'Management Standards' work-related stress in the UK: practical development

Research commissioned for the UK's Health & Safety Executive (HSE) supports the view that a preventative, risk-assessment based approach would be more effective than case-based methods in achieving a nationwide reduction in work-related stress. The background to this approach is described and discussed in a companion paper in this issue (Mackay, Cousins, Kelly, Lee, & McCaig, 2004). The present paper describes the development of HSE's new stress Management Standards—which offer organizations continuous improvement through a three-phase stress preventative process—and the development of a supporting 'Indicator Tool' (a two-phase questionnaire to assess employee perceptions of working conditions). The Management Standards comprise a series of 'states to be achieved', which are statements of good practice in six key stressor areas: demands, control, support, relationships, role and organizational change. For each stressor area there is also a 'platform statement' that outlines the main aims to be achieved by the organization. This statement may include a target percentage of employees finding that the organization meets the standard: this matter will be settled after the standards have been assessed in a public consultation campaign. To use the new process, an organization's state can first be assessed using the Indicator Tool; liaising with workers in focus groups enables a further exploration of issues raised; finally, there may be formulation of interventions and subsequent review. It is not intended that the standards will be legally enforceable. HSE's aim is that they and the associated methodology will enable organizations to effectively tackle work-related stress, and subsequently reduce both its incidence and prevalence.     

'Management Standards' and work-related stress in the UK: policy background and science

In the late 1990s, the Health and Safety Commission, as the lead authority in the UK responsible for Health and Safety at Work, conducted an extensive consultation exercise to elicit views about how work-related stress should be tackled. The Commission subsequently decided that regulation was not justified and opted for an approach with four strands. One of these was to work with stakeholders to develop clear, agreed standards of good management practice. This paper describes and discusses the rationale behind a standards-based approach that is essentially based on a method of controlling hazards. The Management Standards approach uses a taxonomy of six stressors that has evolved out of extensive research carried out on behalf of the UK's Health and Safety Executive (HSE) and in conjunction with stakeholders, and a three-phase risk assessment methodology. Further developmental work on the standards (which are to be subjected to public consultation) and associated measurement tools is described in a companion paper in this issue of Work & Stress (Cousins, Mackay, Clarke, Kelly, Kelly, & McCaig, 2004). The emphasis is on prevention towards reducing stress in the UK working population. We review current thinking on models of work stress, consider evidence linking workplace psychosocial factors and various health and organizational outcomes, and examine the effectiveness of organizational interventions. We argue that the literature supports an approach that aims to move organizational states (represented by the current situation) to more desirable ones (represented by the six Management Standards), and that this is an effective 'population' based approach to tackling workplace stress and promoting individual and organizational health.     

Psychometric analysis of the UK Health and Safety Executive's Management Standards work-related stress Indicator Tool

Abstract

Numerous tools have been developed that attempt to measure work-related stress and working conditions, but few practical instruments in the literature have been found to have a reliable psychometric factor structure. In the UK, the Health and Safety Executive (HSE) Management Standards (MS) Indicator Tool is increasingly used by organizations to monitor working conditions that can lead to stress. In Health and Safety Executive (2004), a factor analysis was conducted demonstrating the reliability of the scales. However, the authors acknowledged that direct reassessment of the same factor structure was impossible as the questionnaire was split into two separate modules for data collection. Furthermore, the tool is designed to enable comparisons between as well as within organizations to take place, yet reliability has only previously been tested at the individual level. The current study is the first to examine the factor structure of the HSE MS Indicator Tool using organizational-level data. Data collected from 39 UK organizations (N=26,382) was used to perform a first-order Confirmatory Factor Analysis (CFA) on the original 35-item seven-factor measurement scale. The results showed an acceptable fit to the data for the instrument. A second-order CFA was also performed to test if the Indicator Tool contains a higher order uni-dimensional measure of work-related stress. These findings also revealed an acceptable fit to the data, suggesting that it may be possible to derive a single measure of work-related stress. Normative data comprising tables of percentiles from the organizational data are provided to enable employers to compare their organizational averages against national benchmarks.     

Workforce size and work-related role stress

This paper examines the relationships between workforce size and four work-role stressors, along with two variables that are proposed here to mediate these relationships: objective organizational support and perceived organizational support. A total of 112 clerical workers in organizations of 1-500 employees participated in the study. Workforce size was positively associated with role ambiguity, role conflict, quantitative and qualitative role overload, and objective organizational support; and it was negatively correlated with perceived organizational support. Partial correlations were then computed between workforce size and role stress, controlling sequentially for objective and perceived support. The relationships between workforce size and the four role stressors remained significant when objective support was controlled. However, the corresponding relationships were non-significant after partialling out the effects of perceived organizational support, which suggests that the effect of workforce size on role stressors is indirect, and a function of perceived organizational support.     

