Podcast: Wellness, Job Insecurity, Unemployment, and Authenticity

in industrial organizational psychology, job strain, Uncategorized

This episode of the Redesigning Wellness podcast (below) is brilliant. Kudos to Chrissy Ball, Michelle Bartelt, and Scott Dinwiddie for having the courage to share their experiences and feelings around job loss. Thank you Jen Arnold for organizing and facilitating a bold conversation.

My take: As much as we wellness pros talk about “authenticity,” we rarely display it. Perhaps we feel obligated to project a veneer of exuberance. Indeed, this often seems to be expected. (I had a boss lament that she’d always imagined her wellness director would be “peppy” — which I proudly am not.) These panelists model real wellbeing as they describe hard times — anger, sadness, fear, and separation (as well as resilience, connection, and growth).

This conversation reminds us of the psychosocial influences on wellbeing that too often are obscured by our preoccupation with behavior change. Key amongst these is *job security*, as well as employment itself and role identity.

As we listen, we’ll do well to think of workers who are struggling — single parents, folks living on the poverty line, et al — and how their wellbeing is threatened by job insecurity and unemployment. How can we, as wellbeing leaders, help?

225: Job Loss During a Pandemic with Chrissy Ball, Michelle Bartelt, and Scott Dinwiddie

Supporting worker sleep is good for business

in industrial organizational psychology, job design, job strain, total worker health, Uncategorized
Don’t sleep on the job.
Matthew Jacques/Shutterstock.com

Leslie Hammer, Oregon Health & Science University and Lindsey Alley, Oregon Health & Science University

A long-haul truck driver fell asleep during his shift in Sunbury, Pennsylvania, on Jan. 13. Heading north on Route 147, he drifted into the eastbound shoulder for almost 375 feet, struck the side of the road and flipped his rig. Thankfully, the driver only suffered a minor injury and nobody else was harmed.

Poor sleep affects up to 70% of Americans and increases the risk of shortened lifespan and death. This includes deaths and injuries related to road accidents, stroke and reduced cardiovascular health. Continue reading »

Our Usual Construct of Psychological Safety Isn’t Enough

in burnout, job strain, total worker health

woman in psychological distress

Gruesome. A worst case scenario that exemplifies why it’s not enough to view psychological safety as encouraging risk-taking and authenticity. We have to use what we know about workplace psychosocial risk factors — like organizational injustice, job insecurity, and social isolation — to prevent psychological injury.

Click on image or here to read the New York Times article, “35 Employees Committed Suicide. Will Their Bosses Go to Jail?

Notes on Physician Burnout

in job strain, Stress

When job burnout was first described by Christina Maslach et al, it was specific to caring professionals. Eventually, it was found that it can occur in all occupations and across all demographics. Physician and nurse burnout has been the hot topic the last few years, though a recent meta-analysis pointed out that there’s little that can be concluded about physician burnout because of the level of variation in definition and measurement (a lot of people disagree with this).

Studies have found that pervasiveness of Electronic Medical Records plays a big role in physician burnout. This makes sense, as it can be connected to several of the known burnout antecedents, especially autonomy/control, but also unsatisfactory social interaction and values conflict.

For anyone who wants to quickly get up-to-speed on burnout research, I recommend “Burnout: 35 years of research and practice,” authored by Schaufeli, Maslach, and Leiter.

Behavior-Based Programs Have Their Place — Near The End Of An Employee Wellbeing Process

in job design, job strain, total worker health, Uncategorized
NIOSH Hierarchy of Controls for Total Worker HealthHierarchy of Controls applied to NIOSH Total Worker Health

I agree with the position paper, Behaviour-Based Safety Programs, recently published by The International Union of Food, Agricultural, Hotel, Restaurant, Catering, Tobacco and Allied Workers’ Associations (IUF). An employer’s primary role in employee wellbeing is to protect employees from Continue reading »

Effort-Reward Imbalance Underpins Worker Stress

in industrial organizational psychology, job design, job strain, Stress, total worker health, Uncategorized

effort-reward balance scaleIt may be hard to get your brain around abstract models of stress, especially when they don’t line up with the usual fright-or-flight illustrations or seem remediable by the relaxation tips commonly sold as solutions. But if we care about workers, and how employers may be able to help them, we can’t ignore the harmful effects of effort-reward imbalance.

