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Guidelines for the Management of Stress at Work Responsible Directorate: Date Approved Committee Signature of Accountable Director Print Name

Human Resources/Organisational Development 25.06.08 Governance Committees/Partnership Forum, PCT Board

Sue Ellis Director of HR and OD Calderdale and Kirklees PCTs

Document Title Document number Author Contributors Version Date of Production Review date Postholder responsible for revision Primary Circulation List Web address

Restrictions

Guidelines for the Management of Stress at work Two Ed Sherwood, Norah Wright See Stakeholders Three March 2008 March 2011 Ed Sherwood. TBC http://www.kirklees-pct.nhs.uk/publicinformation/publications/policies-andprocedures/employment-policies/ None

Domain Core / Development Standard Reference

C7C undertake systematic risk assessment and risk management; D1 Health care organisations continuously and systematically review and improve all aspects of their activities that directly affect patient safety and apply best practice in assessing and managing risks to patients, staff and others, particularly when patients move from the care of one organisation to another. D12 Health care is provided in well-designed environments that a) promote patient and staff well-being, and meet patients’ needs and preferences, and staff concerns

Performance Indicators

1. Staff Surveys 2. Occupational Health reports 3. Reports to HR Committees


Index Section

Heading

Page

1

Policy Statement

2

2

Introduction

2

3

Associated Policies and Procedures

2

4

Aims and Objectives

2

6

Scope of guidance

3

6

Accountabilities

3

7

Definition of Stress

3

8

Recognition of stress at work

3

9

Handling stress at work

4-5

10

Management if stress in the workplace

5-9

11

Risk assessment tool

9 - 11

12

Equality Impact assessment tool

11

13

Training need analysis

11

14

Monitoring system

15

References

12

16

Stakeholders

12

Appendices A. Equality Impact Assessment Tool

11 - 12

13

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1. Policy Statement The PCT is committed to protecting the health, safety and welfare of employees and acknowledges that workplace stress is a risk to health and the importance of identifying and reducing workplace stressors. This guidance is provided for the use of all PCT employees and is provided for contractors to use as required. 2.

Introduction.

The guidance is intended to provide clarification for staff and managers in handling work related stress and should be read in conjunction with the PCT Policy on Managing Work-Related Stress This guidance has been produced with reference to various Health and Safety Executive [HSE] publications and good practice guidance. 3.

Associated Policies and Procedures.

The guidance should be read in accordance with the following PCT policies, procedures and guidance which are available on the PCT shared drive or web site or from the Human Resources Department: • • • • • • • • • • • 4.

Capability Management Guidelines Managing Stress at Work Policy Communications Strategy Equality and Diversity Strategy Guidelines on Dealing with Ill Health Dignity at Work Policy and Procedure Human Resources Strategy Improving Working Lives and Services action plans Leadership Strategy Whistle blowing policy Policy on Special Leave

Aims and Objectives. •

To provide guidance for managers to enable them to manage stress related concerns both as an immediate concern and in the longer term.

To enable all staff to understand the system and processes available to them regarding stress related concerns.

To identify what support mechanisms are in place for staff regarding the management of stress in the workplace.

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5.

Scope of guidance.

The PCT is working to develop a positive working environment for all its employees, ensuring better communications, support systems and policies and procedures to help staff manage their work-life balance. Data from the national staff survey has identified that stress is an issue of concern for the whole NHS. It is the intention of these guidelines to pull together the many initiatives that the PCT is developing to support staff. A significant part of managing stress is simply following good management practice. There are a number of tools that line managers and employees have available to them that should ensure that there are opportunities to identify and address stressors at an early stage – these include specific formal processes (e.g. recruitment, induction, appraisal, occupational health) and the informal processes that form a key element of managing staff effectively. 6.

Accountabilities & Responsibilities

The roles and responsibilities for the management of stress in the workplace are identified in the Managing Stress at Work Policy 7.

Definition of Stress

The Health and Safety Executive define stress as “the adverse reaction people have to excessive pressure or other types of demand placed on them�. This makes an important distinction between pressure which can be a positive state if managed correctly, and stress which can be detrimental to health. Stress is commonly identified with a lack of control over the working environment although there is no defined measure or standard set of symptoms. 8.

Recognition of Stress at Work

An employee may admit that they are feeling stress at work, this may be through formal processes such as appraisal or in more informal contact. Stress may be a reason for a deteriorating performance at work or a poor attendance record. There may be evidence of poor concentration or punctuality, increased irritability and deteriorating relationships at work The employee may give indications of increased health problems (eg headaches, stomach problems) tiredness or increased alcohol, smoking or drug use It should be noted that there may well be other explanations for the above signs and that these can only serve as indicators Page 3 of 13


9.

