Managing Stress at Work Policy - pat.nhs.uk · Provide access to information and advice on stress management. Pennine Acute Hospitals NHS Trust EDH015 Managing Stress at Work Policy

Managing Stress at Work Policy

Keywords: Stress

Document Number: EDH015

Version Number: 4.1

Developed in Conjunction with: Central Policy Group and Health and Safety Advisors/Committee

Ratified by: Health and Safety Committee

Date Ratified: 21 March 2013

Next review due to start: September 2015

Date Amended 26 November 2015

Expiry date: 30 November 2016

Document Author: Health and Safety/HR Department

Pennine Acute Hospitals NHS Trust EDH015 Managing Stress at Work Policy Version 4.1

Expiry date: 30 November 2016 Page 2 of 37

It is your responsibility to ensure that this print out is the most up-to-date version of this document Check on the ‘Documents’ pages of the Trust intranet

Pennine Acute Hospitals NHS Trust


Main Revisions from previous issue

Name of Previous Document:

Managing Stress At Work Policy

Previous Document Number: EDH015

Previous Version Number: 4

Reason for Revision: Expiry date extended whilst review ongoing




Contents

Section Page 1. Introduction 4

2. Aim 4

3. Scope 4

4. Roles & Responsibilities 4 4.1 Trust Health & Safety Committee 4 4.2 Divisions 5 4.3 Managers 5 4.4 Learning & Organisational Development 6 4.5 Governance Team 6 4.6 Occupational Health Service 6 4.7 Human Resources 7 4.8 Employees 7

5. Function of Trade Union Safety Reps 8

6. Process for managing work related stress 8

7. Risk assessment 8

8. Other Relevant Guidance 8

9. Implementation 9 9.1 Dissemination 9 9.2 Report Back Process 9 9.3 Training Arrangements 9 9.4 Financial Impact 10

10. Monitoring 10

11. Review Arrangements 10

12. References 10 12.1 Associated Trust Policies & Guidelines 10 12.2 Supporting References 10

13. Abbreviations 10

14. Appendices Appendix 1 - Monitoring Table 11 Appendix 2 - Equality Impact Assessment Form 12 Appendix 3 - Departmental audit template 15 Appendix 4 - Individual stress audit 19 Appendix 5 - Managing stress at work: guidance notes 22 Appendix 6 - Symptoms / Signs of Stress 37




1. Introduction

1.1 ‘Work-related stress’ is the adverse reaction people have to excessive pressures or other types of demands placed on them. Individuals vary in their capacity to cope with different types of pressures or stress. Some levels of pressure, even when high, can be motivating and challenging. Pressures that can be responded to effectively are likely to lead to job satisfaction. Too little pressure or challenge can in some cases be just as stressful as too much with the individual feeling unfulfilled and frustrated. However, there is a point where increasing pressures may have serious consequences for both the individual and those around them. Timely and appropriate action can help minimise the effects.

1.2 The Pennine Acute Hospitals NHS Trust is committed to ensuring that as far

as is reasonably practicable it protects the health, safety and welfare of all its employees at work. The Trust recognises that staff may face risks from work related stress, as well as non-work related stress, and does take action to identify and reduce these risks as far as possible.

2. Aim

2.1 The Trust will strive to create an environment that will minimise stress at work, by raising awareness, identifying potential and actual stressors, and taking preventative action. The Trust will offer support to individuals whose health is adversely affected as a result of stress irrespective of the source.

2.2 The Trust will take every reasonable care to ensure that staff health is not

placed at risk from stress through excessive demands, inadequate controls, lack of management support or the way people deal with each other at work.

3. Scope

3.1 Employers have a duty under the Health and Safety at Work Act 1974 to ensure, so far as is reasonably practicable, the health, safety and welfare of its employees.

3.2 Under the Management of Health and Safety Regulations 1999, employers

must assess the risks to health in the workplace and base control measures upon this assessment.

3.3 This policy applies to all staff working within the Trust with the exception of

those doctors in training who are employed under the Lead Employer arrangements who have their own policies which are to be followed.

4. Roles and Responsibilities

4.1 The Health and Safety Committee will oversee the implementation of this




policy. 4.2 Divisions will provide adequate resources to enable managers to implement

this policy. 4.3 Managers 4.3.1 Managers are in a key position to identify the early changes in behaviour

associated with increased stress and to ensure that timely and appropriate action is taken to minimise adverse effects on health.

Managers will:

Undertake a thorough and adequate stress risk assessment in all their areas of responsibility. Stress risk assessments should be completed for staff who may be absent from work due to stress as well as for those employees who remain in work but are suffering from stress. The work place stress risk assessment should be undertaken, using the Health and Safety Executive’s Management Standards, contained within Appendix 5, which cover the primary sources of stress at work. A risk assessment tool based on these standards has been developed to assist managers to undertake work place assessments, (Appendix 3). A supplementary risk assessment tool has been developed to assist managers to assess issues of stress in individual employees, (Appendix 5).

All cases of absence with a diagnosis of work related mental ill health, (which may include stress, anxiety or depression), and non-work related mental ill health should be referred to Occupational Health. It is good practice to include in the referral the background to the case and copies of any relevant risk assessments.

Ensure that new starters and current employees are aware of this Policy, where it is located and the support available via team meetings and the local induction process.

Ensure that all employees have access to appropriate self-development training, (e.g. coaching, time management, performance management, assertiveness etc.), to enhance their skills to improve their own personal resilience to stressors, (this may be through open learning), via the formal PDR process and feedback sessions.

Provide an opportunity for early indicators of stress to be raised at all return to work interviews and implement appropriate action / support as necessary dependant on individual circumstances.

Ensure that the competency and capabilities of staff are assessed in relation to their work at recruitment and are reviewed on significant changes in job demand. This will be achieved by adherence to the Trust’s Recruitment Code of Practice (EDH046) including ensuring job descriptions and person specification are up to date and accurately reflect the duties and responsibilities of the post.

Wherever possible managers will ensure that an individual’s capabilities are




appropriately matched to job requirements throughout their career with The Pennine Acute Hospitals NHS Trust.

