Stress as the modern day back pain

Abstract

It has been estimated by MIND, the mental health charity, that in excess of five million people in the United Kingdom are suffering such an extreme level of work related stress as to put them at risk of a complete breakdown (cited in Laurence 2005). The pressures on individuals suffering from stress frequently results in them being absent from work although, whilst they remain in work there are effects on the level of accidents and the productivity rates. With the significant financial loss that this gives business, it would be expected that managers are highly proactive in reducing the causes and effects of stress.

This report sets out to determine if this is true and to measure people’s knowledge of stress, their awareness of its prevalence and the ways in which it is being controlled.

The research suggests that managers have very little knowledge of any of these areas. Despite the increasing level of publicity in both the public and professional press, the problem of stress remains unmonitored and its effects inaccurately measured by the majority of the companies questioned.

The guidelines produced by the Health and Safety Executive and the legal requirements under the Health and Safety at Work Act have seemingly had no impact on organisations. Failure to recognise and address the issue of work-related stress will, therefore, lead to it becoming a blight on British industry, being misunderstood, unchecked and poorly measured, as the problem of non-specific back pain was for much of the second half of the last century.

The costs of work-related stress are well reported. The European Agency for Safety and Health at Work reports that over 40 million days a year are lost to British industry because of stress-related problems (Health and Safety Executive 2004). A recent report by the mental health charity, MIND, states that more than five million people in the United Kingdom are suffering such as extreme level of work related stress as to put them at risk of a complete breakdown (cited in Laurence 2005).Their report goes on to say that for every £10 generated in the economy, £1 is lost due to stress related issues and that “less than 10% of companies have a policy to deal with it” (cited in Laurence 2005pg. 16).

ACAS report the Health and Safety Executives findings of 1995 that the cost to society of work related stress was £3.7 billion. Lord Layard reported to a Government seminar more recently that he estimates the current costs to be £25 billion (cited in Laurence 2005). It is noted that they do not define what is included in these costs. The most recent statistics show that disability claims due to mental and behavioural disorders has risen from 28% of the total claims submitted in 1997, to 37% in 2003 and is expected to continue to rise (Personnel Today magazine 2005).

The subject of stress is appearing more often in both the popular press and professional publications. O’Driscoll et al refer to the work offset and Schuler who suggest that there are four main reason for this: “concern for individual employee health…the financial impact on organisations…organisational effectiveness and legal obligations on employers to provide safe and healthy work environments” (O’Driscollet al 2002 pg 188).

The question remains as to how organisations are monitoring, reducing and managing the stress experienced by their employees and how they can improve in these areas.

Literature Review

Stress is not a new phenomenon. It was first identified in 1910 by Sir William Osler who identified that some patients appeared to be under strain during medical treatment. In was not until 1936 that a specific definition of stress as a reaction to a demand on a person was reported by Selly (O’Driscoll et al 2002). A major period of research was in the1950s, when Lazarus et al examined the effects of stress on work performance. McGrath noted that stress is due to “environmental demands exceeding a person’s resources and capacity, when the outcomes are important for the person” (cited in O’Driscoll et al 2002 pg 190) and French et al formalised the role of the environment in stress by saying that “strain can result from the mismatch between the person and the environment on dimensions important to the well-being of the individual” (cited in O’Driscoll et al 2002 pg 190).

Lazarus continued his work to examine the three phases of cognitive appraisal of stress. He identified that these are primary – the initial reaction to a risk, secondary - the assessment of how to overcome the source and reappraisal - judging whether or not the reaction to the source of stress was successful (cited in O’Driscoll et al 2002). This work was important as it initiated more investigations into coping mechanisms. Behr and Franz’s work differentiated between the concept of stressors as “the environmental stimulus or event” and strains “the person’s response to the stimulus or event” (cited in O’Driscoll et al 2002 pg192) and this differentiation became and has remained important when looking at how to reduce stress in the workplace (Fontana 1989).

It is recognised that stress is a natural aspect of life, but also that work-related stress is becoming global in nature and affects both manual and professional staff in industrialised and developing countries. The University of Manchester Institute of Science and Technology have measured certain jobs as being prone to more than 6 one stress scale rating of 1 to 10. These include miner, police officer and prison officer (Health and Safety Executive 2004).

The National Institute for Occupational Safety and Health (NIOSH) is the American equivalent of the UK’s Health and Safety Executive. NIOSH is a Federal agency responsible for “conducting research and making recommendations for the prevention of work-related illness and injury”(Saunter et al 1999). Their report, publication number 99-101, cites three statistics to illustrate the problem of work-related stress in the USA. Northwester National Life found that work is the main stressor for a quarter of people, Princeton Survey Research Associates report that three quarters of workers think there is more stress at work than the previous generation experienced and St Paul Fire and Marine Insurance found that health complaints are much more likely to be duet factors associated with work than with family or financial problems(Saunter et al 1999).

This leads us to determine the exact nature of stress.

Fontana makes the point that it is not so much “the events that determine whether we’re stressed or not, as our reaction to them”(Fontana 1989 pp. 3). He goes on to call individual’s reaction to potentially stressful situations as a result of their cognitive appraisal of the situation i.e. what one person sees as being stressful, someone else will not. He cites the philosopher, Epictetus, who said “men are not disquieted by things themselves, but by their idea if things” (Fontana 1989 pg. 63).

The Health and Safety Executive echo this view in defining stress as “the adverse reaction people have to excessive pressure or other types of demand placed on them” (Sauté ret al 1999). Similarly, the European Commission’s definition is: “the emotional, cognitive, behavioural and psychological reaction to aversive and noxious aspects of work, work environments and work organisations. It is a state characterised by high levels of arousal and stress and often by feelings of not coping” (Health and Safety Executive 2004). Selly noted that stress is not always a detrimental emotion. He defined the difference between “eustress”, which is seen as positive, motivating and challenging circumstances, which give people an opportunity to stretch themselves and achieve self-satisfaction, and “distress”, which is where people cannot cope (cited in Foot et al1999).