Think back to Psych 101 and you’ll remember that most human transactions are based on our expectation of an even exchange, or social reciprocity. It’s like an unwritten contract. We’re hard-wired for evenhandedness, and when we get — or believe we’ve gotten — a raw deal, we suffer from physical and emotional stress.

In the workplace, employees trade their currency — effort — for the employer’s currency, rewards, which include:

  • compensation
  • job security and prospects for promotion
  • respect and prestige within the organization

The balance — or imbalance — of effort and reward may be influenced by an employee’s motivational style, especially for employees who are intrinsically driven to overextend their effort independent of rewards, often to fulfill their underlying longing for approval. This surfaces as “overcommitment” in the effort-reward imbalance model.

When physical and or mental job effort outweigh the reward — or employees perceive the balance to be out of whack — the result is chronic stress and, over time, the physical and mental problems that stress can lead to.

This understanding of work stress was first conceptualized by medical sociologist Johannes Siegrist.

The model of effort rewards imbalance claims that lack of reciprocity between costs and gains (i.e., high-cost/low-gain conditions), define a state of emotional distress with special propensity to autonomic arousal and associated strain reactions.

— From Johannes Siegrist’s seminal paper, Adverse Health Effects of High-Effort/Low-Reward Conditions 

Siegrist’s theory was put to the test in Britain’s classic “Whitehall II Study,” which followed more than 10,000 civil service workers for 11 years. Results showed that effort-reward imbalance led to increased risk of cardiovascular disease, as well as declines in overall physical and mental health. Study subjects who were lower on the organizational chart and those with less workplace social support had the highest levels of risk among those with effort-reward imbalance. Since then, research has shown even more pronounced effects of effort-reward imbalance, especially on the risk of heart disease and depression — based on rigorous studies of employees in a wide range of occupations working in countries across the globe.

The Whitehall researchers, led by social determinants of health pioneer Sir Michael Marmot, felt their results showed that cardiovascular disease and other stress-related illnesses could be prevented by improving work conditions. Their work led to a campaign to encourage employers to:

  • Improve rewards by recognizing good job performance
  • Encourage job-skill and professional development
  • Increase salaries
  • Foster social support at the workplace
Siegrist has proposed additional solutions:

  • Leadership development among supervisors, emphasizing the importance of esteem, recognition and appropriate feedback.
  • Building upon non-monetary rewards, like flexible work options, more effectively matching job status to achievements, and fostering job security.

Effort-reward imbalance is one of the two most influential frameworks for understanding job stress, alongside the demand-control model of job strain. In fact — despite our preoccupation with other models that push accountability for stress solely on workers — regarding both demand-control and effort-reward imbalance, Siegrist wrote in 2014:

Empirical evidence on their health-adverse effects is far broader than is currently the case for any other stress-theoretical model related to work and employment.

Ultimately, most elements of the psychosocial work environment can be plugged into one or both of these models.

Whether effort-reward imbalance is a product of employee perception or actual work conditions remains a topic of debate. Most likely, both play a role. Certainly, job demands and job control have been validated as causes of cardiovascular disease and high blood pressure, in contrast to trendy notions that stress is a mindset or is a good thing and that employees are on their own to address it. The role of personal interventions is to help employees with problem-solving skills that can help them advocate for themselves, assess their level of effort as objectively as possible and, in some cases, moderate overcommitment. Stress management and resilience programs may play a supporting role.