Regularly review staff in order to ensure that individuals are not subjected to too much or inappropriate pressure and that they have the appropriate training and support to minimise the adverse effects of stress in the delivery of their work via the formal PDR process and feedback sessions.

Facilitate access to specialised support and rehabilitation in accordance with the guidance from the Occupational Health Service and promotion of the Trust’s policies to assist in maintaining a work / life balance.

Promote an environment that enables employees with stress-related problems to seek help within their workplace and give them the confidence and reassurance that any issues raised will be dealt with promptly and sensitively.

Monitor holidays to ensure that staffs are taking their full entitlement.

Ensure that bullying and harassment is not tolerated within their area, that policy is adhered to, and, where appropriate, that any issues identified/raised are dealt with promptly making best use of the support mechanisms available.

Ensure good communication between management and staff at all times.

4.4 Learning and Organisational Development Department The Learning and Organisational Development Department incorporates work

related stress recognition and management in a number of training programmes. These range from advice and guidance on self care to good practice guidelines for managers to ensure factors affecting the health and well-being of themselves and their staff are actively considered and managed.

The department also provides bespoke training on this subject at the request

of a manager who has identified a need for it in their work area. Detailed information can be accessed via the Professional and Personal

Development Plan and Health and Well-being sites via the Trust’s intranet.

4.5 Governance Team The Health and Safety Advisors will:

Give guidance and support to managers on undertaking risk assessments.

Give advice to managers and staff on any risk management or health and safety issues relating to stress at work.

4.6 Occupational Health Service The Occupational Health Service will:

Provide access to information and advice on stress management.




Advise managers on appropriate rehabilitation of individuals suffering ill health as a result of work related stress or non-work related stress.

Provide access to confidential counselling support or other therapies (such as Cognitive Behavioural Therapy and anxiety management) which are identified and deemed appropriate by Occupational Health for those suffering from ill health as a result of work related stress.

Liaise with external agencies where other treatment or specialist referral is required.

4.7 Human Resources Human Resources will:

Provide support and guidance to managers and staff in the operation of this Policy.

Support Occupational Health advice with regard to rehabilitation.

4.8 Employees It is the responsibility of Employees to:

Exercise personal responsibility in the prevention of harm to themselves or others by looking after their own physical and mental well being, and taking action to prevent stressful situations developing wherever possible

Treat all colleagues with respect, and be willing to engage in processes to resolve conflict if it occurs.

Be aware of signs of stress in themselves and colleagues and be willing to seek, receive, or offer support as appropriate (see appendix 6).

Attend appropriate training.

Contribute to a co-operative environment in which stress-related problems about any issues which may affect their work, including any relevant personal problems, can be discussed openly and in confidence with their manager, Human Resources, Health and Safety representatives and the Occupational Health Service in order to identify appropriate support at an early stage.

Report any perceived workplace stressors to management as soon as they become evident.

Seek and follow medical advice if they become unwell.

Participate in the completion of individual stress audits / questionnaires.

Develop their own techniques supported by appropriate training (see paragraph 4.4) for building up resilience to work stressors.




5. Function of Trade Union Health & Safety Representatives

5.1 Trade Union Safety Representatives have a right to:

Be consulted on any changes to work practices or work design that could precipitate stress.

Consult with members on the issue of stress including workplace surveys.

Be involved in the risk assessment process.

Paid time away from normal duties to attend any Trade Union training relating to workplace stress.

Conduct joint inspections of the workplace (1977 Regs on Safety Reps and Safety Committees).

6. Processes for Managing Work related Stress 6.1 The Health and Safety Executives Management Standards on Work Related

Stress define the characteristics, or culture, of an organisation where the risks from work related stress are being effectively managed and controlled.

6.2 The Management Standards cover six key areas of work design that, if not properly managed, are associated with poor health and well-being, lower productivity and increased sickness absence. This information can be found in appendices 3-5)

6.3 The process for identifying workplace stressors and further guidance can be found in Appendix 5 (Managing Stress at Work Guidance Notes).

7. Risk Assessment

7.1 Work place risk assessment should be undertaken using the Health and Safety Executives Management Standards (Appendix 5) which cover the primary sources of stress at work. A risk assessment tool based on these standards has been developed to assist managers to undertake work place assessments (Appendix 3 - Department Audit). A supplementary risk assessment tool has been developed to assist managers to assess issues of stress in individual employees, (Appendix 4 Individual Stress Audit).

8. Other relevant guidance

8.1 Other policies implemented within the Trust have an impact on the reduction of stress within the organisation and they are listed below for information:

Accidental Inoculation Policy, CPDI018

Attendance Management and Sickness Absence Policy, EDH027




Bullying and Harassment Policy, EDH005

Complaints Handling Policy, EDG004

Disciplinary Procedure for Medical Staff, EDH010

Flexible Working / Work Life Balance Policy, EDH050

Guidance Notes on Managing Stress At Work (Appendix 6)

Grievance Policy and Procedure, EDH003

Management Guidelines: Investigations Conduct & Disciplinary Cases, EDH055

Management Guidelines: Investigations Grievance/Bullying & Harassment Cases, EDH059

Managing Violence, Aggression and Unacceptable Behaviour, EDE005

Siege or Hostage Situations Policy and Procedure, EDE029

Job Banding Policy & Procedure, EDH049

Protecting Lone Workers from Violence, EDE006

Redeployment Guidelines for Managers, EDH072

Special Leave Policy, EDH028

Whistle Blowing Policy, EDH013

Staff Health and Well-Being Strategy 2011–2016, EDH070

9. Implementation

9.1 Dissemination A variety of dissemination methods are in place to ensure all staff will be

made aware of, have access to and comply with this policy and procedure, these include:

Publication in the Weekly Bulletin when implemented

Publication in the monthly Medical Director/Nursing Director Bulletin when implemented

Inclusion on the Document Management System on the Trust’s intranet site, which all staff are encouraged to use

Briefing at monthly Divisional Management/Team meetings when implemented

9.2 Report Back Process

Minutes from Divisional Management/Team meetings

9.3 Training Arrangements

Briefing at monthly Divisional Management Meeting by the line manager

Cascade to all staff through Directorate/Clinical Area Team/ Department Meetings as required




9.4 Financial Impact Practice within this document should be taken into account within existing

budgets.