Within the human resources professional publications, it is frequently cited that there is no actual definition of stress or its symptoms as it is not a recognised medical term (Personnel Today magazine 2005).However, several writers have described the body’s reaction to stress and the effects it has.

Fontana defines stress as the demand on the adaptive capacity of the body and mind and highlights that too little of this demand leads to boredom and under stimulation, whereas too much results in being overstretched and overwhelmed. When faced with a challenge, the natural reaction of the body is that of fight or flight – either standing the ground and confronting the source of the challenge or by strategically withdrawing. This fight or flight reaction is meant to be a short term, immediate reaction to perceived danger as a method of survival. If its allowed to continue, it can have an adverse effect. As Fontana points out, “our modern society doesn’t usually allow us physically to fight or run away when we face stressors so that we are allowed to relax. We remain in a state of preparedness for action which we aren’t permitted to take” (Fontana 1989 pp. 6).

The body’s responses to stress can be divided into four categories. Firstly, several chemicals are released into the bloodstream including adrenalin, no radelin, thyroid hormones and cholesterol. These stimulate the body through increasing the reflex rate and increasing the blood supply and blood sugar levels to increase the metabolism. However, if this increase in metabolism is not dissipated through physical activity, it can increase the likelihood of heart disease, strokes and kidney disease and aggravate diabetes (Fontana 1989). A racing metabolism can lead to tiredness and exhaustion.

The second response is the redirection of blood from those organs which can cope with this forth short term, such as the skin and the stomach, to the air passages in the lungs to increase the aeration of the blood to feed the muscles. Again, if this continues over an extended period of time it can resulting digestive problems, bouts of unconsciousness and malfunctions of the body’s natural temperature control mechanism. The third reaction is an increase in concentration abilities. This is caused by the release of endorphins and cortisone which lowers the body’s natural immunity system and decreases the body’s sensitivity to pain. Again, over the long term, this can result in increased susceptibility to infection, ulcers and extreme allergies. Finally, because the blood thickens to accelerate the clotting process in the case of injury, it also becomes more difficult to move round the body, putting pressure on the heart and possibly leading to heart disease and strokes (Fontana 1989).

The phenomenon of “burn out” is described by Malachi as the state where “emotional exhaustion, depersonalisation of others in the work context, and feelings of low personal accomplishment on the job” lead to an inability to function in the work environment (cited in O’Driscoll teal 2002 pg. 202) and is seen as the end result of unchecked stress.

The causes of stress may come from several sources. Work is seen by many as being a primary source. General organisational problems include insufficient or poorly communicated process and procedures, unclear roles and responsibilities and a lack of basic tools and facilities. A lack of support functions which are often viewed as non-essential, not only increases the workload of individuals who have to do more in their day-to-day activities, but can also lead to feelings of worthlessness.

The increased tendency to long or unsociable hours can not only affect the body’s natural circadian rhythm, but can make it difficult to establish and maintain those things which people find help to diffuse their stress e.g. relationships and hobbies. Lack of prospects in apposition can be stressful, although, as will be discussed later, thesis not the case for everyone. A lack of job security is seen as an initiator of stress and becomes particularly significant during a time of change when other stressor may be encountered such as having to alter established work routines and methods. Apart from these general organisational problems, there are a whole host of specific conditions which lead to high levels of stress (Fontana 1989).

NIOSH summarise these as: “the design of tasks, management style, interpersonal relationships, work roles, career concerns and environmental conditions” (cited in Saunter et al 1999). NIOSH relate a list of eighteen work-related areas that can produce stress (cited in Saunter teal 1999). These are referred to in more depth later in the report. What also needs to be taken into account are the sources of stress outside the workplace which lead to the symptoms being displayed whilst artwork. These include domestic problems and also more deeply seated psychological issues such as obsessionality, sensation seeking and over-identification (Fontana 1989).

It has been suggested that certain personality types are more susceptible to stress. Commonly used is the distinction between Type And Type B people, as initially defined by Cooper and Bram well (cited in O’Driscoll et al 2002). Fontana describes this distinction impersonality types as being generally accepted by psychologists and medical doctors. A Type A person displays the characteristics of competitiveness, impatience and inflexibility. They work better when given tough deadlines and will tend to take a leadership role. They set themselves high standards to achieve and our highly self-critical if they don’t achieve them.

Although Fontana does not provide details, he claims that Type A people are more likely to develop heart disease and high blood pressure. He goes on to suggest that Type A people are more likely to be susceptible to stress as they are highly competitive and “mobilised almost permanently for action” (Fontana 1989 pg. 72). Other writers, Gangster and Schaubroeck 1991, Haskins, Baglioni and Cooper1990 and Froggatt and Cotton, all cited in O’Driscoll et al 2002,debate whether Type A people are subject to increased stress because they put themselves in more situations that can be deemed as being stressful because of their competitive nature, or that they are more likely to experience stress in any given situation NIOSH report that whilst some employers believe that remain competitive in the economy, organisations need to exert pressure on their employees to maximise productivity and reduce costs, research shows that organisational performance is adversely impacted by the increase absenteeism, error rates and poor motivation. Similarly, they have found that those organisations that incorporate policies that encourage good health in employees showed a corresponding healthiness in their competitiveness in the economy (cited in Saunter et al 1999).

This differentiation as to the relative importance of environmental factors over personality traits has remained an important factor in stress research and, consequently, the approaches to managing stress in the workplace. Ivancevich et al suggest three approaches to managing organisational stress. These are: “reduce the number or intensity of stressors experienced by employees, help employees modify their appraisal of the stressfulness of the situation or help employees in coping more effectively with stressors and their consequences” (cited in O’Driscoll et al 2002 pg 213).

Kahn and Bossier, 1992, identified that the majority of action taken in relation to stress occurred at the second level i.e. involved in changing the way people viewed stressful situations through training and employee assistance programmes (EAPs),rather than trying to remove the actual source of the strain (cited in O’Driscoll et al 2002 pg 213). O’Driscoll (2002) argues that the evidence for the effectiveness of these programmes is limited and that there are questionable benefits to training employees to be able to cope with poor working conditions or practices.