Further Reading
  • For a good overview of effort-reward imbalance, and researching showing how it leads to cardiovascular disease, see Siegrist’s 2010 overview from the International Journal of Occupational Medicine and Environmental Health, Effort-Reward Imbalance at Work and Cardiovascular Diseases.
  • Siegrist’s overview of effort-reward imbalance and depression has not been translated into English, but you can read the abstract here.

Mapping Workplace Demons to Health, Costs, and Mortality

in job design, job strain, Stress, Uncategorized
Desk worker stressed with long working hours

Photo courtesy of Adam Foster. http://ow.ly/MKMke

The workplace demons that threaten employee health include long work hours, job insecurity, low job control, high job demands, shift work, effort/reward imbalances, role ambiguity, work-family conflict, inadequate workplace social support, and unfair treatment. These can be bucketed in various ways, but whatever you call them, they are the work conditions — controllable by employers — that research has consistently shown to influence employee health and well-being.

Now, along comes a study out of Stanford University that not only endeavors to quantify the burden — in terms of health outcomes, cost, and mortality — of these demons (what the researchers called “stressors” and I sometimes refer to as the workplace determinants of health), but also puts it into context relative to other, more commonly recognized, health issues.

Spoiler alert: More than 120,000 deaths per year and approximately 5% to 8% of annual healthcare costs may be attributable to how U.S. companies manage their workforce, according to this analysis. The mortality rate for these stressors, plus another the researchers found to have significant impact — lack of health insurance — was on par with the fourth and fifth largest causes of death in the U.S.: heart disease and accidents. It was greater than mortality resulting from diabetes, Alzheimer’s, or influenza.

Exposure to the following stressors was found to be more harmful than secondhand tobacco smoke:

  • Lack of health insurance
  • Low organizational justice (fairness)
  • High job demands
  • Shift work
  • Unemployment

And — again, using secondhand smoke as a benchmark — the conditions that had a greater affect on mortality are:

  • Low job control
  • Unemployment
  • Long work hours
  • Lack of health insurance
  • Work-family conflict

The Stanford researchers concluded,

Employers may not make appropriate decisions concerning workplace management if they are unaware of the link between management decisions and employee health and healthcare costs. Our analysis suggests that for such organizations, paying attention to the structure of the workplace and the associated job stressors experienced by their employees may be a fruitful way to reduce unnecessary healthcare costs.

But they acknowledge that employers may have limited motivation to address these issues if, indeed, they’re not on the hook for the costs of health care — for example, in the cases of employees who have been laid off or who are not offered health insurance. The study didn’t delve into associations between stress and productivity.

The analysis was conducted by Joel Goh, Jeffrey Pfeffer, and Stefanos A. Zenios and published in Management Science. Goh is now on the faculty of Harvard Business School.

The researchers are conservative yet insightful in their expectations regarding the implications of their work:

While we stop short of claiming that employer decisions have a definite effect on these outcomes and costs, denying the possibility of an effect is not prudent either. Analyzing how employers affect health outcomes and costs through the workplace decisions they make is incredibly important if we are to more fully understand the landscape of health and well-being.

And what of our current approach to employee well-being, with its slaphappy embrace of screenings, health risk assessments, health coaching, apps, wearables and incentives? How does it jibe with the real determinants of worker health? Not very well, according to study co-author Jeffrey Pfeffer. In his YouTube interview for the Stanford Graduate School of Business, he says,

Employers worry mostly about individual decisions: eating, exercise, smoking, drinking…things like that. Or about policy issues like how we pay for health care. A lot of their excess health care costs come from what happens to people every day in the work environment… Things that employers could fix, if they wanted to.

Desk worker stressed with long working hours

Read Dr. Pfeffer’s summary of this research in the Fortune article, “Is Your Employer Killing You?


[This post was originally published on Bob Merberg’s Health Shifting blog on May 12, 2015. Edited on March 21, 2018 — minor word changes — for clarity.]