10. Monitoring

10.1 Please see monitoring table (appendix 1).

11. Review Arrangements 11.1 This policy will be jointly reviewed through the agreed policy review process

by March 2016 or earlier at the request of either side with three months’ notice.

12. References 12.1 Associated Trust Policies & Guidelines

Recruitment Code of Practice (EDH046) See also section 8 above. 12.2 Supporting References

The Health and Safety At Work Act (1974)

The Management of Health and Safety Regulations (1999)

NHS Litigation Authority (2012). ‘NHSLA Risk Management Standards 2012-13 for NHS Trusts providing Acute, Community, or Mental Health & Learning Disability Services & non-NHS Providers of NHS Care, Version 1 Jan 2012, NHSLA.

13. Abbreviations HEA Health Education Authority

HR Human Resources

HSE Health & Safety Executive

NHSLA NHS Litigation Authority

OHS Occupational Health Service

PDR Personal Development Review

VDU Visual Display Unit, e.g. Computer Monitor

WRS Work Related Stress




Appendix 1 - Monitoring Table The arrangements for monitoring compliance of this document are summarised in the following table: Standard/ Criterion

Minimum requirement to be monitored

Process for Monitoring

Responsible Individual/ Group/ Committee for Monitoring

Frequency of Monitoring

Responsible Individual/ Group/ Committee for Review of Results

Responsible Individual/ Group/ Committee for Development of Action Plan

Responsible Individual/ Group/ Committee for Monitoring of Action Plan

NHSLA Risk Management Standard 3: Competent & Capable Workforce 3.10 Stress

Duties Audit Annual Report to Health and Safety Committee on compliance with this policy

HR Quarterly Health and Safety Committee

Line manager in conjunction with HR

Health and Safety Committee

Process for accessing information on the management of work-related stress

Audit HR and Health and Wellbeing group

Quarterly Health and Safety Committee



Process for identifying workplace stressors

Audit Health and Safety Committee will undertake audits to confirm manager’s compliance with the completion of ward/department stress risk assessments

HR H&S Advisors

Quarterly Health and Safety Committee



Requirement to undertake appropriate risk assessments for the prevention and management of work related stress

Audit Health and Safety Checklist

HR H&S Advisors

Quarterly Annually







Appendix 2 – Completed Equality Impact Assessment Pro-forma

Part One

Name of Policy

Managing Stress at Work Policy Date of assessment

Is the policy new or for review?

Review

Area HR Name of Author(s)

HR

1.1 Briefly describe the aims and objectives and the purpose of the policy

To support the Trust to create an environment which will minimise stress at work by raising awareness, identifying potential and actual stressors and taking preventative action

1.2 Are there any associated objectives or directives of the policy? i.e. Care Quality Commission (CQC), NHS Litigation Authority (NHSLA)

NHSLA

1.3 Who is the policy intended to benefit, and what are the expected outcomes?

All employees – The Trust will take every reasonable care to ensure that staff health is not placed at risk from stress through excessive demands, inadequate controls, lack of management support or the way people deal with each other at work

1.4 What factors could influence the intended outcomes either positively or negatively?

OHS involvement, lack of knowledge/understanding of risk assessments, personal responsibilities of employees

1.5 Who are the main stakeholders in relation to the policy

Staff Service Users Public Other

1.6 Who implements and is responsible for the policy?





Part One (cont)

For each of the nine Equality Categories ask the question below:

Hu

ma

n

Rig

hts

Ag

e

Dis

ab

ilit

y

Eth

nic

ity

(Ra

ce

)

Re

lig

ion

Ge

nd

er

Se

xu

al

ori

en

tati

on

Ca

rers

So

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l

De

pri

vati

on

1.7 From the evidence, does the policy affect or have the potential to affect individuals or communities differently or disproportionately, either positively or negatively (including discrimination)?

No No Yes No No No No No No

1.8 Is there potential for, or evidence that, the proposed policy will promote equality of opportunity for all and promote good relations with different groups?

Yes Yes Yes Yes Yes Yes Yes Yes Yes

1.9 Is there public concern (including media, academic,

voluntary or sector specific interest) in the policy area about actual, perceived or potential discrimination about a particular community?

No No No No No No No No No

1.10 Is there any doubt about answers to any of the questions? No No No No No No No No No

Part Two

2.1 In what way does the policy impact on any particular group listed above? Include here what evidence you have collated, whether there are any gaps and what further information is required.

Potential for staff to be classed disabled under the Equality Act. However, the Trust is committed to ensuring that as far as practicable and reasonable it protects the health, safety and welfare of all its employees at work and takes action to reduce any risks identified as far as possible. The policy, therefore, aims to provide advice/support and guidance to assist in minimising stress at work by raising awareness, identifying potential and actual stressors and taking preventative action.

2.2 Adverse Impact - if you have identified potential or real direct or indirect discrimination. If so, can it be justified (e.g., legislation, clinical or social evidence)?

No adverse impact identified. The policy supports the Trust to create an environment which will minimise stress at work by raising awareness, identifying potential and actual stressors and taking preventative action

2.3 Positive Impact - does the policy actively promote equality of opportunity and/or good relations between different groups of people? Yes, the policy provides for all staff irrespective of protected characteristics




Part Three

Policy Title (as it appears on the Document Management System)


Policy Number

EDH015

Ratifying Committee


Date sent to Committee

21 March 2013

This policy has been assessed as having no or low equality impact. Part 1 is completed.

This policy has been assessed as having low to medium impact. Parts 1 and 2 have been completed. Full impact assessment is unnecessary.

Yes

This policy has been assessed as having medium to high impact. Parts 1 and 2 have been completed. Full impact assessment is necessary.

Assessors Name

Nick Hayes

Designation

Deputy Director of HR

Signed*

Equality Champion

Michelle Waite

Directorate

HR

Signed*

Date 21 March 2013 Please scan or insert electronic signature




Appendix 3 - Department Audit/Risk assessment

Standard What should be happening/states to be achieved:

Suggested ways of containing/controlling the risk Actions to be taken

1. DEMANDS = Includes issues like workload, work patterns and the work environment 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.

