Service-area stress audits get to the heart of the organisational causes of workplace stress. Simon Naish CMIOSH describes the considerations, processes and interventions required.
The rate of reported work-related stress, depression and anxiety has increased significantly in recent years. In 2019-20, a reported 828,000 workers in Great Britain were suffering from new or long-standing issues, leading to 17.9 million lost working days (GB Health and Safety Executive (HSE), 2020). The pandemic will undoubtedly have had a catalytic effect on these statistics.
While the recognition and the reporting of stress at work has increased, it is time to ask how effective we are at tackling the triggers for stress when the perceived cause is occupational – and when it is affecting a number of employees within a particular service area or organisation.
It is well known that it is an employer’s duty, via line management, to ensure individual cases of stress are assessed using traditional and effective stress risk assessment tools. These tools represent a very efficient means of tackling individually reported cases, regardless of whether the trigger is work, home life, or perhaps a mixture of the two. However, this approach is usually reactive and often centred on individuals. It also relies on people being willing either to report the reason for sickness absence as stress, anxiety or depression, or to be open enough to raise the issue with their manager. This, by the very nature of the trigger, could be something an employee finds difficult to do.
How do we tackle triggers that may be occupational, may have widespread impact, may never be formally reported, and that senior management may only be anecdotally aware of, if at all? In addition, how do we attempt to turn the study of stress into a proactive rather than reactive initiative? And most importantly, how can we generate sustainable actions that address root causes instead of looking to provide individuals with support (including access to employee assistance programmes or, as often is the case, an individual referral to occupational health (OH))?
Taking cues from the HSE’s How to tackle work-related stress (HSE, 2009), what is proposed, depending on the size of the organisation, is a more holistic, organisational stress audit. In larger organisations, it would be a service-level stress audit that actively seeks to identify and address causation.
Such a study will support workforce health and wellbeing strategies by underpinning the commitment of the leadership team by way of a pre-emptive strike. It translates the desire to achieve a working environment in which staff feel valued, happy, engaged and motivated via a pragmatic number of tangible actions. It also minimises the cost of sickness absence, increasing productivity and reducing employee turnover, associated litigation and enforcement action.
It is worth reflecting on the hierarchies of control and noting that, in this scenario, it is important for senior managers and employees alike to recognise the existence of eustress and distress in the work environment. Eustress is stress that is not too extreme and is good for someone and performance in the workplace.
The Yerkes-Dodson law, which is very similar to eustress graphs, outlines the empirical relationship between pressure and performance. It shows the elimination of stress is not the desired outcome, recognising instead that performance increases with physiological or mental arousal – but only up to a certain point. When levels of arousal become too high, then that's when performance decreases.
Our hybrid version of eustress and the Yerkes-Dodson law (see Figure 1) shows the three clear subdivisions. So, while not striving for elimination, we apply the principles of prevention as described in the UK's Management of Health and Safety at Work Regulations 1999, and seek to combat risks at source rather than taking palliative measures. These are measures that will seek to protect the whole workforce – thereby ensuring collective protective measures rather than on a person-by-person basis.
The precursors to audit
For this type of occupational root-cause audit to be effective and appropriate, a number of factors should be considered before commissioning. These include, but are not limited to:
- Indication from sickness absence data (and from employee assistance programmes, where in place) that a pattern of sickness absence is related to stress/anxiety/depression within the service area or across an organisation
- That the reasons given include those related to the work activity
- Where available, any employee survey data that may indicate high levels of stress
- That measures taken in relation to individual stress risk assessment have not been effective (due to the wider and perhaps organisational nature of the trigger)
- That attempts have been made locally by managers to tackle the perceived cause of stress within a team with little or limited success
- That OH data indicates increasing patterns of referrals and live cases within a particular area – or indeed a pattern of repeat referrals
- And certainly, a consideration of rumours, beliefs and anecdotal evidence that suggest that a particular service area may be suffering from high levels of stress. Formal reporting systems may not substantiate this evidence as there are often issues with the levels of reporting in any organisation and the reliance on the openness of individuals to report an absence as one related to stress.
If these considerations have been made, and it is perceived that there are more widespread or inherent root causes that may benefit from an independent review, then a service-area stress audit should be considered.
Defining work- related stress
The HSE defines work-related stress to be ‘the adverse reaction people have to excessive pressures or other types of demand placed on them. Employees feel stress when they can’t cope with pressures and other issues. Employers should match demands to employees’ skills and knowledge’ (HSE, 2021).
Outside the audit
An audit of this nature is not a series of OH referrals collated into an all-encompassing report to address personal triggers outside the workplace. The legitimacy and severity of such issues are of course not in question, though they may be better addressed through individual stress risk assessments using traditional interventions and support. OH referrals may also be triggered indirectly from the audit, where other factors are cited as being the cause. Therefore, certain responses personal to individuals, which do not represent an occupational trigger or form a consensus, will tend to be excluded from the study but may be flagged with line management outside of the study.