How Unhealthy Is Job Strain?

in job design, job strain, Stress, Uncategorized

job strain is harmful to employee health and wellbeingJob strain is a particularly insidious form of stress that goes far beyond overflowing inboxes or tight deadlines. It is characterized primarily by organizational environments and job structure in which employees have high levels of demands placed on them and limited control over those demands (that is, low “decisional latitude”). This is the demand-control model that was originally described and measured by Robert Karasek. Other organizational and job-related factors that contribute to unhealthy job-related stress are effort-rewards imbalances, long work hours (sometimes including long commutes), job insecurity, and lack of social support on the job. Some researchers have categorized all of these stressors as job strain, others differentiate them. But most agree that these stressors — all related to organizations and job design and not to individual behavior — lead to negative health outcomes.

How unhealthy is job strain?

Job strain has been linked to hypertension and to heart disease. This is not a simple matter of people who have other risk factors, like pre-existing hypertension or what used to be called Type A personality, being drawn to stressful jobs. Research suggests a causal relationship between job strain and both hypertension and cardiovascular disease. (Some studies also have linked job strain to depression, musculoskeletal disorders, dyslipidemia, physical inactivity, obesity, and adverse birth outcomes.)

Blue collar workers are more prone to the effects of job strain compared to white collar workers, but no one is immune.

Not every study of job strain has confirmed this relationship, but most have. A 10-year prospective study of 22,086 female health professionals, published in 2012, revealed that women with active jobs (high demand, high control) and high levels of job strain (high demand, low control) were 38% more likely to experience a cardiovascular disease event (such as heart attack or diagnosis of atherosclerosis) compared to women reporting low job strain. During the study, there were 170 myocardial infarctions, 163 ischemic strokes, 440 coronary revascularizations, and 52 cardiovascular-disease-related deaths, reaffirming that cardiovascular disease is a major concern for employers and for public health.

A Finnish study of 812 employees, followed for more than 25 years, found that employees with high demands at work and low job control had a 2.2-fold increased cardiovascular mortality risk — independent of other risk factors — compared to their colleagues with low job strain.

Earlier this year, an Israeli study confirmed a link between job burnout and coronary heart disease. Job burnout was defined as physical, cognitive, and emotional exhaustion that results from stress at work. Factors contributing to burnout included most of those typically associated with job strain or job stress: heavy workload, lack of control over job situations, lack of emotional support, and long work hours. Over the course of the study, 8,838 male and female employees were followed for an average of 3.4 years. Each subject was measured for burnout, which, as it turned out, was associated with a 40% increased risk of developing heart disease. Of greatest concern, the 20% of participants with the highest burnout scores had a 79% increased risk of heart disease.

A British study of 6,014 workers, followed for an average of 11 years, found that three to four hours of overtime per day is associated with a 1.6-fold increase in coronary heart disease risk, independent of other risk factors. (More about overtime in a future post.)

Countless research studies have demonstrated the relationship between job strain and health.

Unlike many other countries (again…especially Scandinavian countries), American employers continue to insist on offering employees behaviorally based stress management programs, such as relaxation programs and time management seminars, rather than trying to address the program where the employer actually has the most control: the structure of the organization and the jobs within it.

Even the National Institute for Occupational Safety and Health declares, “Working conditions play a primary role in causing job stress” and it advises,

As a general rule, actions to reduce job stress should give top priority to organizational change to improve working conditions.

Check out the NIOSH page for some ideas about the type of organizational change that is needed.

Emphasis on the organization’s role, rather than the employee’s role, may have applications beyond stress. Fitness challenges, biggest loser contests, tobacco-free campuses, incentives, health risk assessments, coaching, health screenings, yoga classes, and even culture-of-health have limited potential to evoke meaningful population health improvement…as long as the roots of the problem persist.

[A version of this post was first published on Bob Merberg’s Health Shifting blog on December 20, 2014]