■ 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.

▪ Hold weekly team meeting to discuss the expected workload for the week ahead

▪ Develop regular meetings with individual’s to discuss their workload

▪ Adjust work patterns to be able to cope with busy periods and staff absences

▪ Allocate resources to enable staff to carry out their jobs satisfactorily

▪ Put system in place for regular appraisals of personal development plans so that staff know what their job involves

▪ Provide formal or informal training to help staff prioritise

▪ Keep training records up to date to ensure that employees are competent to undertake their core duties

▪ Review working patterns and shift work systems

▪ Consider flexible working patterns to help employees cope with external pressures Develop systems where staff are communicated to regarding unplanned tight deadlines and the need to work longer hours

▪ Provide conflict resolution training for staff to deal with difficult situations

▪ Take firms steps to deal with violence and verbal abuse in consultation with staff & other appropriate




2. CONTROL = How much say the person has in the way they do their work The standard is that: ■ employees indicate that they are able to have a say about the way they do their work; and


■ where possible, employees have control over their pace of work;

■ employees are encouraged to use their skills and initiative to do their work;

■ where possible, employees are encouraged to develop new skills to help them undertake new and challenging pieces of work;

■ the organisation encourages employees to develop their skills;

■ employees have a say over when breaks can be taken; and

■ employees are consulted over their work patterns.

▪ Develop systems where staff can have a say over how their work is organised.

▪ Provide opportunities for discussion and input during the planning stages of projects

▪ Allocate responsibility to teams to take projects forward

▪ Define teams at the start of the project

▪ Agree objectives

▪ Agree roles

▪ Agree timescales

▪ Agree the amount of managerial support that would be provided

▪ Discuss the following with employees

▪ Is there scope for more involvement during decision making processes

▪ Do people feel that their skills can be utilised to better effect

3. SUPPORT = Includes the encouragement, sponsorship and resources provided by the organisation, line management and colleagues The standard is that: ■ employees indicate that they receive adequate information and support from their colleagues and superiors; and


■ the organisation has policies and procedures to adequately support employees;

■ systems are in place to enable and encourage managers to support their staff;

■ systems are in place to enable and encourage employees to support their colleagues;

■ employees know what support is available and how and when to access it;

■ employees know how to access the required resources to do their job; and

■ employees receive regular and constructive feedback.

▪ Develop a support system i.e. supervision, buddying, mentor system

▪ Develop a system where regular one-to-one’s are held with staff to discuss issues or pressures

▪ Hold regular team meeting to discuss departmental pressures

▪ Include work related stress as a standing item in team meetings and appraisals

▪ Introduce flexible working where possible to help staff to cope with external pressures

▪ Develop systems to ensure the training and competencies are up to date and that the individual are able to carry out the core functions of their job

▪ Discuss ways that the organisation could provide support to an employee experiencing problems outside work

▪ Distribute information on other support agencies for example human resources, occupational health, counselling service




4. RELATIONSHIPS = Includes promoting positive working to avoid conflict and dealing with unacceptable behaviour

The standard is that: ■ employees indicate that they are not subjected to unacceptable behaviours, e.g. bullying at work; and


What should be happening/states to be achieved: ■ the organisation promotes positive behaviours at work to avoid conflict and ensure fairness;

■ employees share information relevant to their work;

■ the organisation has agreed policies and procedures to prevent or resolve unacceptable behaviour;

■ systems are in place to enable and encourage managers to deal with unacceptable behaviour; and

■ systems are in place to enable and encourage employees to report unacceptable behaviour.

▪ Make sure that staff are aware of your organisation’s policy for dealing with unacceptable behaviour – display this

▪ Develop procedures to resolve conflict at work – communicate this to staff

▪ Agree and implement a confidential reporting system for reporting unacceptable behaviour

▪ Make sure that staff are aware of grievance and disciplinary procedure – display this

▪ Provide conflict resolution training to help staff deal with conflict

▪ Discuss how individuals work together and how positive relationships can be build

▪ Celebrate success at the end of a project or a difficult time

5. ROLE = Whether people understand their role within the organisation and whether the organisation ensures that the person does not have conflicting roles The standard is that: ■ employees indicate that they understand their role and responsibilities; and


■ the organisation ensures that, as far as possible, the different requirements it places upon employees are compatible;

■ the organisation provides information to enable employees to understand their role and responsibilities;

■ the organisation ensures that, as far as possible, the requirements it places upon employees are clear; and

■ systems are in place to enable employees to raise concerns about any uncertainties or conflicts they have in their role and responsibilities.

▪ Hold team meetings to enable members to clarify their roles and to discuss possible role conflict

▪ Display departmental targets / objectives to help clarify unit and individual roles

▪ Agree specific standards for jobs and individual tasks and review at regular intervals

▪ Agree personal work plans that are in line with the objectives of the unit

▪ Ensure that job descriptions are up to date so that the core functions and priorities of the job are clear

▪ Develop a system where staff have regular one-to-one’s to ensure that staff are clear about their role

▪ Develop induction system for new staff




6. CHANGE = How organisational change (large or small) is managed and communicated in the organisation The standard is that: ■ employees indicate that the organisation engages them frequently when undergoing an organisational change; and


■ the organisation provides employees with timely information to enable them to understand the reasons for proposed changes;

■ the organisation ensures adequate employee consultation on changes and provides opportunities for employees to influence proposals;

■ employees are aware of the probable impact of any changes to their jobs. If necessary, employees are given training to support any changes in their jobs;

■ employees are aware of timetables for changes;

■ employees have access to relevant support during changes.

▪ Agree a system of how change will be communicated to staff

▪ Ensure that staff are aware of why the change are taking place

▪ Explain the key steps of the change.

▪ Ensure that staff is part of the consultation process and that there is support in place for staff during the change process

▪ Agree methods of communication for example meetings, notice boards, newsletters as well as the frequency of this methods of communication

▪ Ensure that staff are aware of the impact of the change on their jobs

▪ Develop a system to provide staff with the opportunity to ask questions during, before and after the change.

