Promoting health and wellbeing in the workplace

Health & wellbeing - important issues

The interest in stress, health and wellbeing has been fuelled by the research evidence highlighting the costs to individuals, their families, employers and society. In 2008 the influential UK government think tank Foresight highlighted the opportunities and Challenges facing the UK around mental capital and well-being.

The review by Dame Carol Black, Working for a Healthier Tomorrow commissioned by secretaries of state for health and for Work and Pensions, and the governments response to the Black Report, Improving Health and Work: Changing Lives, have placed health, work and wellbeing at the top of the political and business agenda.

Health & wellbeing at work

Health and wellbeing can have a major impact on engagement, performance and productivity at all levels in every organisation.

Psychological health and wellbeing creates the energy that generates strategic thinking, innovation and optimal performance. There is a growing body of research from positive psychology showing how positive emotions are powerfully linked to optimal functioning by increasing cognitive and behavioural flexibility, creativity, and engagement.

Stress at work - an expensive problem

Business success is directly linked to the performance of key individuals and teams. Psychological health and wellbeing creates the energy that generates engagement, strategic thinking, innovation and optimal performance.

Stress is known to create a wide range of distressing physical symptoms as well as impacting on cognitive fitness (concentration, memory, decision-making and creativity), sleep quality and inter-personal behaviour. There is a powerful business case for improving health and wellbeing and reducing stress at work.

Stress is now the most common cause of work absence. The recent Boorman Review (2009) looking at health and wellbeing in the NHS delivered a stark message: 10.3 million working days are lost in the NHS in England each year. This is the equivalent of 45,000 wholetime equivalent (WTE) staff or some 4.5% of the current workforce. The annual direct cost of absence is some ??1.7 billion a year.

The Sainsbury Centre for Mental Health have estimated that the costs associated with loss of productivity for those who are at work but unwell, presenteeism, is even greater than the costs of work absence, estimated at ??100 billion in 2007. The latest occupational research shows that stress accounts for 80% of lost productivity (presenteeism working when unwell).

What causes stress at work?

Stress is best understood as a dynamic state involving an interaction between the individual, various social factors, the workplace, and wider environmental factors.

Individual factors include: maintaining a work/life balance; social support from family and friends; nutrition, exercise and sleep; job satisfaction; self-esteem and self-efficacy; resilience and mood state - this could be stress, anxiety or depression.

Workplace factors include: managerial style; work content; amount of control/autonomy the individual has in the workplace; workload and role; long hours; the physical environment; uncertainty/ambiguity of the role; mood contagion; social support and relationships with peers; career devlopment.

Environmental factors include: global markets; restructuring/change within the organisation; mergers; competition; downsizing/outsourcing and job insecurity.

What are the warning signs of workplace stress?

Stress can cause a wide range of distressing physical symptoms, which in turn can impact on health, wellbeing, engagement and performance in the workplace. These symptoms might include:

• chest tightness/throat tightness
  
• rapid heart rate, palpitations or sweating
• muscle tension - causing localised discomfort (headache, neck stiffness for example)
• musculo-skeletal pain
• breathlessness (hyperventilation) dizziness, light-headed, numbness, pins and needles, tingling, faintness, tremor, feeling strange or detached
• indigestion, dyspepsia, nausea, heartburn, diarrhoea, irritable bowel syndrome, dry mouth
• migraine
• fatigue
• skin rashes
• urinary frequency
• increased physical sensitivity to light, touch, pain and sound
  

Such unpleasant physical symptoms, caused by stress, can become a source of worry and concern which only serves to amplify both the stress and the physical symptoms. These symptoms often result in repeated medical consultations and work absence.

What are the consequences of workplace stress?

Cognitive consequences
Stress can have a major impact on how we think about or perceive things. This can impact on employee engagement, cognitive fitness and performance.

The cognitive changes such as poor concentration, poor memory and negative thoughts that are commonly associated with stress can become a source of worry and concern in their own right, which only serves to amplify both the stress and the cognitive problems.

Behavioural consequences
Stress can also result in a range of negative behavioural patterns. The behaviours associated with stress such as inability to relax, sleep disturbance being critical and irritable can damage relationships at home, or at work, creating additional problems and amplifying the level of stress.

