A Successful Work and Family Stress Program — Looking Back

in EAPs, Stress, Uncategorized, Wellbeing

health care worker with stress

I’ve fessed up about two of my employee mental health flops. But I’ve had successes, too, including providing health care workers with one of the best-proven opportunities to get stress under control.

The scene was a large population of employees at a major medical center, where I served as employee wellness program manager, and partnered with our internal Employee Assistance Program (EAP) to offer the Yale Work and Family Stress Program. EAP counselors went to Yale to get trained on the program, and made a few adaptions suitable for our health care worker population. Continue reading »

My 2 Biggest Employee Mental Health Flops

in Stress, Uncategorized, Wellbeing

What Were You Thinking?

Podcast interviewers and conference organizers often ask me to talk about my mistakes and failures. Thank you very much.

It’s okay; I get it. Others can learn from our mistakes and also take solace in the fact that we all make them. Listening to some presenter prattle on about how perfect their programs are  especially when they’re from companies with nearly unlimited resources  can be discouraging rather than inspiring. (Besides, if our professional social media is pervaded exclusively by self-promotion and ungrounded thought leadership, it’s hard to grow in a way that’s relevant to the real-life work environment.)

For some reason, two of my professional flops fell in the realms of mental health and emotional well-being. Continue reading »

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.

Japan Gets Real About Workplace Stress

in Stress

Job Stress

In 2015, Japan passed a law requiring businesses with 50 or more employees to offer workers an annual assessment — the “Stress Check” — which measures risk of stress and other mental health concerns based on three domains:

  • Psychosocial and other stressors in the work environment, including job demands, job control (autonomy), work intensity, and sense of purpose.
  • Mental and physical symptoms of stress like irritability, exhaustion, difficulty concentrating, musculoskeletal discomfort, difficulty sleeping.
  • Social support, including connection with supervisors, co-workers, and loved ones.

The Japanese government recommends their 57-question assessment tool, the Brief Job Stress Questionnaire (BJSQ). Take a look at the English version here. Employers can use alternative questionnaires, but they’re required to include the same domains — workplace stressors, symptoms, and support.

The law — designed to help prevent stress in response to an epidemic of stress-related death and disease — mandates that

  • Employees are given the results of their Stress Check.
  • Employees found to be at high-risk for potentially harmful stress are referred to a physician.
  • Employers modify stressful work conditions (such as schedules, work location, or responsibilities) in collaboration with high-risk employees’ physicians.
Stress Check process (click to enlarge)

The law encourages employers to improve the workplace environment based on analysis of their group’s data. Specific interventions aren’t prescribed, although models and case studies are available.

The law prohibits release of employees’ data to employers without the employee’s permission, and it prohibits discrimination based on Stress Check participation or results. Though employers are required to offer the Stress Check, workers aren’t required to participate.

No one’s advocating a program like this outside Japan, but it should evoke dialog among wellbeing professionals and enlighten how we view job stress.

  • Japan — like much of Europe, Canada, and the US’s NIOSH — recognizes that job stress is rooted in workplace risk factors: lack of autonomy, role ambiguity, job insecurity, lack of social support, excessive demands, harsh environments, inadequate rewards, work/life conflict, and unfair treatment.

The Stress Check questionnaire draws on a growing body of evidence showing that it does, indeed, identify people who are at high risk of mental health-related disability.

As for intervention… There’s a lot of experimentation to be done before we can definitively say what works. To date, evidence supports organizational change more than personal interventions to prevent worker stress.

Recently, a small initial study failed to demonstrate positive outcomes for either the questionnaire alone or for workplace interventions alone. However, the researchers reported:

Combining the annual stress survey with improvement in the psychosocial work environment can effectively reduce psychological distress.

Like it or hate it, the Stress Check program is innovative. We’re reminded that innovation is not always technology driven. We need innovators to follow Japan’s example and take a fresh look at our job stress paradigms.

Job Demands-Resources: Untangling Stress and Motivation

in job crafting, Stress
Still shot from Charlie Chaplin's "Modern Times" illustrating high demands, low resources, no social support on an assembly line.

High demands, low resources. No social support.

