Stress Workbook
A framework
for the implementation of the
Stress At Work Policy
in support of the
•
Staff Support Strategy;
•
Dignity at Work Policy;
•
Health and Safety Policy; and
•
Other associated policies and guidelines
Page 1
INDEX
Understanding Stress in NHS Grampian..........................................................3
Principle Job Features Which Help To Reduce Stress In The Workplace .......5
Staff Support Mapping Guide – Sources of Existing Support...........................6
A risk-based approach to workplace stress – flowchart ...................................7
Stress At Work Toolkit for NHS Grampian (Pilot Version)................................8
Stress At Work Action Plan Template for NHS Grampian (Pilot Version) ......10
October 2004
Page 2
UNDERSTANDING STRESS - A GUIDELINE FOR NHS GRAMPIAN
NHS Grampian Stress Workbook
October, 2004
This information is a simple introduction to stress at work.
detailed at the end of this section.
Further sources are
Stress is "the reaction people have to excessive pressure or other types of demand
placed on them. It arises when they worry they can't cope" (Health & Safety
Executive). Pressure is not necessarily a negative feeling and can in fact be a
positive one. Some pressures and challenges at work are necessary to maintain
motivation. Stress arises when the demand placed upon a person exceeds that
person's ability to cope.
NHS Grampian acknowledges that each individual’s ability to manage and cope with
stress is variable and personal. There is no simple way of predicting what will cause
harmful levels of stress. Everyone is different and a person's ability to cope with
stress may also vary throughout life. Much depends on a person's personality,
experience and motivation and the support available from managers, colleagues,
family and friends. This involves home as well work life experiences.
Fundamentally, no individual should have unreasonable demands placed upon
them. We will address this through the management of job design, development
and training as well as effective people management (supported by the People
Management Project). Support will also be offered for any person who is affected by
factors outside the work environment.
Through the risk assessment process, NHS Grampian will continue to identify
hazards and assess all mental and physical risks to health and safety with the
objective of reducing them, as far as is reasonably practicable. The first step in
managing stress at home or at work is being able to recognise the symptoms. Often
the individual fails to recognise such symptoms in themselves. However, there are
certain common symptoms that can be displayed by work teams and individuals.
Everyone has a role to play in creating a positive working environment and in
maintaining the mental health of employees. However the responsibilities at each
level are quite distinct, and the most effective results will be achieved with a
combination of individual and managerial effort. In NHS Grampian, we believe that
we have a responsibility to work with everyone to minimise the excessive pressures
arising at work.
Signs of Possible Stress
•
•
•
•
•
•
•
•
•
•
•
•
Work Performance
Reduction in output or productivity
Increase in error rate
Poor decision making
Deterioration in planning and control of work
Poor quality
Relationships at Work
Tension and conflict between colleagues at work
Poor relationships with patients / clients
Increase in industrial relations or disciplinary problems
Irritability
Poor sleep
Aggression
Mood swings
Staff Attitude & Behaviour
• Loss of motivation and commitment
• Staff working increasingly long hours but
diminishing returns
• Erratic or poor timekeeping
Sickness Absence
• Increase in overall sickness absence,
particular frequent short periods of absence
•
•
•
•
Drinking/eating/smoking more
Depression
Raised blood pressure
Chest Pains
Page 3
UNDERSTANDING STRESS - A GUIDELINE FOR NHS GRAMPIAN
NHS Grampian Stress Workbook
October, 2004
RELATIONSHIP OF STRESS FACTORS
Intrinsic to job
Role in the Organisation
Relationships at Work
Career Development
Organisation Structure &
Climate
Home - Work interface
INDIVIDUAL
•
•
•
•
•
•
•
•
High blood pressure
Excessive Drinking
Depressed mood
Irritability
Chest pains
Mood swings
Aggression
Excessive smoking
•
•
•
•
•
•
•
High absenteeism
High error rate
High Staff Turnover
Poor quality
Frequent sickness
Frequent disciplinaries
Poor decision making
Coronary
Heart
disease
Mental
Illness
Apathy
Frequent
accidents
Industrial
action
Job assessments must evaluate the necessary skills, qualifications, experience and
training that individuals require for their role. In doing so, consideration should
include the following factors. Where there is a gap between job requirements and
people skills, then managers and staff are responsible for arranging appropriate and
adequate training and development through the appraisal system and Personal
Development Plans.
Opportunity
for Control
Opportunity
for Skill Use
Work
Demands
Variety
Work clarity
Availability of
Income
Physical
Security
Interpersonal
Contact
Job Prestige
Autonomy, discretion, influence, participation in decision making. In moderation,
greater control is associated with better mental health.
The degree to which a staff member or manager has the opportunity to use and
extend his or her skills. No opportunities to use skills and abilities leads to feelings of
anxiety, hostility, lower job satisfaction and poor self-esteem.
Low work demands lead to low job satisfaction and increased anxiety. Work
“overload” is also naturally stressful. Competing priorities or unclear objectives don’t
help.
Highly repetitive work gives rise to low satisfaction. Expand & develop roles wherever
possible. There are clear implications for job design and appraisal. Managers and staff
should take opportunities to review job roles on a regular basis.
