Introduction
The issue of workplace health has gained a high prominence in the media over recent years. In part, this has been driven by the high cost to employers, and to society as a whole, of sickness absence from work. Analysis of data on sickness absence reveals the primary causes of absence in the UK economy are stress and musculo-skeletal disorders (MSD).
The business case for action is clear; Health and Safety Executive (HSE) statisticsFootnote 1 for 2008/2009 indicate that 230,000 workers first became aware of work-related stress issues and an estimated 415,000 believed that work-related stress was making them ill. Absence due to work-related stress, depression or anxiety, usually called common mental health conditions, accounted for an estimated 11.4 million lost working days. It is estimated that absence due to work-related stress costs the UK economy over £3.4 billion annually.
At this point it is worth asking ourselves why do we go to work? It is suggested that it is not in order to be made ill from our work. Therefore, there is a strong moral case to ensure work does not adversely affect the health of workers. There is also a legal case to be considered. Under UK health and safety legislation there is a requirement (Health and Safety at Work Etc Act 1974) to ensure, as far as reasonably practicable, the health, safety and welfare of workers.
The remainder of this article will discuss the prevention of work-related stress and the related issue of bullying and harassment, within the framework of the HSE Management Standards approach. Before proceeding, it is important that we have a common understanding of what we mean by stress and bullying.
The term stress is pejorative and is commonly used as both a cause and an effect. A more useful set of definitions make a clear distinction between pressure, which is generally good for us, as it is a motivator, and stress which is always negative as it has adverse effects on our health and wellbeing. The HSE definition of work-related stress is: the adverse reaction people have to excessive pressure or other types of demands placed upon themFootnote 2.
The definition of what behaviours constitute workplace bullying has drifted in recent years. The working definition of bullying often used in academic research has three components:
1. Unreasonable behaviour;
2. The unreasonable behaviour must be repeated and;
3. There is a power imbalance between the perpetrator and victim.
A review of recent media coverage on the issue of bullying in the workplace suggests that the current understanding of the term is ‘any behaviour I don't like’. This later definition is clearly problematic in the workplace and in many respects makes the management of a complex issue more difficult.
Models of work-related stress
In this section the two most relevant theoretical models of work-related stress will be discussed. Firstly, Karasek's (Reference Karesek1979) Job Demand/Control Model (JD-C) focuses on the interaction between the objective demands of work and the decision latitude (control) of employees in meeting those demands (Karasek & Theorell, Reference Karesek and Theorell1990). Further elaboration of this model recognised the importance of support from supervisors and co-workers to form what is today referred to as the DCS (demand, control, support) model of work-related stress. In simple terms, this model looks at the relative balance between the demands of the job and the level of control and support the worker has over those demands. The rationale being that the adverse health affects of excessive demands can be ameliorated by high levels of control and/or support. High demand coupled with low levels of control and support is said to be a toxic mix and is predictive of long term health effects such as cardio-vascular disease.Footnote 3
Secondly, Siegrist's (Reference Siegrist1996) Effort Reward Imbalance model (ERI) is based on the notion of social reciprocity whereby investments of effort are equalised by respective rewards. Reciprocity fails when the effort expended is not adequately rewarded, which can elicit negative emotions and a sustained stress response. Within this model rewards are distributed by three mechanisms: money, esteem and career opportunities (including job security). A further dimension of overcommitment was added to this model to accommodate individual differences. Overcommitted workers suffer from a distorted perception of demands and their own ability to cope making it more likely they will perceive an effort/reward imbalance.
Mackay et al. (Reference MacKay, Cousins, Kelly, Lee and McCaig2004) provide a comprehensive coverage of the theoretical underpinnings of the Management Standards.
The HSE Management Standards Approach
The Management Standards approach is a risk assessment for work-related stress that is designed to assist employers in meeting their legal duties. The Management Standards approach has modified the normal 5-steps to risk assessment promoted by the HSE by the inclusion of a firm definition of the psychosocial (interaction between psychological and social factors) hazards and by defining, in the states to be achieved (STBA), what good practice may look like; the Management Standards (Cousins et al. Reference Cousins, Mackay, Clarke, Kelly, Kelly and McCaig2004).
The management standard and associated STBA for the psychosocial risk factor of demands is shown below as an example. The management standards for all six psychosocial risk factors share the same format.
Management Standard for demands:
The standard is that:
• Employees indicate that they are able to cope with the demands of their jobs and;
• Systems are in place locally to respond to any individual concerns.
States to be achieved are:
• The organisation provides employees with adequate and achievable demands in relation to the agreed hours of work;
• People's skills and abilities are matched to the job demands;
• Jobs are designed to be within the capabilities of employees and;
• Employees' concerns about their work environment are addressed.
The Management Standards themselves are a set of psychosocial hazards, commonly referred to as risk factors (demand, control, support, role, relationships and change) that, if not adequately managed within an organisation, can result in psychological harm to workers. The written guidance provided to users of the Management Standards tool-kit (www.hse.gov.uk/stress) suggests and facilitates the identification of high risk groups (HSE Indicator and Analysis Tools) measured against the psychosocial risk factors. The primary objective of identifying the high risk groups is to facilitate the prioritisation of organisational resources. The Management Standards approach requires the completion of a risk assessment. For large organisations (>250 employees) this will mean starting with high risk groups before moving on to all other employees. This type of implementation should allow organisations to learn from the high risk groups and apply that learning to other groups as appropriate. Conversely, it also facilitates the identification of good practice that can be introduced across the organisation to at risk groups.