To understand what job crafting has to do with employee health and wellbeing, it’s important to understanding the inner workings of job stress and motivation.

In a previous post — “I’ve Seen the Future of Employee Wellbeing: It’s Name Is Job Crafting” — I explained how, in 2001, Amy Wrzesniewski and Jane Dutton proposed that employees tweak their job tasks, workplace social connections, and perspective about their role to gain a greater sense of purpose and meaning, potentially leading to better job performance.

Around that same time, in the Netherlands, Evangelia Demerouti, Arnold Bakker, and others introduced their model of Job Demands-Resources (JD-R), which has since been fine-tuned and validated as relevant to a full range of occupations and outcomes in countless studies around the world.

If you’re familiar with job stress research, you know that job stress has causes, and shouldn’t be dismissed as a choice employees make.

Forget trendy notions that “stress is good.” It’s wishful thinking based on cherry-picked evidence. If stress is so great, why aren’t employees demanding more of it?

Forty years of research has shown that harmful job stress is a result of jobs that have low levels of autonomy and high demands.

Job Demands and Autonomy Are Linked to Health Problems

Over the years, job autonomy (or control) has been defined different ways, but can be broadly understood as limited flexibility (for example, with the tasks of the job) and limited decisional latitude, meaning the employee isn’t permitted or encouraged to make decisions in their work or about their work.

Job demands originally meant the psychological intensity of work, but ultimately can be understood to include workload, time pressure, and physical demands.

Job strain illustration shows relationship of demands, control, social support, and health.

Job strain

Robert Karasek introduced the theory of demands and control in 1979. He and others have shown that jobs in which workers consistently encounter high job demands with low job control — the combination of which is called job strain — are linked to a variety of health issues, especially high blood pressure and cardiovascular disease, as well as depression, anxiety, burnout, and metabolic disorders. Reducing job strain can improve productivity.

Karasek later learned that social support “buffers” the negative effects of high-strain jobs. Social support originally meant supervisors’ and co-workers’ support for performing job tasks, but can be understood in all of the many ways it’s been defined: Having a sense of “belongingness” at work; having co-workers who are empathetic and confidantes; having supervisors who take a genuine interest in the personal and professional lives of team members; and having a best friend at work.

In sum, high demands and low control are an unhealthy combo. (High demands and high control are not necessarily bad.)

Effort-Reward Imbalance Is Linked to Health Problems

Unhealthy job stress has been framed in other ways. Germany’s Johannes Siegrist found that work in which the required effort is disproportionately high compared to the job rewards— effort-reward imbalance — leads to the same kinds of health problems that result from job strain. “Rewards,” here, doesn’t just mean financial compensation, but also career opportunities and level of esteem within the organization.

The effort-reward imbalance model reminds me of an encounter I once had with a business analyst who transferred to another department because she didn’t feel valued in the department she was hired into. When I asked her, “What would have made you feel more valued?” her answer was not “better pay” or “someone saying ‘good job’”…

“I just wanted someone to listen to my ideas,” she told me.

A worker who doesn’t feel valued (i.e. esteemed) by being “listened to” is likely to have a higher level of disengagement and health impairment. This offers a glimpse into how management style, job design, organizational culture, performance, turnover, health, and wellbeing are all interconnected.

Overtime, Job Insecurity, Injustice, and More…

Several other causes of job stress have been identified, and most of them can in some way fit into the demand-control and/or the effort-reward imbalance model:

      • • chronic overtime
      • • job insecurity
      • • work-life conflict
      • • role ambiguity (not being clear of what’s expected, receiving contradictory direction, duplication with other workers’ roles, or not understanding how the work fits into the overall organization — all of which are among the most common complaints I’ve heard from employees who report high job stress).
      • • organizational injustice (being treated unfairly, which at the extreme includes bullying and harassment)
      • • lower levels of status within the organization
      • • sustaining high levels of vigilance (e.g. first responders, air traffic controllers, etc.)

Back to Bakker

The overlaps between and the nuances of these job stress theories makes them difficult to understand and apply. That’s where Bakker and Demerouti’s Job Demands-Resources model comes in. While building on the existing theories and expanding upon them, it also provides a simpler way of making sense of job stress and motivation. I consider it a comprehensible and practical  unifying theory.

