An Introductory Guide for Managers, Supervisors and Union Members
Janet Cahill, Ph.D., Department of Psychology, Rowan College of New Jersey
Paul A. Landsbergis, Ed.D., M.P.H., Hypertension Center, Cornell University Medical College
Peter L. Schnall, M.D., M.P.H., Center for Social Epidemiology
Presented at the Work Stress and Health ’95 Conference. September 1995, Washington D.C.
Requests for additional copies or references should be sent to:
Dr. Janet Cahill
Department of Psychology
Rowan College of New Jersey
201 Mullica Hill Road
Glassboro, NJ 08028-1763
(609) 256-4500 ext. 3520
Internet address: CAHILLJ@SBS.ROWAN.EDU
This handout assumes a working knowledge of the relationship between occupational stress and both psychological and physical strain, including cardiovascular disease. We will also assume that you have identified some of the organizational costs of high stress levels to your workplace and employees. Another key assumption, is that you are interested in a change strategy that includes structural, or organizational change. The approach discussed in this handout views individual approaches as augmenting, not replacing organizational change. Finally, we will assume that you have the opportunity to improve the quality of work in your organization.
If these assumptions are correct, congratulations. You have already taken the first steps toward improving the health and possibly the productivity of your employees. This handout will detail this process of healthy organizational change. Basically, this handout has two goals:
1. Identifying the major features of healthy organizational change.
2. Developing organizational and individual change strategies.
We will also provide you with some examples of successful organizational change efforts. One general note is in order. This handout will not review various theoretical models of change. It is intended to be a concrete and practical guide for healthy organizational change. For a review of theoretical models and references for additional examples, you can refer to the companion piece to this handout, Interventions to Reduce Job Strain (Landsbergis, Cahill & Schnall, 1995).
Where to Start:
When you think about it, a serious organizational change effort has two important levels to it. The first is the content of the change and the second is the process of the change. In common sense terms, the content of change is what you want to do and the process is how you are going to do it. In practical terms, the process of the change effort is the more crucial aspect. The primary goal of any change process needs to reflect that overarching goal.
Making a Real Commitment to Stress Reduction
Probably the most important step in healthy organizational change is to make a serious and sustained commitment to it. In non-unionized workplaces, this commitment should be made by top management. In unionized workplaces, both top management and union representatives need to be involved.
Healthy organizational change takes time. Lots of time. No serious change effort should be initiated with a time frame limited to weeks or a few months.
Healthy organizational change includes employee health and satisfaction as an explicit and independent outcome measure. These outcomes should be the key goals of the change effort, not potential by products.
Broad Organizational Goals
Healthy organizational change can include:
· Changes that will increase employees’ autonomy or control.
· Changes that will increase the skill levels of employees.
· Changes that will increase levels of social support (both supervisory support and coworker support).
· Changes that will improve physical working conditions.
· Changes that will make a healthy use of technology.
· Changes that provide a reasonable level of job demands.
· Changes that provide for job security and career development.
· Changes that provide for healthy work schedules.
· Changes that improve the personal coping mechanisms of employees.
· Changes that will do no harm (i.e. do not have the unintended side effect of degrading the quality of work).
Obviously, we need to translate these broad objectives into concrete steps and programs, but it is sometimes useful to first see the forest and then the trees. Broadly speaking, reducing unhealthy job stressors involves a workplace in which employees have a sense of control, connectedness, where they are working at a reasonable pace, where they are challenged and motivated, where they have a sense of support and security. We’ll get back to specific ideas along these lines shortly.
For now, we want to outline some workable steps to begin this process of change. You can’t change everything at once, so you need to prioritize what it is you want to tackle first. There are several useful ways to start this process, but perhaps the most manageable strategy is to offer an occupational stress workshop.
Offer an Occupational Stress Workshop
The workshop strategy has several advantages. It sends a message to employees that you are concerned about them and their stress levels. It will help to educate them so that you are all speaking a common language about stress. Finally, it can help to identify some of the most important personal and organizational concerns about the issue. In fact, for employees to take such a workshop seriously, it is important that discussion of both organizational change strategies and personal stress management be included.
This training can be comfortably done in either a half or full day session. Prior to the end of the training, you should ask participants to indicate if they are interested in working further on the issue of workplace stress.