The Management Standards approach is designed to be a framework against which to carry out a risk assessment, rather than a prescriptive process that should be adhered to rigidly. The steps of the risk assessment process are specified and guidance given on one way of achieving the objectives of each step, but users are free to use an alternative methodology to complete the steps. This approach is based on an understanding that organisations do not operate in a vacuum. There are normally structures or initiatives in place within organisations that can be utilised to deliver some or all of the desired outcomes from specific steps of the process. This methodology is consistent with the Management Standards approach having the status of guidance under health and safety law and therefore it is not enforceable.
The steps of the management standards approach require consultation between different groups of workers and their representative, if appropriate. This dialogue is a critical contributing factor in the success of addressing the underlying causes of work-related stress. This approach casts the worker as an expert, experts in their own work. Therefore, if an employer is to understand the issues for a particular group of workers, they have to ask the experts: the workers themselves. Experience has shown that many large employers rely heavily on the output from staff surveys as a way of measuring issues within the workplace. This is a good starting point, but has limited value in understanding the underlying causes of the issues identified. Therefore, the HSE recommend that workers are involved in the process of identifying the issues and in the development of strategies to address them. Within the Management Standards approach it is suggested that focus groups should be used for face-to-face discussions on the issues, informed by the results of staff surveys, other available metrics and the management standards themselves. However, dependent on the size and structure of the organisation, other forums such as team meetings or existing working groups, can be utilised.
Figure 1: HSE Management Standards ApproachFootnote 4
The result of following the Management Standards, or equivalent approach, is the development of strategies that address the cause of work-related stress at source. It is often the case that strategies for alleviating work-related stress focus on secondary or tertiary issues. Secondary measures focus on helping the worker to cope with the work situation without addressing the underlying cause and tertiary interventions focus on healing the damaged worker, but once again, not addressing the underlying causes.
Meta analysis of intervention research (LaMontagne et al. Reference LaMontagne, Keegel, Louie, Ostry and Landsbergis2007) suggests that secondary and/or tertiary interventions aimed at the individual are ineffective, when used alone or in combination, at reducing the incidence and prevalence of work-related stress. A challenge to this statement is the apparent lack of knowledge within organisations in respect to the design of primary interventions. Most organisations appear to understand secondary interventions that often focus on training, development and management issues, delivered by human resource professionals. Similarly, there appears to be a good understanding of tertiary interventions delivered via occupational health professionals. However, primary interventions that directly address the issue at source appear to be more challenging. In simple terms, primary interventions within the workplace are concerned with job design; work content, context, organisation and environment.
When considering tackling the causes of work-related stress at source, using primary interventions, there is often a fear within organisations of opening the proverbial can of worms. Theory and practice have shown that this is generally not the case. Many interventions, designed in consultation with workers, are cost neutral as they address minor issues in relation to a task that have a disproportionate impact on the workers' perception of their work. The objective is to create good jobsFootnote 5, that is, jobs that support worker development, allow skill utilisation and generally enable workers to flourish within the workplace. As the psychologist Frederick Hertzberg said “if you want people do a good job for you, give them a good job to do”. It is likely to take time to achieve this goal. However, addressing issues in respect to the six psychosocial risk factors contained within the HSE management standards can facilitate a step on this journey.
Conflict within the workplace
The HSE Management Standards approach deals with bullying and harassment within the psychosocial risk factor of relationships. It should be noted that in recent guidance on harassment and violence in the workplace issued by the European CommissionsFootnote 6 it is stated that “harassment occurs when one or more worker or manager are repeatedly and deliberately abused, threatened and/or humiliated in circumstances relating to work”. As can be observed, this definition comprises two of the three elements of the definition of bullying given earlier. For the purposes of the current discussion these terms, bullying and harassment are used to describe the same negative behaviours.
The causal factors that can lead to bullying behaviour within the workplace are multi-factorial and can include societal and organisational culture, group dynamics, relationships and individual personality. In short, psychological and social factors that include those included within the Management Standards namely: demand, control, support, role, relationships and change. The correlation between bullying and stress is reasonably easy to understand, however, the direction of causality is less clear. Does excessive pressure cause the bullying behaviour or the bullying behaviour cause stress? In reality, both scenarios are probably true. This highlights one of the challenges with dealing with allegations of bullying behaviour: identifying the underlying causes.
Research carried out by Rayner & McIvor (2006) for the Dignity at Work PartnershipFootnote 7 shows that many organisations have both formal and informal policies and procedures in place to tackle bullying in the workplace. The general advice is to intervene as early as possible in an informal way. The cause of the negative behaviour is often a consequence of poor communication, “….bad communication and confused expectations of managers and colleagues are at the core of 80% of cases”. The more formal the procedure and the longer the bullying behaviour is allowed to go unchallenged, can increase the difficulty in de-escalating and recovering the situation. It is an unfortunate consequence of the use of formal bullying procedures that, in some instances, one or both of the parties involved leave the organisation. The general advice is to have a zero tolerance approach to bullying in the workplace, where the organisation culture is such that negative behaviour is not accepted and workers feel empowered to challenge what they believe is bullying behaviour within the workplace. To enable such a culture to develop requires strong leadership to make workers, at all levels of the organisation, aware that negative behaviours will not be tolerated. In addition, strong support systems need to be in place to ensure the delivery of informal and formal procedures to quickly tackle any incidence of bullying.
Conclusion
There are many similarities to both the causes and effects of stress and bullying within the workplace. This means that interventions aimed at improving the management of psychosocial risk factors should reduce the incidence of both stress and bullying. What is clear, from both research and practice, is that there is no quick fix or silver bullet that can magically resolve all the cases of stress and bullying in the workplace. However, following the HSE management standards, or a similar type of approach, can deliver strategies that start to address the underlying psychosocial risks within the workplace.