▪ Review unit and individual work plans after the change to ensure that the unit and individual objectives are clear




Appendix 4 - Individual Stress Audit

Person’s Name

Manager’s Name

Date

Dept / Division

Does the person feel that:

DEMANDS

Y

N

Partly

Notes / Actions to be taken

1) they are able to cope with the demands of their jobs? 2) they have adequate and achievable demands in relation to the agreed hours of work? 3) their skills and abilities are matched to the job demands? 4) their job is designed to be within their capabilities? 5) their concerns about their work environment are addressed?

CONTROL

6) they are able to have a say about the way they do their work? 7) they have control over their pace of work? 8) they use their skills and initiative to do their work? 9) they are encouraged to develop new skills to help them undertake new and challenging pieces of work? 10) the organisation encourages employees to develop their skills? 11) they have a say over when breaks can be taken? 12) they are consulted over their work patterns?




SUPPORT

13) they receive adequate information and support from their colleagues and superiors? 14) they receive support from their manager? 15) they receive support from their colleagues? 16) they know what support is available and how and when to access it? 17) they know how to access the required resources to do their job? 18) they receive regular and constructive feedback?

RELATIONSHIP

Y

N

Partly

Notes

19) They are not subjected to unacceptable behaviours, e.g. bullying at work?

20) the organisation promotes positive behaviour(s) at work to avoid conflict and ensure fairness? 21) they can share information relevant to their work? 22) they feel that the TRUST has agreed policies and procedures to prevent or resolve unacceptable behaviour? 23) they are able and encouraged to report unacceptable behaviour?

ROLE

24) they understand their role and responsibilities? 25) the different requirements placed upon a person are compatible? 26) the trust provides information to enable the person to understand their role and responsibilities?




27) the requirements placed upon the person are clear ? 28) they feel free to raise concerns about any uncertainties or conflicts they have in their role and responsibilities?

CHANGE

29) the organisation engages them frequently when undergoing an organisational change? 30) the trust provides timely information to enable them to understand the reasons for proposed changes? 31) the trust ensures adequate consultation on changes and provides opportunities for people influence proposals? 32) they are aware of the probable impact of any changes to their jobs, if necessary, employees are given training to support any changes in their jobs? 33) they are aware of timetables for changes? 34) they have access to relevant support during changes?

35) they can freely express their concerns?

Pennine Acute Hospitals NHS Trust EDH015 Managing Stress at Work Policy Version 4.1.



Appendix 5 – Guidance Notes

GUIDANCE NOTES

Contents

1 ▪ Definition of Stress

▪ Pressure v Stress

2 ▪ Warning signs and symptoms of stress

▪ Potential long-term effects of stress

▪ Negative effects of stress on the organisation

3 ▪ Tools to identify problems and needs

▪ Steps to take if you suspect a person is experiencing stress

▪ Dealing with sickness absence due to stress

▪ Planning the return to work

▪ Examples of adjustments that can be made

4 5 6 7

▪ Why should organisation tackle work related stress

▪ Sources of work related stress

▪ Causes of stress in the NHS

▪ The Health & Safety Management Standards for work related stress.

▪ Practical ways to achieve the HSE Management standards and reduce

stress at work

▪ Five-step Stress Risk Assessment Process

▪ Organisational Well-Being Assessment




Definition of Stress

“The adverse reaction people have to excessive pressure or other demands placed on them” Health & Safety Executive 2001

“Stress occurs when perceived pressure exceeds your perceived ability to cope” S. Palmer

However, stress can also occur when too few demands are made, when people feel bored, under-valued and under- stimulated.

Line Managers’ Resource, Mind out for mental health

nagging Stress = Balancing Life

Creative

Alert

Effective

Decisive

Motivated

Stimulated

Sense of self worth

Gives meaning to life

Provide a sense of

personal accomplishment

Overload

Irritable

Indecisive

Difficulty concentration

Reduced confidence

Lethargic

Fatigued / Exhaustion

Anxious

Reduced productivity

PPPrrreeessssssuuurrreee vvvsss SSStttrrreeessssss

111




Warning Signs & Symptoms of Stress

Behavioural ▫ Change in appetite ▫ Loss of interest in work ▫ Reduced concentration ▫ Poor decision making ▫ Undue sensitivity ▫ Over-reaction to problems ▫ Criticism of others ▫ Reduced work performance ▫ Poor time keeping ▫ Loss of assertiveness ▫ Uncharacteristic errors ▫ Temper outbursts ▫ Lapses in memory ▫ Increased time spend at work ▫ Lack of holiday planning / usage ▫ Increased absenteeism and lateness ▫ Increased consumption of caffeine, tobacco, alcohol or drugs ▫ Bullying or harassment ▫ Inability to maintain personal relationships at home and at work ▫ Marital and family conflicts/breakdown ▫ Social isolation

Physical ▫ Fatigue ▫ Headaches, backache, indigestion and nausea ▫ Increased susceptibility to infections ▫ Change in sleep patterns ▫ Raised blood pressure ▫ Raised cholesterol levels ▫ Chest tightness / pain in chest ▫ Palpitations ▫ Dizziness ▫ Generalised aches and pains ▫ Rapid weight loss / gain ▫ Increased risk of heart disease and other major illnesses

Emotional ▫ Mood swings ▫ Anxiety, agitation, depression ▫ Irritability, anger, frustration ▫ Undue feelings of being under time pressure ▫ Feelings of guilt ▫ Feelings of hostility and resentment ▫ Reduced confidence and self-esteem ▫ Apathy ▫ Low in mood ▫ Feeling out of control, helpless ▫ Low motivation ▫ Loss of job fulfilment

(Organisational stress, planning and implementing a programme to address organisational stress in the NHS. HEA (1996))

222




Potential long-term effects of stress

▪ High blood pressure ▪ Heart attack ▪ Increased cholesterol levels ▪ Stroke ▪ Cancer ▪ Angina ▪ Diabetes ▪ Ulcers ▪ Irritable Bowel Syndrome ▪ Rheumatoid arthritis ▪ Psychological disorders, including breakdowns / depression

Negative effects of stress on the organisation

▪ Poor working relationships ▪ Low morale ▪ Reduced quality of products and/or services ▪ Reduced productivity ▪ Service targets not being met ▪ Increased absenteeism and lateness ▪ High accident rates ▪ Increased disputes amongst workforce ▪ Increased staff turnover ▪ Increased recruitment costs ▪ Increased training costs ▪ Risk of financial compensation ▪ Diminished public relations ▪ Increased ill health retirement

This list above is not intended to be exhaustive

Tools to identify problems and needs

▪ Regular work planning sessions

▪ Appraisals

▪ Informal chats

▪ Use open-ended questions for example

‘How are you doing at the moment?’