Despite this, NIOSH report that nearly half of large companies in the United Sates offer stress management training to their employees, usually involving such topics as time management and relaxation techniques. They point out that these types of interventions have only a short-term effect on the symptoms of stress as well as emphasising the need to alleviate the root causes of the stress (cited in Saunter et al 1999).

Elkin and Rosh have put forward a number of actions that could be taken to resolve the stress at source. These include task redesign, allowing flexible work patterns, empowerment of employees and reviewing reward systems to ensure they are equitable. Evaluations of these interventions are reported by O’Driscoll as being positive, but he goes on to emphasise that their use has been limited (O’Driscoll et al2002). Burke noted that the “removal or reduction of stressors is the most direct way to reduce stress since it deals with the source” (Burke1993 pg. 85). Whilst he does concede that “these approaches may entail immediate costs for the organisation”, he also notes that “these will be offset by long-term benefits not only for individual employees but also the organisation as a whole” (Burke 1993 pg. 85).

NIOSH recommends combined approach, as even if the causes of stress for the majority of employees were removed, because of individual appraisal of stressors, it would be impossible to remove them all. They also emphasise the need for the size and nature of the organisation to be taken into consideration, as what is possible and desirable for a large multinational may not be appropriate or practical for a small enterprise (cited in Saunter et al 1999).

NIOSH identify that the three main factors required for an individual to be able to “reduce the effects of stressful work conditions” are: “balance between work and family or personal life, a support network of friends and co-workers and a relaxed and positive outlook” (cited insurer et al 1999). They also advocate a basic programme to initiate actress prevention programme. This involves awareness building for all employees, securing the support and commitment of the senior management team, seeking an utilising employee input to all areas of the programme and ensuring the technical skills of stress management are incorporated through training specific employees of using the resources of consultants. They see employee involvement as being particularly useful when looking at the job design causes of stress and the employee have first-hand knowledge of the tasks (cited in Saunter et al 1999).

The Health and Safety at Work Act 1974 and the Management of Health and Safety at Work Regulations of 1999 made employers legally bound to undertake risk assessments in the workplace to identify the potential hazards and to take measures to reduce them. Within the definition of potential hazards was stress. As there remained some confusion as tithe nature and causes of stress, the HSE developed a series of standards to be used by employers to identify and manage the key causes of stress at work. These are: “the demands made on employees, the level of control employees have over their work, the support employees receive from managers and colleagues, the organisational policies in place, the clarity of the employees role within the organisation, the nature of relationships at work and the way that change is managed”(ACAS 2004).

In the second half of the last century, a common problem for businesses was the amount of absence from work due to no specific back pain. As it’s difficult to prove that someone is not suffering from back pain, concerns existed as to how it could be controlled. It is suggested that, not only may work-related stress take this position as the main cause of absence from work, but also that the two conditions are related. Occupational Health magazine has reported the findings of research which indicates that musculo skeletal disorders (MSDs) are one of the most common symptoms of stress (Occupational Health 2004).

It is suggested that the rise in incapacity benefit claims related to mental or behavioural problems is directly linked to the decrease in claims for back problems and this is due to doctors being more likely to diagnose mental problems as they have less of a stigma than previously for patients. It is therefore possible, that there has been no actual increase in the amount of stress related illness, rather that it is now called that whereas previously people reported one of the symptom of stress which was back pain (Personnel Today magazine 2005).

The difficulties in determining whether a reported illness is merely symptom of the deeper underlying problem of stress leads to questions being raised as to amount of stress experienced by today’s workers. Charlesworth (1984) suggests that “as many as 75% of all medical complaints are stress related” in the United States.

Methodolgy

The questionnaire was divided into two parts. The first section was asked only of those in senior management positions such as general managers and personnel managers. This was done to determine organisational policies, procedures and measurement of stress. The second set of questions was asked of everybody and included the senior managers so that the effects of stress on them could also be measured.

The questionnaire was sent out to variety of business types including catering, production and financial services. The objective was to gain an overall view of the effects of stress on businesses, not to concentrate on those industries which have been classed as particularly stressful as this would have given a distorted view. A limitation of this approach is noted however, as being that some of the respondents indicated low levels of stress or no stress at all and may have therefore been unable to answer all the questions from personal experience.

The main objective of the questionnaire was to collect information on the effects of stress in the workplace, the cost of stress and the benefits of a stress free environment. The questionnaire included admixture of quantitative questions to determine factual information and qualitative questions to collect opinions. As the research did not want to suggest answers to the respondents, all the questions were asked aspen questions. Providing multiple-choice answers may have had detrimental effects on the replies received, as it would provide options the respondent may not have considered.

However, it is accepted that there may have been an effect in that people did not realise that point was relevant. For example, in the question regarding the symptoms of stress, the respondents might not consider backache unless it was suggested to them. Two exceptions to this were question nine in the manager’s questionnaire and question eight in the general questionnaire which examined the respondents views on the sources of work-related stress given by NIOSH (cited in Salter et al 1999).

The replies given to all the other questions were then categorised byte writer. When collating the replies on managing stress, the guidelines set out by the Health and Safety Executive were used and the writer determined which category the answer came under (demands, support, control, policies, role and change). It is accepted that this was a potential weakness in this part of the questionnaire as it was based on the writer’s opinion.

The questionnaire was distributed in a postal format to non-senior managers following personal visits to the organisations to conduct separate survey with the senior managers and to gain their consent. Whilst this method has benefits in that respondents would be more likely to be honest as the replies were anonymous (except for those in specific management positions), there are also drawbacks in that a low response rate was expected. To overcome this, the number of questionnaires sent out allowed a population sample of one hundred tube expected with a return rate of 20%.

The actual number returned was seventy-five. The questionnaire was conducted on a face-to-face basis for the management roles, as it was important that their questionnaires were returned to provide important information as to policies and procedures. This resulted in a 100% return rate of management surveys. The responses from the general questionnaire were subdivided into those from management and non-management with the supervisors being defined as managers.

This allowed better analysis of the results. Where appropriate, it is indicated whether the respondents were manual workers, office based and/or customer facing as this is seen as being relevant to the research. As stated earlier, as the purpose of the research was not to determine which job sectors are more stressful, the results do not differentiate between organisations.

