At
a time when the HSE has bared its teeth and issued an enforcement notice
against an NHS trust to cut stress levels, Goodhope Hospital NHS Trust stands
out as a shining Beacon of Excellence in Stress Prevention, by Steven Hogg
The prestigious award of Beacon of Excellence in Stress Prevention was given
to Goodhope Hospital NHS Trust by the Health and Safety Executive (HSE) for its
innovative, OH-led Managing Pressures programme, which has saved the trust more
than £100,000 in sickness absence costs.
Following on from the introduction of the HSE’s pilot stress management
competencies, which outline the six main factors that can lead to stress,1 the
Beacon Programme was set up to discover areas of best practice that could be
adopted by other organisations.2 Of the 80 organisations that were assessed
against the Beacon Model by Robertson Cooper Ltd, on behalf of the HSE,3,4 only
15 received the Beacon Award.
The following is an overview of Goodhope’s contribution to best practice
stress management, elements of which may be applicable to your organisation.5
Motivation for the programme
There was a great deal of motivation for the hospital to introduce a
programme for managing pressure. Goodhope is a very busy hospital – servicing
the mainly urban Sutton Coldfield area – with 2,500 staff, and an A&E
facility. The OH department had noticed that the stressed individuals it was
helping were going back into a ‘sick’ environment.
The organisation was also all too aware that health and safety law
requirements, the HSE and Government-backed initiatives are encouraging a more
responsive approach to stress management. There was also an understandable
desire among managers to reduce sickness absence costs.
Finally, a staff survey carried out by the hospital in 2000 showed that only
16 per cent of staff thought stress management provision was adequate.
Crucial to the success of the programme was the establishment of a steering
group. This was selected from the OH team, the personnel department and other
appropriate departments.
Lynn Holland – the now retired OH service manager – and Steven Hogg
facilitated the programme, with members of Steven Hogg Partnership (SHP) acting
as competent persons.6,7
Use of the term ‘stress’
An early decision was taken on the use of the term ‘stress’. It was decided
that it would be avoided, as many people see ‘stress’ as a negative, ambiguous,
over-used and abused word. The programme was therefore called ‘managing
pressures’. If ‘stress’ had to be referred to, it was put across as pressures
that may lead to stress or strain.
With reference to the Managing Pressures Policy, written by Holland, the HSE
Beacon case study report commented, "the trust has a very well developed
policy and strategy to positively manage stress."
The key strength of the policy was also highlighted in the report:
"Unique among Beacon candidates, Goodhope enshrined in its policy a
managerial responsibility to conduct a risk assessment in different situations,
by:
– Responding to a stress audit report with an action plan of risk control
measures
– Where other indicators reflect a mental health hazard, investigating and
assessing the level of risk
– Where unacceptable levels of pressure are identified, where reasonably
practicable, implemented risk control measures to reduce the pressures."
Holland was very specific in her requirements as the above managerial
responsibilities suggest. SHP had developed close ties with Holland through its
joint use of the CALM workplace pressures8 and personal stress audit, which SHP
used in the programme. SHP’s risk assessment, training and coaching expertise
helped design and deliver the skills necessary to implement managerial
responsibilities.
Risk assessment
SHP started to develop a pressures/stress risk assessment process along HSE
lines in the late 1990s. Holland took a key interest in its work, and together
OH and SHP tailored the process to fit the policy requirements. During the risk
assessment process, SHP:
– Trained OH nurses to deliver feedback to groups audited
– Trained managers in audit validation techniques (an audit on its own is
not considered to be a valid assessment of stress risks), including comparison
with other relevant data, such as health and safety audits. Training also
included risk-rating and facilitating the development of risk control measures
with their respective teams
– Reviewed all the audits conducted across the hospital to identify the top
six stressors and focused on cross-departmental issues that could be tackled
across the whole hospital.
The risk assessment process, in which managers were trained, enabled them to
fulfil their responsibilities as laid out in the stress policy. As a result,
the risk assessment process at Goodhope was given high praise in the HSE Beacon
case study report, which said: "The audit and risk assessment approach
adapted by Goodhope is more rigorous, valid and far reaching than many of the
risk assessment programmes conducted by other Beacon candidates."