Feedback on performance and behaviour clarifies uncertainty and sets requirements
for performance and development of skills. Feedback on work in general is vital, as
well as any specifics to the individual (e.g. planned change etc).
This is a speculative factor. A positive relationship between standard of living and
mental health has been frequently recorded in research .
Concerned with physical working conditions - the need to protect staff and managers.
Poor working conditions (bad light, dangerous equipment, excessive heat, harmful
substances and so on) will naturally give rise to negative job-related feelings.
Interpersonal contact is essential for good mental health. Support from colleagues and
Managers helps with anxiety, depression and can increase feelings of high selfesteem.
All jobs play a vital role in NHS Grampian. Although some jobs are perceived as more
important than others, staff should receive feedback on their contribution to NHSG.
Some very useful information is given by the following links: -
http://www.hse.gov.uk/stress/index.htm
http://intranet/grampintranet/gpct/psychology/flowchart.cfm
PRINCIPLE JOB FEATURES TO REDUCE STRESS IN THE WORKPLACE
NHS Grampian Stress Workbook
October, 2004
The following diagram outlines some organisational programmes to assist in the
reduction and control of stress. Confirm your departmental links to these programs.
Decision Making & Planning
• Opportunities for staff to contribute ideas,
in particular in the planning and
organisation of their own jobs.
• Partnership Working
• Staff Governance Standards
• Local Partnership Forum
General Management & Culture
• Clear organisational objectives
• Good Communication
• Close employee involvement, particularly during
periods of organisational change
• Good management support and appropriate
training and development.
• Partnership Working
• Organisational Change Policy
• Single System Working
Employee's role in the Organisation
• Clearly
defined
objectives
and
responsibilities linked to organisational
objectives
• Support for those with high level of
responsibility for the welfare and wellbeing of people.
• Annual & regular appraisal
• Personal Development Plan
• Objectives in Health Plan
SOME OF THE THINGS THAT CAN HELP
IN A POSITIVE APPROACH TO MENTAL
HEALTH
Relationships at Work
• Training in People Management skills
• Effective systems for dealing with interpersonal
conflict, bullying and racial or sexual
harassment,
including
agreed
grievance
procedure
and
proper
investigation
of
complaints.
• People management project
• Dignity at Work Strategy
• Stress at Work Policy
Work Schedule
• Flexible work schedule
• Planned and agreed work hours
• Family friendly policies
Job Design
• Well defined tasks and responsibilities
• Variety, avoiding short work cycles
• Proper use of skills
• Proper training for those dealing
constantly with the public or client
groups
• Proper hazards control
• Modernisation Agenda
• Agenda for Change
Workload / Work Pace
• Targets that are stretching but reasonable
• Organisational Change
Page 5
STAFF SUPPOPRT MAPPING GUIDE - SOURCE OF EXISTING SUPPORT
NHS Grampian Stress Workbook
October, 2004
Organisational Level Support - to assist NHS Grampian at corporate level
!
Management of Stress at Work Policy
!
Dignity At Work Strategy and Policy
!
Health & Safety Management Strategy
!
Internal Communication Strategy
!
\Workforce Development Strategy
!
People Management Skills and Project
!
Leadership Development Programme
!
Learning & Development Strategy
Individual Level Support - for all staff
!
Appraisals, supervision, mentoring
!
Family friendly policies
!
Human Resource policies
!
CD - ROM learning and self-assessment guide to stress
!
Stress Workshops
!
Occupational Health Service & Counselling
!
Occupational Psychology Department
Teams Level Support - for services, departments, teams
!
NHS Grampian Stress At Work Toolkit (attached)
!
Public Health, Health Improvement
!
Scotland Health at Work (SHAW) Programmes
!
Learning & Development Teams
Page 6
RISK-BASED APPROACH TO WORKPLACE STRESS IN NHS GRAMPIAN
NHS Grampian Stress Workbook
October, 2004
•
•
•
This flowchart sets out the general approach recommended by the Staff Support Group
in identifying and dealing with stress in NHS Grampian.
Flexible but consistent approach to enable flow of information within / between services.
It seeks to support staff as they strive to find innovative solutions to resolving the
negative impacts from stress in the workplace.