Most organizations obtain participant evaluations as a routine part of any training. This practice is a particularly good idea for an occupational stress workshop. This type of feedback will help you judge the quality of the training, and how important a concern stress is to employees. Finally, the feedback may be extremely useful in demonstrating the need for additional programs or activities to reduce stress.
An occupational safety and health training agency in Massachusetts offered a stress reduction workshop to a diverse group of workers. They expected that the workshop would be of most interest to human service workers as well as other public sector workers. However, a number of workers from the manufacturing sector also came to the workshop and were active participants. One concrete benefit to emerge from the initial workshop was that both the training agency and the manufacturing workers realized the extent to which stress on the job was negatively impacting on the workers’ home lives. This led to additional training on coping skills and family dynamics. Workers participating in this second round of training found it to be extremely useful. A serious problem was identified, and employees were motivated to address it during the initial occupational stress workshop.
What to do After the Workshop – An Occupational Stress Committee
A reasonable next step might be the formation of an occupational stress committee. This group could meet on an ongoing basis and formulate a strategy for improving the work environment in your organization. This group should have a unique identity and focus. Group membership should include both labor and management. If employees are represented by a union or bargaining unit, they should be included in the committee. Potential conflicts with the collective bargaining process need to be avoided. If no bargaining unit exists, then a representative group of employees and administrators should attend meetings. Since this committee is examining issues of the work environment, everyone involved in that work environment should be involved including clerical, support and maintenance staff.
Employees from various departments, divisions, shifts, and work groups should be included. Management representatives should include persons with real authority in the organization.
It is also essential that employee representatives be protected from discrimination for their participation on the committee. The committee should be provided with adequate resources to make a serious and sustained effort. These resources might include access to relevant consultants, training materials, relevant records, and release time.
An effective committee needs an effective group of rules and guidelines. What should the committee discuss? What limitations are there? What topics are off limits because they are part of the collective bargaining agreement? How confidential should the meetings be?
Social scientists have written many volumes on what good group process is, but here are a few, brief common sense guidelines to start with:
· Every member of the group should be valued and have a chance to speak.
· There should be no negative consequences to opinions expressed in the meetings.
· The groups should be given a clear mandate and the authority to make specific recommendations. This includes a clear understanding of what issues they may not address because of collective bargaining restraints. (As one example, discussing salary levels and job categories would not be allowed outside of a collective bargaining process).
· Meetings should have a clear starting and ending time. Participants should understand that their time is valuable.
· The chairperson of the committee should be rotated between management and employees.
· The committee needs to be distinguished from other ongoing committees. This is not a training committee, or a productivity committee. This is an occupational stress committee and reducing stress levels and enhancing coping strategies should be its focus.
A public service agency on the East Coast formed a joint labor management stress committee after a survey of staff found serious morale problems. The ongoing committee consisted of both top administrators and union leaders, which gave it credibility with the rest of the staff. After determining what issues could be addressed by the committee, it generated a number of effective individual and structural strategies to improve the working climate of the agency.
Sometimes a committee can best get started by setting up a personal stress management activity along with an organizational activity. A personal coping strategy would be targeted towards the individual staff member while an organizational, or structural, change strategy is targeted towards the larger work environment. Of the two, structural strategies are more effective in reducing long term stress and risk of illness. At first, choosing projects small enough to succeed but large enough to matter is a good way of getting some momentum going and gain support for the committee. What follows are some specific strategies that parallel the broad organizational goals detailed above.
Increasing Employees’ Sense of Control and Participation in the Workplace
The key point here is to increase real control and participation; not the illusion of control. Possible workplace strategies:
1) Using staff meetings more effectively to encourage participation and input.
A state law had been passed in California that required more frequent staff meeting in hospitals. In one hospital, an organizational psychologist worked with employees and management to measure the effects of participation in decision-making on job stress, job satisfaction, absenteeism and turnover. Units where the intervention was carried out reported greater influence, less role conflict and ambiguity, less emotional strain, and greater job satisfaction, at 3-month and 6-month follow-up.
