HEALTH AND WELL-BEING AT WORK PROJECT

Transcription

1 HEALTH AND WELL-BEING AT WORK PROJECT Report To: The Partnership Occupational Safety and Health in Healthcare group Interim Project Update Report Published: February 2011 This report was produced by Zeal Solutions Ltd

2 Contents Section 1: Background... 3 The structure and content of this report... 3 Section 2: The audit approach... 4 Stress and health at work... 4 The health audit using ORA TM... 5 Section 3: Project progress... 7 Project remit... 7 Participants and progress... 7 Section 4: General findings... 9 Common findings... 9 Observation 1: Management behaviour is integral to individual and organisational health and well-being... 9 Observation 2: Experiencing a sense of value and recognition for the work they do is linked with improved health outcomes... 9 Observation 3: Effective team working is critical for buffering the impact of increased work demands Observation 4: The lack of resources (i.e. information, training and/or equipment) is linked with poor health outcomes Observation 5: There are specific elements of organisational culture and/or climate that are important for improving individual and organisational health Perspectives on action to promote health and well-being Perspective 1: Some stress is good for you Perspective 2: Inadequate assessments of stress/health and well-being Perspective 3: Leading in difficult times will create conflicts for health and well-being Perspective 4: Under appreciation of the importance of health and well-being Perspective 5: Poor or non existent evaluation of action and interventions taken to improve health and well-being Section 5: The intervention study Overview Rationale, approach and potential Section 6: Next steps and close Next Steps Close Zeal Solutions Ltd 2011 Contents 2

3 Section 1: Background Individual and organisational heath go hand-in-hand. Organisational effectiveness and performance cannot be achieved without safeguarding and promoting the health of employees. As part of it s commitment to valuing health and well-being, the Partnership for Occupational Safety and Health in Healthcare (POSHH) a sub group of the NHS Staff Council - has initiated a project that aims to identify both the positive and negative characteristics of work (e.g. the content of the job) and the workplace (e.g. organisational procedures and elements of the physical environment) that influence employee health and so contribute to organisational effectiveness. The project is a direct response to the recent Boorman review of Health and Well-Being in the NHS. In line with the Boorman review - and with a focus on the healthcare sector -this project has been commissioned to: Identify best practice relating to working conditions that contribute towards a healthy workplace and workforce; Establish a valid and useable evidence base on healthy working practices through the completion of a tailored health and well-being assessment with a limited number of organisations; and Publish a final report on the health and well-being project which includes case studies of best practice that can be disseminated to all. To get the best out of this project, it was agreed that we needed to work very closely with a limited number of organisations. This close work involves the completion of a bespoke health and well-being assessment, i.e. one that will be tailored to the collaborating organisation and will result in each host organisation receiving a personalised health and well-being report, together with support in implementing any change on the basis of the findings. Further information on this assessment is provided in Section 2. The structure and content of this report This interim report has been produced to provide the executive team with an overview of the progress being made on the project progress together with an outline of key findings and next steps. Detailed information on the evidence collected for all participating organisations will be published in the final report scheduled for November Zeal Solutions Ltd 2011 Section 1: Background 3

