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MAS Management Advisory Service www.mas.org.uk

Building a stress prevention culture

A Wellbeing and Performance Strategy Narrative of presentation to SOLACE Conference, April 2011

Derek Mowbray Director, the Management Advisory Service Visiting Professor in Psychology, Northumbria University [email protected]


www.mas.org.uk P a g e | 2 www.orghealth.co.uk 0845 8331596 [email protected]

Introduction We live in the context of organisations. Organisations come in many shapes and sizes, and are formed and disbanded constantly. This workshop is an organisation – it has a common purpose, a structure (in me standing at the front talking to you sitting quietly listening, with luck), it has rules and you are exhibiting behaviours appropriate to the context you are in.

Formal organisations are controlled communities, controlled by managers. Managers influence everything to do with organisation.

What is stress? Stress occurs in organisations. There are four aspects of stress, each important, and each can be attenuated by actions of managers. They are shown in the slide below:

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Pressure is a stimulant; so is tension. However, if individuals lose control of their own actions whilst under pressure or suffering tension he or she will deteriorate towards strain, which is a diversion, and causes under performance. Performance, in this context, is about concentration, and if concentration lapses, under performance follows. It normally leads to actions having to be repeated, or work being interrupted or something else is done rather than the work in hand.

Presenteeism People who feel well perform better than people who feel ill. Quite often people will come to work whilst feeling unwell. The more obvious examples are those people suffering flu who, not only feel unwell, are unwell and are most likely to under perform because they are under the weather.



However, for those who feel psychologically distressed, it is not obvious to others that the person is distressed. Nevertheless, if they feel unwell because of their distress they will be under performing, as their concentration will be impaired.

Those who come to work whilst feeling unwell due to psychological distress are part of a phenomenon known as psychological presenteeism. The main feature of psychological presenteeism is loss of concentration. People who lose concentration cannot focus effectively on their work, and, therefore, under perform. People in this situation will eventually leave work either on sick leave or because the job and workplace is no longer tenable, despite the provision of a range of services offered to keep people in work. Examples of the causes of psychological presenteeism are shown in the slide below.

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The impact of psychological presenteeism on businesses and services are considerable, and often place the organisation at risk. The risks include: loss of profits, lack of compliance with Health and Safety regulations, increased insurance premiums for medical insurance, risk of legal action and the risks associated with an under performing workforce.



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The costs to business and services is high. In research conducted by The Sainsbury Centre the cost has been estimated at 1.5 times the combined cost of sickness absence and staff turnover. More recent estimates suggest the real cost is between 4 and 5 times the combined cost of sickness absence and staff turnover – a massive loss of profits, or opportunity costs for budgeted services.

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How does psychological presenteeism arise? All organisations face risks to their survival and growth. Managers have the task of managing organisations to mitigate the risks, and, where possible, take advantage of a favourable situation to stimulate development and growth within the business or service.

The risks are also faced by the workforce and the individual, as the slide below shows:

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Psychological presenteeism arises where individuals feel unwell. They may feel unwell because of the failure in managing corporate risks, which translate over into risks for the workforce and for individuals. Anyone suffering psychological presenteeism is likely to experience one or more of the risks above.

In times of economic constraint the economic risks facing organisations will have a direct impact on the workforce. In general, the impact produces five categories of staff, all of whom have experienced a degree of psychological distress due to the circumstances they face.



Impact of organisational threats on individuals

Those who have been asked to stay (Survivors)

Those who have been asked to stay but re‐locate (Survivors)

Those who have been asked to stay but expect to leave sometime in the future

(Uncertain survivors)

Those who have been asked to leave

(Opportunity Knocks)

Those who remain uncertain about what will happen


MASManagement Advisory Servicewww.mas.org.uk

What is going on? Before seeking strategies and actions to prevent psychological presenteeism it is important to understand what is happening to those who suffer distress and why.

Everyone experiences events all the time. For the most part we accommodate events easily as they pose no threat to our survival, and we may have experienced events of a similar nature several times before, and suffered no sense of threat to our wellbeing. However, there are occasions when an event will place us on alert, and cause us to divert energy to understanding what the event means and whether it is a threat to our survival.

Part of the process of understanding the meaning of an event is to understand the context within which the event has taken place. Context is everything, as it provides the cultural environment in which events and responses take place, and may even be the contributing cause of the event itself. For example, an operating theatre that embraces a culture of long hours of intensive work is more likely to provide the environment for errors and mistakes than a culture based on intensive bursts of energy with breaks between.

