Experts in strategic workforce development

Stress and resilience in the workplace

9 Feb 2018

stress in the workplace

 Introduction

The evidence is clear.  Psychological distress in the workforce (stress), has a significant negative impact on the individual and on their performance at work.  This is so across all employment sectors, and is particularly the case for those staff engaged in highly interpersonal, highly complex, and emotionally draining work.

The impact of psychological distress affects performance and productivity at a number of levels; it affects the individual, the organisation, and impacts across the system as a whole.  All of which affect the quality of patient care.  Psychological distress is a significant issue of concern for health and care services.

It is well documented that there is a high prevalence of sickness/ absence due to work related stressors (albeit they are not always openly reported as such).  Work related stress has also been associated with reduced performance and an increased risk of clinical errors, having a major impact on the ability of services to deliver high quality of care and best patient outcomes.  It is in recognition of these factors, there is a significant amount of activity taking place, within the NHS and across other business sectors, aimed at addressing workplace distress and increasing resilience.

The case for managing work-related distress and supporting psychological resilience in the workplace

Today’s health & care environment is busy, complex, and demanding, compounded by significant workforce shortages, and marked financial pressures.  All of which, without the right to supportive measures in place, can increase the level of workplace stressors.

Many studies demonstrate correlation between the levels of psychological distress experienced by staff and their ability to perform their duties effectively and professionally, by example:

Health & care is not the only sector grappling with these issues; local authority services, police and prison services, complaints handling departments, are is just a few examples of those areas which have high levels of work related stressors; often intense interpersonal activities, highly emotionally charged relations, frontline staff with a high level of autonomous decision making, often working in complex environments. 

The case is strong and clear, the evidence is plentiful and irrefutable.   What is less clear is the most effective measures to both minimise workplace stressors and to mitigate their impact on staff.

Quality of care

There is clear evidence of a correlation between a positive and supportive environment and the quality of care experienced by patients.  When it comes to psychological distress, many factors may impact on the quality of care received by clients and patients.  The issue may be one of capacity, of staff sickness/ absence, inability to recruit to posts, or poor retention of staff (and thereby an inability to deliver service).  There is an increased risk of clinical errors and of reduced quality of care resulting from excessive staff’ stress.  Where psychological distress is not managed effectively it can have a negative effect on the individual and the team, and through that on the system and the patient.

The workforce

For health & care professionals the risk of psychological distress is particularly pertinent.  The highly interpersonal, highly complex, and often emotionally charged, work that health & care professionals undertake is in itself potentially traumatic, and this is compounded by a highly pressurized work environment and staff shortages.  In addition to these factors; the empathetic and compassionate nature of our health & care professionals, the level of rapport they develop, the very thing that makes them stand out is exceptional, makes them even more vulnerable to psychological distress than other workforce groups.

A word that comes to mind in considering the impact on the workforce is ‘waste’.  There is a waste in terms of productivity and effectiveness, a waste of resources providing recovery for those affected by psychological distress, and the waste of potential for those staff performing below capability.  And this at a time when we currently have marked shortages, we work in a system that cannot afford to waste an ounce of available resource.  Moreover, we are expecting the current workforce to work many years longer than the previous generation, and this will not be possible if we do not preserve their capability to continue to deliver.

Of course, each person is different, each one of us has a different level of tolerance to stressors, and different ways of dealing with stress.  Health & care is an interpersonal activity, and each person brings their own perception, their own experience, a piece of their self, into the equation.  There is no panacea, no ‘one size fits all’ solution.  Yet the need for change is clear, and there is significant work taking place across the system to address that need.

Leadership & culture

Psychological distress and resilience is a very difficult domain to have robust mechanism for measuring, and thereby for comparing, the extent of the issue.  It is complex for many reasons; reasons of definition, measurement and identification of accurate markers of stress and resilience, for reasons of stigma in the workplace, and the extent to which issues of stress are masked or disguised.  Evidence suggests that the extent of psychological ill health is significantly under-reported.  Perceptions of stigma and fear of possible impact on ones’ career leads to the misreporting of stress and other mental health issues, often being disguised as physical health issues. 

‘Good’ environments are often described in value-based terms; honesty, positive culture, authenticity, transparency, leadership, fairness.  Whilst this makes it difficult to robustly measure, it equally gives a roadmap for those aspects that require attention.  We are looking for open, reflective, supportive environments, ones with positive cultures, a clear feeling of value and purpose in the staff, effective leadership, and cohesive supportive teams.  These terms require leaders who are themselves compassionate, who have a degree of emotional intelligence, and who are willing to apply the tools available to them to support their peers, colleagues, and subordinates.

The leadership challenge

Leaders and managers are in a pivotal position to impact on both the perceptions and the experience of their peers and subordinates in respect psychological distress and resilience in the workplace.  Leaders and managers have the opportunity to create the space and to promote positive cultural norms of sharing, discussing, and supporting a psychologically informed environment.

It must be recognised however that offering psychological support does not necessarily come easy.  Managers have the challenge of meeting complex clinical demands with finite resources, and the simultaneous need to provide compassionate leadership for compassionate care.  They may lack the skills and confidence to explore these issues and may be fearful of opening an issue for which they feel unprepared to address.  They may also feel reluctant to explore such issues if referral pathways for remedial support are not available within the trust.  We should also remember that managers may also be experiencing psychological distress and may themselves be in need of support whilst being expected to provide it to their team.

Notwithstanding those difficulties, managers and leaders are in a pivotal position to have a positive impact on this agenda through influencing individual perceptions, enhancing team culture, and improving interpersonal relations within their sphere of influence.

Designing the change

There is a huge amount of reference literature and policy guidance in respect of the need to develop psychologically informed environments.  There is also a significant volume of good practice examples across the country; from individual teams and departments, to the activities of national bodies.  Notwithstanding this psychologically informed work places are not yet the norm throughout the system.

Across the system there are many examples of good practice in respect remedial/ recovery pathways for those staff suffering psychological distress.  However, important as recovery pathways are, there is a need for organisations to take a proactive and preventative approach to this issue.  To put in place mechanism that support staff and managers to recognise and plan for psychological distress in the workplace.  Resilience is only one element of the solution.  It is not simply about mechanism to support the individual to manage stress more effectively, it is about creating an environment that is more psychologically informed and thereby less stressful; relying less on individual resilience and more on a psychologically informed culture.

It is clear that, for staff to be able to deliver compassionate care and effective services they need compassionate leadership.  They need a culture that is supportive, a sense of purpose as part of a team, they need emotional awareness of self and others, and they need an open and transparent culture in which to discuss these issues free of stigma.

Leadership at all levels is key to addressing this issue.  Board level recognition of the potentially damaging effects of psychological distress, and committed leadership to address the issue, is key to the culture change necessary to bring about sustainable culture change.  As well as strategic leadership, the strength of bond within a team, and particularly the example set by the team leader, are key to making any organisational change reality at the front line.  In this respect managers (if they are not so already) need to be developed to become leaders.  And these leaders need in turn to be supported with their own issues; managers in distress are unable to support the distress of others.

Conclusion

We are becoming increasingly aware of the negative impacts of psychological distress on the individual, the team, the system, and our patients.  And with that we are employing many mechanism to enhance staff resilience.  We now need to look further.  We need to consider what we can do within the system of health and care delivery, to identify, minimise, and mitigate the stressors.  And we need to look to our leaders to provide emotionally intelligent leadership, safe and supportive environments, and to facilitate change at a unit level.

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