2) Develop autonomous work groups
Blue-Collar employees in a British confectionary company reported low scores on three job characteristics (autonomy, task identity and feedback), low work motivation, low job satisfaction and high levels of emotional distress. Increases in group autonomy were attempted by shifting responsibility and control to work teams and away from the supervisor. Teams had control over the work pace, organization of rest breaks, and allocation of overtime and assignments. Six months and 18-month follow up revealed reduced emotional distress and lasting increases in autonomy.
Increasing the Skill Levels of Employees
Healthy work is skillful work. It allows for the ongoing development of new skills and the opportunity to use them. There has been a great deal of discussion at the national level concerning the importance of high skill, high wage work in increasing the productivity of U.S. companies. Unfortunately, many of the jobs being added to the economy are extremely low skill ones. Possible workplace strategies to counter this deskilling effect:
1) Increased skill based training.
A public sector child welfare agency initiated a competency based training program that targeted core practice skills. The trainings were designed to improve the professional skills of the staff in handling difficult client situations. Participants in the training showed a significant decrease in psychological strain symptoms compared with a control group.
Skill development from this perspective should benefit the employee as well as the organization.
2) Use of career ladders to reward skill development.
3) Use of job rotation to expand skills.
4) Use of job redesign to increase range of skill needed.
5) Healthy use of computers for skill development.
An intervention designed to improve the case practice skills of child protective workers utilized interactive, multimedia computer-based training to both provide information, and to encourage further development of computer skills. This project also had extensive input from the staff regarding the design and implementation of software utilized by the agency.
Increasing Levels of Social Support
Key components to social support in the workplace are supervisory support and coworker support. Possible workplace strategies:
1) Training in proactive supervision.
This supervisory approach emphasizes positive feedback, employee growth and development, open lines of communication, and strong levels of support.
2) Training in conflict resolution and team building.
3) Appropriate use of staff retreats.
Changes that Improve Physical Working Conditions
There is extensive evidence that poor physical working conditions contribute not only to physical hazards, but stress levels as well. Possible workplace strategies:
1) Improving indoor air quality.
2) Reducing levels of physical hazards such as noise, toxins, chemicals, etc.
3) Job redesign to reduce incidence of repetitive strain injuries (that is, reducing repetitive work, awkward work postures and/or heavy lifting.
Healthy Use of Technology
1) Healthy use of computers
More and more of our working time is spent in front of computers. While they can be a tremendous help in our work, they can also increase stress levels if the computer work is poorly designed. Cumulative trauma disorders can be a particular physical hazard of increased computer use.
Good ergonomics is a key to healthy computer use. State health departments usually have someone who is an expert in this area. They can help you with proper equipment, lighting and pace of work issues. They can also help you reduce the risk of repetitive strain injuries among your staff.
2) Staff involvement in choosing new equipment:
This is a common sense strategy that is often overlooked. Allowing the end users to be able to make informed choices about the type of equipment to be purchased. This can have payoffs for both job satisfaction and productivity.
A large state human service agency was planning to buy new computer work stations for its 3000 employees. This represented a tremendous expenditure for the agency. Instead of making a unilateral decision, they put three different work stations in one office and left them there for two months. At the end of that time, they asked the staff which work station they preferred, and the overwhelming favorite turned out to be the least expensive, and was purchased state wide.
Maintaining Job Demands at Healthy Levels
Human beings can become sick if they work too long at a high sustained pace. They are at their most productive and healthy if they can work at a manageable level. Possible workplace strategies:
1) Reduced use of overtime
2) Caseload restrictions
3) Brake mechanism – an administrative group designed to reduce the amount of change the organization initiates.
4) Formation of “What don’t we need to do?” committee – an internal group charged with finding low priority or unnecessary tasks. Job reduction is not a goal of this approach.
Changes that Provide for Job Security and Career Development
Frequently, workplace changes occur in a climate of job insecurity or downsizing. From the perspective of occupational stress, changes that are intended to eliminate jobs are usually incompatible with efforts to improve the quality of the working environment. Employees are particularly resentful of participating in changes that may well lead to their own job loss such as time and motion studies.
More positive approaches attempt to use the skills of existing employees in a more effective manner. Possible workplace strategies:
1) Extension of career ladders.
2) Expansion of responsibilities and tasks.
