Analysis of work related stress

The word ‘stress’ is in itself extremely wide and far reaching, in this respect the specific focus of this literature review will concentrate on work related stress.

Work related stress is one of the foremost challenges facing organisations, affecting not only the health of the workforce but ultimately the success of the business. The aim of this literature review is to provide a critical evaluation of the current relevant literature discussing the topic. It will present a range of views, definitions and contemporary attitudes associated with work related stress, and examine the main broad areas of the issue, exploring the extent of work related stress and the direct and indirect costs to both the economy and on organisations. With reference to different areas of literature it will also examine the main causes of work related stress, the existing legislative arrangements and discuss whether the current support arrangements are sufficient in assisting organisations to effectively control and prevent the problem.

Furthermore it will look at the roles and responsibilities of all stakeholders involved in delivering management supports, including specific review of the roles of those involved in the conception of procedures and processes, the role of those involved in delivering front line support to employees, and finally focusing on the role and responsibilities of the employees themselves.

Finally, it will review and evaluate the range of existing management theories and organisational approaches, aimed at raising awareness and seeking improved management approach and employee engagement within the case study organisation, Housing & Social Work Services, the second largest service within North Lanarkshire Council.

2.1 The Definition of Stress in the Workplace

The term “stress” is a phrase which in itself is not always clearly defined within literature. Arthur (2005) gives emphasis to this, stating that stress “has so many different meanings that it is confusing, elusive, and heard so often its meaning is frequently distorted and its implications taken for granted”. This therefore intensifies the difficulty of being able to provide accurate definitions for work related stress.

There is a general perception that stress is an illness, the Health and Safety Executive take a different approach and describe stress as being a ‘state’ and not an illness, in addition they also provide a useful definition of work related stress which is widely referred to within research, describing this as “the adverse reaction people have to excessive pressures or other types of demand placed on them at work” (HSE, 2008).

There is a general opinion within existing literature that pressures and stress can, and usually do, exist within an individual’s working life, however these factors in themselves do not necessarily create illness or poor health. Stress is a multi factorial phenomenon, which may result in both positive and negative outcomes for individuals. This is supported by Seyle (cited in Landy and Conte, 2010), who was one of the first writers on stress and who made the distinction between good (pleasant) stress “eustress” and bad (unpleasant) stress “distress”. Seyle also discussed the particular effects of good stress, and how it can stimulate positive, motivational outcomes. Stranks (2005) further explored the positive effects of ‘eustress’, and how it can ultimately inspire both improved work performance and output.

The opposing definition however ‘distress’ is what is normally associated with the term of stress itself. It is when levels of this type of stress exceed what is considered to be expected or reasonable within an individuals working environment, that it can lead to employees experiencing illness or poor health, impacting on both an individual’s psychological and physical health.

Lazarus (1966) provided an early definition of stress, however one which still remains relevant today, putting forward his view that stress is an individuals’ perception to the demand placed upon them, and how this can exceed their capacity to cope with the situation. The inclusion and relevance of the term ‘perceived’ is further explored by Colligan and Higgins (2006), who suggest that it is the perception of stress that produces a negative reaction rather than the situation itself. As such, an individuals’ emotional and behavioural response to a situation can govern how they react, or are able to manage, the stressor itself. This is consistent with the findings of Hale et al (2010) who reported that negative stress can be both personal and subjective depending on the stressor. In addition Hale et al (2010) described three different categories of particularized stress. The first, acute stress which is triggered by short term events, the second episodic stress which is caused by either habitual or sporadic events i.e. either monthly or weekly etc, and finally chronic stress which is constant and persistent events. Each of these stages stimulates a different emotional and psychological response within an individual.

