Stress Workbook. A framework. for the implementation of the. Stress At Work Policy. in support of the. Staff Support Strategy;

Stress Workbook A framework for the implementation of the Stress At Work Policy in support of the Staff Support Strategy; Dignity at Work Policy; Health and Safety Policy; and Other associated policies and guidelines Page 1

INDEX Understanding Stress in NHS Grampian...3 Principle Job Features Which Help To Reduce Stress In The Workplace...5 Staff Support Mapping Guide Sources of Existing Support...6 A risk-based approach to workplace stress flowchart...7 Stress At Work Toolkit for NHS Grampian (Pilot Version)...8 Stress At Work Action Plan Template for NHS Grampian (Pilot Version)...10 October 2004 Page 2

UNDERSTANDING STRESS - A GUIDELINE FOR NHS GRAMPIAN This information is a simple introduction to stress at work. Further sources are detailed at the end of this section. Stress is "the reaction people have to excessive pressure or other types of demand placed on them. It arises when they worry they can't cope" (Health & Safety Executive). Pressure is not necessarily a negative feeling and can in fact be a positive one. Some pressures and challenges at work are necessary to maintain motivation. Stress arises when the demand placed upon a person exceeds that person's ability to cope. NHS Grampian acknowledges that each individual s ability to manage and cope with stress is variable and personal. There is no simple way of predicting what will cause harmful levels of stress. Everyone is different and a person's ability to cope with stress may also vary throughout life. Much depends on a person's personality, experience and motivation and the support available from managers, colleagues, family and friends. This involves home as well work life experiences. Fundamentally, no individual should have unreasonable demands placed upon them. We will address this through the management of job design, development and training as well as effective people management (supported by the People Management Project). Support will also be offered for any person who is affected by factors outside the work environment. Through the risk assessment process, NHS Grampian will continue to identify hazards and assess all mental and physical risks to health and safety with the objective of reducing them, as far as is reasonably practicable. The first step in managing stress at home or at work is being able to recognise the symptoms. Often the individual fails to recognise such symptoms in themselves. However, there are certain common symptoms that can be displayed by work teams and individuals. Everyone has a role to play in creating a positive working environment and in maintaining the mental health of employees. However the responsibilities at each level are quite distinct, and the most effective results will be achieved with a combination of individual and managerial effort. In NHS Grampian, we believe that we have a responsibility to work with everyone to minimise the excessive pressures arising at work. Signs of Possible Stress Work Performance Reduction in output or productivity Increase in error rate Poor decision making Deterioration in planning and control of work Poor quality Relationships at Work Tension and conflict between colleagues at work Poor relationships with patients / clients Increase in industrial relations or disciplinary problems Irritability Poor sleep Aggression Mood swings Staff Attitude & Behaviour Loss of motivation and commitment Staff working increasingly long hours but diminishing returns Erratic or poor timekeeping Sickness Absence Increase in overall sickness absence, particular frequent short periods of absence Drinking/eating/smoking more Depression Raised blood pressure Chest Pains Page 3

