Workplace stress is increasingly recognised as a contributing factor to
employee absence and illness. Investors in Health (IIH) is one response to the
problem. By David Ryan & Roger
It was estimated recently that 200 million working days were lost in the UK
through sickness, and that workplace stress was a major contributor.1
The cost of absence from work is more than £10bn a year – a problem that
should be addressed both for the good of employees and in order to increase
The problem has also been recognised by the Department of Health through the
National Service Framework for Mental Health, where specific reference was made
to a "healthy workplace" which "can promote mental
Investors In Health (IIH) is a health promotion initiative in the workplace,
based on the principle of NHS/local employer partnership. IIH aims to address
the health and well-being of staff, and the role that organisations can play in
creating and ameliorating the stress and strain experienced.
What is Investors in Health?
The IIH programme has been developed by drawing widely on the expertise of
NHS specialists in OH and mental health, health promotion and public health. Originally
an NHS-funded initiative, IIH and its certification mark are now administered
by an accreditation society (IIH Publications and not-for-profit company).
IIH has developed standards of good practice and accredits companies against
one of three levels of award. The programme is open to private, public and
voluntary sector organisations of all sizes.
The aim of IIH is to put workplace health and well-being on the agenda of
every local employer, at board level. To achieve this, its objectives are to
raise awareness and concern within organisations about:
– the health of the organisation
– the prevalence of stress-related occupational illness among employees
– the cost of occupational illness in lost productivity, loss of creativity
and commitment, poor retention rates and the loss of key skills
– corporate risks such as litigation, and the failure to meet statutory
requirements, such as health and safety and disability legislation
– corporate image and quality standards.
Through its programme, IIH aims to achieve reductions in stress-related
illness and to promote mental health and well-being in the workplace.
IIH sees it as desirable to encourage a positive corporate culture in
relation to employee health and to identify and foster good management practice
consistent with national standards of good practice in HR management. To
achieve this IIH provides information on the access to relevant resources,
encourages a positive approach towards those with disabilities and endeavours
to alter public health attitudes by employer initiatives in the workplace.
Developing the programme
IIH was developed over three years. In the first stage, IIH developed
standards of good practice for health promotion in the workplace by thorough
and systematic review of available research evidence. The framework components
of the standards address management practices that protect employees’ health,
management practices that mitigate ill health, and practices that promote
recovery back to full and effective employment. Consequently, audit mechanisms,
audit tools and indices for outcome measurement have been developed.
The programme was then piloted with a local private sector employer (Bemrose
Booth Printing) and the local NHS Community Trust (Hull and East Riding Community
Trust), with further product development and field testing with a group of
eight local employers in the Hull region. In 2003, the IIH accreditation and
award scheme was finalised, with the preparation of regulations, assessment
procedures and the preparation of a guidance manual and resource pack for
For companies becoming involved in IIH awards, three levels of compliance
are available, corresponding to the level of achievement of IIH standards.
In addition to seeking accreditation and awards, the participating companies
are asked to commit themselves to membership of a benchmarking forum. This is
not mandatory but is viewed as helpful to companies in achieving full
engagement with the IIH programme.
An evaluation of the scheme was carried out in 2002 involving 11
organisations taking part in the programme field tests.
The purpose of the exercise was to see how participating companies rated
their involvement in the processes of IIH, and to take advice on any changes or
amendments required, rather than to attempt a formal outcome evaluation or
Questionnaire responses provided information about how organisations found
out about IIH and how companies achieving engagement found the process of joining
IIH. The expectations of the company about what membership of IIH meant and the
likelihood of achieving those objectives were also surveyed. The participants
were asked to rate various aspects of IIH and to provide comments on the
positive aspects of IIH and to point to any improvements that could be made.
In fact, only three of the individual respondents to the questionnaire had
been personally involved in getting the company to join IIH, but they all viewed
membership as being positive and identified with the ethos of IIH.
Most respondents expressed satisfaction with a wide range of factors, such
as the guidance, support and interaction with other organisations provided by
IIH, although some respondents believed the ethos of IIH was already
encapsulated in their companies and therefore questioned the value of
continuing involvement with the project.
In the same way, time commitment for individuals was a concern for some
respondents. Clear guidance on the measurement of successful compliance with
IIH Standards was requested (this has since been addressed via the production
of an accreditation manual).
Particular strengths of the IIH programme were described by participants and
included interaction between the different types and sizes of organisations
involved, which was useful in providing new perspectives for participants.
The contributions of NHS members of the original steering group to the
benchmarking process was viewed as a valuable asset to the group and
benchmarking participants developed a sense of ownership of the IIH programme.
There was also a lack of bureaucracy and a view that the IIH scheme was
The IIH support team was positively evaluated in terms of responsiveness to
enquiries and the support provided. Respondents said that the best advice
newcomers to IIH could get was to ensure that there was commitment at the top
of the company hierarchy to ensure that sufficient resources were made
available to implement the programme.
Workplace stress is a major health and economic issue and this has been
recognised by the Government through the Development of Health and the Health
and Safety Executive.
IIH is one response to workplace stress and (although it has parallels to
Investors in People) is unique in its corporate approach to health and
well-being. Programmes like IIP seek to value workers in their roles, training
and contribution at work. It seeks to enable workers to survive the stress that
is entailed in meeting demanding targets, working long hours and the
concomitant strain that this puts on personal and family life. IIH is still in
its early days but the initial indications from field testing are promising.
The IIH awards scheme now offers organisations accreditation at one of three
levels of achievement and the use of the IIH certification mark.
1. Confederation of British Industry (1999) Focus on Absence, CBI, London
2. Health and Safety Executive (2002) Work-related Stress, HSE, London
3. Department of Health (1999) A National Service Framework for Mental
Health, DoH, London
– Project director, Investors in
Health, c/o Community Mental Health Centre, Manor Road, Beverley, East
Yorkshire, HU17 7BZ
– Roger Watson, professor of nursing, University of Hull
Full details of the IIH award scheme and its regulations can be
reviewed on the IIH website. Go to www.investorsinhealth.org