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The X-Factor in wellbeing and performance

Derek Mowbray derek.mowbray@mas.org.uk www.mas.org.uk www.orghealth.co.uk March 2010

Introduction People who feel well perform better than people who feel ill. This arises because individuals who

feel well can look outside of themselves and focus on their work, whilst those who feel unwell

tend to focus more on the sensations within themselves of feeling unwell - a form of protection.

The individual perception of wellness is idiosyncratic. People with a diagnosable illness may feel

well, whilst someone with no recognisable illness may feel unwell. The idea of wellbeing and

wellness embraces sensations of anxiety, depression and fear, which, at their lowest intensity,

may not register as being externally identifiable. It’s not uncommon for people feeling depressed

to appear to be well and difficult to diagnose. Nevertheless people with low intensity unwellness

tend to focus their attention on themselves, limiting their capacity to focus on activities outside

of themselves. The extent to which individuals can focus on work whilst feeling unwell is largely

due to their personal level of resilience and tolerance.

This paper focuses on psychological distress arising in work however caused with origins at home

or at work, including distress caused by physical ill health.

Diverting attention and concentration away from the outside world towards internal sensations

can also come about because of boredom, mismatch of skills, knowledge and experience needed

to complete tasks, as well as the activities of others that may not accord with internal beliefs and

values of the individual affected, such as bullying, harassment, shouting and rudeness.

The beliefs and values of the individual are a central element of the Psychological Contract that is

the unwritten and silent agreement between the employee and the employing organisation and

its controllers based on a personal sense of fairness. The sense of fairness is based on personal

beliefs and values, and is, also, idiosyncratic. One person can be resilient to and tolerate rudeness

in others because rudeness doesn’t feature as a challenge to their personal beliefs and values,

whilst to others rudeness may be a challenge to a core belief on the grounds that rudeness masks

a whole range of other unacceptable forms of behaviour that combine together to create an

adverse event – an activating event that any individual might trigger for any reason.

Individual response to events, such as rudeness and diagnosable illness, is key to the sense of

personal wellbeing and presents a major challenge to organisations that wish to eliminate the

high costs attributable to sickness absence, staff turnover and presenteeism (the phenomenon

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of people working but under-performing whilst feeling unwell due to ill health, psychological

distress or threats to wellbeing, such as fear).

The relationship between wellbeing and performance is on the ability of individuals to apply their

skills, knowledge and experience to a task in a way that absorbs their concentration and energy.

If concentration is interrupted or personal energy is directed towards self preservation then

performance falls off. This is the basis for much of presenteeism, the total costs of which are

about 58% of all costs attributable to staff sickness absence, turnover and presenteeism

combined.

Presenteeism is a massive challenge to all organisations. For many managers and employees

presenteeism occurs as a step towards sickness absence which may be a step towards turnover,

where the reason for turnover is disengagement with the current employer, and engagement

with an alternative or no employer.

Presenteeism and dis-engagement are linked. Engagement has been described as ‘a positive,

fulfilling, work-related state of mind that is characterised by vigour, dedication and absorption’.

Vigour is characterised by ‘high levels of energy and mental resilience whilst working, and

willingness to invest effort in one’s work, and persistence in the face of difficulties’. Dedication

refers ‘to be strongly involved in one’s work and experiencing a sense of significance,

enthusiasm, inspiration, pride, and challenge’. Absorption is characterised by being ‘fully

concentrated and happily engrossed in one’s work, whereby time passes quickly and one has

difficulties with detaching oneself from work’.

Dis-engagement, therefore, is the opposite of engagement and is the principal feature of

presenteeism where people come to work but under-perform because they cannot concentrate

on their work effectively, and are dis-engaged with their work and/or their organisation.

The standard solutions There has been a spate of advice since early 2008 arising from a significant number of reviews

relating to health and wellbeing. Amongst them are:

Mental Health and Work – March 2008. Royal College of Psychiatrists.

‘Going the extra mile’ July 2008. Institute for Employment Studies.

Staff Engagement in the NHS. Briefing no. 50 November, 2008. NHS Employers.

Improving health and work: changing lives. November 2008. DoH/DWP

Improving working lives in the NHS. July 2009. DoH.

NHS Health and Wellbeing Review – Interim Report. August 2009

NHS Mutual. Engaging staff and aligning incentives to achieve higher levels of performance. 2009. The Nuffield Trust

Psychological Health and Wellbeing: a new ethos for mental health. November 2009. BPS.

NHS Health and Wellbeing. Final Report. November 2009.

Promoting Mental Health through productive and healthy working conditions. November 2009. NICE.

New Horizons in Mental Health. November 2009. DoH

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Much of the advice offered in these reviews can be interpreted within the standard therapeutic

framework of the ABC model where A is the activating event that causes ill health and/or

psychological distress, B is the belief, values and physiology that influence individual response to

the adverse event and C is the consequential behaviour and outcome that arises from the

individual response. The therapeutic intervention is often to support the individual at B by either

applying psychological therapies such as Cognitive Behaviour Therapy (CBT) or Acceptance and

Commitment Therapy (ACT) or bio-medical interventions. The role of Occupational Health

Services is frequently advocated in this context as are the services of Employee Assistance

Programmes, General Practitioners and Counsellors. The interventions are designed to modify

the individual response to the events so that the C – consequence –is that the individual remains

in work or returns to work.

However, this approach does little to address the massive challenge of presenteeism.

The HSE/CIPD report on ‘Manager Competencies for preventing and reducing stress at work’ in

2008 and The MacLeod Review – ‘Engaging for Success – enhancing performance through

employee engagement’ 2009 – come closer to addressing the fundamental issues relating to the

causes of psychological distress, presenteeism and under performance at work.