‘What is your workload like at the moment?’

‘What can we do to help?’

▪ If there is specific reasons for concern e.g. reduced performance, it needs to be addressed promptly

before the situation worsens

▪ Open-ended questions work very effectively

‘I’ve been noticing that you have sometimes been coming in late and was wondering whether

there was a problem’

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Steps to take if you suspect a person is experiencing stress

▪ Meet in a private confidential setting

▪ Reassure them that your door is always open if it’s too difficult for them to talk at that moment

▪ Be clear about confidentiality and explains the limits – personal information is confidential but issues

that may affect health & safety might need to be discussed further

▪ Ask open-ended question about how they are feeling, what the causes of the stress might be and

any possible solutions

▪ Discuss any adjustments that need to be made and how it will be monitored

▪ Where adjustments are being made, ask the person how they want this communicated to the rest of

the staff

▪ Advice person regarding other support mechanisms available e.g. counselling service, occupational

health, Stress Management Workshops

▪ Arrange a follow-up meeting to review the adjustments that’s been made

Dealing with sickness absence due to stress

▪ Sickness absence due to stress should be treated the same as any other sickness absence.

▪ Keep in touch

▪ Provide employee with the opportunity to explain what’s happening by asking open-ended questions

▪ Respect personal and medical boundaries

▪ Ask whether there is anything you as manager can do to help

▪ Explore potential for them to have a half-way house between work & home e.g. work for a few hours

a day from home.

Planning the return to work

▪ Effective planning between the individual, the line manager and other relevant parties for example

GP, Occupational Health & Human Resources will increase the chances of a successful return.

▪ Discuss the following with the employee prior to their return:

▪ Factors that contributed to their absence and what adjustments can be made realistically

▪ Factors that can’t be changed due to service demands, organisational factors out of you control

– how can their effect be moderated

▪ How will their progress be monitored

▪ Brief them on what’s been happening in the department both from a work perspective &

socially

▪ A mentoring scheme

▪ Be aware that some people might feel that they have to prove themselves, set realistic workloads

and goals that will make them feel that they are making progress




▪ Have regular informal chats

▪ Give positive and constructive feedback

▪ Make the person feel welcome back

▪ Don’t make them feel that they are a special case – this can cause resentment with both the

individual and colleagues.

Examples of adjustments that can be made

▪ Phased return – this can be reduced hours or part-time and gradually building up to contracted hours

(usually limited to a maximum period of four weeks (see Attendance Management and Sickness

Absence Policy)).

▪ Working from home for a period of time

▪ Identifying aspects of the job that is particularly stressful and rearranging responsibilities where

possible

▪ Adjusting the content of the job where possible

▪ Identify potential training needs, this might be around specific job requirements or personal skills for

example time management, assertiveness training, customer care etc.

▪ Time off for attending therapeutic sessions

▪ Exploring flexible working options for example part-time, job-share, change in shift patterns

▪ An earlier or later start and finish time to avoid rush hour

▪ Adjusting the physical working environment where possible

▪ Arranging for a quiet place they can go to when feeling stressed / anxious

▪ Child care support

(Line Manager’s Resource. A practical guide to managing & supporting mental health in the workplace. Mind Out for Mental Health)

Why should Organisations tackle work related stress?

To meet Government Standards

▪ The Revitalising Health and Safety Strategy (2000) targets for 2010

▪ 20 % reduction of work related ill health

▪ 30 % reduction in working days lost due to ill health

▪ To provide opportunities and rehabilitation for people unable to work due to ill health or

disability

▪ Health and Safety Executive (HSE) Management Standards were launched in November 2004.

These standards provide guidelines to organisations of states that need to be achieved for the

reduction of work related stress

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Legislation

▪ Health & Safety at Work Act (1974) section 2 – All employers have a duty of care to ensure health,

safety and welfare at work.

▪ The Management of Health & Safety at Work Regulations 1999 require all employers to carry out

adequate risk assessments. It also requires the employer to take into account the individuals

capabilities when assessing the risks. Failure to either produce and/or act upon assessments may be

evidence of negligence.

Equality Act 2010

Improvement of working Lives

▪ 536 000 Britons suffer from work related stress

▪ 5 million people in Britain believe they are exposed to work stress

▪ 80 000 people reported work related heart disease

▪ 20 % of individuals rate their jobs as very or extremely stressful

To reduce costs

▪ At over 13 million days a year, work-related stress is the biggest occupational cause of working days

lost through injury or ill-health

▪ With an average of 29 days lost per case, it costs society about £3.7 billion a year.

Sources of work related stress

The Physical Environment

Hazards: noise, temperature, bad lighting etc., smoking

Buildings: overcrowded, badly maintained; poor workplace layout, inadequate staff facilities, isolation

and lack of contact with colleagues

Inadequate or poorly sited equipment; over-exposure to VDUs.

The Job Itself

The design of the job

Disruptive shifts and rotas

Work overload: unsustainable demands on quantity, quality, responsibility or diversity of work;

fluctuating workload

Work under load: work which makes insufficient demands on the capacity and capability of the

individual, who becomes soporific or torpid, deskilled

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Role conflict: conflicting demands of multiple roles within or outside the organisation

Role ambiguity: lack of clarity or mixed messages about what individuals are required to do

The Organisation

A corporate culture, which presents individuals with dilemmas, they cannot resolve (e.g. to be a

workaholic, but also bring up a family).