Workers' compensation in stress-related claims: Some thoughts for employers in the UK

This article looks at the extent to which the Workmen's Compensation Laws in the USA and Canada accommodate stress-related claims. It questions the extent to which a similar pattern may follow in the UK and the potential implications for employers.     

Workers' compensation in stress-related claims: Some thoughts for employers in the UK

Abstract

This article looks at the extent to which the Workmen's Compensation Laws in the USA and Canada accommodate stress-related claims. It questions the extent to which a similar pattern may follow in the UK and the potential implications for employers.     

Musculoskeletal discomfort and work-related stress in New Zealand dentists

Abstract

There has been little research into the stressors, psychological distress and musculoskeletal symptoms experienced by dentists. The present study was carried out among a random sample of New Zealand dentists (N=413). The present study aimed to identify the severity of work psychosocial stressors, examine the occurrence of musculoskeletal discomfort and psychological disturbance, and determine relationships between these factors. The average age of the dentists was 43 years, with 74% being male. The annual prevalence of symptoms in both the lower back or neck was 63%, with 49% experiencing symptoms in the shoulders. Older dentists were no more likely to suffer musculoskeletal discomfort than younger dentists. The highest ranking dentistry-specific work-related stressor was ‘patients having a medical emergency’ with 78% scoring this stressor very highly. Dentists scored mental demands as the highest general work-related stressor. One-fifth of the dentists scored highly for psychological disturbance, which was very similar to the general population. Dentists with high scores for dentistry-specific work-related stressors were more likely to have evidence of psychological disturbance. The relationships between psychological disturbance and musculoskeletal discomfort needs to be taken into account when considering any multidisciplinary approach to prevention.     

Musculoskeletal discomfort and work-related stress in New Zealand dentists

There has been little research into the stressors, psychological distress and musculoskeletal symptoms experienced by dentists. The present study was carried out among a random sample of New Zealand dentists (N=413). The present study aimed to identify the severity of work psychosocial stressors, examine the occurrence of musculoskeletal discomfort and psychological disturbance, and determine relationships between these factors. The average age of the dentists was 43 years, with 74% being male. The annual prevalence of symptoms in both the lower back or neck was 63%, with 49% experiencing symptoms in the shoulders. Older dentists were no more likely to suffer musculoskeletal discomfort than younger dentists. The highest ranking dentistry-specific work-related stressor was 'patients having a medical emergency' with 78% scoring this stressor very highly. Dentists scored mental demands as the highest general work-related stressor. One-fifth of the dentists scored highly for psychological disturbance, which was very similar to the general population. Dentists with high scores for dentistry-specific work-related stressors were more likely to have evidence of psychological disturbance. The relationships between psychological disturbance and musculoskeletal discomfort needs to be taken into account when considering any multidisciplinary approach to prevention.     

Using computerized ambulatory diaries for the assessment of job characteristics and work-related stress in nurses

Abstract

Much research into work-related stress is based on retrospective self-reports, whereas records made at the time could be more valuable. In this study the primary components of two models of work stress, Karasek's demand-control (DC) model and Siegrist's effort-reward imbalance (ERI), were assessed in trained nurses using ambulatory diaries and traditional questionnaire methods. The diaries were entered on small hand-held computers and the method used has been termed ecological momentary assessment (EMA), in which recordings are made in real time in the working environment. The participants were 36 nurses who completed standardized questionnaires evaluating ERI, strain (from DC model), and, over three shifts, computerized behavioural diaries that measured effort-demand, control, reward, and stress every 90 minutes on average, enabling determination of strain and ERI repeatedly in the work situation. A total of 674 observations were recorded. Using multilevel linear modelling, it was found that the questionnaire and computerized diary derived measures of strain (DC) and ERI were reliably correlated. In addition, the ambulatory measures of both strain (DC) and ERI correlated with ratings of stress taken at the same time. From this study it would appear that ambulatory diaries could be a powerful and flexible way of assessing work related stress and its putative determinants in a real life work setting.     