Questionaire - Managers

1. What do you understand by the word “stress”?

Answer Number of respondents Percentage of respondents
An inability to cope with something that causes panic 4 31
Anxiety 5 38
Fear of failure or not being able to continue 7 54
Depression 2 15
When you have too much to do and not enough time or resources to do it 8 62
When you cannot remain rationale about a situation 2 15
Losing control 1 8
Don’t know 0 0

2. What causes stress?

Answer Number of respondents % of respondents
Too much to do and not enough time to do it 6 46
Different things for different people 4 31
Don’t know 2 15
Other 1 8

3. What would indicate to you that an employee is suffering from work related stress?

Answer Number of respondents Percentage of respondents
Through being absent and giving stress as the cause 10 77
They would submit a grievance 1 8
They would tell their manager 1 8
Other 0 0
Don’t know 1 8

4. Do you or your organisation, actively measure stress levels amongst your employees, and if yes, how?

Answer Number of respondents Percept of respondents
Absenteeism reported as due to stress 10 77
Performance measures 1 8
Combination of these 1 8
Do not actively measure 1 8

5. How do you evaluate the success of any interventions to reduce stress?

Answer Number of respondents Percentage of respondents
Look for a reduction in absenteeism with stress given as the reason 12 92
Don’t measure 0 0
Staff surveys 1 8
Don’t know 0 0

6. Where is the emphasis of your efforts to manage stress

Answer Number of respondents Percentage of respondents
Reducing or eliminating the causes of stress 1 8
Helping employees to modify their appraisal of the stressfulness of situations 0 0
Helping employees in coping more effectively with stressors and their consequences 2 15
Managing attendance issues 8 60
None of these 0 0
No effort 0 0
Don’t know 2 15

7. How do you balance people’s needs for challenge and achievement under pressure with ensuring they are able to cope?

Answer Number of respondents Percentage of respondents
By setting realistic targets 9 69
By allowing people to work at a rate they feel comfortable with 0 0
By asking them 0 0
By identifying when stress occurs and reducing it 2 15
Bu setting consistent expectations 2 15
Other 0 0
Don’t know 0 0

8. What do you feel are the main causes of stress in life in general?

Answer Number of respondents Percentage of respondents
Financial problems 10 77
Relationship problems 6 46
Peer pressure 2 15
Work 3 25
Traffic 7 54
Concerns over the environment 3 25
Concerns over politics 4 30
Concerns over war or terrorist attacks 4 30
Concerns over family members 9 75
Don’t know 0 0

9. Which of the following factors do you believe cause stress to your employees in your workplace?

Answer Number of respondents Percentage of respondents
Workload – too much or not enough 2 15
Pace/variety/meaningfulness of work 6 46
Autonomy 2 15
Shift work/hours of work 3 23
Physical environment (noise/air quality etc.) 2 15
Isolation at the workplace (e.g. working alone) 0 0
Role conflict 0 0
Role ambiguity 0 0
Level of responsibility 0 0
Under/over promotion 0 0
Job security 0 0
Supervisors 0 0
Co-workers 0 0
Subordinates 0 0
Threat of violence 0 0
Participation in decision making 0 0
Management style 0 0
Communication patterns 0 0
None of these 0 0

10. What are your legal obligations in terms of identifying and managing work-related stress?

Answer Number of respondents Percentage of respondents
There aren’t any 7 54
Comes under HASAW Act 2 15
Have to complete risk assessments which includes assessing possible sources of risk 1 8
Other 0 0
Don’t know 3 23

11. What are the HSE standards that organisations should use to identify and manage stress?

Answer Number of respondents Percentage of respondents
Don’t know 13 100
Could name all six 0 0
Could name five 0 0
Could name four 0 0
Could name three 0 0
Could name two 0 0
Could name one 0 0

12. What actions do you take under each of the HSE standards:

Answer Number of respondents Percentage of respondents
Demands 7 54
Support 6 46
Control 4 31
Policies 7 54
Role 0 0
Change 5 38
Other 0 0
Don’t know 0 0

a. demands – ensuring employees do not become overloaded and unable to cope with the amount of work they are asked to do (job design, flexible hours and training)
b. support – management style and degree of intervention
c. control – allowing employees to have input into how they complete their tasks
d. relationships – personnel policies on grievance, poor performance etc.
e. role - induction, objectives
f. change – managing change

13. How would one of your employees alert management if they were experiencing work-related stress?

Answer Number of respondents Percentage of respondents
Through grievance procedure 8 62
During appraisal 7 54
Through formal representatives e.g. union of employee consultative committee 4 31
Would just say 0 0
Don’t know 0 0
Other 0 0

14. What are the symptoms of stress?

Answer Number of respondents Percentage of respondents
Being absent from work 4 31
Panicking 4 31
Nervousness 2 15
Heart problems 1 8
Crying 7 54
Alcohol and drug use 6 46
Accidents in the workplace 1 8
Don’t know 0 0
Other

15. What is the absence rate in your organisation?

Answer Number of respondents Percentage of respondents
0 – 2% 7 69
2 – 4% 5 8
4 – 6% 0 8
6 - 8% 1 15
Don’t know 0 0

16. What percentage of this absence level is due to stress related illnesses?
Answer Number of respondents Percentage of respondents
Less than 10% 9 69
More than 10% but less than 30% 1 8
More than 30% but less than 50% 1 8
More than 50% but less than 75% 2 15
More than 75% 0 0
Don’t know 8 62

17. What is the financial impact of stress in your workplace?

Answer Number of respondents Percentage of respondents
Calculated the same as any absence from work 13 100
Don’t measure 0 0
Don’t know 0 0

18. What do you include when you measure the financial impact of stress which you do not include when measuring the cost of other reasons for absenteeism:

Answer Number of respondents Percentage of respondents
Reduced productivity 0 0
Employee turnover 0 0
Absenteeism 0 0
Medical costs 0 0
Recruitment 0 0
Use of temporary staff 0 0
Retraining costs 0 0
Loss of production 0 0
Poor customer service 0 0
None 13 100
19. Which level of employee do you feel is more susceptible to stress in your organisation?