Authoritarian or laissez faire management styles

Staff have insufficient control over their own job

Staff have no say in shaping organisational policy and decisions

Poor systems of vertical and horizontal communication

Hostile, suspicious or oppressive relationships, between colleagues, superiors and subordinates,

management and staff side

Discriminatory relationships and practices

Lack of recognition, through feedback on performance, opportunities for development, pay, service

conditions

Organisational change and anticipation of change, job losses, relocation, poorly managed change

processes

(Stress Management and Counselling – Theory, Practice, Research and Methodology. Edited by Stephen Palmer and Wendy Dryden. Redwood Books Limited (1996)

Tackling Work Related Stress: A manager’s guide to improving and maintaining employee health and well-being. Health and Safety Executive (2001))

Causes of Stress in the NHS

Invasion of autonomy / lack of control over work

Work / Life Balance

Rigidity of hierarchy

Doing tasks below grade

Lack of the right tools / broken tools to do the job

Increase in patient’s expectations

Increase in administrative duties

Organisational confusion / “right” and “wrong” channels

Isolation form other team members

Colleagues not understanding each others roles and competencies

Lack of management support




The Management Standards for Work Related Stress

Demands

Includes issues like workload, work patterns, and the work environment 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.

What should be happening / states to be achieved:

▪ 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.

Control

How much say the person has in the way they do their work The standard is that:

▪ Employees indicate that they are able to have a say about the way they do their work; and ▪ Systems are in place locally to respond to any individual concerns.


▪ Where possible, employees have control over their pace of work; ▪ Employees are encouraged to use their skills and initiative to do their work; ▪ Where possible, employees are encouraged to develop new skills to help them

undertake new and challenging pieces of work ▪ The organisation encourages employees to develop their skills; ▪ Employees have a say over when breaks can be taken; and ▪ Employees are consulted over their work patterns.

Support

Includes the encouragement, sponsorship and resources provided by the organisation, line management and colleagues The standard is that:

▪ Employees indicate that they receive adequate information and support from their colleagues and superiors; and

▪ Systems are in place locally to respond to any individual concerns.

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▪ The organisation has policies and procedures to adequately support employees; ▪ Systems are in place to enable and encourage managers to support their staff ▪ Systems are in place to enable and encourage employees to support their colleagues; ▪ Employees know what support is available and how and when to access it; ▪ Employees know how to access the required resources to do their job; and ▪ Employees receive regular and constructive feedback.

Relationship

Includes promoting positive working to avoid conflict and dealing with unacceptable behaviour The standard is that:

▪ Employees indicate that they are not subjected to unacceptable behaviours, e.g. bullying at work; and



▪ The organisation promotes positive behaviours at work to avoid conflict and ensure fairness; ▪ Employees share information relevant to their work; ▪ The organisation has agreed policies and procedures to prevent or resolve unacceptable

behaviour; ▪ Systems are in place to enable and encourage managers to deal with unacceptable behaviour;

and ▪ Systems are in place to enable and encourage employees to report unacceptable behaviour.

Role

Whether people understand their role within the organisation and whether the organisation ensures that the person does not have conflicting roles The standard is that:

▪ Employees indicate that they understand their role and responsibilities; and ▪ Systems are in place locally to respond to any individual concerns.


▪ The organisation ensures that, as far as possible, the different requirements it places upon employees are compatible;

▪ The organisation provides information to enable employees to understand their role and responsibilities;

▪ The organisation ensures that, as far as possible, the requirements it places upon employees are clear; and

▪ Systems are in place to enable employees to raise concerns about any uncertainties or conflicts they have in their role and responsibilities.




Change

How organisational change (large or small) is managed and communicated in the organisation The standard is that:

▪ Employees indicate that the organisation engages them frequently when undergoing an organisational change; and



▪ The organisation provides employees with timely information to enable them to understand the reasons for proposed changes;

▪ The organisation ensures adequate employee consultation on changes and provides opportunities for employees to influence proposals;

▪ Employees are aware of the probable impact of any changes to their jobs. If necessary, employees are given training to support any changes in their jobs;

▪ Employees are aware of timetables for changes; ▪ Employees have access to relevant support during changes.

http://www.hse.gov.uk/stress/standards/standards.htm

Practical ways to achieve the HSE Management Standards and reduce work related stress

Demands ▪ Hold weekly team meeting to discuss the expected workload for the week ahead

▪ Develop systems where regular meetings are held with individual’s to discuss their workload

▪ Put system in place for regular appraisals and discussions of personal development plans so that

staff know what their job involves

▪ Adjust work patterns to be able to cope with busy periods and staff absences

▪ Allocate enough resources (time, equipment etc.) to enable staff to carry out their jobs satisfactorily

▪ Provide formal or informal training to help staff prioritise

▪ Keep training records up to date to ensure that employees are competent to undertake their core

duties

▪ Review working patterns and shift work systems

▪ Consider flexible working patterns to help employees cope with external pressures Develop systems

where staff are communicated to regarding unplanned tight deadlines and the need to work longer

hours

▪ Provide conflict resolution training for staff to deal with difficult situations i.e. abusive patients / family

members, phone calls etc. Agencies (police)

▪ Carry out risk assessments for physical hazards

▪ Assess the risk for physical violence & verbal abuse

▪ Take firms steps to deal with violence and verbal abuse in consultation with staff & other appropriate




Control ▪ Develop systems where staff can have a say over how their work is organised, this can be through

one-to-one’s appraisals, project meeting, etc

▪ Provide opportunities for discussion and input during the planning stages of projects

▪ Allocate responsibility to teams to take projects forward

▪ Define teams at the start of the project

▪ Agree objectives

▪ Agree roles

▪ Agree timescales

▪ Agree the amount of managerial support that would be provided through regular meetings

▪ Discuss the following with employees

▪ Is there scope for more involvement during decision making processes

▪ Do people feel that their skills can be utilised to better effect

Support ▪ Develop a support system i.e. supervision, buddying, mentor system

▪ Develop a system where regular one-to-one’s are held with staff to discuss issues or pressures

