Organisational or service-level stress audits can help to identify and address causes of work-related stress and, from there, support appropriate interventions. Simon Naish outlines how to make such audits work, and the role and leadership occupational health can bring to the table as a result.
Work-related stress, anxiety and depression (S/A/D) has increased significantly in recent years along with the considerable additional impact of the pandemic and now the anxieties (for certain occupations) attributable to a return to a physical workplace.
With a strong commitment to really address S/A/D, Birmingham City Council has developed and fine-tuned an innovative approach, one that adopts a more holistic, service-area level or organisation view of the situation and, importantly, what interventions may be possible to tackle root causes directly.
Although the full impact of this approach on sickness absence will take time to measure (and we should acknowledge the impact of factors like presenteeism, absenteeism, leaveism and under-reporting and so on on that measurement) there have already been some significant gains.
These include a hard look at the effectiveness of historic support mechanisms, the collaborative working of internal disciplines, consistency of internal approaches and a shift to a more root cause analysis of stressors, with a move away from the reliance on palliative, individual control measure that have limited long-term effectiveness.
A more holistic approach
Whilst the recognition of and the reporting of stress within the workplace has therefore increased nationally, what we wanted to do at Birmingham City Council was to consider a number of different precursors and interventions.
This was to seek out issues proactively, to better address the requirements of the principles of prevention, and to seek to combat risks at source. In turn, this would benefit the wider workforce and provide protective measures over the individual.
A note on individual stress risk assessment
The employer’s duty via line management to ensure that individual cases of reported stress are assessed using traditional and effective stress risk assessment tools is well known and represents a very effective means of tackling individually reported cases of stress, regardless of the trigger, whether work, home life or perhaps a mixture of the two.
This approach, however, is usually reactive and often centred on the individual. It also relies upon the candour of the individual to either report the reason for sickness absence as ‘stress/anxiety/depression’ or to be open enough to raise the issue with their manager. By the very nature of the trigger, this could be something that an employee finds difficult to do.
A wider consideration
So, how do we tackle triggers that may be occupational, that may have widespread impact, that may never be formally reported, and which senior management may only be anecdotally aware of, if at all?
How do we attempt to turn the study of stress into a proactive rather than reactive initiative and importantly, to generate sustainable actions that address root causes instead of looking to solely provide individuals with support such as access to employee assistance programmes, mental health first aiders, chaplaincy services or (as often is the case) an individual referral to occupational health?”
In addition, how do we attempt to turn the study of stress into a proactive rather than reactive initiative and importantly, to generate sustainable actions that address root causes instead of looking to solely provide individuals with support such as access to employee assistance programmes, mental health first aiders, chaplaincy services or (as often is the case) an individual referral to occupational health?
Taking cues from the HSE’s How to tackle work-related stress, what is proposed, depending on the size of the organisation is a higher-level, organisational stress audit or, in larger organisations, a service-level stress audit that actively seeks to identify and address causation.
Such a study supports 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 where staff feel valued, happy, engaged and motivated via a pragmatic number of tangible actions as well as minimising the cost of sickness absence, increasing productivity and reducing employee turnover, associated litigation and enforcement action.
Not boredom, not breakdown
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 destress in the work environment.
The Yerkes-Dodson law outlines the empirical relationship between pressure and performance, so the elimination of stress is not the desired outcome, rather a recognition that performance increases with physiological or mental arousal, but only up to a point.
When levels of arousal become too high, performance decreases. So, whilst not striving for elimination, we apply the hierarchy of control to help us to get that balance right – and a workforce that understands what is transient and manageable with support, and what is not sustainable, organisational and requires a more thorough consideration of both trigger and remedy.
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 which 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 occupational health 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 suggests that a particular service area many be suffering from high levels of stress. Although formal reporting systems may not substantiate this evidence, as there are often issues with the levels of reporting in any organisation and as mentioned, the openness of individuals to report the absence as one related to stress.
If these considerations have been made and the perception remains that there continues to be more widespread or inherent root causes which may benefit from an independent review, then a service area stress audit should be considered.
Outside of the audit
An audit of this nature is not a series of OH referrals collated into an all-encompassing report whereby personal triggers outside of the workplace are addressed.
The legitimacy and severity of such issues are of course in no question, though better addressed via individual stress risk assessment utilising traditional interventions and support.
Occupational health referrals may also be triggered indirectly from the audit where other factors are cited as being the cause. Certain responses therefore personal to the individual which do not represent an occupational trigger or form a consensus will tend to be excluded from the study but may be flagged outside of the study with line management.
The method – phase I; scope, commitment and data collection
1) Define the scope. The study needs to be carried out with a sufficient representation of employees within the identified area – both across grades and job roles (and if appropriate locations). This can be done randomly to ensure transparency, or targeted where there is sufficient trust between senior management and the workforce.
2) Secure commitment. The subscription and commitment of senior management and employees alike to the study is vital. We need to acknowledge and accept in advance that the report will make recommendations that will require acknowledgement, acceptance and timely action and without establishing this contract prior to commencing the audit, the resultant effect could be the opposite of what is being intended – much ado about nothing.
