1. TRUST STRESS MANAGEMENT PROJECT
Sue Grimshaw
Acting Head of Occupational Health Dept & Stress Project Lead

2. Common causes of stress in the workplace
Unreasonable demands for performance
Lack of interpersonal communication between the employer and the employees
Lack of interpersonal relationship among the employees
The fear of losing one's job.
Long working hours
Less time to spend with the family
Under utilization of skills
Underpaid jobs
A promotion that did not materialize – promises promises promises!

3. The cost of stress
Sickness absence in the NHS is estimated to cost the service some £1.7billion each year
A quarter is likely to be attributable to stress related sickness.
Time lost to sickness absence amounts to 10.3 million working days or
The equivalent of having 45,000 whole time equivalent staff not at work
Of these, a quarter are likely to be due to stress related sickness Nhs employers

4. Money Money Money
£175,000
£850,000
£109,754
Ask the group what they think these figures represent? How could these amounts of money be used for?
Explain that numerous cases have gone through the courts where the individuals have been awarded significant compensation:
Walker v’s Northumberland County Council (1995)
Mr Walker was a social worker with a heavy case of child abuse claims. He had a nervous breakdown and returned to work some 5 months later having been promised assistance and a reduced workload. The promised assistance did not materialise and Mr Walker suffered another breakdown. The High Court held that the Council was liable for psychiatric damage caused to him through stress. The Council had failed to provide assistance or reduced workload and therefore were in breach of their care. The risk was foreseeable. The Council made a payment of £175,000 to the employee in an out of court settlement. The case made it cleat that an employers common law duty is to protect them from psychiatric harm and failure to do this could lead to a claim that this was reasonably foreseeable.
Green v’s DB Services (2006)
In this case a secretary was awarded over £850,000 in her claim against Deutsche Bank. She had suffered stress and a nervous breakdown after being bullied by colleagues. The employer was found to be vicariously liable for that bullying and in breach of its duty of care.
Dickins v O2 (2009)
An employee was given a promotion to role of management accountant and promised support and training. This was not given and the employee found the role to be overly demanding and asked to be moved to a job within her capabilities, but as there were no vacancies she was told that the situation would be reviewed in three months. She asked for a 6 month sabbatical and was told that she would be referred to OH for counselling, but this was actioned before she went off sick with stress and did not return. She was awarded £109,754.

5. Signs of Symptons of Stress
Physical
Headaches
Indigestion
Colds/Flu
Skin condition
Acne
High BP
Sleeplessness
Nervous ticks
Tense Muscles
Emotional signs
Anxiety
Anger
Feeling hopeless
Depression
Negativity
De-motivated
Low self-esteem

6. Signs of Symptons of Stress
Behavioural Signs
Smoking
Alcohol
Increased caffeine
Irritability and aggression
Increased forgetfulness
Moodiness and sulking
Apathetic
Withdrawal
Obsessive behaviour
Increased mistakes
Crying
Decreased personal standards
Changes in Thinking Style
Confused
Negative
Indecisiveness
Poor concentration
Blinkered
Things out of proportion
Constant criticism
Cynicism

7. What started the project?
Occupational Health (OH) data demonstrated a doubling of cases of work related stress in 2006/7
Perceived causes – workload, interpersonal conflict at work and the £21m restructure
High sickness absence rate at 5.34%
This demanded a management led approach, not medical “treatments”
Occupational Health gathered data routinely - to start with
Doubling work related stress – MSK unchanged
OPRA/THOR national comparator showed us to be out of line
Gathered the data without using it is a futile exercise – we had a responsibility to act on it as far as we were able – but this required Trust Board level support

8. Next steps Trust Board >to consider analysis/findings so far
>they took ownership
>to support a Stress Management Project
Timing
>Trust emerging from Financial recovery programme
>Aiming FT status and focus on Patient Quality
>The Blackpool way still needing to embedded
Management Standards approach would have suggested the next step as individual formal risk assessments at a divisional and departmental level

9. Broader effects Individual Colleagues Organisation
Unhappy, de-motivated, disengaged, absence
Colleagues
Frustrated, antipathy to Trust
Increased workload pressure from absent colleagues
Disengagement
Organisation
Increased grievances and management problems
High absence rates
Inconsistent patient care/ service delivery
Negative public image
Reputation hinders recruitment
Workforce lacking in skills & competency

10. Impact on individual, colleagues and organisation
Increased grievances and management problems
High absence rates
Inconsistent patient care/ service delivery
Negative public image
Reputation hinders recruitment
Workforce lacking in skills & competency
Individual
Unhappy, de-motivated, disengaged, absence
Colleagues
Frustrated, antipathy to Trust
Increased workload pressure from absent colleagues
Disengagement

11. Our strategy & targets Existing Data, Board & Workforce Engagement
Reduce sickness 4.3% / Work related Stress cases by 30 %
Adhere to Hse Management Standards who supported the project fully
Make the Trust a great place to work = increased recruitment /retention

12. Barriers to the project
This is too difficult/ too big
This is not my role
What problem?
Stress makes people work harder
Nothing to do with the Organisation
Targets affected if we take our eye off the ball
Everyone will say they are stressed if its highlighted
They should try my job!