Answer Number of respondents Percentage of respondents
Senior managers only 0 0
Blue collar workers only 3 23
Middle managers only 0 0
All management levels 8 62
Everyone is equally susceptible 2 15
Don’t know 0 0

20. What type of personality is more prone to stress?

Answer Number of respondents Percentage of respondents
Depends on education/upbringing 3 23
People who worry a lot 3 23
Pessimists 2 15
Everyone equally prone 5 38
Don’t know 0 0

21. How can stress be managed?

Answer Number of respondents Percentage of respondents
Remove source of stress 3 23
Change people’s perception of what is stressful 0 0
Train/support people when they are stressed 9 69
Don’t know 0 0
Other 0 0
Can’t be managed 1 8
22. Is stress the modern day back pain?

Answer Number of respondents Percentage of respondents
Yes, people use it as a reason for absence which cannot be fully diagnosed 7 54
Yes, it is the main cause of absence from work 2 15
No, I cannot see any relationship between the two 3 23
Don’t know 1 8

Questionnaire - employees

1. What is your job title?

Answer Number of respondents Percentage of respondents
Senior manager 6 8
Human resource professional 7 9
Middle manager 3 4
Supervisor 6 8
Manual worker 28 37
Administrator 25 33
Other 0 0

2. Do you deal with external customers in your role?

Answer Number of respondents saying “yes” Percentage of each level who said “yes”
Senior manager 0 0
Human resource professional 0 0
Middle manager 1 33
Supervisor 3 50
Manual worker 13 46
Administrator 6 24
Other 0 0

3. How many hours a week do you work?

Answer Number of respondents Percentage of respondents
Part time – permanent 9 12
Part time – temporary 2 3
Full time - permanent 63 84
Full time- temporary 1 1
Other 0 0

4. What is your highest level of education?

Answer Number of respondents Percentage of respondents
Post graduate 2 3
Graduate 8 11
A level 0 0
GCSE 12 16
HND/equivalent 17 23
No educational qualifications 36 48

5. What, in your opinion, is stress?

Answer Number of respondents Percentage of respondents
An inability to cope with something that causes panic 26 35
Anxiety 17 23
Fear of failure or not being able to continue 8 11
Depression 6 8
When you have too much to do and not enough time or resources to do it 48 64
When you cannot remain rationale about a situation 4 5
Losing control 3 4
Other 1 1
Don’t know 0 0

6. Using the seven-point scale shown below, where one is low and sevens high; indicate the amount of stress you experience in your work.

Answer Number of respondents Percentage of respondents
Managers Non managers Total Managers Non managers Total
1 1 22 23 8 68 31
2 1 6 7 8 10 9
3 3 0 3 23 0 4
4 4 5 9 31 16 12
5 2 0 2 15 0 3
6 2 7 19 15 31 25
7 0 22 22 0 35 29

7. What is the main cause of this stress?

Answer Number of respondents Percentage of respondents
Managers Non managers Total Managers Non managers Total
Quantity of work 0 9 9 0 15 12
Nature of work 0 3 3 0 5 4
Relationship with co workers 0 3 3 0 5 4
Relationship with superior 2 7 9 15 11 12
Lack of resources 8 1 9 62 2 12
Out of work problems affecting work 3 4 7 23 6 9
Threat to job security 0 4 4 0 6 5
Frustration 0 5 5 0 8 7
Customers 0 26 26 0 50 35
Don’t know 0 0 0 0 0 0

8. Which of the following factors cause you stress in your workplace?

Answer Number of respondents Percentage of respondents
Managers Non managers Total Managers Non managers Total
Workload – too much or not enough 2 16 18 15 26 24
Pace/variety/meaningfulness of work 0 20 20 0 32 27
Autonomy 0 7 7 0 11 9
Shift work/hours of work 0 3 3 0 5 4
Physical environment (noise/air quality etc.) 0 5 5 0 8 7
Isolation at the workplace (e.g. working alone) 0 0 0 0 0 0
Role conflict 3 1 4 23 2 5
Role ambiguity 2 8 10 15 13 13
Level of responsibility 0 12 12 0 19 16
Under/over promotion 0 0 0 0 0 0
Job security 0 24 24 0 39 32
Supervisors 0 12 12 0 19 16
Co-workers 0 4 4 0 6 5
Subordinates 5 0 5 38 0 7
Threat of violence 0 2 2 0 3 3
Participation in decision making 1 15 16 8 24 21
Management style 0 34 34 0 55 45
Communication patterns 0 2 2 0 3 3
None of these 0 0 0 0 0 0

9. What have you done to combat the stress?

Answer Number of respondents Percentage of respondents
Managers Non managers Total Managers Non managers Total
Personally tried to remove or reduce source of stress 9 6 15 69 10 20
Reported source of stress to manager/other 0 12 12 0 19 16
Complained officially about source of stress 0 8 8 0 13 11
Tried to ignore it 0 9 9 0 15 12
Asked for transfer/seeking alternative employment 0 5 5 0 8 7
Relax when not in work 0 0 0 0 0 0
Use specific relaxation techniques 4 23 26 31 37 36
Other 0 0 0 0 0 0

10. What does your organisation do to reduce or manage stress?

Answer Number of respondents Percentage of respondents
Managers Non managers Total Managers Non managers Total
Will listen to and act on reported stress 8 12 20 62 19 27
Offer training to reduce stress 7 0 7 54 0 9
Offer specific relaxation training/provision 3 1 4 23 2 5
Provide confidential help line 10 46 56 77 74 75
Don’t know 0 0 0 0 0 0
Nothing 0 4 4 0 6 5
Other 0 0 0 0 0 0

11. What extra do you believe your company should do to reduce or manage stress?
Answer Number of respondents Percentage of respondents
Should listen to and act on reported stress 55 73
Offer training to reduce stress 20 27
Offer specific relaxation training/provision 60 80
Provide confidential help line 10 13
Don’t know 3 4
Nothing 1 1
Other 0 0

12. How much time have you taken off work in the last twelve months as a direct result of work related stress?

Answer Number of respondents Percentage of respondents
Managers Non managers Managers Non managers
None 12 25 92 40
1 – 5 days 0 30 0 58
6 – 10 days 0 1 0 2
10 – 20 days 1 2 8 4
20 – 30 days 0 4 0 8
More than 30 days 0 0 0 0
Prefer not to say 0 0 0 0
Don’t know 0 0 0 0

13. When you had any absence due to stress, did you report stress as the cause?

Answer Number of respondents Percentage of respondents
Yes 3 8
No 32 84
Prefer not to say 3 8

Findings

Manager’s questionnaire:
The results for the manager’s questionnaire are reported as numbers as the total was too small for percentages to give an accurate picture.