Training
Goodhope has 2,500 employees and a training solution was required to ensure
as many people as possible were covered by stress prevention measures.
SHP’s solution was the training of managers in risk assessment, plus other
stress prevention and risk control measures, so they could support their staff
more effectively. Managers had a full day’s training (maximum of eight
managers) and the rest of the staff were given a half-day (maximum of 12
staff).
The training was designed to help staff:
– Recognise and manage personal stressors
– Recognise and manage key workplace stressors (as outlined in HSE guides)9
– Manage their manager, body language, communication and listening skills
– Have autogenic relaxation techniques and an action plan
Managers were trained in the above, as well as being trained to:
– Recognise the need to refer staff to OH department for coaching
– Support staff
– Have risk assessments.
As a result, the case study report stated that: "Feedback from the
training showed it was well received, and is considered to be useful and of
high quality."
Major aim
The major aim at Goodhope was to help individuals recognise when they were
on the slippery slope towards the draining effects of stress; they could then
self-refer or speak to their manager. Managers were taught to support staff,
but were also given guidance as to when a referral to OH was appropriate.
Two elements of the programme were especially highlighted for their
innovative aspects and were featured as presentations by Holland and Hogg at
the Beacon Best Practice Conference in Manchester; they were self-rostering and
coaching.
Self-rostering
Self-rostering allows staff to plan their own hours, provided certain core
hours are met. This allows staff to tackle the pressure of organising work and
home life, and so helps work-life balance. Goodhope’s overall aim is to
introduce a flexible working culture.
The programme was set up as a pilot and then introduced into two wards,
which are now fully operational. According to the Beacon case study report,
self-rostering is "an excellent example of primary intervention for
nursing staff."
Coaching
Holland was very specific in what she wanted from a one-to-one support
service. She wanted individuals’ real stress issues to be identified, as well
as a maximum of three sessions and practically-focused solutions.
SHP suggested the use of its behavioural profile (ADT), which enabled it to
quickly identify workplace and personal stressors, plus individual’s
behavioural responses to the stressors.10
Often the problem presented by the client is not the real one. ADT profiling
and coaching helped the client:
– See through to the real issue
– Become aware of their own stressful behaviours
– Create effective solutions.
One key strength of using coaching and the ADT profile is in rehabilitating
staff off work with stress-related illness. This is because stressful
behavioural patterns can be addressed during absence, effective risk management
measures can be created before a return to work and ADT can be repeated to
ensure progress. See HSE best practice rehabilitation.11
The Beacon case study report said of the coaching, "Coaching would seem
to be as effective, if not more so, than many of the traditional counselling
appr-oachesÉ Coaching is often able to deal with most clients in one session,
compared to the normal four to eight offered elsewhere."
The benefits of coaching are that it is more cost-effective and quickly
identifies the real problem. This means it can help identify whether the real problem
is work related, personal or even behavioural. It also enables more focused
solutions.
In issues of bereavement, if underlying stressful behaviour patterns can be
identified and managed, the use of the profile and coaching is of great
assistance to individuals in their grieving process.
Programme reviewed
In line with all excellence, best practice and risk assessment models, SHP
conducted a thorough review of its practices and procedures – warts and all – with
the end result being recommendations for improvements.
According to the case study, "The trust is unique among Beacon
candidates for the value and emphasis placed on review."
SHP found that key strengths were management responsibility for risk assessment,
and a generally well-developed policy. However, while there was a steering
group, co-ordination was difficult as various interventions and provisions to
combat stress fell into a desperate array of departments and organisational
initiatives. In a very busy hospital environment, with difficulties in ensuring
manager attendance at training sessions, the policy was not considered as well
embedded as other Beacon candidates.
So, while SHP’s risk assessment was more vigorous, valid and far reaching
than most, it did encounter some problems. With the demands of a busy hospital,
not all managers could attend training before the audit was fed back. As the
Beacon case study pointed out, and also confirmed from the coaching of managers
using the ADT profile, not all managers have the skills to develop effective
stress prevention solutions.