From experience, employees are willing to participate in the audit, although with the subject matter in mind 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 worked-up action tracker therefore is the lifeblood of the audit’s success.
3) Data collection. The data is collected via a number of independent consultations (readily achieved via telephone considering the restriction of Covid-19 and then with regards to availability of employees, shifts and so on).
These can be conducted by the occupational health or health and safety team. Where there may be issues around confidentially or capacity, then 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 on average between 20 minutes to 40 minute depending on the employee’s perception of stress and their willingness to discuss.
Questions are kept to a minimum (below 20). Half should be related to the fundamentals of management (frequency of one to ones, communication, return-to-work interviews, completion and success of SRAs and so on).
The other half should be based upon the HSE’s Management Standards (the impact of demands/control/support/relationships/role/change). The total number and specific target areas can be tailored to each team, however.
Questions are not sent to the employees prior to the consultation to avoid collusion or raise concern. To increase openness, the consultations are confidential, and no names are used in the resultant report. This is critical to the success of the report. It is important also that the entire duration for both the data capture and production of the resultant report is kept as brief as possible so as not to lose focus and to keep the faith of those involved.
The defined aim is kept very much in mind during the questions. This is both to capture the underlying/innate occupational factors and not the personal; this is made clear to the interviewee. Question answers are in the main ‘yes’ and ‘no’ so that overall trends can be reported.
Questions related to the HSE Management Standards are scored to allow for the final report to display the results 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.
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).
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.”
The method – phase II; production of the report, recommendations, management interventions
1) Production of the report. Once all of the consultations have been undertaken, the raw data can be analysed, with trends and root causes established. The raw data is readily converted into a series of graphs and headlines from which inferences can be drawn.
The report is presented in a non-technical format. A limited number of slides showing what root causes appear to exist along with direct recommendations to address.
2) Recommendations drive to the heart of the root cause. So, as stated, rather than recommending palliative measures or further risk assessment, remedial actions may identify a belief that there is a lack of resourcing (for example).
Therefore, demands plotted over time versus the organisation’s full-time equivalent (FTE) workforce 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 options. Alternatively, if demand has decreased, a study as to the reasons why workload appears to have increased, which could for example be due to the effect of long-term sickness absence or staff turnover.
3) Management interventions at phase II. There are many such responses to the identified root causes which an organisation can put into action beneath any one of the questions asked/HSE management standards.
Organisations will often have the internal skills, knowledge and experience to modify the way that their organisation operates whilst increasing the wellbeing of those undertaking the work. This is reliant of course on the cause of stress being understood – which, after all, is the overall aim of the study.
4) HR and organisational development teams. These will have these existing skills and this is the opportunity for theories and concepts to be turned into tangible strategies that more adroitly straddle the spans and layers of an organisation or service area.
The approach then also helps to integrate internal disciplines, establishing a joined-up consistency of approach, a deeper understanding of organisational issues which may exist, and cultural influences. It all ultimately supports the goal of a wraparound, intelligent support service.
The audit will also inform and represent a secondary assessment of the reporting of and effectiveness of individual stress risk assessment where work has been cited as the trigger or where thought to be compounding the personal trigger.
It is recommended that the audit process is revisited after a period of around 12-24 months, asking the same questions with a view to measuring progress and to develop internal benchmarking data.
The occupational health team at Birmingham City Council have really embraced and honed this change in how we support the organisation to manage stress. Working in partnership with service areas, the positive impact to date is expected to continue and we highly recommend other occupational health teams to consider the effectiveness of current measures with a view to adopting a similar service level / organisational approach.
‘Work-related stress and how to tackle it’, Health and Safety Executive, https://www.hse.gov.uk/stress/what-to-do.htm#:~:text=HSE%20defines%20stress%20as%20’the,to%20employees’%20skills%20and%20knowledge. The HSE definition of work-related stress is ‘the adverse reaction people have to excessive pressures or other types of demand placed on them.’
‘Work-related Stress, depression or anxiety in Great Britain 2020’ (+ 2019), Health and Safety Executive, https://www.hse.gov.uk/statistics/causdis/stress.pdf
LFS – Labour Force Survey – Self-reported work-related ill health and workplace injuries: Index of LFS tables, https://www.hse.gov.uk/statistics/lfs/index.htm. The Labour Force Survey states that 828,000 workers are suffering from work-related stress, depression or anxiety (new or long-standing), leading to 17.9 million working days lost.
Schedule 1 of The Management of Health and Safety at Work Regulations 1999 ‘The Principles of Prevention’, https://www.legislation.gov.uk/uksi/1999/3242/schedule/1/made
‘How to tackle work-related stress: a guide for making the management standards work’, Health and Safety Executive, INDG430, https://www.hse.gov.uk/pubns/indg430.pdf
Eustress, means ‘stress that is not too extreme and is good for someone’. From: https://dictionary.cambridge.org/dictionary/english/eustress
The Yerkes-Dodson Law and Performance
“What are the Management Standards?”, Health and Safety Executive,