Health and Wellbeing: Organisational Stress
So far we have considered the implications of stress and burnout for individuals. However we have another important dimension to consider – what are the practices responsibilities to manage stress caused by or made worse by work.
As we have seen individuals differ in their risk of experiencing stress and in their vulnerability to the effects of exposure to stress. Physical health, psychological health and personality type all will impact on an individual’s ability to manage the stress they are exposed to and the extent of harm they may suffer if the “balance” between demand on the person and their resources to manage that demand becomes disturbed.
Workplace factors that can cause stress can be broken down into those to do with the content of work and those to do with the social and organisational context of work.
Sources of stress at work
- Intrinsic to the job
- Role in the organisation
- Career development
- Relationships at work
- Organisational structure and climate
- Home-work interface
How might these be seen in your practice? Take a few moments to think about your practice and how some of these sources of stress are affecting your staff.
In general practice at the moment then the obvious risk factors in this category are
- Time pressures and deadlines
- Work overload
These hazards apply across the organisation and all members of staffs are exposed.
Think about the staff in your surgery that might be most at risk
Role in the organisation
This source of stress usually comes from either having too much or not enough responsibility within the organisation, role conflict or ambiguity and lack of management support. A classic example in general practice would be the practice manager who is constantly undermined by the partners.
This stress risk is usually linked to under or over promotion, thwarted ambition and threat of job losses.
In the uncertain times we now find ourselves we should acknowledge the uncertainty that this brings and that some people will find this very stressful.
Relationships at work
This relates to relationships across the organisation with your boss, colleagues or subordinates. Obviously personality clashes are common but difficulty in delegating responsibility is another common issue.
Think about the relationships in your practice. Which ones might you be able to predict might cause stress?
Organisational structure and climate
This relates to the “feel” of a practice. When we visit practices it is amazing at how quickly you can get a sense of how that practice works and what it might be like to work there.
Office politics are inevitable but how are they managed? What participation in decision making do staff actually have and how do the management consultant and communicate? Lack of consultation is cited as a cause of about half of the cases of occupational stress.
Think about how your practice might feel to an outsider? Is it a happy place to work? Are your staff truly engaged in the business of making your practice successful?
This relates to issues covered in the first sections on stress and burnout. General practice is a demanding job for doctors and for managers and the demands can cause conflict of loyalties between work and home. Also, problems outside of work can affect performance in work that leads to stress in the workplace.
How good are your boundaries between work and home? How can you strengthen them?
Hopefully this will have given you some food for thought and some ideas may be developing as to what you might be able to do to help yourself and the staff at your surgery manage stress across your organisation. It is worth considering briefly the legal position on stress in the work place and the responsibilities that employers have to manage stress.
Stress at work and the law
Employers have duties towards the health and safety of their staff. These are either:
These fall under the Health and Safety at Work Act (HSWA) 1974 and the Management of Health and Safety at Work Regulations (MHSWR) 1999. These are regulated by the Health and Safety Executive (HSE) and Local Authorities (LA).
The HSE have stated that ill health resulting from stress caused by work must be treated as the same as ill health due to other physical causes present in the workplace. This is important as it clearly sets out that employers have a responsibility to manage or at least attempt to manage stress in the workplace.
Under the management regulations an employer must:
- Proactively identify causes of stress in the workplace
- Undertake a risk assessment
- Implement control measures which prevent or control the risk of physical or mental harm
However the duties are limited and will be considered in terms of:
- Degree of control
- Reasonable practicability i.e. what might be reasonable within the resources of the practice
The burden of proof for criminal conviction is “beyond reasonable doubt” so prosecution is harder to secure than civil claims.
To date there have been no prosecutions under health and safety law relating to work related stress.
- Civil Law
This relates to civil cases brought by individuals under the tort of negligence. The individual must prove that they were owed a duty of care by the person or organisation they are suing and that any injuries or harm were the direct consequence of a failure to take reasonable care. The burden of proof is “in the balance of probabilities”, i.e. lower than criminal convictions.
The key issues are the extent to which the harm was foreseeable and what steps has an employer taken to control the risk of harm.
Case law has established that employers have a duty of care to an employee’s mental as well as physical health.
One difficulty in managing stress from an employer’s perspective is deciding what assumptions can you make about an employee’s resilience, mental toughness and stability of character, given that people of clinically normal personality may have widely differing ability to absorb work related stress?
A recent decision in the House of Lords was that it did not matter if the employee was not of normal “fortitude”. The employer must take the employee as he finds him. This may imply that employers need to be especially active in managing stress as they may be subject to a negligence claim even if the individual was especially vulnerable to stress.
What actions can a practice take?
Given the brief explanation of the legal position it seems that all practices should consider how they manage stress in the practice. This means more than writing a stress management policy that sits on a shelf gathering dust!
You need to find out what the common stress triggers are in the practice. This may be different for different members of the team e.g. what stresses a receptionist may be very different to the senior partner or the practice manager.
A team meeting, either as the whole practice or by role in larger practices, would be a good way of finding out. Get a flip chart and brain storm. Encourage honesty and you be surprised by what you find out. When you have a list try to classify them into the six classes of stress we discussed at the start of this article.
You now need to risk assess each stressor. This means thinking about if the stress situation is a high risk of causing harm either because of scale or frequency. Do you have evidence that this might have caused harm in the past? Look at sickness absence records. Can you see any patterns that might indicate stress related behaviour e.g. higher absence amongst reception staff on very busy days etc.
The likely top categories will be time pressures and deadlines, work overload, lack of control over work, poor social support and feeling isolated and relationship issues. But it’s really important that you try to find out what causes stress in your organisation.
Next is putting a control measure in place. Remember this can be proportional to the resources available. So, for example, if a member of staff identifies not being able to park their car near the surgery is a major stress factor then you will not be expected to build a new car park but you might be able to look at car share schemes or adjusting the employees working times to allow her time to drop her children at school and get to work without rushing if she can’t park nearby.
So it is important to think about what causes the stress in your practice, how much impact that stress is having on your staff and what control measures can be put in place to reduce the risk of harm.
Credit: This article is based on a Thor-GP learning module. Thor-GP is the national reporting system of occupational diseases by doctors with training in occupational health based at the University of Manchester