Copper (2002) discussed the harmful outcomes of stress within the workplace and how its effects can be disruptive, negatively impact on the organisational effectiveness, achievements and impede efficacy. For the individual, this can result in outcomes such as poor performance, loss of job satisfaction and motivation leading ultimately to increased levels of both employee absence and organisation turnover rates. Copper (2002) also noted that there are several factors which can serve to influence an individual’s ability to manage their own stress or pressures, these can include their general health and well-being, their ability to manage and deal with pressures, their personality and personal circumstances both in and out of the workplace. Lazarus and Folkman (1984) provided further observation in this respect, stating research had evidenced that increased individual effort and lead to increased susceptibility to stress in situations where there was high commitment levels combined with poor performance.

The CIPD (2010) advocate that one of the key preventions of excessive stress within the workplace in having effective health and well-being arrangements, this is supported by Dame Carol Black (2008) who reported that employers having effective management arrangements in place to look after employees health was key to improving and maintaining their workforce health and well-being. Similarly, the Work Health Organisation (1985) supports this view, and that whilst work related stress may serve to aggravate poor health, it may only be a contributory factor, rather than the specific reason for the health condition

2.2. The Cost and Extent of the Problem

It has been estimated that the financial cost of sickness at work is £110 billion per year on the UK economy (Black, 2008), the actual financial cost of work related stress however varies enormously. The World Health Foundation (2007) has estimated the cost of work related stress related illness in the UK varies between £5 billion (TUC) to £12 billion (CBI) per year. On average, the cost in terms of lost days associated to stress at work is the most expensive of all absences from work in the UK (The Work Foundation, 2007).

The CIPD (2010) reported that stress, although not specifically work related, is consistently amongst the top five reasons for both short and long term absence within the respondent organisations. Whilst the report demonstrated little variance across the different sectors, public sector organisations did present the highest percentile of causes of work related stress were to workload and organisational change. Furthermore, a third of organisations reported an annual increase in work related stress, these statistics are also in line with previous years CIPD research.

Research undertaken by the TUC (2010) who surveyed trade union safety representatives, found that stress was a greater hazard in organisations which employ more than 1,000 people. The survey also found that 62% felt that stress was the biggest and most significant hazard currently facing employees, this increases to 70% within local government which is relevant to the case study organisation. Other significant hazards the survey identified included bullying and harassment, overwork and long hours which themselves are either directly related to, or can ultimately lead to, work related stress (TUC, 2010).

Organisations do appear however to be putting in place measures to address the issue of work related stress. This is notably prevalent in public authorities, where 66% (compared with 38-44% in other sectors) have put in place pro-active wellbeing strategy in an effort to reduce levels of stress within their organisation. Examples of methods included within these strategies ranged from undertaking staff surveys, improved work life balance arrangements, risk assessments, stress audits and training for both their managers and employees (CIPD, 2010)

In response to the concern surrounding high levels of work related stress, the Health and Safety Commission agreed a strategy in 2000, which undertook extensive research to study potential solutions and practical advice on how to tackle stress in the workplace (MacKay et al, 2004). As a consequence, a ten year plan was established which focused on developing a range of practices and procedures which could be developed and inform the current HSE approach to stress in the workplace. These studies formed the basis of the HSE guidance, Tackling Work Related Stress (2001), and highlighted the Risk Assessment process as a method which could be implemented when dealing with work related stress.

It remains however that the true and exact extent of stress at work however is very hard to quantify and measure, with individuals failure or reluctance to disclose or admit that they are experiencing stress (Unison, 2011).

2.3 Causes and Effects of Work Related Stress

There have been extensive studies examining the causes of work related stress within organisations, the particular research within public sector organisations (relevant to case study organisation) identified the principle causes of work related stress were workload pressures (58%) and organisational change (56%). Further non work related causes were also identified by respondents, such as relationships, family and financial worries (CIPD, 2010).

In a further effort to deal with the problem, in 2004 the HSE introduced a set of management standards which set out six principle provisions that reveal the stratum of possible health, well-being and organisational performance stressors, which, if properly managed can help reduce stress in the workplace (Edwards et al, 2008). The management standards were utilised to develop a Managing Stress Tool to be used within organisations to assess the risk of work related stress.

The Health and Safety Management Standards (2004) are:

Demands: this includes issues fundamental to their job, such as workload management, work patterns and the workplace environment.