The review process identified self-rostering as an extremely effective tool
of staff empowerment. This was because it gave staff a marked degree of control
over their working hours, which dramatically improved morale and led to a fall
in sickness absence, increasing staffing levels. This meant sickness absence,
labour turnover, and recruitment costs all fell.
With the diverse number of departments involved in the implementation of the
programme, co-ordination was often difficult. However, the overwhelming success
of the self-rostering intervention has now led to plans to roll out the
programme hospital-wide, making further cost savings.
Results of the coaching review
The coaching review identified some key points. They are:
– Average session length was 1.67 hours as opposed to four to eight hours
statistically for counselling
– At the start of programme, most people seen were absent. By the end of the
first year, SHP was seeing people that recognised they were having
difficulties. Management thus prevented absence
– With the permission of the client, SHP could form a coaching triangle with
their manager to solve issues more effectively
– The long-hours culture of many senior managers
– Common behavioural characteristics gained from the ADT profile were used
as an aid in training:
– Putting others first to the detriment of self (people pleasing)
– Perfectionist (also confirmed from risk assessment/audit)
– Low levels of defined work and personal boundaries.
Because SHP knew these behavioural traits created major stress issues both
at work and personally for staff and managers alike, it was able to feed these
characteristics back into the training sessions to make the training even more
effective and tailored to the needs of the individual and group alike.
There were some coaching monitoring difficulties. SHP monitored people
returning to the OH department, and the rates of individuals returning with the
same problem were very low. However, except with rehabilitation, SHP did not
have the resources to do ongoing repeat profiles to confirm progress.
Results of the training review
During the training review, SHP found that many individuals repeated the
training as their own review.
The training also helped staff and managers to refer to OH, which prevented
absence. Any difficulties centred around those already outlined in ensuring
training before audit and manager skill levels in creating effective solutions.
SHP also repeated the staff survey, which showed impressive results. The
2000 survey found 19 per cent of staff felt the trust effectively dealt with
stress, and 51 per cent with work-life balance. By the 2001 survey, conducted
six months into the managing pressures programme, this had risen to 33 per cent
for stress and 60 per cent for work-life balance.
As manager skill levels are crucial to the success of the programme, SHP’s
key recommendations were to introduce a senior manager coaching programme to
reduce long hours, and a more targeted management training programme aimed at
improving skill levels.
SHP’s challenges now lie in developing the audit and risk assessment process
to fully embrace the new HSE Stress Management Competencies to ensure Goodhope
remains a Beacon of Excellence in stress prevention.
Steven Hogg BA (Hons) is a behavioural scientist with more than 22 years
international experience. Hogg is a joint senior partner at SHP, specialists in
stress risk management and rehabilitation, and expert witness to the growing
stress litigation field in the public and private sectors. Tel: 0870 7476208,
e-mail [email protected]
References
1. HSE Stress Management Competencies, www.hse.gov.uk/stress/stresspilot/index.htm
2. HSE Beacon Programme case studies, www.hse.gov.ukresearch/rr133pdf
3. HSE Beacon Model outlined in case studies2
4. Robertson Cooper Ltd, www.robertsoncooper.co.uk
5. Goodhope case study, www.shpstress.co.uk/beacon
6. Lynn Holland – [email protected], 0121 233 3100
7. Steven Hogg – [email protected], 0870 747 6208
8. CALM, 0121 233 3100
9. HSE Publications on Stress – Tackling Work Related Stress, INDG281REV,
www.hsebooks.co.uk
10. Advanced Diagnostic Technology profile (ADT), www.shpstress.co.uk/adt
11. HSE/IES Best Practice Stress Rehabilitation,
www.hse.gov.uk/stress/research.htm
12. Goodhope Hospital OH department,0121 378 6099
Further reading
Sign up to our weekly round-up of HR news and guidance
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Stress and Employer Liability
(Developing Practice), Earnshaw & Cooper, CIPD publications
Managing the Risks of Workplace Stress, Cooper & Clarke,
Routledge,Due for publication December 2003