A total of thirteen managers from seven organisations were asked the management set of questions. Of these six were operational senior managers and seven were human resource senior managers.

The respondents gave a variety of answers as to what they understood byte word “stress” with many giving more than one definition. The majority (eight) identified that it is related to having too much to do and not enough resources to do it and/or a fear of failure or not being able to complete something. Similarly, in response to the second question, the most cited cause of stress was given as having too much to do and not enough time to do it. Interestingly, the six people that gave this response were all from the operational management population, with the human resource specialists mostly feeling that it was due to different things for different people.

When asked specifically about the stress they experienced under the headings suggested by NIOSH, six managers gave pace, variety and/or meaningfulness of work as the factor they thought was a cause of stress for their employees. None of the other factors were given to significant degree.

A large proportion (ten), said that they would identify that an employee was suffering from stress only if they went off sick and gave stress as the cause and, unsurprisingly, this was also the most common way that the managers measured stress levels and evaluated the success of any interventions to reduce stress. Their management of stress therefore related mostly to how they approached controlling the absence rate.

The majority of respondents (nine) said that they managed the balance between challenging their employees and subjecting them to stress by setting realistic targets. Two said that they do this by ensuring consistent expectations i.e. that people carrying out similar duties would be expected to complete equal amounts of work.

When asked what they thought were the major causes of stress, a variety of answers were given with most people providing more than one. Financial problems and concerns over family members were the most frequently given with over three quarters of respondents including them. Work was given as a source of stress by only three people, less than gave concerns over war and terrorist attacks or concerns over politics.

Most of the respondents believed they had no legal obligations to manage work related stress. The seven who gave this reply were admixture of human resource and other management. Only two people knew that it comes under the Health and Safety at Work Act.

None of the respondents could name any of the Health and Safety Executives recommended standards to manage stress. Two people were aware that they existed.

The results of the question regarding actions they took under the Health and Safety Executive guidelines showed a much more positive response, although it did require the questioner to give examples under each heading. In total, forty-one actions were identified and spread reasonably evenly under each heading. The most action was taken under the heading role, for which the examples of providing full induction and having objectives were given. The least number of actions was under the heading of control where the examples of allowing employees to have input into how they complete their jobs. They also felt that there were sufficient ways in which an employee could communicate with management if they felt they were under undue stress.

The most common were through the grievance procedure or at their appraisal.

The managers identified several symptoms of stress with crying and alcohol and drug use being the most common given. A third gave being absent from work as a symptom.

All the organisations questioned gave an absence rate for the company. All except one reported rates of below four present, the remainder reported 7.5%. When asked what proportion of this was due to stress related illnesses, the answers were less specific. Eight of the respondents initially said they did not know and then went on to make an estimate. These estimates ranged from less than 10% to between 50and 75% with over two thirds of the respondents saying less than 10%.

All the respondents calculated the cost of absence due to stress as being the same as the cost of absence due to other factors. The organisations were not asked the actual figure, as this would not provide useful information. To know one organisation estimated at£45,000 for example is a meaningless figure unless a variety of other financial information is included such as turnover, profit and labour costs. The respondents also failed to recognise the full range of costs incurred through absence due to stress, although the writer would add that as the literature does not specifically suggest that there are extra costs involved in stress absence that other forms, this question may have been misleading and has not therefore been referred to in the conclusion.

Eight of the respondents felt that managers were more likely to be susceptible to stress than blue-collar workers. Three felt that the blue-collar workers were more likely to be susceptible and only two people felt that everyone was equally susceptible.

When questioned about the link between personality type and stress, the two traits given were a tendency to worry and pessimism and these were cited by only five people. A further five thought that everyone was equally prone whilst three believed that education and upbringing would have an effect.

Most respondents saw the key to managing stress as being offering training or support when people are already stressed. Three people identified removing the source of stress, but again this was once the stress had occurred, and one person felt it could not be managed because it is a personal thing in that what one person found stressful, another would not.

Just over half the respondents agreed that stress is the modern back pain from the point of view that it can be used as a reason for absence which is difficult to disprove. Three could not identify a relationship between the two and only two thought it was the new back pain as it was the main reason for absence from work in today’s society.

General questionnaire:
Of the respondents for the main questionnaire, 29% were classed as managers, 37% as manual workers, 33% as administrators (office based)and 31% of the whole population described themselves as dealing directly with external customers.
84% were full time permanent employees, 12% part time permanent, 3% part time temporary and the remainder full time temporary.

Most of the managers, 77%, were educated to degree level or above whilst most of the non-management staff, 58%, had no formal educational qualifications.

When asked what they understood by the word "stress", the results from the general population were quite similar to those of the management population in that they identified the same characteristics. Having too much to do and not enough time or resources was again the most frequently cited understanding of stress with an inability to cope leading to panic again being the second. A fear of failure or not being able to continue was less popular, 11% compared to 54% in the management population.

When asked about the amount of stress they experienced in their jobs, roughly a third came under each of the groupings of low, medium and high. However, a much higher present of none managers where either experiencing low (45% compared to 15% of managers) or high stress (63% versus 15% of managers) and significantly less (8% versus 69% of managers) experienced a medium amount of stress. Also it is noted that all the non-managerial sample population who described themselves as external customer facing also rated themselves as on the high end of the scale as did the two customer facing managers.