Handling Stress at Work

All roles have a level of stress inherent within them. This is not necessarily a bad thing unless that level of pressure becomes excessive. Under their duty of care for employees employers are required to do a risk assessment of duties or posts where there is a potential for that risk to be excessive. An employee experiencing stress may raise this through their line manager, Occupational Health, Human Resources, staff representatives, or another manager with whom they feel comfortable A staff member with a concern about a colleague may wish to encourage them to seek help especially as all have a duty of care towards colleagues and may need to consider raising concerns with line managers, human resources, staff representative or occupational health. Employees may be reluctant to admit that they are under stress so they must be reassured that the issue will be treated in confidence. Managers should be aware that staff may experience high levels of stress caused by individual events both at work and at home. These events can cover many situations but include traumatic events including violent or aggressive situations, road traffic accidents or sudden deaths of patients. In these cases it may be necessary to support the staff and to seek further advice, support or guidance from occupational health or Human Resources. Where an employee reveals that they are feeling stressed they should be encouraged to seek help. They may wish to discuss the matter with their General Practitioner or with Occupational Health. It is important that staff are aware they can access a confidential counselling service through the occupational health department on 01924 212467 ext 2467. Not all stress is work related and support at work may help employees manage these stresses which may otherwise lead to deterioration in their work performance. Managers should always try to resolve stress related concerns straight away including the provision of direct support or by seeking advice support and guidance from Human Resources, Risk Management or Occupational Health. The number for Occupational Health should be provided as a matter of course to staff. It is important to be aware that changes in people’s lives outside work can lead to work related stress because they may remove individual’s support mechanisms, resulting in them no longer being able to cope as effectively with the same level of pressure. Page 4 of 13


It is not possible to be too prescriptive in dealing with work related stress. The HSE Standards of Stress Management (section 7) will help guide a discussion with an employee as to what areas are causing them problems Where a member of staff is absent from work on a long term basis or on a frequent short term basis their absence should managed through the process defined in PCT Ill Health Management policies, procedures and guidance. It should be noted that stress related illness may be defined as a disability as defined in the Disability Discrimination Act, which places a statutory duty on employers to make reasonable adjustments. Where an employee indicates they are absent from work due to work-related stress a referral should always be made to the Occupational Health Department for an assessment and advice on the support that the employee may need to return to work. Any advice should be discussed with the employee and the HR department There should be an agreed plan to support the employee back to work including a risk assessment of areas that are identified as contributing to the employee’s stress. Advice on this should be sought from the Occupational Health department. It is often beneficial to phase a return to work and agree how the employee will build up their duties. The discussion may also cover flexible working (if applicable), or a temporary change to duties or hours of work. The employee may wish to seek permanent redeployment and will be supported to do so in line with the guidelines for managing ill-health. Regular meetings should be held to discuss progress with the employee and they should be given the opportunity to be accompanied by a friend or representative. 10.

Management of stress in the workplace.

*Adapted from the Management Standards published by the HSE. 10.1. Key Principles We all have a legal duty of care for ourselves and others in the workplace. Every employee needs to exhibit responsibility and leadership by proactively reviewing risks and ensuring that individual behaviours support a positive and safe working environment. The principles of the HSE risk management standards simply echo principles that run throughout all good management practice. The PCT has a number of corporate, human resources and risk management policies and procedures that support all the above management standards. Page 5 of 13


These policies are available to all staff on the intranet and managers should ensure staff are aware of where they can access these. These provide a framework to help all staff remain safe at work – by applying these fairly and consistently most issues will be resolved at an early stage. It is critical to the vision of the PCT that we value our staff and provide the support and systems that they need to do their jobs and to develop personally and professionally. These values are reflected in the following HSE management standards. Additionally, a number of “indicators”, have been identified. Where concerns are identified relating to stress these are intended to help determine whether the management tools are in place to help alleviate stress and to help guide any discussion with the employee. They are intended as guidance, it is unlikely they will all be relevant to every situation. 10.2. Demands The standard is: • Employees indicate that they are able to cope with the demands of their jobs • Systems are in place locally to respond to any individual concerns What should be in place: • The organisation provides employees with adequate and achievable demands in relation to agreed hours of work • People’s skills and abilities are matched to the job demands • Jobs are designed to be within the capabilities of employees • Employee’s concerns about their work environment are addressed Examples of Indicators • Up to date job descriptions, person specifications and KSF outlines • Personal development reviews and development plans • Local induction check lists • Back to work interviews • Exit interviews • Staff survey results • Essential training attendance • Team and individual meetings • Supportive team culture • Work practices • Staffing levels • Working patterns • Open communication, formal and informal • Individual’s understand organisational/service objectives • Individual’s understand responsibilities • Health and safety reports Page 6 of 13