JD-R posits that all job traits can be categorized as either demands or resources. 

      • • Demands require sustained effort from employees. They’re an expenditure of personal energy.
      • • Resources help fuel progress toward work-related goals. They’re restorative, buffering the effects of job demands —and activating personal development.

I interpret JD-R to mean that Karasek’s “demands,” Siegrest’s “efforts,” as well as role ambiguity, job insecurity, injustice, tedium, and work-life conflict are demands.

Job autonomy, social support, rewards, recognition, feedback, task variety, and training are examples of resources.

Side note: If you’re familiar with Edward Deci and Richard Ryan’s self-determination theory — popularized in the Daniel Pink bestseller, Drive — which tells us that motivation and flourishing depend on autonomy, competence, and relatedness (i.e. social connection), you may recognize that job resources generally can be matched to the components of self-determination.

So…

      • • Demands regulate job stress. 
      • • Resources regulate job motivation and engagement. 
      • • And the two forces may act upon each other.

Looking Forward…

That’s enough theory for now. What I’ve come to appreciate about JD-R is how, according to research by Bakker and others, it serves as a foundation for a practical application: job crafting.

JD-R takes job crafting beyond meaning and purpose — which has received most of the public attention — and ties it directly into health and wellbeing.

I’ll spell this out further in a future post, and also draw the important distinction between positive and negative job demands. I’ll share what research shows about the effectiveness of job crafting interventions for improving employee wellbeing, work engagement, absenteeism, performance, and productivity. And I’ll offer evidence-based tips on how you can prime your organization for job crafting.

*************

For an excellent overview, see Bakker and Demerouti’s 2016 article: Job Demands-Resources Theory: Taking Stock and Looking Forward

Dealing With Burnout

in industrial organizational psychology, Stress, Uncategorized

burnt out personIf you can find some downtime (or some treadmill time?), listen to “Dealing With Burnout” the Wisconsin Public Radio Morning Show. One of the guests was Monique Valcour PhD CPCC, who has a gift for articulating, in super-practical terms, the connection between work and wellbeing. Monique explains what burnout really is, and delivers keen insight when the first caller makes a reference to the role of autonomy in addressing his own burnout. She talks about burnout as an “interpersonal phenomenon” and notes the supportive effects of mindfulness and emotional intelligence. And she provides practical tips for workplace leaders.

By the way, not only is it essential for us wellness professionals to address the burnout that occurs amongst employees, but I’m observing that it’s increasingly common within HR, Employee Benefits, and Employee Wellness teams. So if you don’t feel the need to learn about burnout for your organization, learn about it as an act of compassion for yourself.

https://www.wpr.org/shows/dealing-burnout

 

 

Holiday Stress Programs? Bah!

in Commentary, Employee Wellness Programs, Stress, Uncategorized

The Joy of Sharing image

It may be too late for employee wellness professionals to adjust their plans for holiday-season programs this year, but now is an ideal time to rethink the holiday stress programs we typically offer.

Every December, wellness program managers promote programs about managing “holiday stress.” These commonly take the form of lunch-and-learns or communication campaigns. They have the usual catchy titles like Holiday Stress Less and Take the Hassle Out of the Holidays.

The holiday season is stressful for many employees — no doubt about it. And it’s distinct from other sources of stress in the workplace in that the conditions that cause holiday stress can, indeed, be modified with behavioral approaches.

But I suspect that our holiday stress programs add to employee stress. They contribute to a culture that considers stress the primary mental state in which we experience the holidays and, as such, comprise a self-fulfilling prophecy.

May I suggest a new approach to promoting mental health during the holidays, even if some of the content may be the same? Let’s offer programs that promote happiness and joy, rather than just trying to remediate stress. Next year, instead of teaching people to manage holiday stress, why not teach them how to nurture their holiday happiness? Why not publish newsletter articles like “How to Share Holiday Joy”?

Instead of “5 Tips for Managing Your Holiday To-Do List,” how about “101 Reasons to Enjoy a Holiday Vacation”? Rather than “Balancing the Burdens of Work/Life During the Holidays,” how about “Focus on Family this Holiday Season!”