The remainder of the customer facing managers rated themselves as medium on the scale.
When asked what the main cause was of stress in their work, by far the most cited factor was customers with 35%. Relationships with superiors, quantity of work and lack of resources were equal second popular on12%. No other factors were given by more than 10% of the sample population as a whole. When looking at the differences between managerial and non-managerial staff, a lack of resources was the main source of stress for managers (62%), whereas for non-managerial staff, customers were cited as the main source by 50%.

Quantity of work was given by 15% of the non-managerial population and relationship with superiors by 11%. The managerial group also gave out of work problems and relationship with supervisor as significant (23% and 15%respectively). When asked specifically about the degree of stress caused by the factors put forward by NIOSH, 55% of the non-management staff felt that management style was a source, 39% gave job security,32% pace/variety/meaningfulness of work, 26% workload and 24%participation in decision-making.

When asked what measures they personally take to reduce the amount of stress they suffer at work, the most common answers were the use of specific relaxation techniques (36%), to try and remove or reduce the source themselves (20%), report it to a manager (16%). The specific techniques included meditation, aromatherapy, massage and breathing exercises.

The most commonly cited provision for managing stress was given by both managerial and non-managerial staff as being a confidential help line(75%). Managers were more likely to believe their organisations offered training to reduce stress and were willing to listen and act on reported stress than their non-managerial employees perceived. 54% of managers said that they offered training to reduce stress, but none of the non-managerial sample gave this as something their organisation did.

When asked what extra they thought their organisation should do to help relieve stress, all those who had said that they did not currently listen and act on reported stress, should do so. 80% of respondents thought their employer should offer specific relaxation training or provision and this was mainly in the form of paying for gym membership or paying for relaxation classes.

92% of managers and 40% of non-managerial staff said they had not taken any days off work as a result of stress in the last twelve months. 58%of non-managerial staff said they had taken between one and five days off and 8% reported having taken between twenty and thirty days off.84% of those who had taken time off as a result of stress said that they had not given this as the cause of the absence at the time.

Discussion and Conclusions

The manager questionnaire demonstrated a disappointingly low awareness of the nature, causes responsibilities and possible solutions to the problem of work related stress. Most managers believed the main sources of stress to be non-work related. They saw work-related stress as being reaction to over demanding workloads and fear of not being able to complete the work given to them rather than considering the full range of factors such as support in the workplace, change, having clear policies etc. as recommended by the Health and Safety Executive. Monitoring of stress in the workplace was done mainly through measuring the number of people who were off work with stress given as the reason. This is a short-sighted view which will result in an inaccurate picture of the occurrence and impact of stress within their organisations as was found in later answers.

It also indicates a lack of proactiveness amongst the management personnel and a failure to implement the Health and Safety at Work Act Risk Assessment requirements. It is noted by the writer that health and safety may be the responsibility of someone other than those questioned e.g. a nominated health and safety manager. However, the writer believes that all management should understand the legal requirements as stated in the Act.

As sickness rates featured highly in the recognition and measurement of work related stress, it is unsurprising that efforts to manage stress were generally limited to managing attendance issues. A variety of systems were in place in the organisations surveyed, but they had common characteristics relating to return to work interviews to investigate the cause of the absence and a progressive system of actions in line with the disciplinary policy. This is very concerning as it is a further indication of a lack of recognition of the cause, nature and solutions to work related stress. It also suggests an emphasis in managing the effects without effort to reduce the root causes.

When asked how they balance the need for challenge with the reduction of stress, the replies showed an emphasis on setting targets and consistent expectations. This shows a lack of consideration of the different needs and requirements of individuals. What one person may be able to complete within a given time frame may be significantly less than another person and the demands on their ability to complete the tasks may also vary.

The respondents did not view work as a major source of stress, seeing it as originating mainly from financial problems or concerns over family members. This again supports the view that managers are failing to identify that they could actively manage stress by addressing its causes.

The lack of knowledge regarding their legal responsibilities to identify and manage the causes and effects of work related stress maybe considered to be misleading as the respondents generally said that there was no actual legal responsibilities but gave the impression that they knew they had some responsibilities. However, this is again concerning as all managers should be aware of the legal requirements they have to fulfil. It is possible that the lack of attention given to stress has led many to disregard its inclusion in risk assessment, as the emphasis has tended to be on accidents in the workplace caused by more physical hazards.

This may also be the reason why there was such a general lack of awareness of the Health and Safety Executives standards for the identification and management of stress which is indicated by the fact that no one could name any of them. These standards have received little publicity in the press and the following question on actions they take under the six standards was supplemented by examples to overcome the lack of knowledge. The number and range of actions taken was much more promising than the replies to the previous questions and showed that many of the organisations have practices in place which fall under the standards even though they are not identified by the managers as doing so.

These include ensuring all new employees have full induction, setting personal objectives based on organisational goals, the provision of employee representation groups, personnel policies on grievance, substandard work performance, harassment and discrimination, the provision of training to ensure employees could do their jobs and the allowance of flexibility in working hours. However, it must be concluded that these actions and policies were not introduced as a response to efforts to manage stress, but due to other factors within the business, possibly legislative.

The ways in which the respondents felt that their employees would let them know if they were suffering from stress again goes back to are active approach. The most common method of submitting a grievance would necessitate the problem to become pronounced before action was taken. The second most popular way, during an appraisal, is disappointing as an employee would be required to wait until their appraisal was taking place rather than reporting concerns as and when they occurred. No managers believed their employees would just tell them if there was a problem, suggesting poor communication and a lack of trust between the levels.

Managers had limited knowledge of the symptoms of stress which would therefore make it much more difficult for them to recognise them in their employees either whilst they were at work or as a reported reason for absence. They were likely to make an association with alcohol and drug misuse as being stress related, but would not do so for heart problems or an increase in the accident rate. This lack of knowledge would also affect the accuracy of any risk assessments they conducted, as they would not be aware of the signs.