10.3. Control The standard is: • Employees indicate that they are able to have a say about the way they do their work • Systems are in place locally to respond to any individual concerns What should be in place: • Where possible employees have control over the pace of their work • Employees are encouraged to use their skills and initiatives to do their work • Where possible, employees are encouraged to develop new skills to help them undertake new and challenging pieces of work • The organisation encourages employees to develop their skills • Employees have a say over when breaks can be taken • Employees are consulted over their work patterns Examples of Indicators • Personal development reviews • Team and individual meetings • Supportive team culture • Work practices • Work patterns • Open communication, formal and informal • Individual’s understand organisational/service objectives • Working patterns 10.4. Support The standard is: • Employees indicate that they receive adequate information and support from their colleagues and superiors • Systems are in place locally to respond to any individual concerns What should be in place: • The organisation has policies and procedures to adequately support employees • Systems are in place to enable and encourage managers to support their staff • Systems are in place to enable and encourage employees to support their colleagues • Employees know what support is available and how and when to access it • Employees know how to access the required resources to do their job • Employees receive regular and constructive feedback

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Examples of Indicators • Personal development reviews and development plans • Local induction check lists • Exit interviews • Staff survey results • Team and individual meetings • Awareness of communication systems • Individual’s understand organisational/service objectives • Supportive team culture • Open communication, formal and informal 10.5. Relationships The standard is: • Employees indicate that they are not subjected to unacceptable behaviours e.g. bullying at work • Systems are in place locally to respond to any individual concerns What should be in place: • The organisation promotes positive behaviours at work to avoid conflict and ensure fairness • Employees share information relevant to their work • The organisation has agreed policies and procedures to prevent or resolve unacceptable behaviour • Systems are in place to enable and encourage managers to deal with unacceptable behaviour • Systems are in place to enable and encourage employees to report unacceptable behaviour Examples of Indicators • Personal development reviews and development plans • Local induction check lists • Back to work interviews • Exit interviews • Staff survey results • Awareness and access to formal policies especially Dignity at Work • Complaints and concerns • Supportive team culture • Open communication, formal and informal 10.6. Role The standard is: • Employees indicate that they understand their roles and responsibilities • Systems are in place locally to respond to any individual concerns Page 8 of 13


What should be in place: • The organisation ensures that, as far as possible, the different requirements it places on employees are compatible • The organisation provides information to enable employees to understand their roles and responsibilities • The organisation ensures that, as far as possible, the requirements it places on employees are clear; and systems are in place to enable employees to raise concerns about any uncertainties or conflicts they have in their role and responsibilities

Examples of Indicators • Up to date job descriptions, person specifications and KSF outlines • Personal development reviews and development plans • Local induction check lists • Staff survey results • Essential training attendance • Team and individual meetings • Open communication, formal and informal • Individual’s understand organisational/service objectives • Individual’s understand responsibilities 10.7. Change The standard is: • Employees indicate that the organisation engages them frequently when undergoing an organisational changes • Systems are in place locally to respond to any individual concerns What should be in place: • The organisation provides employees with timely information to enable them to understand the reasons for proposed changes • The organisation ensure adequate employee consultation on changes and provides opportunities for employees to influence proposals • Employees are aware of the probable impact of any changes to their jobs. If necessary employees are given training to support any changes to their jobs • Employees have access to relevant support during changes Examples of Indicators • Staff survey results • Essential training attendance • Team and individual meetings • Briefings • Supportive team culture Page 9 of 13


• • • • 11.

Open communication, formal and informal Formal consultations Individual’s understand organisational/service objectives Health and safety reports

Risk Assessments

A risk assessment is simply an examination of potential hazards to identify whether reasonable precautions have been taken to ensure that the risk of injury is small. The PCT will undertake risk assessments in line with its duty of care to ensure a safe working environment for all employees A risk assessment should identify the causes of stress and identify reasonable steps to reduce them. Conducting a Risk Assessment *Based on HSE guidance “5 steps to risk assessment” available free from the HSE website (www.hse.gov.uk) Where the need for a risk assessment related to stress is identified advice should be sought from the Human Resources department who may involve Occupational Health, Risk management and staff Health and Safety representatives. Step One: Look for the hazards In terms of stress this process will usually concern an individual who may be suffering from stress due to a number of factors. These can include workload, work patterns, environment, relationships with colleagues, lack of training and education, gaps with instruction, guidance or information required to fulfill the role, external pressures such as court appearances, home life or changes brought about by organisational or local restructuring. The list is not exhaustive. Managers and staff are encouraged to discuss any concerns they may have either with their line manager, HR, Occupational Health or staff side representative. Step Two: Decide who might be harmed and how A staff member suffering from stress may have an impact on themselves but can also have an impact on colleagues, managers, members of public, families and ultimately on patients. When a risk assessment is conducted on any stress related concerns then the impact on others must be considered