4 Section 2: The audit approach Stress and health at work Stress is sometimes thought of, or construed, as a matter of the demands or pressures put upon a person, as epitomised in the phrase, I am under so much stress. In this sense, measuring stress is a matter of finding out what are the demands or pressures that the person is under. But another common phrase, I am stressed out, encapsulates a rather different meaning of stress. Here stress is more a question of what is going on inside the person than a matter of the demands or pressures that the individual is attempting to meet or carry. At the very least then, measuring stress at work should embody assessment of both (1) the potentially damaging features of the work environment, known as stressors or hazards, and (2) signs or symptoms of diminished or impaired well-being, typically referred to as indicators of strain or harm. Importantly, these indicators of strain or harm should reference both the individual and the organisation. The rationale here is simple. Not only is stress associated with significant damage to a person s physical health, but it also brings about marked changes in the way a person thinks, feels and behaves. Many of these changes in psychological health are directly or indirectly detrimental and counter-productive to the employing organisation, e.g.: o A reduced ability to think straight, weigh up options, plan and problem solve; o A diminished enjoyment of what one is doing, with less motivation to continue; o An increased irritability, moodiness and emotionality; o An increased desire to withdraw from meaningful interaction with others and to get out. In short, any attempt at stress auditing should measure signs and symptoms of organisational health as well as those of individual well-being. Crucially, of course, stress auditing must also demonstrate that any identified hazards are actually related to the measured indicators of individual and organisational harm. A third required aspect of stress auditing is therefore a demonstration of the empirical link or association between any identified hazards and measured indicators of harm. Without evidence of this link we have only assumption and conjecture, hardly the basis for informed intervention! Often, however, the stressfulness of a situation and its effects upon us is as much a matter of how we attempt to cope with the demands it places upon us, as it is a matter of those demands per se. With a major examination of some sort looming, for example, we might attempt to cope with any experienced pressure in a variety of ways, e.g. by some structured attempt at preparation; by reminding ourselves that it is only an examination and not a life and death matter ; by trying not to think about the impending examination; by deliberately attempting to focus our mind elsewhere; by asking for help; and so on. The key question then becomes, how effective are these utilised ways of coping in terms of maintaining and supporting well-being? Having help, support and assistance to call upon Zeal Solutions Ltd 2011 Section 2: The audit approach 4

5 when times are difficult or demanding is a particularly important aspect of coping. As the saying goes, a friend in need is a friend indeed. Although the rationale for completing a stress audit is the ultimate prevention and/or mitigation of any identified risks (i.e. negative features) it must also concern itself with the identification, demonstration and promotion of existing positive practices or experiences of the workplace. This approach ensures that a balanced review of the workplace is achieved. The health audit using ORA TM The valid and accurate assessment of health and well-being is integral to the success of this project being able to inform working practice. It is for this reasons that the Organisational Risk Assessment (ORA) tool is being used to as a basis for completing the health audits within all participating organisations. ORA is a proven, reliable and realistic tool for identifying aspects of the workplace whether positive or negative - that contribute to such things as job satisfaction, work engagement, symptoms of stress and absence. The tool provides a means of identifying practical interventions for enhancing the health, motivation and performance of the workforce. In line with best practice, the process is participative from the outset and ensures that all employees have an opportunity to contribute. There are at least four important aspects, or elements that are assessed when using ORA, these are: 1. Identifying both the sources of unmanageable pressure ( negative characteristics of the work environment) and the sources of reward and satisfaction ( positive characteristics of the work environment) that are most frequently experienced by staff; 2. Profiling the health and well-being of staff as a whole, or significant and identifiable sub-groups thereof; 3. Demonstrating how positive and negative work environment characteristics and experiences actually influence health and well-being; 4. Demonstrating how other intervening factors, e.g. the coping strategies used and the support available to call upon, influence both the experience of work as well as health and well-being outcomes. The underpinning rationale for completing the assessment in this way is to use a rigorous and systematic process to establish an evidence base that can be used to support decision making regarding interventions aimed at developing and sustaining a healthy workplace and workforce. The approach is one that is tailored to each participating organisation and can therefore identify unique features of the workplace that serve to promote and/or diminish both individual and organisational health and performance within the local setting. However, the process has been designed to allow for the collection of evidence on generic workplace Zeal Solutions Ltd 2011 Section 2: The audit approach 5

6 features so that common themes can be identified and learning generalised across the healthcare sector more generally. As shown below in Figure 1, the health audit is only one part of a health management cycle. Once the assessment has been completed it is important to engage staff from the organisation in a sense making process. In essence, employees from the participating organisation are invited to reflect on the results and help validate the findings. This process is premised on the notion that staff are experts by experience and are best placed to identify solutions as well as prioritise where action should be directed. Following on from the sense making phase, and as part of an overall risk management approach to health and well-being, it is important that organisations adopt a coordinated and strategic response to help reduce any risk and promote action that will help to improve health, well-being and the quality of working life. Figure 1: Risk Management Framework for Health Auditing Overall, the process that is used is one that provides a very practical strategy for assessing the design and management of work within the participating organisation as it is outcome focussed i.e. it is centred upon showing how work impacts upon outcomes that are important for continuous individual and organisational development and improvement. Zeal Solutions Ltd 2011 Section 2: The audit approach 6