Control: this covers how much influence and autonomy an individual has in how their work is carried out.

Peer/Management Support: includes peer support, encouragement and resources provided by the organisation, line manager and colleagues.

Relationships: this includes promoting positive relationships at all levels, such as managers, colleagues and subordinates all working together to avoid conflict and deal with unacceptable behaviour, such as bullying and harassment.

Role: the clarity and understanding of individuals and their role within the organisation, serves to avoid potential for conflict or ambiguity.

Change: how organisational change is introduced, managed and communicated within the organisation.

(HSE, 2004)

There has however been divided opinion on the effectiveness of the Management Standards following their implementation in 2004. One criticism is that the standards fail to recognise if there is further risk associated to stressors which are present in people’s home lives, and how these may negatively impact within the workplace, this is sometimes referred to as the work life balance (The Work Foundation, 2008). In 2009 the HSE commissioned a review of the Standards, to assess strengths and weaknesses. Overall it was felt that the Standards were easy and simple to follow, however a further criticism was that organisational implementation of outcomes were problematic mainly due to poor levels of line management skills and knowledge (Cox et al, 2009).

It is well documented within existing research that stress can have a negative impact on individual performance, behaviour and health. Exposure to sustained pressure can, if not managed by either the individual, line manager of the organisation, result in stress which subsequently negatively influence performance, behaviour and health (Spiers, 2003). Conversely, work related stress can also be an outcome of employees feeling that there are insufficient pressures and demands within their job. The outcome of such a position can lead to individuals feeling “bored and undervalued” feeling there is a “lack of recognition” (HSE, 2010). This thinking is supported by Sanders (1983) who felt that levels of individual performance were higher when exposed to controlled and reasonable levels of stress, however it is only when moderate levels are exceeded, performance and concentration deteriorates. The research therefore suggests that whilst the psychological effects of stress are broadly similar, the effects of stress can be varied, dependent on individual responses. Griffin and Moorhead (2009, p167) support the thinking that stress is a reaction caused by stimulation, and it is how an individual is able to “adapt” in response to these stimuli, Griffin and Moorhead expand this point further, writing that individual responses to these stimuli can result in both “psychological or physical demands”.

2.7 The Legal Position

Organisations have a statutory duty to consider their employees health at work, and as such there are a number of different Acts which governs and protects employees in the workplace. In terms of wider employment legislation this includes protection against sex discrimination, bullying and harassment and disability discrimination. The specific legislation pertaining to employees’ health, safety and well-being within the workplace comes under the terms of the Health and Safety at Work etc Act (1974) (HASWA). Within the terms of this Act, all organisations within the UK have a duty of care towards their employees, this is laid down within section 2 (1) which states that “it shall be the duty of every employer to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all his employees.”

The general duties of the HASWA are further expanded by the requirements of the Management of Health and Safety at Work Regulations (1999) (MHSWR), specifically regulation 3 which require all employers to “make a suitable and sufficient assessment of the risks to the health and safety of his employees to which they are exposed whilst they are at work.”

Whilst there is no specific mention within the current legislation which sets out the particular responsibilities for work related stress, within paragraph 80 of the accompanying Approved Code of Practice for the MHSWR it is stated that “when allocating work to employees, employers should ensure that the demands of the job do not exceed the employees’ ability to carry out the work without risk to themselves or others”. This recommendation is reflected within the HSE Management Standards (2004) as detailed previously.

Organisations who subsequently fail to comply with the requirements of the legislation are in breach of statutory obligations, and could face action and penalties such as being issued with improvement notice, prohibition notice and/or ultimately prosecution for breach of their statutory health and safety duties.

Whilst a breach of statutory health and safety legislation can result in criminal prosecution, organisations duty of care is not solely contained within the Act or the Regulations it is further extended within common law. Furthermore, legislation also afford employees’ entitlement to seek remedy under common law where they believe organisations have been negligent and have failed to meet their duty of care. Civil liability cases can be heard in courts to establish if organisations are negligent in their duty of care, and if successful, the courts can award unlimited compensation to successful claimants. This was explored further by Cartwright and Cooper (1997) who discussed the impact of indirect cost of stress for organisations in relation to the rise in numbers of employees seeking recourse via litigation. In particular, the consequential increase in the cost of employers’ liability insurance.