Although managers could provide accurate data on the rate of absence within their organisation, they were generally unaware of what proportion of absence was due to stress related illnesses. The popular estimate of less than 10% is contradictory to the International Labour Organisations estimate of 25% (Health and Safety Executive 2004) and that of the union, UNISON, of 65% (UNISON 2002). They would therefore, be unable to put an accurate cost to the organisation of stress related absence. This is supported by the fact that all the managers said that the cost of stress is measured the same way as any absence from work.

Most respondents believed managers to be more susceptible to stress than blue-collar workers. This again shows a lack of understanding of the true nature and range of courses of work related stress. Whilst manager may be deemed to have more responsibility, the common sources of stress, pressure to take on overtime, complexity of tasks, under use of skills, job future ambiguity and role conflict (Argyle 1989), are just as likely to be experienced by blue collar workers.

The characteristics of Type A and Type B personalities and the corresponding likely susceptibility to stress were not identified byte research population when asked their views on personality types. Rather than recognising competitiveness, impatience and inflexibility as key traits, they saw tendencies towards worrying and pessimism as being more likely traits.
Again, the response to how to manage stress showed a reactive approaching offering training and support or identifying and removing the source of stress once it had occurred. None of the sample population identified a multiple approach of managing it at all stages.

The notion that stress is the modern day back pain was supported by the respondents, but for a negative reason in that they felt because it was as difficult to prove that someone is not suffering from stress as it’s that they are not suffering from back pain, it was used as an excuse for absence. They failed to recognise that back pain is one of the symptoms of stress and that as there is no longer such a stigma on admitting suffering from a mental problem, people are more willing to report the cause rather than the symptom.

General questionnaire:

The two groups, managerial and non-managerial staff had widely differing views on the causes of stress cited by NIOSH. The management population believed that in their workplace only pace, variety and meaningfulness of work was a possible source of stress for their employees. The non-managerial population, however, saw a greater number of sources of stress in their workplace.

Non-management employees were more likely to be at either end of the Liker Scale i.e. experiencing little stress or a lot of stress, than in the middle. This may be due to the greater likelihood of a manager’s tasks to change significantly during the working day. It could be suggested that non managerial staff are more likely to have a set job to do which they would either find stressful or not stressful whereas manager may have several aspects to their work some of which are stressful and others which are not, which gives them more of a feeling of being moderately stressed. As previous research has found that it is the sustained effects of stress that are harmful (Fontana 1989), it would seem that an employee who finds their whole job to be a source of stress would be more likely to suffer ill effects than a manager who faces stress intermittently.

This questions also identified that people are much more likely to rate themselves as high on the Liker Scale if they are facing external customers in their role. This is supported by results from the following question which showed that customers were the main source of stress for non-managerial staff whereas for managerial staff it was lack of resources.
Managers were significantly more likely to try and remove or reduce the source of stress they encounter themselves. This would be expected, as they are more likely to have control over the source of stress.

When examining what organisations are doing to manage and alleviate stress, the provision of a confidential help line was seen to be common measure. Although this is promising action at the tertiary level, it is yet again a reactive approach. It is also noted that this type of employee assistance programme has become much more common with the emphasis on harassment and bullying and is seen as being generally standard for all sizes of organisation.

The difference in perception between managers and non-managerial staffs to what was offered by their employers to manage stress is another area of concern. Managers believed they offered a much wider range of resources than the non-managerial staff thought were available. It is possible that the management group answered this question from accompany rather than a personal point of view. Had it been worded as “what is available to you…” the results may have been different.

The reported amounts of time the sample population had taken off as a result of stress in the last twelve months did not correspond to the primary research which suggested that the average length of absence was twenty days when it was related to stress (Saunter et al 1999). The sample population were general absent for between one and five days. There are several possible reasons for this including the organisations absence policy encouraging them to return early, a keenness to return to work as soon as possible, early relief of the symptoms or inaccurate reporting of the cause of the absence. The writer feels unable to conclude that inaccurate results were reported, but feels that the results of the next question reveals some grounds for suspicion as 84%of respondents did not give stress as the cause when they took this absence.

In summary, the findings of the research are that managers are generally failing to identify, measure or monitor the amount of stress their employees are subjected to. There is little knowledge of the legal requirements or official guidelines relating to stress management and, as a result, actions taken are mostly reactive and do not concentrate specifically on stress. The effects of stress on the work environment is underestimated and therefore so are the costs and the benefits that could be gained by eliminating sources of stress.

Recommendations

Despite growing evidence that work related stress is a major cause of absence from work, the management population questioned in the survey lacked awareness of the nature, cause and legal requirements surrounding the subject. They also underestimated the negative effect performance of their organisation.

The structure for them to identify and manage stress in their business does exist, but seems to have had little implementation. By applying the six standards set out by the Health and Safety Executive to the three levels of stress management identified by Ivancevich et al (cited in O’Driscoll 2002), organisations would have a significantly more proactive and therefore effective approach to the management of stress. This would enable them to fulfil their legal obligations under the Health and Safety at Work Act. If they were aware of the symptoms of stress and took more action in terms of measuring it’s financial impact on their business, they would be able to calculate the benefits of identifying and managing it quite easily.

BT is a good example of where the HSE standards have been applied to combat work-related stress. They have taken up the major finding s of research into stress to be able to attack the problem from the primary, secondary and tertiary angles. This includes the use of an on-line questionnaire which categorises employees as green, amber or red in terms of the stress they are experiencing and the source of the stress based on the six areas highlighted by the HSE. A confidential report is then sent to the employee and their line manager to initiate a discussion on reducing the stress factors. Top-level results are supplied to the senior management team so that they can analyse the extent of the problem across the company and benchmark their approach against other organisations (Millar 2005).

To persuade organisations of the importance of identifying and alleviating sources of stress, it may be necessary to highlight to them the potential financial implications. Not only is there the cost to industry, estimated to be £25 billion, the loss of productivity, calculated as £1 in every £10 (cited in Laurence 2005), but also the financial costs of situations where employees have successfully taken their employers to court in cases relating to stress. Examples of these include Ballantine, a worker in a retirement home who gave stress as a reason for losing their job due to poor management and Ingram, who in2000 was awarded a record of £203,000 having resigned from their job as a result of stress caused by a lack of management support during change in their role (ACAS 2004).

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