UNDERSTANDING STRESS - A GUIDELINE FOR NHS GRAMPIAN RELATIONSHIP OF STRESS FACTORS Intrinsic to job Role in the Organisation Relationships at Work Career Development Organisation Structure & Climate Home - Work interface INDIVIDUAL High blood pressure Excessive Drinking Depressed mood Irritability Chest pains Mood swings Aggression Excessive smoking High absenteeism High error rate High Staff Turnover Poor quality Frequent sickness Frequent disciplinaries Poor decision making Coronary Heart disease Mental Illness Apathy Frequent accidents Industrial action Job assessments must evaluate the necessary skills, qualifications, experience and training that individuals require for their role. In doing so, consideration should include the following factors. Where there is a gap between job requirements and people skills, then managers and staff are responsible for arranging appropriate and adequate training and development through the appraisal system and Personal Development Plans. Opportunity for Control Opportunity for Skill Use Work Demands Variety Work clarity Availability of Income Physical Security Interpersonal Contact Job Prestige Autonomy, discretion, influence, participation in decision making. In moderation, greater control is associated with better mental health. The degree to which a staff member or manager has the opportunity to use and extend his or her skills. No opportunities to use skills and abilities leads to feelings of anxiety, hostility, lower job satisfaction and poor self-esteem. Low work demands lead to low job satisfaction and increased anxiety. Work overload is also naturally stressful. Competing priorities or unclear objectives don t help. Highly repetitive work gives rise to low satisfaction. Expand & develop roles wherever possible. There are clear implications for job design and appraisal. Managers and staff should take opportunities to review job roles on a regular basis. Feedback on performance and behaviour clarifies uncertainty and sets requirements for performance and development of skills. Feedback on work in general is vital, as well as any specifics to the individual (e.g. planned change etc). This is a speculative factor. A positive relationship between standard of living and mental health has been frequently recorded in research. Concerned with physical working conditions - the need to protect staff and managers. Poor working conditions (bad light, dangerous equipment, excessive heat, harmful substances and so on) will naturally give rise to negative job-related feelings. Interpersonal contact is essential for good mental health. Support from colleagues and Managers helps with anxiety, depression and can increase feelings of high selfesteem. All jobs play a vital role in NHS Grampian. Although some jobs are perceived as more important than others, staff should receive feedback on their contribution to NHSG. Some very useful information is given by the following links: - http://www.hse.gov.uk/stress/index.htm http://intranet/grampintranet/gpct/psychology/flowchart.cfm

PRINCIPLE JOB FEATURES TO REDUCE STRESS IN THE WORKPLACE The following diagram outlines some organisational programmes to assist in the reduction and control of stress. Confirm your departmental links to these programs. Decision Making & Planning Opportunities for staff to contribute ideas, in particular in the planning and organisation of their own jobs. Partnership Working Staff Governance Standards Local Partnership Forum General Management & Culture Clear organisational objectives Good Communication Close employee involvement, particularly during periods of organisational change Good management support and appropriate training and development. Partnership Working Organisational Change Policy Single System Working Employee's role in the Organisation Clearly defined objectives and responsibilities linked to organisational objectives Support for those with high level of responsibility for the welfare and wellbeing of people. Annual & regular appraisal Personal Development Plan Objectives in Health Plan Relationships at Work Training in People Management skills Effective systems for dealing with interpersonal conflict, bullying and racial or sexual harassment, including agreed grievance procedure and proper investigation of complaints. People management project Dignity at Work Strategy Stress at Work Policy SOME OF THE THINGS THAT CAN HELP IN A POSITIVE APPROACH TO MENTAL HEALTH Job Design Well defined tasks and responsibilities Variety, avoiding short work cycles Proper use of skills Proper training for those dealing constantly with the public or client groups Proper hazards control Modernisation Agenda Agenda for Change Work Schedule Flexible work schedule Planned and agreed work hours Family friendly policies Workload / Work Pace Targets that are stretching but reasonable Organisational Change Page 5

STAFF SUPPOPRT MAPPING GUIDE - SOURCE OF EXISTING SUPPORT Organisational Level Support - to assist NHS Grampian at corporate level! Management of Stress at Work Policy! Dignity At Work Strategy and Policy! Health & Safety Management Strategy! Internal Communication Strategy! \Workforce Development Strategy! People Management Skills and Project! Leadership Development Programme! Learning & Development Strategy Individual Level Support - for all staff! Appraisals, supervision, mentoring! Family friendly policies! Human Resource policies! CD - ROM learning and self-assessment guide to stress! Stress Workshops! Occupational Health Service & Counselling! Occupational Psychology Department Teams Level Support - for services, departments, teams! NHS Grampian Stress At Work Toolkit (attached)! Public Health, Health Improvement! Scotland Health at Work (SHAW) Programmes! Learning & Development Teams Page 6