Using computerized ambulatory diaries for the assessment of job characteristics and work-related stress in nurses

Much research into work-related stress is based on retrospective self-reports, whereas records made at the time could be more valuable. In this study the primary components of two models of work stress, Karasek's demand-control (DC) model and Siegrist's effort-reward imbalance (ERI), were assessed in trained nurses using ambulatory diaries and traditional questionnaire methods. The diaries were entered on small hand-held computers and the method used has been termed ecological momentary assessment (EMA), in which recordings are made in real time in the working environment. The participants were 36 nurses who completed standardized questionnaires evaluating ERI, strain (from DC model), and, over three shifts, computerized behavioural diaries that measured effort-demand, control, reward, and stress every 90 minutes on average, enabling determination of strain and ERI repeatedly in the work situation. A total of 674 observations were recorded. Using multilevel linear modelling, it was found that the questionnaire and computerized diary derived measures of strain (DC) and ERI were reliably correlated. In addition, the ambulatory measures of both strain (DC) and ERI correlated with ratings of stress taken at the same time. From this study it would appear that ambulatory diaries could be a powerful and flexible way of assessing work related stress and its putative determinants in a real life work setting.     

What employers are looking for right now

What specific skills are employers and recruiters looking for in physician executive candidates? Here are the top dozen characteristics that were invariably mentioned in interviews with high profile headhunters, as well as in analyzing open job orders. The most sought-after skill is leadership. Employers want someone who has courage. Expect this list to change in 1997 as the industry changes. However, there will be more additions than deletions, in keeping with overall trends toward higher, not lower, expectations of physician managers.     

Employee stress litigation: The UK experience

This paper considers the extent to which stress-induced illness can be regarded as a personal injury that could give rise to civil action for damages against employers in the UK. It outlines the results of a brief survey of personal injury solicitors, which indicates that claims are already being initiated by employees who allege they have suffered a stress-induced illness. The potential for claims within industrial tribunal cases that have already been decided is also examined. Consideration is given to the hurdles that litigants will have to surmount, such as proving that their condition was in fact caused by some feature of their working conditions, showing that it was foreseeable that they would suffer a stress-based injury, and demonstrating that their employer was in some way at fault. This leads to a questioning of what employers can do to protect themselves from such claims, or at least defend them successfully. The paper points out that success is likely to depend heavily upon the quality of expert medical opinion, and also upon policy conditions that may influence those adjudicating on such cases. It is concluded that the cost of losing claims may be significant, and that employees who ignore the warning signs do so at their peril.     

Nurses' representations of the perceived causes of work-related stress: A network drawing approach

This paper reports a study, involving a network drawing approach, that examined how nurses perceive the interrelationship between causes of workplace stress. Network analysis originated in sociology as a method of examining the relationship between people, objects or events. It has recently been adapted to examine participants' perceptions of the relationships between causes of a phenomenon, either by asking participants to complete a grid rating the strength of all the possible links between causes or by getting them to draw a diagram of the links that they think are important. The network drawing technique, in which participants are asked to draw a diagram indicating perceived causal links between nominated causes of stress and also to indicate the strength of these links, was employed in this study. The causes of stress were taken from a previous study in which nurses kept a diary for one week detailing stressful events and their causes. There were 48 participants in the present study and the main results confirmed the importance of staffing levels and inadequate support as perceived direct causes of stress. The study also revealed the importance of indirect links between staffing levels and other causes of stress. The networks illustrate how direct and mediating causes of stress are connected and lie largely outside nurses' control. The results are discussed in relation to other recent work on the causes and experience of stress by nursing staff.     

Nurses' representations of the perceived causes of work-related stress: a network drawing approach

This paper reports a study, involving a network drawing approach, that examined how nurses perceive the interrelationship between causes of workplace stress. Network analysis originated in sociology as a method of examining the relationship between people, objects or events. It has recently been adapted to examine participants' perceptions of the relationships between causes of a phenomenon, either by asking participants to complete a grid rating the strength of all the possible links between causes or by getting them to draw a diagram of the links that they think are important. The network drawing technique, in which participants are asked to draw a diagram indicating perceived causal links between nominated causes of stress and also to indicate the strength of these links, was employed in this study. The causes of stress were taken from a previous study in which nurses kept a diary for one week detailing stressful events and their causes. There were 48 participants in the present study and the main results confirmed the importance of staffing levels and inadequate support as perceived direct causes of stress. The study also revealed the importance of indirect links between staffing levels and other causes of stress. The networks illustrate how direct and mediating causes of stress are connected and lie largely outside nurses' control. The results are discussed in relation to other recent work on the causes and experience of stress by nursing staff.     

