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.

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

“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