In 1995, a landmark case was heard in the high court, John Walker v Northumberland County Council (1995). This was the first time that the courts had found in favour of a claimant who suffered a nervous breakdown as a direct consequence of work related stress. This case established that the organisation, Northumberland County Council was found to be in “breach of its duty of care in failing to take reasonable steps to avoid exposing the employee to a health endangering workload”. The case established liability on the part of the organisation for the psychological injury to an employee, caused directly by work related stress. This is of particular relevance to the case study organisation, as John Walker was employed as a Social Worker in charge of fieldwork staff, involved in handling particularly sensitive case loads, he was subsequently awarded compensation totalling £175,000, the total cost to the employer however was estimated to be around £400,000.

2.4 Roles and Responsibilities

No one individual is responsible for the management of work related stress, there are several stakeholders both within, and outwith an organisation who all have distinct roles to play in managing and preventing the problem (HSE, 2010). The management of stress became a function managed by Health and Safety professionals, under the direction of appropriate legislation and procedures and processes developed by the Health and Safety Executive. This arrangement is consistent within the case study organisation, where health and safety is a specialist function managed by the HR Manager, who delegates these responsibilities to the Senior Health and Safety Officer. To provide some clarification of roles and responsibilities, the HSE have identified a number of key stakeholders which are explored further below:

2.4.1 CEO/Board Director (Senior Management)

The CIPD (2010) advocate that it is an employers’ responsibility to ensure they “identify any problems that your organisation might be having with stress at work”. These general duties are contained within legislation and are explored further within this research. In addition, the CIPD further emphasise the relevance of top level leadership within organisations and how this can assist in establishing a shared positive culture, one such method identified was recognising how improved employee well-being can contribute significantly to organisational effectiveness. This can be demonstrated by visible senior management support to develop employee well-being strategies, advocating the engagement of management support arrangements, and putting in place sufficient resources to manage work related stress. Examples of such arrangements could include engaging with safety representatives and focus groups (where they exist), reviewing existing stress arrangements, analysing and/or actioning staff stress surveys, re-review of risk assessments and appropriate analysis of absence data (CIPD, 2009).

2.4.2 HR Manager/Specialist

HR managers have a key role in the management of stress in the workplace. These responsibilities include ensuring that they put in place and develop robust policies and procedures, effective data gathering systems and provision of appropriate training arrangements specifically targeted at stress management (HSE, 2010). Guest and Conway (2004, p.67) discussed the concept of the “high quality workplace”, examining how the presence of positive HR policies, in particular those associated with employee well-being, can positively influence the psychological contract between the organisation and the employee.

 2.4.3 Health and Safety Manager/Specialist

The health and safety manager is normally the competent person as required by Regulation 6 of the Management of Health and Safety Regulations (1999) and therefore has responsibility for all aspects of health and safety, which includes the health and well-being of the workforce. In larger organisations, the health and safety provision is normally embedded within the HR function and works closely with other HR colleagues, occupational health advisors, employee representatives and line managers in providing specialist advice and support.

2.4.4 Line Manager

Line managers are one of the key stakeholders involved in the management of work related stress however conversely, they are also one of the principal contributors to high levels of stress (The Work Foundation, 2008). Line managers are often appointed or promoted as a result of their specialist knowledge or abilities, and as such may lack the necessary leadership qualities and skills to support the employees’ they manage, including necessary support to employee well-being (Willmott & Purcell, 2009).