▪ Hold regular team meeting to discuss departmental pressures

▪ Include work related stress as a standing item in team meetings and appraisals / performance

reviews

▪ Introduce flexible working where possible to help staff to cope with external pressures

▪ Develop systems to ensure the training and competencies are up to date and that the individual are

able to carry out the core functions of their job

▪ Discuss ways that the organisation could provide support to an employee experiencing problems

outside work

▪ Distribute information on other support agencies for example human resources, occupational health,

counselling service

Relationships

▪ Make sure that staff are aware of your organisation’s policy for dealing with unacceptable behaviour

– display this

▪ Develop procedures to resolve conflict at work – communicate this to staff

▪ Agree and implement a confidential reporting system for reporting unacceptable behaviour

▪ Make sure that staff are aware of your organisation’s grievance and disciplinary procedure – display

this

▪ Provide conflict resolution training to help staff deal with conflict




▪ Encourage staff to attend •Discuss how individuals work together and how positive relationships can

be build

▪ Celebrate success at the end of a project or a difficult time (informal lunch, night out etc)

Role

▪ Hold team meetings to enable members to clarify their roles and to discuss possible role conflict

▪ Display departmental targets / objectives to help clarify unit and individual roles

▪ Agree specific standards for jobs and individual tasks and review at regular intervals

▪ Agree personal work plans that are in line with the objectives of the unit

▪ Ensure that job descriptions are up to date so that the core functions and priorities of the job are

clear

▪ Develop a system where staff have regular one-to-one’s to ensure that staff are clear about their role

▪ Develop induction system for new staff

Change ▪ Agree a system of how change will be communicated to staff

▪ Ensure that staff are aware of why the change are taking place

▪ Explain the key steps of the change.

▪ Ensure that staff is part of the consultation process and that there is support in place for staff during

the change process

▪ Agree methods of communication for example meetings, notice boards, newsletters as well as the

frequency of this methods of communication

▪ Ensure that staff are aware of the impact of the change on their jobs

▪ Develop a system to provide staff with the opportunity to ask questions during, before and after the

change.

▪ Review unit and individual work plans after the change to ensure that the unit and individual

objectives are clear

Real Solutions, Real People A manager’s guide to tackling work related stress HSE Publication 2003

Five-step Stress Risk Assessment Process 1. Identify the hazards Risk Factors for Work Related Stress

▪ Culture – of the organisations and how it approaches WRS

▪ Demands - Includes issues like workload, work patterns and the work environment

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▪ Control - How much say the person has in the way they do their work.

▪ Support & Training – Includes the encouragement, sponsorship and resources provided by

the organisation, line management and colleagues

▪ Relationships – Includes promoting positive working to avoid conflict and dealing with

unacceptable behaviour

▪ Roles – Whether people understand their role within the organisation and whether the

organisation ensures that they do not have conflicting roles.

▪ Change – How organisational change (large or small) is managed and communicated in the

organisation

Methods that can be used to identify hazards

Qualitative

▪ Performance Appraisal

▪ Supervision sessions

▪ Return to work interviews

▪ Informal talks to staff

Quantitative

▪ Sickness Absence Data

▪ Productivity data

▪ Staff turnover

▪ Number of complaints

▪ Questionnaires – seek specialist advice prior to using a questionnaire

2. Decide who might be harmed and how WHO?

▪ Stress can affect any member of your team, regardless of age, gender, ethnicity, status or

disability

▪ Certain staff might be more vulnerable for example pregnant women and young workers

HOW?

▪ The risk factors will affect your staff in different ways

▪ A partnership approach, based on openness, honesty and trust is the most effective way to

explore how the factors are affecting your staff and which issues should be targeted first

3. Evaluate the Risk For each of the risk factors identified in step 1, ask the following three questions




▪ What actions are already being taken?

▪ Is it sufficient?

▪ What more needs to be done

Aim to minimise the risks as possible and to combat it at an organisational / departmental level first,

before considering stress / pressure management training for individual members of staff. Take action

that protects everyone, instead of just a few individuals

4. Record your findings and Formulate action plans ▪ To help you prioritise

▪ Help set you goals to work towards

▪ Demonstrate that you are serious about addressing staff’s concerns

▪ To provide a measure that you can evaluate against

▪ Include the following in the action plan:

▪ The problem identified

▪ How was it identified?

▪ Suggested intervention

▪ Mechanisms for introducing the intervention

▪ Key milestones and dates for them to be reached

▪ How you are going to provide feedback to staff

▪ Review date against the action plan

5. Review the assessment ▪ Regulation 3 of the Management of Health & Safety at Work regulations (1999) require employers to

review assessments at any time when there is a reason to think that the assessment is not be valid

anymore

▪ At first review six-monthly

▪ If this period becomes too frequent – review annually

▪ The assessment should also be reviewed if there is changes in the foreseen future that could affect

your staff i.e. changes in management structure, moving site, new hospital being build, merger.

▪ It’s important to involve staff and staff representatives in the review process.




Appendix 6 – Symptoms/Signs of Stress

Symptoms / Signs of Stress

Poor Performance at work including:

Memory lapses

Uncharacteristic errors

Indecisiveness

Emotional Signs

Irritability

Tension

Moodiness

Alienation

Dissatisfaction

Tearful

Anxious

Withdrawal

Withdrawal of interest or commitment:

Arriving late

Leaving early

What to look for in

others

Fixation – e.g.

Repeating arguments in meetings

Refusing to listen to suggestions

Insisting on using inadequate solutions Aggressive behaviour

such as:

Bullying

Criticising others

What to look for

in

yourself

Immature or emotional behaviour such as:

Crying

Sulking

Bad temper

Loss of sense of humour

Physical Signs

Headaches

Tension

Indigestion

Breathlessness

Rashes

Frequent Colds

Reoccurrence of previous illness

Sleep Disturbance

Dizziness

Mental Signs

Inability to concentrate

Worrying

Mistakes

Muddled thinking

Persistent negative thinking

Nervousness

Behavioural Signs

Unsocial

Restlessness

Lying

Reckless Driving

Increased drinking or smoking

Change in appetite