7 Section 3: Project progress Project remit The project remit was to work with three healthcare organisations applying the health audit methodology to measure, understand, learn and share information on working practices that contribute to individual and organisational health and well-being. Following the risk management framework (see Figure 1) the approach shown in Figure 2 was initially agreed with the project sponsor. Org. 1 Org. 2 Org. 3 Phase 1: Assessment Phase 2: Sense Making Phase 3: Evaluation Yes Yes Yes Yes Yes No Yes No No Case Study Yes Yes Yes Figure 2: Original project remit and approach The approach shown in Figure 2, illustrates that all participating organisations will receive a health audit/assessment, two of the participating organisations will also undergo the sense making process and one participating organisation will undertake an evaluation (i.e. they will be supported and followed through an entire health management cycle). To maximise the value and applicability of the process for the project sponsor, participating organisations and the healthcare sector more generally, the project research team has decided to extend the project approach in at least two ways: 1. Completing a translation process in all participating organisations 2. Extending the number of participating organisations Both of these extensions have been implemented and without any concomitant impact on the overall project budget. Participants and progress Table 1 below provides an overview of project progress. As can be seen from Table1, the requirement for the original project has already been achieved. The project has experienced some delays due to the inclement weather experienced throughout the latter part of 2010 as well as from the more recent changes and planned transformations affecting the entire NHS. However, and as can be seen from the Table 1, good progress has been achieved to Zeal Solutions Ltd 2011 Section 3: Project progress 7

8 date and work is ongoing throughout each of the named organisations. The projected end date for this project is November ORGANISATION PROGRESS NEXT STEPS Leicester City Community Health Services Ambulance Service* Northumberland, Tyne and Wear NHS Trust - Older People Mental Health Services Somerset Community Health Services Phase 1 Completed Phase 2 Completed Report Completed Phase 1 Completed Phase 2 Ongoing Phase 1 Launching 1 st March 2011 Phase 1 Launching 7 th March 2011 Intervention Launching April & May 2011 Evaluation Ongoing Report To be submitted April 2011 Phase 2 April 2011 Phase 2 April 2011 North East Ambulance Service Project Initiation March 2011 Project Initiation March 2011 University Hospitals of Morecambe Bay Walsall Hospital NHS Trust Project delay Case study involvement and potential health audit in 2011 Project Initiation March/April 2011 Focus groups to gather case study information * Agreement has not been obtained to name this service in any written documentation. Table 1: Showing current project participants and progress It should also be noted that discussions are being held with other organisations to assess whether specific evaluation evidence may feasibly be collected on any ongoing health and well-being initiatives within the project timescales and budget. Zeal Solutions Ltd 2011 Section 3: Project progress 8

9 Section 4: General findings This section is divided into two parts. The first part highlights some general or common findings from the results that have been collected to date. The second part highlights some reflections on action that is being taken within the Healthcare sector to assess and promote health and well-being more generally. Common findings Although the data collection process is incomplete, the audit process has already established some common themes critical for individual and organisation health and wellbeing. In particular, we would like to provide five key observations from the evidence that has been analysed to date: Observation 1: Management behaviour is integral to individual and organisational health and well-being Management behaviour continues to be one of the most important determinants of individual and organisational health. Developing tailored management behaviour programmes that can be shown to effectively promote health and well-being is going to be fundamental to ensuring healthcare sector organisations can meet the challenges that lie ahead. While generic management development programmes are not being criticised, to date they have not been found to have the impact these organisations desire. How will the research address this observation? The health assessment being conducted within each participating organisation measures specific management behaviours. The findings from the assessment and the sense making phase of the project will be used to inform action within the local organisation as well as identify more general learning points for the healthcare sector more generally. A management behaviour intervention programme is being designed for one of the participating organisations (see Section 5). The focus of the intervention is on extending the repertoire of effective and supportive management behaviour. The programme will be evaluated and the results of the programme will be published in the final report. Observation 2: Experiencing a sense of value and recognition for the work they do is linked with improved health outcomes Staff who obtain a sense of value and recognition from what they do are generally healthier (i.e. more satisfied on the job, more engaged with their work, report fewer absences, etc.). This sense of value is not associated with financial reward but with members of staff being able to see how what they do is positively contributing to the service or to patient outcomes. Zeal Solutions Ltd 2011 Section 4: General findings 9