The MacLeod Review focuses on the importance of engagement in reducing costs attributable to

sickness absence and staff turnover, whilst the HSE/CIPD research emphasises the behaviours of

managers as moderators of sickness absence and staff turnover.

The X-Factor in wellbeing and performance In their report ‘The Wellness Imperative: Creating more Effective Organisations’ (2010) the World

Economic Forum identifies the importance of embedding wellness strategies into organisation

strategies so that they become part of the bloodstream of daily organisational life. The report

shows the unambiguous link between wellness and productivity and performance.

This supports the approach set out in ‘Building Resilience – An Organisational Cultural Approach

to Mental Health and Well-Being at Work: A Primary Prevention Programme’ by Derek Mowbray

(2008) that promotes the building and sustaining of a Positive Work Culture as part of the

organisational strategy for all organisations to improve performance and eliminate the costs

attributable to sickness absence, staff turnover and presenteeism.

The key element is a focus on the cultural foundations and context within which people work. A

Positive Work Culture provides the context that promotes commitment, trust and engagement

between employees and their employing organisation. As everyone acts according to the

meaning of the situation they find themselves, a Positive Work Culture provides the meaning

most closely allied to commitment, trust and engagement, and this stimulates the behaviours

that actively promote the characteristics of commitment and trust.

These characteristics include:

Purpose that is clear, unambiguous and succinct.

Architecture that engages people in decision making about themselves.

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MASThe X-Factor in wellbeing and performance

X = conteXt

A = activating event

(within the cultural context of the organisation)

B = thoughts, emotions and behaviours

(reaction to activating event)

C = consequential outcome

(the manifested response to an event)

The XABC formula

Rules for recruitment, jobs, citizenship, life balance that promote commitment and trust.

Behaviours that promote encouragement, discretion, challenge, team working, support

and routine appraisal leading to commitment and trust.

The approach of building and sustaining a Positive Work Culture has a direct influence on how

individuals respond to activating events. If a cultural context has wellbeing and performance

embedded as part of the organisational strategy there is less risk of activating adverse events

occurring. Should such events occur, the individual response will be proportionate to the culture

that promotes commitment and trust. This furthers the opportunity for stronger engagement

between employees and their

employing organisations.

This is described as the XABC formula.

This places an emphasis on building

and sustaining a Positive Work Culture

based on wellbeing and performance

principles, using commitment, trust

and engagement behaviours. X is the

context within which managers are

expected to behave and is the cultural

foundations for the organisation as a

whole. A is the activating adverse event and will be influenced in its type and severity by X; B is

the thoughts, emotions, values and behaviours that influence the reaction to the adverse event

and which is influenced by X, and C is the consequential behaviour and outcome from the

reaction to the event

Without the X-Factor in wellbeing and performance, all organisations will continue to employ

people who fall back on their own thoughts, emotions, beliefs and behaviours, encumbered by,

at best, a neutral, and at worst, a hostile, cultural context, to react to activating adverse events.

This is effectively allowing chaotic responses to take place, all of which will impair wellbeing and

performance amongst managers and staff – a feature of much of organisational life in the UK

today. A partial antidote to this is building and sustaining organisational and personal resilience

(www.orghealth.co.uk). A full antidote is to incorporate the X-Factor into organisational strategy.

Implementing change The implementation process is based on the identification of the whole organisation and its

constituent organisations. Each organisation, whether large or small, needs to build its own

cultural context which is allied closely to that of the hosting organisation. Managers of the

constituent organisations need to be identified and developed in the behaviours that promote

commitment and trust.

The strategy of change that drives a change in culture is the strategy of conviction. This relies on

convincing managers and employees of the benefits of a Positive Work Culture and the relative

ease with which such a Culture can be built and sustained.

A Wellbeing and Performance Agenda can be agreed that incorporates:

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Step 1 – is working with the top team of managers and non-Executive Directors. At this level the

focus is on reviewing and revising, as required, the purpose, architecture, rules and behaviour

expectations that form the cultural foundations for the organisation as a whole. This is part of

the organisational strategy, and will involve the identification of benefits to be accrued from a

Positive Work Culture.

Step 2 – is a survey of all managers and employees using the Quality of Working Life Assessment

(www.qowl.co.uk) to identify ‘hot spots’ and provide a benchmark against which changes are

measured.

Step 3 – is the preparation of a Manager’s Code (www.mas.org.uk) that sets out the behaviours

of managers in a) managing the organisation b) managing people and c) managing the business

or service.

Step 4 – is raising awareness of all managers and staff to the benefits and processes involved in

building and sustaining a Positive Work Culture and the adoption of a Manager’s Code.

Step 5 – management development of all leaders, managers and aspiring managers in all aspects

of a Positive Work Culture.

Step 6 – the provision of cognitive coaching for managers to help them re-align their thinking and

behaviour with the requirements of a Positive Work Culture based on wellbeing and

performance.

Conclusion The relationship between wellbeing and performance is well established but inadequately

implemented in organisations. Consequently many organisations under-perform because they fail

to focus on eliminating the level of presenteeism that exists. Instead, most organisations provide

services in support of the ABC model of care, that helps individuals to respond to adverse

activating events by offering personal therapy, coping strategies, and other interventions to keep

people at work, or help them to return to work.

A more effective approach to the elimination of presenteeism is to be found in the XABC

formula. This formula places an emphasis on building and sustaining a Positive Work Culture that

will prevent presenteeism from being a drain on resources, and turn those who contribute to

presenteeism into high performing and engaged employees. The application of the XABC formula

to organisation strategy elevates the significance of wellbeing and its impact on performance,

leading organisational success.

For more information on building and sustaining a Positive Work Culture, and on the application

of the XABC formula please contact barbara.leigh@mas.org.uk

For more information on resilience training please see www.orghealth.co.uk

20th March, 2010