Our understanding of the context helps us to understand the meaning of the event. We evaluate the event according to these factors combined with our own degree of resilience and our capacity to evaluate. All of this provides us with the information to enable us to form an attitude towards the event, which is the trigger for what we decide to do in the face of the event – the outcome. This is shown below:



Impact of organisational threats on individuals

Those who have been asked to stay (Survivors)

Those who have been asked to stay but re‐locate (Survivors)

Those who have been asked to stay but expect to leave sometime in the future


Those who have been asked to leave

(Opportunity Knocks)

Those who remain uncertain about what will happen


MASManagement Advisory Servicewww.mas.org.uk

What is going on? Before seeking strategies and actions to prevent psychological presenteeism it is important to understand what is happening to those who suffer distress and why.

Everyone experiences events all the time. For the most part we accommodate events easily as they pose no threat to our survival, and we may have experienced events of a similar nature several times before, and suffered no sense of threat to our wellbeing. However, there are occasions when an event will place us on alert, and cause us to divert energy to understanding what the event means and whether it is a threat to our survival.

Part of the process of understanding the meaning of an event is to understand the context within which the event has taken place. Context is everything, as it provides the cultural environment in which events and responses take place, and may even be the contributing cause of the event itself. For example, an operating theatre that embraces a culture of long hours of intensive work is more likely to provide the environment for errors and mistakes than a culture based on intensive bursts of energy with breaks between.



Our understanding of the context helps us to understand the meaning of the event. We evaluate the event according to these factors combined with our own degree of resilience and our capacity to evaluate. All of this provides us with the information to enable us to form an attitude towards the event, which is the trigger for what we decide to do in the face of the event – the outcome. This is shown below:

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What is going on?

What are the main threats to our psychological wellbeing at work? Because we are poor at interacting with each other without causing distress, the main threat to our psychological wellbeing is ourselves. The secondary threat arises from the existence of organisations, and as we all live within the context of organisations almost all the time, the secondary threat is real for all of us. The tertiary threat arises from failed interactions within the context of organisations, together with some other factors. Some of these are categories of behaviour that are often difficult to define at the margins, but are wrapped up into categories as a device to aid action to be taken to resolve behavioural conflicts of various kinds. The threats are shown in the slide below:



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Building a stress prevention culture The starting point is a strategic framework. The framework here has five strategic purposes – to prevent psychological distress at work by promoting a wellbeing and performance culture and agenda; to prevent deterioration in those suffering psychological distress; to restore back to normal independent life and beyond those who have been absent due to psychological distress; to restore back to any form of work those who suffer chronic psychological distress; and to sustain a wellbeing and performance culture.



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Wellbeing and Performance Strategic framework

The focus, therefore, for developing a prevention culture is on building a wellbeing and performance culture, and reinforcing this with manager behaviours based on achieving commitment, trust and social engagement.

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In the slide above it will, also, be noticed that the majority of support services are offered to individuals who have already started to suffer psychological distress. The efficacy of providing lifestyle and supporting services is frequently challenged in the context of their relative ineffectiveness at reducing the overall morbidity of psychological distress at work.



The implementation of a wellbeing and performance culture requires a systemic approach. This is not a quick fix. It requires modifications to the ways in which the organisation currently undertakes its activities, as well as different thinking towards effective prevention interventions.

There are several stages to go through to achieve full implementation – a wellbeing and performance strategy, a wellbeing and performance agenda, organisation development activities, management development activities and a strategy of change.

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The overall strategy could also be implemented in three parts – managing my organisation (organisation development), managing my people and managing myself (management development).



Managing my organisation This aspect of the strategy focuses on the features of a wellbeing and performance culture. The key feature is the identification of corporate values, and it is suggested that amongst these are commitment, trust and engagement between the organisation entity and its workforce, including its managers.

Next is a description of how the top managers and staff would like the organisation to be like. An illustration is provided below:

MASWellbeing and Performance culture



An approach to implementing this kind of culture is to review the purpose, structure and rules of the organisation to ensure they promote commitment, trust and engagement. There are some specific rules to be reviewed and re‐designed.