10 How will the research address this observation? Through sense making the research programme will be able to understand more readily what value and recognition looks like and how this can be achieved within the workplace. Examples of any interventions taken to improve value and recognition will also be published in the final report. Observation 3: Effective team working is critical for buffering the impact of increased work demands Enhancing collective (team) working is important for promoting health and well-being and supporting staff through periods of change and uncertainty. Where negative interpersonal relationships at work are experienced this is associated with poor health outcomes at both the individual and organisational level. How will the research address this observation? Through the assessment and sense making phases, the project will aim to establish any systemic issues which prevent collaborative working as well as identify what within each local setting promotes effective working at the group level. Observation 4: The lack of resources (i.e. information, training and/or equipment) is linked with poor health outcomes Provision of appropriate resources whether through information, training and/or equipment has been found to have a profound impact on individual and organisational health. There is a danger that the transformation, change and level of uncertainty being experienced across the NHS will limit the availability of resources further and magnify the negative impact of this issue on both individual and organisational health outcomes. How will the research address this observation? The project will aim to establish how organisations may act to counter/buffer the negative impact of limited resources. Although the financial constraints existing within the public sector will prove challenging for organisational leaders, the research will seek to identify practicable steps for addressing this issue. Observation 5: There are specific elements of organisational culture and/or climate that are important for improving individual and organisational health The culture of the organisation provides a context for behaviour that is accepted and valued. In this research to date, safety, fairness and supportiveness are three cultural components that have been found to improve both individual and organisational health and well-being. Zeal Solutions Ltd 2011 Section 4: General findings 10

11 How will the research address this observation? Through the assessment and sense making process, the research will begin to understand how to develop and promote these cultural elements more readily. In addition, the research will be able to identify work practices that prevent or negatively impact on the development of these cultural components. This evidence can then be used to inform day to day practices at both a local and national level. Perspectives on action to promote health and well-being Although the data collection process is still underway our experiences and reflections as a research team assist in highlighting what in our view are some fundamental challenges to the promotion of health at work. Perspective 1: Some stress is good for you There continues to be a general myth or belief that some stress is good for you. The confusion seems to be related to the fact that in research and more general terms the word stress has come to represent distress (i.e. experiencing an imbalance between demands that are made of someone and their believing that they are able to cope effectively with these demands). Eustress is a term that is used to represent what some term good stress (i.e. a positive response to job demands and a sense that one is able to cope and deal with these demands). In this project, stress is seen as representing a negative process and leading to ill health and other negative consequences. Perspective 2: Inadequate assessments of stress/health and well-being Stress and/or health and well-being is a complex process, understanding this process is fundamental to informing action and intervention for achieving positive individual and organisational health outcomes. The ubiquitous employee opinion survey provides only part of the picture in understanding individual and organisational health and well-being. Aside from some of the psychometric shortfalls, there is also a real danger that standard opinion surveys over simplify what is a complex issue and can unwittingly mislead decisions taken to allocate resources for improving health and well-being. Modern workplaces are becoming increasingly complex and multiple factors interact that either serve to enhance or diminish health and well-being. Understanding this interaction underpins effective stress and/or health and well-being assessments. Perspective 3: Leading in difficult times will create conflicts for health and well-being As has been argued throughout this update, the way that staff are managed and/or led by those around them is inextricably linked to their health, well-being, performance and effectiveness. The NHS is an extremely complex and highly pressured work environment. Leaders and/or managers have often commented on the change that is generally being Zeal Solutions Ltd 2011 Section 4: General findings 11