RISK-BASED APPROACH TO WORKPLACE STRESS IN NHS GRAMPIAN This flowchart sets out the general approach recommended by the Staff Support Group in identifying and dealing with stress in NHS Grampian. Flexible but consistent approach to enable flow of information within / between services. It seeks to support staff as they strive to find innovative solutions to resolving the negative impacts from stress in the workplace. GAPF to review policy on annual basis based on feedback and progress Continual audit through Staff Survey, Risk Management Audit, Staff Governance Audit, etc Staff Survey & Local Audit to measure impact of stress at work Development of Staff Support Strategy & Stress at Work Policy Local Commitment to dealing with stress in the workplace on a partnership basis between management and staff Identify local lead to champion the project Establish working group as sub-group of Local Partnership Forum or Local Risk Committee O R G A N I S A T I O N T E A Ensure all staff have access to Stress Policy M Use the Stress At Work Toolkit to complete stress risk assessment as a group I Develop an Action Plan N D I V Seek urgent advice from Occupational Health and Staff Support Group for any health concerns For example counselling management advice Use stress-map for shortterm measures to manage & alleviate impacts of stress For example Seminars CD awareness for staff Develop links to NHSG initiatives for longer term elimination and control For example People Management Modernisation Agenda I D U A L Feed into Staff Support Sub-Group for Stress through Local Partnership Forum with comments on progress and policy Page 7

STRESS AT WORK TOOLKIT FOR NHS GRAMPIAN (PILOT VERSION) INTRODUCTION The GAPF has developed a Staff Support Action Plan based on the feedback from staff regarding stress starting with the 2002 Staff Survey. The Action plan recognises the need for: (a) An overall NHS Grampian Plan (b) Awareness and Training Support (c) Local Team Staff Support Action Plans OBJECTIVE LOCAL TEAM ACTION PLANS FOR STAFF SUPPORT To discuss issues important to staff particularly around health and well-being. BENEFIT Staff Teams may have unique requirements which an organisation wide programme may not address and Staff Team are more likely to sort out their own issues. TOOLKIT SETTING THE SCENE The team needs to meet to decide if it wishes to commit to developing a Local Action Plan. TEAM VALUES/GROUND RULES As part of that discussion, the following team values need to be assessed: Acceptance that stress exists Building trust and openness Commitment to support each other Team commitment to agreed actions Team commitment to implementation and monitoring COMPETENCIES It is key that the Team Leader, or nominated facilitator, or the team itself, has skills in involving all members of the team SKILLS Awareness of what stress is Listening Facilitating outcomes - sometimes with a majority rather than unanimous support Project planning and monitoring Personal people/listening/support orientation Managers will develop the above skills, as required, through existing training and development programmes, such as the People Management Initiative. These skills will facilitate the removal or control of stressors in the workplace. In addition to this, specific training will be available, where appropriate, to assist a department or individuals to manage stress where already it exists.

STRESS AT WORK TOOLKIT FOR NHS GRAMPIAN (PILOT VERSION) PROCESS Review Organisation-wide Staff Support Action Plan Team Meeting / Stage 1 Identify in Local Action Plan the issues/causes that are pertinent to the team at this time Ask members to come back with other local team issues Team Meeting / Stage 2 Complete the form including local issues and agree Action Plan Set clear and achievement goals for improvement (within the local team s control) Team Meeting / Stage 3 Nominate an Action Plan Leader for an agreed initial period Identify if assistance is required from partnership or other staff Determine actions required to meet these goals Regular Staff Meetings / Contact Discuss progress After 6 months produce an interim evaluation of progress

STRESS AT WORK TOOLKIT FOR NHS GRAMPIAN (PILOT VERSION) This action plan template draws should be completed from the findings of toolkit meetings. It is arranged along the seven key factors from the HSE approach to Management of Work Related Stress. Themes/Issues Bullying & Harassment Lack of Support from Manager Work Demands Inadequate Communication Fear of Violent/Aggressive Incidents Inconsistency of Staff Management Policy Application Organisational Change Others??? Locus of Control Impact Initial thoughts on desirable/possible outcome Goals What Action can we take locally plus any that needs to be taken forward at organisational level Assessment of how we have improved, eg stress levels Meeting 1 Meeting 2 Meeting 3 Links to Organisational Action Plan Local Themes/Issues Culture Page 10

STRESS AT WORK TOOLKIT FOR NHS GRAMPIAN (PILOT VERSION) Themes/Issues Locus of Control Impact Initial thoughts on desirable/possible outcome Goals What Action can we take locally plus any that needs to be taken forward at organisational level Assessment of how we have improved, eg stress levels Meeting 1 Meeting 2 Meeting 3 Demands of the Job Control Relationships Change Page 11