[Originally posted by Bob Merberg in May 2010 on the In TEWN blog.]

“Health Shapes Work and Work Shapes Health”

in job design, Stress, Uncategorized
construction workers

Photo courtesy jaimebisbal

The Robert Wood Johnson Foundation, as well as the Harvard T.H. Chan School of Public Health and National Public Radio, may have given a boost last week to advocates of employee wellbeing. Here, I refer to what I consider authentic wellbeing — based on workers’ exposure to harmful job conditions and environments — not the store-bought imitation based on wellness websites, apps, incentives, and medicalized interventions.

To promote the findings of their Workplace Health poll of 1,601 workers, these sponsoring organizations waged a publicity blitz that brought the “healthy work” perspective to a broad new audience. A Health in the American Workplace panel, streamed live on the web, served as a centerpiece of the campaign.

Workers’ Views on Jobs and Health

Poll results, according to panelists, revealed that many workers view their jobs as impediments to their wellbeing.

  • 43% said their job has a negative impact on their stress level
  • 28% said their job undermines their eating habits
  • 27% reported that their job interfered with the ability to get a good night’s sleep
  • 22% said their job has a negative impact on their weight.

Panelist Marjorie Paloma, director of RWJF, explained how job stress and health are influenced by workplace policies:

If you think about the stress a person feels whether because of their day to day work routines, or the stress they feel because of caring for a loved one while working a full time job, or workers who feel as if they have to go into work despite being sick…These are all stressors that influence health.

Succinctly describing the relationship between behaviors and the environment, Paloma stated:

The choices we make are as good as the choices we have.

She summarized this position with the catchy phrase:

Health shapes work, and work shapes health.

“Human Resource Failures”

Harvard Business School professor John Quelch described how workforce management and the intensification of work have been shown to influence health. Quelch bemoaned…

…the sheer overload that comes from downsizing and outsourcing and asking someone to do two jobs when previously they had to do one.

He cited an often overlooked source of stress:

It can also come from job ambiguity — the requirements of the job are not being clearly articulated by supervisors.

Quelch characterized these workforce management patterns as “fundamental human resource failures.”

Gloria Sorensen, from Harvard Chan, cited her team’s studies of health care workers, whose job conditions have been linked to health problems:

Risk of injury or musculoskeletal pain or accidents on the job increase…when we look at harassment on the job, inadequate staffing, bullying at work, high job demands, lack of control, and poor supervisor support.

Sorensen went on to say that these job conditions also have been linked to fatigue, sleep problems, and risk of obesity. She concluded…

The point is these conditions of work are critical when we look at a range of health outcomes for workers.

The panelists’ remarks revealed mixed feelings about conventional worksite wellness programs that focus on behavior change. The poll results showed that only half of workers have access to wellness programs, which at times the panelists, such as Harvard’s Robert Blendon, seemed to cite as an indictment of employers:

Almost half of people who work are at a workplace that has no workplace health program.…People go to work every day, and this is something they read about in a magazine, but they don’t see in their own job.

On the other hand, Paloma remarked…

Worksite wellness is insufficient if it’s not going hand in hand with efforts to improve the health of communities.

Blendon, director of the poll, said that the findings changed his mind about stress. He led an uncomfortable laugh at the expense of conventional stress management strategies, and noted…

Employers should have some responsibility for lowering the level of stress.

NPR’s Joe Neel, the panel’s moderator, summarized…

It’s all about conditions of the workplace and stress.

Kudos to Harvard Chan’s Sorensen, who introduces the audience to the study of job stress in San Francisco transit operators, in which changing the work — such as modifying schedules, training, staffing changes, and equipment upgrades — succeeded in reducing worker stress, whereas, according to Sorensen, previous efforts to change the workers (for example, with stress management programs) failed. For the curious: The research Sorensen cited has been incorporated into an in-depth analysis of stress prevention for bus drivers, available from the International Labour Organization.

The disconnect between the “healthy work” approach and the behavior change emphasis in the panel’s videos, if anything, highlights the need for an acceleration of credible worker health research, which is exactly what NIOSH’s Total Worker Health initiative has set out to do .

In the interim, watch the full one-hour panel here:

construction workers

 

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.