Phase I: Scope, commitment and data collection
Define the scope – the study needs to be carried out with sufficient representation across grades, job roles and (if appropriate) locations of employees within the identified area. This can be done randomly to ensure transparency, or targeted where there is sufficient trust between senior management and the workforce.
Secure commitment – the subscription and commitment of senior management and employees alike to the study is vital. It is crucial to acknowledge and accept in advance that the report will make recommendations requiring acknowledgement, acceptance and timely action. Without establishing this contract before commencing the audit, the result could be the opposite of what is being intended – much ado about nothing. From experience, employees are willing to participate in audits, although given the subject matter there will likely be a common belief that the audit will lead to little in the way of change. A swift and transparent response, perhaps in the form of a ready-to-use action tracker, is the lifeblood of the audit’s success.
Data collection – data can be collected via a number of independent consultations (readily achieved via telephone, considering any COVID-19 restrictions, availability of employees, shifts and so on). These can be conducted by OH or health and safety teams. Where there may be issues around confidentially or capacity, this can be done by an independent OH provider or third party – with data analysis being readily achieved (due to being compiled anonymously) in house.
Telephone consultations last 20 to 40 minutes on average, depending on the employee’s perception of stress and their willingness to discuss the issue. Questions are kept to a minimum (fewer than 20), with half related to the fundamentals of management (for example, the frequency of one-to-one conversations, communication, return-to-work interviews and so on) and half based on the HSE’s Management Standards – the impact of demands, control, support, relationships, role and change (HSE, 2007).
The total number of questions and specific target areas can be tailored to each team. Questions are not sent to employees before the consultation to avoid collusion or raise concern. To increase openness, the consultations are confidential, and no names are used in the resulting report; this is critical to its success. It is also important that the combined duration of both the data capture and production phases of the report are kept as brief as possible so as not to lose focus, and to keep the faith of those participating.
The defined aim of the research is kept very much in mind during the question stage to ensure underlying or intrinsic occupational factors are captured and not personal ones, and this is made clear to interviewees. Questions are mostly structured to elicit ‘yes’ and ‘no’ answers so that overall trends can be reported. Questions related to HSE Management Standards are scored so that the results can be displayed in the final report in the form of a chronological temperature bar. This has proven to be an effective way of converting qualitative data into quantitative data and presenting the findings in a visually striking way.
'Recommendations should drive to the heart of the root cause rather than suggest palliative measures or further risk assessment'
Internal health and safety teams will need to have strong contacts within HR (where they often sit organisationally) because of the work that the report will generate and the support that will be required to progress the associated interventions (phase II).
Phase II: Production of the report, recommendations, and management interventions
Once all the consultations have been undertaken, the raw data can be analysed, with trends and root causes established. This is converted into a series of graphs and headlines from which inferences can be drawn. The report is presented in a non-technical format: a small number of slides showing the root causes and detailing direct recommendations to address them.
Recommendations should drive to the heart of the root cause rather than suggest palliative measures or further risk assessment. For example, remedial actions may identify a belief that there is a lack of resourcing, and so demands plotted over time, versus the organisation’s full-time equivalent over time, may need to be considered. The option to contract out certain workstreams, a recruitment drive or new ways of working may be the more enduring option. A study into the reasons workload appears to have increased, for example, could find long-term sickness absence or staff turnover to be the cause.
There are many responses to the identified root causes that an organisation can put into action regarding any one of the questions asked. Organisations will often have the internal skills, knowledge and experience to modify the way that they operate while increasing the wellbeing of those undertaking the work. Of course, this relies on whether the cause of stress is correctly understood – which is the overall aim of the study.
HR and organisational development teams will be well versed in turning theories and concepts into tangible strategies that more adroitly straddle the layers of an organisation or service areas. This approach also helps to integrate internal disciplines, establishing a joined-up consistency in how problems are tackled, a deeper understanding of organisational issues, and work culture influences. This ultimately supports the goal of a wraparound, intelligent support service. The audit will also inform and represent a secondary assessment of the reporting and effectiveness of individual stress risk assessments where work has been cited as the trigger.
It is recommended that the audit process is revisited after around 12 to 24 months, asking the same questions, with a view to measuring progress and to develop internal benchmarking data.
Simon Naish CMIOSH is head of occupational health and safety, Birmingham City Council
Image credit | iStock
HSE. (2021) Work-related stress and how to tackle it (accessed 9 September 2021).
HSE. (2020) Work-related stress, anxiety or depression statistics in Great Britain, 2020 (accessed 9 September 2021).
HSE. (2009) How to tackle work-related stress (accessed 9 September 2021).
HSE. (2007) What are the Management Standards? (accessed 9 September 2021).
Management of Health and Safety at Work Regulations. (1999) (accessed 9 September 2021).