The role of line managers has evolved in recent times, with increased devolvement of human resource management functions to line managers (Thornhill and Saunders, 1998a). This higher level of involvement in human resource management and accountability for making decisions associated with managing employees’ creates further pressures on line managers. Managing these additional responsibilities plus the consequential expectations placed upon them puts even greater additional pressures on line managers, who may already be experiencing significant pressures and performance demands undertaking other aspects of their job, such as managing workloads and achieving deadlines. Managers therefore need the support provided by Human Resources to enable them to effectively carry out the supporting role of implementing employee well-being arrangements and reduce any additional pressures placed upon them (Yarker et al., 2007). For this to be fully successful the role of line managers needs to be “integrated with the organisations human resource policies” (Thornhill and Saunders, 1998b, p.460).

It remains however that line managements behavioural relationship approach is integral to ensuring mental health well-being within the workplace. This is supported by Dame Carol Black who undertook a government supported review of health and well-being in the UK and reported that “line managers have a key role in ensuring the workplace is a setting that promotes good health and well-being. Good line management can lead to good health, well-being and improved performance” (2008, p59).

Torrington et al (2009 p298) purporte that “people management activities are shared between the line manager and the HR specialist so that each can contribute according to their skills”. It is therefore acknowledged that the responsibility for managing work related stress is therefore not exclusive, and relies on contribution from both the HR specialist and line manager.

2.4.5 Occupational health and Health Professionals (GP)

The CIPD Absence Survey (2010) reported an increase in the numbers of employees suffering stress related absence, and that referral to occupational health services or their own GP at an early stage in their illness is fundamental to assisting quicker recovery and facilitating an early return to work. The report stated that the engagement of occupational health services for both long and short term absences was one of the top three common organisational interventions utilized by respondent organisations in an attempt to reduce levels of absence (CIPD, 2010).

2.4.6 Trade Unions and/or Employee Representatives

The role of safety representatives is positively acknowledged within a CIPD (2008) survey of their membership, which expressly acknowledged the valued role they provided within the respondents organisations in developing and promoting good practice and management arrangements (CIPD, 2008). The TUC estimate that there are approximately 150,000 appointed trade union safety representatives within the UK. The HSE also emphasise the shared benefits of the role of trade unions and safety representatives in advocating the use of stress Management Standards to assist managing work related stress.

The role of trade unions and safety representatives is also contained within legislation. Within organisations who recognise and consult with trade unions, the union would elect safety representatives, with whom organisations are required to discuss all aspects of health and safety, including stress. These functions are set out within the Safety Representatives and Safety Committees Regulations 1997 and the Health and Safety (Consultation and Employees) Regulations 1996. Their role is specifically conveyed as one of the main recommendations within Dame Carol Black’s review (2008, p17) was that trade unions and safety representatives within organisations “should play an expanded role” to endorse the benefits of employee well-being in an effort to lower levels of stress leading to poor health. The government undertook a swift response to this review in support of this recommendation for improved outcomes to improve health at work. Their response included a commitment to work closely with the TUC in support of greater involvement with trade unions and improved provisions for training for safety representatives (DWP, 2008).

2.4.7 Individual Employee

Palmer et al (2003, p128) explored the specific responsibilities of employees in tackling work related stress, suggesting that employees can “learn to identify and manage stress in your workplace, as well as deal with your own levels of work-stress”. Whilst management may have in place appropriate arrangements which assist employee stress, employees also have responsibility for recognising when their pressures are becoming excessive. O’Connell (2004, p123) suggests that one of the reasons why employees fail to disclose that they are stressed relates to their own personal history and social class, for reasons such as “perfectionism, insecurity, desire to gain approval and lack of relationship building”. The negative connotation and stigma attached to the term itself combined with a lack of stress education and awareness training are further rationale into why individuals fail to admit they are experiencing work related stress (Cooper et al,1997).

The HSE (2008) also recognised the involvement of the employee in managing their own stress at work. This contribution begins by early identification of the principle cause(s), and making sufficient effort to identify what they can do to make things better. Whilst employees may seek wider assistance from outwith the organisation, participation in organisational support systems similar to those suggested within the HSE Management Standards are also vital to enabling organisations manage work related stress.