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Step Three: Evaluate the risk whether existing precautions are adequate The aim of the assessment is to remove, reduce or control the factors (stressors) that are causing the stress in the first place. These factors can be established through a number of data sources including discussion with individuals, HR, Colleagues, Risk Management and Occupational Health. When ever possible the stressors should be removed without having an effect on others but if they cannot be removed then they must be reduced or controlled. The process of reducing or controlling the factors can involve many changes including alterations to work environments or patterns, providing training and instruction or managing relationships. Controls can also be introduced including the facility for occupational health reviews, counseling and other support mechanisms which may be advised from professional organisations, staffside or external bodies including the Health and Safety Executive. Step Four: Record your findings Any agreed actions should be confirmed in writing. It is important that all findings are recorded and agreed so that they can be referred to during future discussion with staff. Step Five: Review and revise your assessment Regular discussions are required to monitor progress and ensure that the measures and controls are being effective. If the changes are insufficient then the review will indicate this and further action will be required. 12.

Equality Impact Assessment.

All public bodies have a statutory duty under the Race Relation (Amendment) Act 2000 to “set out arrangements to assess and consult on how their policies and functions impact on race equality.� This obligation has been increased to include equality and human rights with regard to disability age and gender. The PCT aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. In order to meet these requirements, a single equality impact assessment is used to assess all its policies/guidelines and practices. This guidance document was found to be compliant with this philosophy (Appendix A) 13.

Training Needs Analysis.

A training needs analysis has been undertaken and is incorporated in the PCT Managing Stress at Work Policy.

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14.

Monitoring Compliance with this guidance.

This guidance will be monitored by HR Shared Services who will be responsible for ensuring that the document is made available for staff and managers and that any necessary training is provided. HR Shared Services will monitor the effectiveness of the stress management guidance by collating and interpreting data. The data will include a number of sources including occupational health reports, incident reports, staff side reports, staff questionnaire, claims, grievances, complaints, media, HSE investigations, exit interviews, disciplinarians, external and internal reports. The list is not exhaustive. This data will be shared with Staff side representatives. It is the responsibility of HR Shared services to collate and interpret the data which will be presented to the HR Shared Services Board at least annually or as required by individual organisations. HR Shared Services Board will review the effectiveness of the stress management documents and support programmes and ensure that any deficiencies are noted and resolved. 15.

References

HSE guidance “5 steps to risk assessment”. 16.

Stakeholders •

Senior Management Team and Management Executive Groups for the Calderdale and Kirklees PCTs

Staff Partnership Forums for the Calderdale and Kirklees PCTs

Occupational Health Services – Mid Yorkshire Trust

Assistant Director Corporate Governance and Risk Kirklees PCT

Policy Development Groups.

Provider Services Board

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Equality Impact Assessment Tool

Appendix A:

To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval. Insert Name of Policy / Procedure Yes/No 1.

Does the policy/guidance affect one group less or more favourably than another on the basis of: • Race • Ethnic origins travellers)

2. 3.

4. 5. 6. 7.

(including

gypsies

and

Comments

No No

• Nationality

No

• Gender

No

• Culture

No

• Religion or belief

No

• Sexual orientation including lesbian, gay and bisexual people

No

• Age

No

• Disability - learning disabilities, physical disability, sensory impairment and mental health problems

No

Is there any evidence that some groups are affected differently? If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? Is the impact of the policy/guidance likely to be negative? If so can the impact be avoided? What alternatives are there to achieving the policy/guidance without the impact? Can we reduce the impact by taking different action?

No No

No NA NA NA

If you have identified a potential discriminatory impact of this procedural document, please refer it to Human Resources Dept together with any suggestions as to the action required to avoid/reduce this impact. For advice in respect of answering the above questions, please contact Human Resources Department

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http://www.kirklees.nhs.uk/uploads/tx_galileodocuments/Stress_Management_Guidance_for_Managers_01  

http://www.kirklees.nhs.uk/uploads/tx_galileodocuments/Stress_Management_Guidance_for_Managers_01.pdf

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