13. Key stakeholders identified for the Stress Project to succeed
CEO
Chairman
Executive Directors
Non-Executives
Staff Side representatives
The Workforce
All the above agreed to implement all reasonable recommendations and explain why any were not implemented
STOP

14. Project methodology Focus groups – 8 sites
Robust project management tools
Reporting methods
Role of Ceo & Executive Directors
Working in partnership with HSE

15. Findings of the Focus groups
Issues causing the stress to the workforce
Communication
Management Style
Learning & Development opportunities
Bullying & Harassment
Sickness & Absence
Recruitment & Retention
Lack of staff engagement
Car Parking
How we care for each other
70 recommendations

16. Successes so far (1) Staff Survey 2006 response rate was 44%
Results indicate a widespread improvement and divisional differences have all but disappeared, staff are reporting improvements as individuals.
Divisional differences –
2007 results showed good overall results concealing major divisional differences – inconsistency of good practice and bad practice simultaneously

17. Key Results from 2008 Staff Survey relevant to Stress Project
Key Findings
Change Since 2007 Survey
Ranking compared with all Acute Trusts 2008
Trust commitment to work-life balance
Increase (better than 07)
Highest (best) 20%
% having well structured appraisals in
last 12 months
Support from immediate managers

18. Key Results cont’d …
Key Findings
Change since 2007 Survey
Ranking compared with all Acute Trusts in 2008
Perceptions of effective action from employer towards violence and harassment
Increase (better than 07)
Highest (best) 20%
% reporting good communication between senior management and staff
New question
Staff Job Satisfaction
% that would recommend the trust as a place to work

19. Successes so far (2) Sickness & Absence rate now is 4.31%
By 2009 Work related stress presenting to OH down by 40%
Long working hours culture leading to  stress/ absence from work being actively managed
Occupational Health moved back onto main site 3-4 years ahead of schedule
Winners of HPMA Award 2009 (HSE Category – Stress)

20. Successes so far (3)
Compliance with NHSLA at Level 2 now aiming for level 3
Stress Website for staff
Employment Assistance Programme launched on April 9th 2009
June 2009 – 87 % staff appraised
June 2010 – 100% staff appraised
Stress management training programme Trust-wide – at manager’s request for all staff to access
Stress website –
All workforce can access
Minutes, progress reports, directors action plans etc – nothing concealed
And
General advice on recognising and managing stress at an individual level

21. Successes so far (4) Exit Questionnaires
3 versions and they are being used
Dedicated staff to assist with completion
Will identify trends, issues and successes
Learning & Development reviewing current training provision and induction/mandatory programmes
Trust has implemented Leadership & Management Programmes to develop staff & managers
3 Versions
Staff leaving organisation
Staff transferring within organisation
Staff not leaving – new staff after 6 months

22. Successes so far (5)
Poor performance now being robustly managed across the Trust
Bullying and harassment cases now being dealt with in agreed timescales (6 weeks)
Multi-storey car park being built – parking for all staff on site within next two years
Grapevine magazine
A resource for other organiations nationally

23. Phase 2 – Review of Current OH service provision
Focus groups have been run to ask workforce for further ideas e.g. well being initiatives
> Social events for staff
> Review of catering provision to assist staff with healthy eating options
> Fast track appointments – to employ physiotherapist in the department
> Increased counselling & CBT provision
> Hours Occupational Health extended increased clinic productivity
> Health promotion events
> Improve communication /information for staff accessing Occupational
Health
> Greater telephone access
> Known as Health & Well being centre

24. Overall impact on the workforce if the Project succeeds
Staff will feel:
Valued
Supported
Involved
Happy at work
A sense of worth
Motivated
Staff will have:
Positive working relationships
Career development
A pride in where they work
A sense of belonging.
A voice that is heard

25. Making a difference to patient care
Reduction in Sickness & Absence has improved staff ratios for patient care delivery
Trust converting “Bank Hours” to substantive nursing posts – improved continuity of care
Staff able to access training skill development resulting in competent safe practitioners
Staff more aware of stress (? Good or bad)

26. How to manage stress Responsibility of the Individual
Understand nature and sources of stress.
Make someone aware of how you are feeling – ideally your line manager but if not, HR or contact your Occupational Health provider
Manage your time effectively and efficiently.
Follow an appropriate lifestyle
Develop a personal strategic management process (have a mission, set achievable goals, allocate resources and periodically assess the situation).
Be systematic in decision-making and problem solving.

27. What a manager needs to do…
Be proactive in dealing with stress in the workplace
Offer reassurance to the person – “you’re not on your own”.
Seek advice from HR or their line manager if unsure what to do.
Don’t say ‘so are all of us’
Have self awareness around how your management style may impact on others – in times of difficulties, don’t revert to using the stick!
Take immediate action –
Make time & Listen
Ask what they need
Aim to alleviate the situation & review progress
We can assume that a person can withstand the normal pressures of work but once you are aware of a problem it is reasonable that something is then done
Be aware of the DDA – need to consider reasonable adjustment necessary to support and alleviate stress

28. Responsibility of the Organisation
Ensure that the workload is in line with the employees’ capabilities and resources.
Jobs that have meaning, stimulation,less monotony & opportunities for employees to use their skills.
Clearly define employees’ roles and responsibilities.
Employees should participate in decisions and actions affecting their jobs.
Improve communications - reduce uncertainty about career development & future employment prospects.
Provide opportunities for social interaction among employees.
Establish work schedules that are compatible with demands & responsibilities outside the job.

29. How to manage your own Stress
Smiling
Your thoughts/ what are your 10 top qualities
Exercise /Breathe
Rest – take time out
Support & Feedback 29

30. How to manage your own Stress
Hugging – for you to receive or give
Relaxation – take it easy /
Meditation 10 mins per day/Alternative therapies
Balanced diet –obesity can increase stress
levels. Reduce toxins smoking & alcohol work
against the body
Need Help – Ask!!
Work / Life Balance:- use to do lists 30

31. The Ten Commandments to Stress prevention
Plan your day
Build a balanced system
Know your energy curve & concentration
Be realistic you are not superhuman
Learn to delegate
Aim for satisfaction
Learn to say ‘No’ assertively !
Look for things in your work to enjoy
Laugh to reduce stress
Make time for you 31

32. Thankyou
Any Questions