Cognitive therapy and behavioural coping in the management of work-related stress: An intervention study

Transactional models of stress emphasize the importance of cognitive appraisal of potential stressors in the determination of the stress response. This appraisal can be modified by the use of techniques normally associated with cognitive therapy. The contribution of a specifically cognitive component when intervening in work-related stress has not been well evaluated to date. This research seeks to determine the effectiveness of stress management training in the treatment of the work-related effects of stress by comparing the role of modifying dysfunctional cognitions with the teaching of appropriate behavioural coping strategies. Participants were allocated to one of two intervention conditions or to a waiting list control group. Those in the intervention conditions received group stress management either with the focus on delivering cognitive therapy techniques or with the focus on behavioural coping skills. Measures of general health were taken at the beginning and end of intervention and at 3-month follow-up. Participants in the cognitive therapy groups who were reporting symptoms of general ill-health at the start of the intervention showed a significant improvement at follow-up. Cognitive therapy appears to have been an effective intervention in work-related stress. Those in the behavioural group showed a smaller but still clinically effective improvement. Results are discussed in terms of methodological issues and implications for future research. It is suggested that changes in cognitive appraisal may need to be developed.     

A study of coping: Successful recovery from severe burnout and other reactions to severe work-related stress

This is a qualitative study of the situational determinants of coping with severe reactions to work-related stress, including burnout. The successful resolution of the crisis caused by an incapacity to work due to physical and emotional exhaustion is documented in an exploratory study of broad coping processes and specific strategies involved. Subjects were recruited from a large territory (the province of Quebec in Canada). Comparative analysis of the accounts of the 20 human service workers and 16 other professionals led to the identification of a common process typified by six consecutive stages: admitting the problem, distancing from work, restoring health, questioning values, exploring work possibilities and making objective changes. The recovery process is long and takes from 1 to 3 years. The ultimate strategy utilized by most of the subjects was to change their objectivc working conditions. Various strategies for identity reinforcement (seeking reassurance, understanding causes, seeking support) were observed in addition to the stages. Three-fifths of the subjects resorted to formal psychotherapy in the first sample. The recovery process appears to be of a psychosocial nature. This characteristic may render it sensitive to social context; although it has been observed in two samples, it would require testing in different working conditions and different countries.     

Job satisfaction and occupational stress in UK general hospital nursing staff

This study investigated factors associated with the perceptions of stress reported by nurses in a general hospital environment in the UK. The levels and sources of stress experienced by nursing staff were examined in relation to the type of ward or department, and nursing grade. The association between reported stress and job satisfaction was also examined. By means of a self-completion questionnaire survey, data were collected from 234 nurses from 24 wards in a single general hospital. The Brayfield and Rothe job satisfaction index was used to provide data for analysis. Factor analysis, analysis of variance, and Pearson product moment correlation procedures were performed on these data. The factor analysis identified two main factors concerned with sources of stress: interpersonal relations and resource problems, and dealing with death. Although there were no differences found across wards, the analyses of variance revealed that reported stress varied over different nursing grades. It was also found that job satisfaction was correlated with nursing experience and negatively related to stress.     

Using a stress audit: The construction site manager experience in the UK

The aim of this study was to conduct a stress audit among construction industry site managers in the UK as a precursor to a stress management intervention programme. Qualitative data were obtained from in-dept interviews with a total of 36 male middle and senior construction site managers; and aquantitative data were obtained by questionnaire. Based on the analysis of 561 postal quenstionnaires, eight stressor factors were identified, most significantly, ambiguity (i.e. role and task). Job satisfaction levels were low compared to a normative population and influenced by grade level. Measures of mental health were similar to the norm for males, but both grade of management and type of contract affected mental health. Anxiety levels were signficantly high, independent of managerial grade. The stress of work overload and role insecurity (fear of failure) were associated with reduced mental health and high anxiety, and the stress of the organizational culture and climate was the strongest predictor of job dissatisfaction. There was some cause for concern for the vulnerable high-risk groups, i.e. the extreme type A and those working overtime. Medical data from a small subset of managers (n = 78) revealed that this group evidenced a better quality of psychological health than the group in total; but a high percentage of personnel had high levels of triglycerides and cholesterol. Recommendations for action focused on the needs of specific subgroups, and guided the organization on the acceptability of possible interventions at individual, interpersonal and organizational levels.