A private company in Sweden provided mechanisms for their clerical employees to increase their skill levels, job responsibilities and depth of specialization. Nearly half of the secretaries were eventually promoted to higher job classifications, opening up new career opportunities for them. This process also generated a number of proposals for improved productivity at the company.
Changes that Provide Healthy Work Schedules
Work schedules can have positive or negative health consequences. A number of studies have associated poorer physical and psychological functioning with rotating shifts. On the other hand, more flexible work schedules have the potential of improving employee satisfaction and reducing stress. Possible workplace strategies:
1) Reduced use of forced overtime
2) Rotating shifts in a forward (day to night) schedule.
3) Use of flextime and other alternative work week schedules.
A public sector agency responsible for environmental protection implemented an Alternative Workweek Program for some of its employees. After the program had been in place for approximately 8 months, participants, non-participants and managers were surveyed regarding their satisfaction with the plan. Strong majorities in all three groups expressed satisfaction with the program. Virtually all participants reported that the program improved the quality of their working life, gave them increased flexibility and control over their schedules, improved their productivity, reduced their stress levels, and allowed them to more easily balance work and family responsibilities. Participants in the program also had a significant drop in sick day use compared with non-participants.
Strategies to Improve Personal Coping Mechanisms
Individual strategies are easier to initiate but should never be seen as an equivalent substitute for organizational change. These strategies can, however, be very useful companions to structural change efforts.
One good distinction for person change strategies is the difference between functional and dysfunctional coping mechanisms. All human beings have coping mechanisms. Unfortunately, these mechanisms are not always the most effective or functional. The goal is to replace dysfunctional coping mechanisms with functional ones. Some healthy choices:
1) Improving the diet of employees:
Possible work place strategies: bring in a nutritionist for a day of training, encourage employees to keep diet diaries for a week, offer nutritional foods at the worksite, form a healthy snacks club.
2) Encouraging the employees to exercise.
Possible work place strategies: start a walking club at lunch time, look for group discounts at nearby health clubs, bring in a fitness trainer for an in-service day, provide exercise equipment or facilities.
One intervention study found that combining a health risk assessment with behavioral counseling was effective in reducing some cardiovascular risk factors. This program gave workers a health assessment, education on the risk factors of cardiovascular disease and provided them some behavioral counseling. Among other suggestions, the counseling sessions encouraged workers to stop smoking, improve their diet and increase their exercise level.
3) Training in deep muscle relaxation techniques.
Psychologists have known for some time that anxiety and deep muscle relaxation are mutually exclusive. That is, you can’t be anxious and relaxed at the same time. This finding has been used to successfully treat many phobias, but it can also be a useful strategy for dealing with stress. The goal is to train your employees to be able to become relaxed on demand, thereby cutting the stress cycle short. One widely used relaxation technique was developed by Edmund Jacobsen. It is an effective method for training individuals how to relax their major muscle groups. There are other useful techniques available for employees working on computers.
Possible workplace strategies: Many stress management consultants are able to train your employees in these techniques. A good use of an in-service training day would be to bring in a consultant and either have them train all your employees, or intensively train a small group who would then become your in-house trainers. You want to be sure that you learn some “quick” relaxation techniques. These can be performed in just a few minutes on the job.
4) Training in effective cognitive strategies.
There are several potentially useful techniques here. Remember that something is not stressful unless it is perceived or appraised as stressful. Cognitive psychologists have developed techniques that replace negative cognitions (that is Ñ negative thoughts like “I will never be able to figure this out”, with more positive, empowering thoughts like, “I can get this done if I just take it one step at a time”). Another useful strategy is called thought stopping. Since we know that negative thoughts can increase anxiety and therefore stress symptoms, psychologists have learned to train individuals to literally “stop” these thoughts before they become too repetitive. These techniques have been found to be extremely useful for people who have serious problems with anxiety or depression. However, they can also be effective tools in the workplace.
Some possible workplace strategies: Realistically, these techniques require a trained professional. You should find a competent cognitive psychologist in your area and ask him/her to come in for an in-service day or work through an Employee Assistance Program.
5) Training in Substance Abuse Awareness.
Individuals who are under a great deal of stress begin to self-medicate themselves in order to feel better. They may drink more, take more prescription medication, or take illegal drugs. Every organization has individuals who may already have serious problems in this regard. These individuals probably need professional help. Substance abuse awareness is best used as a preventative measure.