O
R
G
A
N
I
S
A
T
I
O
N
Staff Survey & Local Audit to measure impact of
stress at work
Development of Staff Support Strategy & Stress
at Work Policy
Local Commitment to dealing with stress in the
workplace on a partnership basis between
management and staff
GAPF to
review policy
on annual
basis based
on feedback
and progress
Continual
audit through
Staff Survey,
Risk
Management
Audit, Staff
Governance
Audit, etc
Identify local lead to champion the project
T
Establish working group as sub-group of Local
Partnership Forum or Local Risk Committee
E
A
Ensure all staff have access to Stress Policy
M
Use the Stress At Work Toolkit to complete
stress risk assessment as a group
I
N
Develop an Action Plan
D
I
V
Seek urgent advice from
Occupational Health and
Staff Support Group for
any health concerns
Use stress-map for shortterm measures to manage
& alleviate impacts of
stress
For example
•
counselling
• management advice
For example
• Seminars
• CD awareness for staff
Develop links to NHSG
initiatives for longer–term
elimination and control
For example
•
People Management
• Modernisation Agenda
I
D
U
A
L
Feed into Staff Support Sub-Group for Stress through Local
Partnership Forum with comments on progress and policy
October, 2004
Page 7
STRESS AT WORK TOOLKIT FOR NHS GRAMPIAN (PILOT VERSION)
NHS Grampian Stress Workbook
October, 2004
INTRODUCTION
The GAPF has developed a Staff Support Action Plan based on the feedback from staff regarding
stress starting with the 2002 Staff Survey. The Action plan recognises the need for:
(a)
(b)
(c)
An overall NHS Grampian Plan
Awareness and Training Support
Local Team Staff Support Action Plans
LOCAL TEAM ACTION PLANS FOR STAFF SUPPORT
OBJECTIVE
To discuss issues important to staff particularly around health and well-being.
BENEFIT
Staff Teams may have unique requirements which an organisation wide programme may not address
and Staff Team are more likely to sort out their own issues.
TOOLKIT
SETTING THE SCENE
The team needs to meet to decide if it wishes to commit to developing a Local Action Plan.
TEAM VALUES/GROUND RULES
As part of that discussion, the following team values need to be assessed:
•
Acceptance that stress exists
•
Building trust and openness
•
Commitment to support each other
•
Team commitment to agreed actions
•
Team commitment to implementation and monitoring
COMPETENCIES
It is key that the Team Leader, or nominated facilitator, or the team itself, has skills in involving all
members of the team
SKILLS
•
Awareness of what stress is
•
Listening
•
Facilitating outcomes
•
Project planning and monitoring
•
Personal people/listening/support orientation
- sometimes with a majority rather than unanimous support
Managers will develop the above skills, as required, through existing training and development
programmes, such as the People Management Initiative. These skills will facilitate the removal or
control of stressors in the workplace. In addition to this, specific training will be available, where
appropriate, to assist a department or individuals to manage stress where already it exists.
STRESS AT WORK TOOLKIT FOR NHS GRAMPIAN (PILOT VERSION)
NHS Grampian Stress Workbook
October, 2004
PROCESS
Team Meeting / Stage 1
Team Meeting / Stage 2
•
Review Organisation-wide Staff Support Action Plan
•
Identify in Local Action Plan the issues/causes that are
pertinent to the team at this time
•
Ask members to come back with other local team issues
•
Complete the form including local issues and agree Action
Plan
•
Set clear and achievement goals for improvement (within
the local team’s control)
•
Nominate an Action Plan Leader for an agreed initial
period
•
Identify if assistance is required from partnership or other
staff
•
Determine actions required to meet these goals
•
Discuss progress
•
After 6 months produce an interim evaluation of progress
Team Meeting / Stage 3
Regular Staff Meetings / Contact
STRESS AT WORK TOOLKIT FOR NHS GRAMPIAN (PILOT VERSION)
NHS Grampian Stress Workbook
October, 2004
•
This action plan template draws should be completed from the findings of toolkit meetings.
•
It is arranged along the seven key factors from the HSE approach to Management of Work Related Stress.
Themes/Issues
Locus
of
Control
Impact
Initial thoughts on
desirable/possible
outcome
Goals
Meeting 1
What Action can we take
locally plus any that needs
to be taken forward at
organisational level
Meeting 2
Assessment of how
we have improved,
eg stress levels
Meeting 3
Links to Organisational Action Plan
Bullying & Harassment
Lack of Support from Manager
Work Demands
Inadequate Communication
Fear
of
Violent/Aggressive
Incidents
Inconsistency
of
Staff
Management Policy Application
Organisational Change
Others???
Local Themes/Issues
Culture
Internal:
External:
Risk of not doing:
Page 10
STRESS AT WORK TOOLKIT FOR NHS GRAMPIAN (PILOT VERSION)
NHS Grampian Stress Workbook
October, 2004
Themes/Issues
Locus
of
Control
Impact
Initial thoughts on
desirable/possible
outcome
Goals
Meeting 1
What Action can we take
locally plus any that needs
to be taken forward at
organisational level
Meeting 2
Assessment of how
we have improved,
eg stress levels
Meeting 3
Demands of the Job
Internal:
External:
Risk of not doing:
Control
Internal:
External:
Risk of not doing:
Relationships
Internal:
External:
Risk of not doing:
Change
Internal:
External:
Risk of not doing:
Page 11
STRESS AT WORK TOOLKIT FOR NHS GRAMPIAN (PILOT VERSION)
NHS Grampian Stress Workbook
October, 2004
Themes/Issues
Locus
of
Control
Impact
Initial thoughts on
desirable/possible
outcome
Goals
Meeting 1
What Action can we take
locally plus any that needs
to be taken forward at
organisational level
Meeting 2
Assessment of how
we have improved,
eg stress levels
Meeting 3
Support and the Individual
Internal:
External:
Risk of not doing:
Role
Internal:
External:
Risk of not doing:
Page 12