Finding the right balance

Stress appears to be something of a modern plague, affecting thousands and costing the UK economy billions. The term stress is widely used in lay language and it is not unusual to see headlines like this one from the Daily Mail: “Stress costs more working days to be lost than 1970s strikes.”

Such articles tend to promote a bleak picture with comments like “but today a more modern problem – work-related stress – is proving more costly than industrial disputes did back then.” It would be easy to conclude from some media reporting that this widespread problem is something principally associated with work, but the same newspaper also ran an article with the headline: “Parents find family holidays more stressful than work” and it was suggested that “two thirds of parents admitted that they think going on holiday with the kids is more stressful than being at work.” It appears clear therefore that this thing we label stress has an impact upon life both in an out of work.

What should be done?
The initial response to any health and safety issue tends to be a cry of “risk assessment”, but how does that work with something like stress? Can we hazard spot as we would with trip hazards? We’d ideally like to tackle the problem at source but where is the source and what might constitute primary prevention in this case? To answer these questions and indeed to understand court rulings on stress claims, we need to look at what stress actually is.   

We tend to use the term stress without much thought, but if you take a second to think how it is used, you’ll see it used to describe both a stimulus and a response, and both a state and a process. Often it’s explained as a physiological response whereas at other times it is viewed from a psychological perspective. We even see it described as a disease when it clearly should not be.    

Broadly speaking there are three perspectives on stress – engineering, physiological and psychological. Engineering models are the most basic – in simple terms, if you push us too far we snap. This idea of being pushed to breaking point is a common analogy, but people are much more complex than steel girders or concrete pillars. There is no universal dose-response relationship – individuals vary dramatically and indeed, a single individual may react very differently to the same situation at different points in their life. These models would work very well with traditional risk assessment, but they don’t explain the complex problem of stress amongst people at work.    

Next are the physiological models and it is rare to see a popular reporting of stress which doesn’t mention the ‘fight or flight’ response. Whilst it is certainly true that physiological changes can occur, the notion of a simple, non-specific response to a ‘threat’ doesn’t explain the complex and typically long-term problems we see in the workplace.

Stress models

These days therefore, psychological models dominate our understanding of, and response to, stress at work. These models can be broken down into two types – interactional models and the more complex transactional models. The key difference between the two lies at the very heart of the stress problem and is perhaps reflected better within appeal court rulings than HSE guidance.  

Perhaps the most commonly discussed interactional model was developed in the 1970s by Robert Karasek – the Demand–Control model. This simple, but fairly effective model proposed that strain from work was associated with the interaction of these two key factors, with high demands and little control resulting in ‘high strain.’ This model was later developed to incorporate ‘support’ and could be said to encapsulate perfectly the situation behind the first successful stress claim in the UK – Walker v Northumberland County Council. John Walker was a social worker who flagged concern over his case load, but could exert no control over it and was not offered any support from his superiors. Whilst interactional models have proved useful, they have a fundamental flaw – what we have realised is that reality doesn’t matter in these situations, it is the individual’s perception of reality that counts. It doesn’t matter whether the demands placed on an individual are objectively high, but whether they are perceived to be high. It doesn’t matter whether individuals actually have control, but rather whether they think they have control.

Transactional models
True transactional models of stress are the antithesis of engineering models – the focus is not so much on the environment, but on how the individual reacts. Fundamental to transactional models are the concepts of appraisal and coping. Appraisal is described as the evaluative process that gives meaning to the person-environment transaction. Primary appraisal draws attention to the presence of a problem, and secondary appraisal defines what the individual can do about it. Transactional models were initially championed by Richard Lazarus who made the comment: “In my view, stress itself as a concept pales in significance for adaptation compared with coping.” In rather crude terms, transactional models can be seen as a function of balance. Note that the balance point is not fixed – it will vary between individuals and within individuals at different times or in different circumstances.

So what should we do?
It could be said that the answer to stress is quite simple – understand people and manage them well. That’s very easy to say and very difficult to do. Managing people well comes down to two key issues – competence and systems. Competence is vital at all levels, but particularly amongst managers. The key role of management competencies has been highlighted by recent HSE research which concluded that “stress management is a part of normal general management activities.”    

This is now reflected in a HSE competencies questionnaire for managers. Managing people isn’t easy and it shouldn’t be considered an everyday skill that people will simply possess independent of training. Managers are likely to face a very tough time over the next few years and managers who lack appropriate skills and lead poorly will be cruelly exposed and their staff will suffer. HSE has produced Management Standards in relation to Stress and a quick look will show that the issues described relate to good management and could be argued to be as applicable to organisational performance as to ill health. If the issues covered – demands, control, support, relationships, role and change – are not engrained in an organisation’s systems and processes, the organisation needs to reflect on how well it is being managed.    

Part of effective management is also the production of effective procedures and reporting systems – organisations will typically have a wealth of data which could indicate a developing problem (e.g. IT complaints, non-specific sickness absence, well-being initiatives, other risk assessments, etc.) and it must be ensured that such data is acted upon.

Understanding people
However, whilst the above may sit with an organisational problem requiring an organisational solution mindset, we must not lose sight of the first element of our overall aim – to understand people. Ultimately, stress is an individual experience. In a sense this is recognised by HSE as each of the Management Standards areas is associated with the phrase “systems are in place locally to respond to any individual concerns.” Actions at the individual level are often essential (particularly in relation to competence) and if addressing appraisal, they are effectively primary prevention activities.    

It is quite appropriate to aim for hardy, resilient and competent employees, but this cannot be relied upon to prevent harm – an outstanding employee, apparently able to cope with anything, may crumble completely following a bereavement or messy divorce. The work situation won’t have changed, but the individual’s ability to cope will have. Work systems must be able to pick up these changes such that interventions can be made before health and/or performance suffers significantly.

Acting on the problem

In many ways, stress problems could be said to be well captured in the landmark Appeal Court ruling (Hatton v Sutherland) which stated that “there are no occupations which should be regarded as intrinsically dangerous to mental health,” rather than about individual reactions. The ruling made it clear that whilst it was difficult to predict problems, employers must act decisively once they become aware of them. Initially, it was considered that this initial recognition was likely to be a first break down, but the subsequent Dickins v O2 PLC ruling suggests that the date of knowledge could be the first time a problem is raised by an employee. So if a manager becomes aware of a struggling employee, they must be competent to act appropriately. Equally, organisations must have processes in place to ensure prompt action, particularly where a manager is seen as the main problem.   

So when organisations think about assessing in relation to stress they need to start with an assessment of the competence of key personnel and the effectiveness of existing systems. If the management standards are not engrained in day to day operations, then the organisation has to fundamentally review its management approach and systems. Ultimately, stress problems will not be solved by periodic audits, as they need to be addressed as a function of day-to-day management. In other words, understand people and manage them well.

Andrew Baird is lecturer in Ergonomics at the University of Derby and registered member of the Institute of Ergonomics & Human Factors

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