Stress impacts on our physical health, and influences how we think and behave. Stress has a major impact on performance, productivity, profitability and work absence.

How to keep people well and stress free

There is a powerful business case for implementing effective interventions in the workplace because the evidence consistently shows that working in a healthy, well motivated and resilient workforce improves efficiency, performance and productivity.

The two main recommendations coming out of the extensive policy and research literature on work, health and wellbeing are:-

1. Prevention - proactive interventions specifically aimed at improving physical and mental health in the workplace.
2. Early intervention - reactive intervention offering rapid access to evidence-based treatment for those who become unwell.  

Improving the health, wellbeing and performance across the business needs the buy-in at the most senior level of the organization. It requires a top-down approach if it is going to embed into the DNA of the business and deliver sustainable Benefits.

The importance of managers in promoting wellbeing

Psychological wellbeing is now recognised to be the best predictor of performance and productivity because of its impact on decision-making, creativity, and overall cognitive fitness. Positive mood states help us to broaden our thought-action repertoire and build personal resources.

Raising awareness and gaining relevant skills can help senior managers support their colleagues and improve team working. Early effective interventions will always depend heavily on managers, their understanding, and their ability to recognise and address stress related issues.

The research confirms that employees cope better, and return to work sooner, if their managers have a greater knowledge of the issues and are more proactive.

The National Institute for Health and Clinical Excellence guidelines on promoting mental well-being at work recommends a strategic and coordinated approach to promoting employees mental wellbeing.

Performance Optimisation Modules include:

• positive psychology - effective strategies for maintaining health and wellbeing
• increasing cognitive fitness the better you think, the more you achieve
• building resilience - self-efficacy, self-confidence, cognitive control and learned optimism
• team building - engaging effectively, building rapport, trust and productive relationships
• adaptive problem solving - effective coping strategies
• the latest science from nutritional medicine, exercise and fitness
• self-motivation - intrinsic and extrinsic motivation. The psychology of initiating and maintaining positive change
• motivating others getting the best out of other people
• managing change adapting to uncertainty, enabling and supporting a process of change
• proven strategies for improving sleep quality - sleep impacts on mood, energy, behaviour, engagement, cognitive fitness and physical health
• managing conflict, managing resistance, communicating effectively
• mindfulness - an evidence-based approach to improved psychological health and wellbeing
• emotional literacy - recognising and responding to stress and distress in others.

Early intervention - tackling stress

The majority of presenteeism and work absence is due to mild and treatable conditions with anxiety, depression, and stress related problems being the most common.

The evidence from occupational research shows that one in six of the working population is experiencing a significant level of stress or anxiety at any one time. Sometimes the employee is still at work and there are issues around performance, poor concentration, poor decision making, irritability or physical symptoms and ill health. Sometimes the individual is found to be taking frequent, or prolonged, time off work.

It is important to identify those at-risk as soon as possible and provide early access to evidence-based interventions. The quality of any intervention is crucial. Evidence based simply means it is directly informed by the latest and best knowledge of what actually works. The first six weeks are the most critical and the longer the delay in accessing treatment, the longer the illness (presenteeism) or work absence is likely to persist.  Providing effective and proven cognitive and behavioural interventions (CBT) at an early stage can profoundly change the trajectory of the illness, reducing presenteeism, work absence and disability.

The British Occupational Health Research Foundation (BOHRF) recommend a cognitive behavioural approach as the intervention of choice for helping people with psychological problems remain in the workplace and make an effective adjustment to health and productivity (Seymour & Grove, 2005)

Our recommendation is that employees who have been identified by their manager, HR specialist, occupational health, or their own GP as having some difficulties at work (eg. work-related stress, or stress related physical symptoms such as fatigue or musculoskeletal pain) need to be rapidly referred for specialist assessment and gain rapid access to appropriate evidence-based treatment.

Promote a healthy & well workforce - top tips

The ongoing Challenge for organisations is creating and maintaining a healthy and dynamic workforce through implementing an evidence-based health and well-being policy requires:

• an informed and progressive organisation committed to positive change
• a robust assessment tool - diagnostic
• implementing evidence based strategies to improve health and well-being
  regular evaluation (analysis of outcome data, including KPIs, to demonstrate a clear ROI)
• an audit cycle a quality improvement process