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Recruitment Challenge

Pay

Training

Teamworking

Involvement

Openness

Communication

Encouragement

Performance Appraisal

Career Opportunity

Job Security

Work Life Balance

Citizenship

Behaviour

Rules

Another is to implement an adaptive culture as a key component of a wellbeing and performance culture. This approach is successful in engaging the workforce with the key issues of the organisation and is highly successful in enabling organisations to survive and grow. The basic ingredients are in the slide below and are summed up by the word ‘involvement and distributed ownership’:

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Corporate Adaptive Work Culture

• Elephants in the Room put on the table

• Responsibility for the organisation is shared

• Independent judgements are expected

• Leadership capacity is developed

• Reflection and continuous learning are institutionalised



Managing my people This requires behaviours that promote commitment, trust and engagement between managers and staff. Before any behaviour is shown, everyone thinks. The thinking required to produce the behaviours is shown as attributes below. The attributes are those elements of everyday thinking that managers need to embed to produce the required behaviours. The attributes shown below are those that produce behaviours that persuade others to do things they might otherwise not do and without causing any distress – seduction.

MASManaging my people

Manager’s Code One way to help the implementation is to create a Manager’s Code using the attributes and behaviours as the basic behaviours expected from managers, based on achieving a wellbeing and performance culture founded on the values of commitment, trust and engagement.

Managing myself This aspect of the implementation process focuses on resilience. Resilience is the capacity to cope with, and develop from, adverse events.

Resilience is about attitude towards an event. We construct our attitudes based on our understanding of an event, its context and whether the event is a threat to our survival. Based on an evaluation of this kind will be our attitude and then our response to the event. Strengthening resilience in individuals is an aspect of the wellbeing and performance culture that places a responsibility on both the organisation and the individual to be as prepared as possible for any unexpected event that could threaten the survival of the organisation and the individual.



The resilience model used to strengthen resilience is below. It includes elements that strengthen individual personal features, as well as strengthening the ability to interact effectively with others.

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People with an idea of what they want from life will be more resilient than those who don’t know what they want.

People who are determined to see something through to a conclusion will be more resilient than those who have little determination.

Those who can control the responses of others effectively in an interaction without causing distress will be more resilient than those who cannot do this.

Those with strong relationships that are both important and strong in supporting the individual in achieving personal success will be more resilient that those without such relationships.

Those who like to solve problems will be more resilient.

Those who are able to organise themselves will be more resilient than those who cannot.

Those who have the ability to control their own anxiety in the face of new challenges will develop their self confidence and be more resilient than those who cannot do this.



Copyright ‐ Derek Mowbray April 2011

About Derek Mowbray Derek Mowbray, is a Chartered Psychologist and Scientist, with a doctorate in leadership. Dr Mowbray focuses on the behaviour of leaders and managers in relation to their employees,

and helps them to develop the behaviours that encourage commitment, trust and staff engagement. Derek’s techniques include problem focused coaching, cognitive coaching, group work and consultancy. Professor Mowbray combines the unique features of working on the big picture as a strategist as well as facilitating effective leader and manager performance. He combines

applied academic research with a career as a leader in ground breaking organisations, including MAS, OrganisationHealth and the Stress Clinic. He is a visiting Professor of Psychology at Northumbria University, and works for the European Commission as an Independent Technical Expert.

Recently, Professor Mowbray has been working on the development of a 'Manager's Code', a new Code of Conduct for the NHS, which has the aim, once implemented, of developing positive work cultures and the behaviours required to implement them. This is linked to two further Codes, a Code for Ethical Leadership and a Code for Engagement. Derek is a regular contributor to HSJ, HSE, CIPD and LinkedIn communities, and has made national presentations at the International Stress Management Association, NHS Employers Conference, HSJ’s World Class Workforce Conference and HSJ’s Tackling Staff Sickness and Absenteeism Conference. In 2011, Derek was been invited to speak at the Health and Wellbeing @ Work Conference, the South West Employer Network / Mindful Employer Conference in Exeter where he spoke with Dame Carol Black, SOLACE South East Spring Conference, and still to come, the 2011 Wales Branch HPMA Conference ‘Resilience’ – Building High Performing Cultures, the Wales Public Service Summer School 2011 ‐ Leading for Engagement and the RCGP Annual Primary Care Conference.

Derek Mowbray provides facilitation and advice to all types of organisation on wellbeing and performance, and on the implementation of a wellbeing and performance culture.

www.derekmowbray.co.uk www.orghealth.co.uk www.mas.org.uk [email protected]

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