12 imposed upon them and how this can sometimes conflict with the pressures that exist for delivering quality. As a result of such conflicting pressures, there is a real danger of healthcare organisations suffering from negative health and behavioural spirals (i.e. performance monitoring pressures force managers/leaders to use their authority to demand increased performance which can lead to poor reactions in staff, ill health and poor performance which in turn leads to greater demands for performance). It is hoped that the management behaviour intervention - discussed in section 5 will, in part, assist in addressing these conflicts. Perspective 4: Under appreciation of the importance of health and well-being There continues to be a general under appreciation of the importance of health and wellbeing for individual and organisational effectiveness. This lack of appreciation stems, in part, from a poor understanding of the health process and in demonstrating the link between poor health (i.e. fatigue, low job satisfaction, etc.) and reduced performance outcomes that are of importance to the organisational setting (i.e. efficiency, absence, quality of care, patient satisfaction, etc.). This lack of appreciation also stems from silo thinking (i.e. stress at work being seen solely as a Human Resources (HR) or Occupational Health (OH) issue) which consequently results in poor integration of the health and wellbeing agenda with more general corporate objectives (i.e. demonstrating the link between health and organisational development, strategic thinking, patient satisfaction and outcomes, and so on). Perspective 5: Poor or non existent evaluation of action and interventions taken to improve health and well-being There is a great deal of action and investment being undertaken across the NHS to reduce the impact of stress and improve health and well-being. Unfortunately coordinated effort for evaluating these interventions is lacking. Without appropriate systematic and rigorous evaluation organisations are in danger of investing resources without understanding if their resources have been used wisely or indeed whether or not any resulting intervention has had the desired impact. In addition, without coordinated effort on how to evaluate interventions there is going to be limited opportunity for real learning to be shared about how to effectively implement health and well-being interventions. Zeal Solutions Ltd 2011 Section 4: General findings 12

13 Section 5: The intervention study Overview As shown in Table 1, a scenario based management behaviour intervention programme is being launched within the LCCHS NHS Trust. The intervention programme is being designed by the project research team and will be delivered to the organisation as a train the trainer programme. Rationale, approach and potential The need for the intervention was identified as a result of the health audit process. The assessment identified the importance of management behaviour for enhancing individual as well as organisational health and well-being. The intervention has been tailored to the organisation to allow for contextual issues to be integrated into the overall programme delivery. The training intervention is being delivered as a train the trainer programme to enable the organisation to develop internal expertise and competence. The programme itself is being delivered to the organisation using a blended approach i.e. online/web-based tools as well as classroom based learning. The programme has an in-built evaluation process which will enable the necessary evidence to be collected about the intervention. Primarily, the evidence that is collected will be used to inform the ongoing design and development of the intervention. In addition, the evaluation evidence will also be used to demonstrate to the various stakeholders the general impact and effectiveness of the programme for the promotion of health and well-being. There is scope and potential for this intervention to be introduced more generally across the healthcare sector. The project team will work with the project sponsor and the various organisations to assess the potential for extending the delivery of this programme to the wider network of health organisations once this phase of the project has been implemented fully and successfully. Zeal Solutions Ltd 2011 Section 5: The intervention study 13

14 Section 6: Next steps and close Next Steps As outlined under Section 2, data collection is still underway within some organisations. The intervention programme will be launched in April and May 2011 and the impact and effectiveness of the programme will be evaluated throughout the life cycle of this project. The end date of the project is November A final report will be produced which will summarise key findings from the research and present the main findings and actions of each participating organisation in a case study format. The actual format of the final report will be discussed with the Executive team during the summer of Further information about this project can be obtained by contacting the following members of the research team: Mr Antonio Zarola Dr Kelly Barklamb Director Consultant tony@zealsolutions.co.uk Kelly@zealsolutions.co.uk Close There is still a great amount of work to be done in terms of the effective management of health and well-being within the workplace. As part of this programme of work we are reminded of the messages that need to be extracted and communicated to others namely: Achieving organisational performance outcomes must be matched by a concern for the well-being of those employees who directly affect these practices. Accurately understanding how work conditions and the work itself influences health is an important starting point for achieving wellness at work. Health is a complex process which requires continuous attention, evaluation and action to maintain, improve and demonstrate the importance of health both for individual as well as organisational effectiveness. Health at work relies on constant communication and the availability of effective social resources (i.e. positive working relationships) within the organisation. Zeal Solutions Ltd 2011 Section 6: Next steps and close 14