors.

    If there are no significant changes or problems, the HSE suggests use of the first pass filter tool annually. This would be in addition to any arrangements that have been established to talk about stress-related issues on a regular basis.

    Individuals' problems

    The management standards and tools will identify stressors that are affecting the majority of employees in an organisation, but may not deal with the concerns of small groups or individuals. The HSE believes that it is essential that employers address these concerns, through:

  • creating an environment where employees are encouraged to consult their line manager or a person in their line management chain;

  • encouraging employees to talk to union and safety representatives, human resources personnel or the occupational health team;

  • encouraging employees to seek advice from OH advisors at GPs' surgeries; and

  • providing employee assistance counsellors.

    The HSE is currently developing web-based guidance for individuals on work-related stress. This should be available during summer 2003. The formal pilot study is due to finish in autumn 2003 and evaluation will continue into 2004.

    1www.hse.gov.uk/stress/stresspilot/index.htm.

    2"Tackling work-related stress", HSG218, HSE Books, ISBN 0717620506, £7.95.

    DRAFT MANAGEMENT STANDARDS ON WORK-RELATED STRESS

    STANDARD ACHIEVED IF:

    STATE TO BE ACHIEVED

    DEMANDS

  • At least 85% of employees indicate that they are able to cope with the demands of their jobs; and

  • The organisation provides employees (including managers) with adequate and achievable demands at work.

  • systems are in place locally to respond to any individual concerns.

  • Job demands are assessed in terms of quantity, complexity, and intensity, and are matched to people's skills and abilities.

  • Employees have the necessary competencies to be able to carry out the core functions of their job.

  • Employees who are given high demands are able to have a say over the way the work is undertaken (see "Control" below).

  • Employees who are given high demands receive adequate support from their managers and colleagues (see "Support" below).

  • Repetitive and boring jobs are limited, so far as is reasonably practicable.

  • Employees are not exposed to a poor physical working environment (the organisation has undertaken a risk assessment to ensure that physical hazards are under appropriate controls).

  • Employees are not exposed to physical violence or verbal abuse.

  • Employees are provided with mechanisms that enable them to raise concerns about health and safety issues (eg real or perceived dangers, working conditions) and working patterns (eg shift work systems, uncertain hours) and, where necessary, appropriate action is taken.

    • CONTROL

  • At least 85% of employees indicate that they are able to have a say about the way they do their work; and

  • The organisation provides employees with the opportunity to have a say about the way their work is undertaken.

  • systems are in place locally to respond to any individual concerns.

  • Where possible, the organisation designs work activity so that the pace of the work is rarely driven by an external source (eg a machine).

  • Where possible, employees are encouraged to use their skills and initiative to complete tasks.

  • Where possible, employees are encouraged to develop new skills to help them undertake new and challenging pieces of work.

  • Employees receive adequate support when asked to undertake new tasks; employees are supported, even if things go wrong.

  • Employees are able to exert a degree of control over when breaks can be taken.

  • Employees are able to make suggestions to improve their work environment, and these suggestions are given due consideration.

    • SUPPORT

  • At least 85% of employees indicate that they receive adequate information and support from their colleagues and superiors; and

  • The organisation provides employees (including managers) with adequate support at work.

  • systems are in place locally to respond to any individual concerns.

  • There are systems in place to help employees (including managers) provide adequate support to their staff or colleagues.

  • Employees know how to call upon support from their managers and colleagues.

  • Employees are encouraged to seek support at an early stage if they feel as though they are unable to cope.

  • The organisation has systems to help employees with work-related or home-related issues (eg employee assistance programmes), and employees are aware of these.

    • RELATIONSHIPS

  • At least 65% of employees indicate that they are not subjected to unacceptable behaviours (eg bullying) at work; and

  • The organisation has in place agreed procedures to effectively prevent, or quickly resolve, conflict at work.

  • systems are in place locally to respond to any individual concerns.

  • These procedures are agreed with employees and their representatives and enable employees to report any concerns they might have confidentially.

  • The organisation has a policy for dealing with unacceptable behaviour at work. This has been agreed with employees and their representatives.

  • The policy for dealing with unacceptable behaviour at work has been widely communicated in the organisation.

  • Consideration is given to the way teams are organised to ensure that they are cohesive, have a sound structure, clear leadership and objectives.

  • Employees are encouraged to talk to their line manager, employee representative or external provider about any behaviours that are causing them concern at work.

  • Individuals in teams are encouraged to be open and honest with each other and are aware of the penalties associated with unacceptable behaviour.

    • ROLE

  • At least 65% of employees indicate that they understand their role and responsibilities; and

  • The organisation ensures that, so far as possible, the demands it places upon employees (including managers) do not conflict.

  • systems are in place locally to respond to any individual concerns.

  • The organisation provides induction training for employees to ensure they understand their role within the organisation.

  • The organisation ensures that employees (including managers) have a clear understanding of their roles and responsibilities in their specific job (this can be achieved through a plan of work).

  • The organisation ensures that employees understand how their job fits into the overall aims and objectives of the organisation/department/unit.

  • Systems are in place to enable employees to raise concerns about any uncertainties or conflicts they have in their role.

  • Systems are in place to enable employees to raise concerns about any uncertainties or conflicts they have about their responsibilities.(Role conflict exists when an individual is confronted by conflicting job demands or by doing things he or she does not really want to do, or by tasks that the individual does not believe are part of the job. Workers may often feel themselves torn between two groups of people who demand different types of behaviour, or who believe the job entails different functions. Role ambiguity arises when individuals do not have a clear picture about their work objectives, their co-workers' expectations of them, and the scope and responsibilities of their job. Often this ambiguity results simply because a manager or supervisor has never adequately explained what is required of them or because the job has changed without this being acknowledged in the job description.)

    • CHANGE

  • At least 65% of employees indicate that the organisation engages them frequently when undergoing an organisational change; and

  • The organisation ensures that employees (including managers) understand the reason for proposed changes.

  • systems are in place locally to respond to any individual concerns.

  • Employees receive adequate communication during the change process.

  • The organisation builds adequate employee consultation into its change programme and provides opportunities for employees to comment on the proposals.

  • Employees are made aware of the impact of the change on their jobs.

  • Employees are made aware of the timetable for action, and the proposed first steps of the change process.

  • Employees receive support during the change process.