2.5 Management Systems Framework and Policy

The CIPD (2007) promote the organisational benefits from developing written policies which deal specifically with work related stress, however recent research identified the benefits of developing a wider reaching well-being policy (Black, 2008). The benefits of such an approach which looks in a wider context of improving the health and well-being of the workforce, is aimed wider than reducing stress levels, it also aims to impact on attendance and turnover levels plus potential benefits from reducing the number of stress related litigation.

Within the Health and Safety at Work Act etc (1974), organisations with more than 5 employees are required to have a written policy which outlines the organisations commitment to health and safety. The CIPD set out what the main points of policy should incorporate with regards to employee well-being:

begin with a clear statement which shows that the organisation is committed to developing a working environment that promotes the health and well-being of the organisation and its employees

be supported by senior management

be kept under constant review, together with other company policies, procedures and initiatives to ensure that they maximise employee well-being

provide for identification of and a regular review of the key well-being indicators

ensure the provision of effective advice, support, counselling and training to enhance employee well-being

incorporate the process for evaluating the effectiveness of all well-being initiatives.

(CIPD, 2007)

North Lanarkshire Council has an established corporate Health and Safety Policy; however the Health and Safety team within Housing and Social Work services developed their own well-being strategy which, with the commitment from senior management, identifies a number of initiatives aimed at improving and developing the general well-being of their employees, with a subsequent improvement in employee attendance at work.

Section 3 of the Health and Safety at Work Regulations 1999 contains the requirement for organisations to put in place arrangements to conduct a suitable and sufficient assessment of the risks arising from their work activities. Whilst these arrangements may appear reasonably simplistic in terms of the more obvious hazards within an organisation, when dealing with stress in the workplace, some organisations do not fully understand “how and what to assess and which tools and measures should be utilized (Spiers, 2007 p58).

The relevance of having sufficient stress risk assessment tools in place is endorsed by Cranwell-Ward and Abbey (2005) who supports their use in identifying and preventing potential stress risks, as well as advocating their use in raising awareness. Following extensive research and consultation with all stakeholders, the case study organisation implemented their Stress in the Workplace Management Arrangements and associated tools. These arrangements have been implemented in tandem with the services Employee Well-being Strategy and guidance for line managers and employees. This guidance is directly related to the HSE Management Standards and the six recognised individual stressors.

The first of these stress management tools is an employee self assessment in regards to work related stress, which was developed from the HSE’s Return to Work process (HSE, 2010). The self assessment can be self directed or following agreement with a line manager. Following the completion of a self assessment an employee and line manager would review, and consider and further outcomes. Given that the work to develop this particular part of the arrangements was in consultation with the HSE, on its completion they publicly recognised the work undertaken by the service and included the outcome and full arrangements as part of their Stress in the Workplace case studies, highlighting the service as an example of good practice (HSE, 2010).

Conclusion

With increasing levels of reported employee absences associated to work related stress, organisations are recognising the resultant challenges that this is presents. These challenges are wide, varied and far reaching, impacting on both organisation and individual effectiveness. It is acknowledged that the presence of pressures and stress can generate positive outcomes, however when this exceeds acceptable levels, health and well-being can become adversely affected, and may, if not managed appropriately, result in illness and poor health.

In addition to fulfilling their legal obligations, the benefits for organisations that identify and put in place support arrangements include: a reduction in the financial cost from resulting improved attendance; improved health and well-being of employees; increased motivation and job satisfaction; and increased productivity and performance from their employees who feel supported in their workplace. Such supports can include employee well-being initiatives and occupational health services. The financial costs are particularly relevant under the current economic pressures facing organisations.

There are specific roles provided by different stakeholders involved in supporting employees at work. Human Resources and Health and Safety specialists play a strategic role in developing and improving robust policies and procedures designed to equip line managers and employees with the necessary tools and confidence to implement these policies. Line managers themselves have a central role in managing stress at work, this is particularly reliant however on their management skills and their compliance to the management standards. Research indicates that this is one particular area that organisations must address to ensure that existing measures can be successfully implemented.

This literature review goes some way in identifying the complexity and depth of the issue of work related stress, presenting opposing views and options from researchers and writers on the topic