Possible work place strategies: there are many resources available in the community for substance abuse awareness training. Many human service agencies are willing to do this kind of outreach for free, and many schools are now hiring well qualified counselors who could be an important resource to your employees, or you can establish your own employee assistance program.
6) Organize discussion groups on healthy stress reducers.
The idea is to get employees to share effective strategies with each other.
Possible workplace strategies: this strategy does not need external resources. You can simply pull together a meeting where people share the stress reducers that work for them. You may want to prepare a handout ahead of time that reviews examples of healthy coping mechanisms. This will help to structure the discussion and provide an opportunity for some additional training. An added benefit of this approach is that it also provides a mechanism for giving social support to employees.
7) Transition time.
Many employees leave their jobs only to return to stressful conditions at home. They may have families to take care of, meals to cook, or older parents to visit. Remember that it can take a good 20 to 30 minutes for the body to return to baseline after experiencing a stressor. If the employee walks into their door “stressed out” and then has to deal with a difficult situation at home, their chances of having long-term health consequences increase. Obviously the work place isn’t responsible for solving employee’s domestic problems. But it is in your interest to have the healthiest possible workers. Transition time can be a useful technique in short circuiting the stress response at home. The basic idea is to train employees to find a way to relax for 20-30 minutes before assuming family responsibilities. This allows the body’s autonomic responses (heart rate, blood pressure, etc.) to return to baseline.
8) Leaving stress at the front door – training on family dynamics and parenting skills.
There’s been a good deal of research showing that, as stress increases, so do family problems. It is very easy for angry, frustrated employees to take stress out on their families. Even healthy, supportive families can go through some rough times. Parents who had few problems with their children suddenly have major difficulties with them in adolescence. Again, the work place is not responsible for domestic violence. But improving your employees’ abilities to handle pressures at home can have major payoffs for your organization.
Possible workplace strategies: Many human service agencies can provide your staff with training on family dynamics, dealing with aging parents and parenting skills. You could also consider forming a short term discussion group for employees who are interested in these topics.
Developing Strategies that Do No Harm
It is surprisingly easy to initiate an intervention strategy that results in a deterioration of the quality of working life. One common problem is spending considerable effort in identifying stressors on the job, and then not addressing them in a serious way. Or designing an intervention of insufficient intensity or duration. Or making changes that have the net effect of making employees feel more overwhelmed and confused than before. Or implementing changes that undermine the existing collective bargaining process. Change for the sake of change is not a goal of stress reduction programs.
One effective way to avoid these negative outcomes is to design an assessment mechanism (for example, a survey, or medical record reviews) that will accurately measure key aspects of the work environment and stress symptoms before, during and after your efforts. If these assessments tell you that levels of support are increasing, that is an excellent indication that your supervisor training program is having the desired effect. If, on the other hand, levels of perceived control actually start to decline, you might want to reevaluate the structure of a work organization change.
Important Things to Assess
Since this approach focuses on reducing occupational stress and strain, any assessment of the process should include the following:
· Has social support (both co-workers and supervisory) increased?
· Have job demands decreased?
· Have employees’ sense of autonomy and control increased?
· Has job satisfaction increased?
· Have skill levels and use of skills increased?
· Have physical or psychological stress symptoms decreased?
A positive finding on any of these measures is an encouraging affirmation of healthy organizational change.
Organizational change that improves employee health is hard. While changing individual behavior is tough, changing organizations is even more difficult. However, it is also important to remember that the costs of stress can be extremely high. Initiating change may require a considerable effort, but allowing inertia or the illusion of change to take over may exact an even higher price.
*Adapted from UAW Region EAP program
Health care costs consume a growing part of the costs of doing business. Job stress has been estimated to cost American industry $150 billion per year in:
To get some perspective, these costs are more than 15 times that of all strikes combined. For example:
Stressed workers smoke more, eat less well, have more problems with alcohol and drugs, have more family problems, are less motivated on the job, have more trouble with co-workers, and have more physical illnesses.
Even reducing only the most high strain jobs will translate into a healthier and more productive work force.
A well designed stress reduction program addresses all three levels. But note again, of the three, the organizational level is by far the most important.