1. OUR 0
HEALTHIER
NATION
' Y O R K RELATED
S T R E SL, I N I T I A T I V E S
L
I

2. WORK RELATED
STRESS INITIATIVES SET 3
THREE CASE STUDIES

3. Acknowledgements
Thank you to JackieCobb, David Holmes, Judith Houghton, Karm Qureshl and Phil Smith at Blrmmgham
Children’s Hospital NHS Trust, Paul Harrison, Morag Maddocks, BarbaraWalsh and Diana Shapiro at
Community Health Shefheld, and Sian Williams, Anne Cockcroft, BarbaraWren and Nigel Turner at Royal Free
HampsteadNHS Trust for making this publication possible, and to Andrew Cole for hls developmentof the
orlgmal casestudies.
For further information on any of the initiatives outlined in this publication contac%
JackieCobb, Health Promotion Co-ordinator, Blrmmgham Chddren’sHospital NHS Trust on 01213339999
bleep 55111
Kann Qureshi, Counselor, Blrmmgham Children’s Hospital NHS Trust on 01213338047
Morag Maddocks, Consultant Organlsatlonal Psychologist, Commumty Health Sheffield on 01142716370
Diana Shapiro, Consultant Psychologist m Workplace Health, Communny Health Sheffield on 01142261810
Skm Wdhams, Consultant m OccupationalMedicine, Royal Free HampsteadNHS Trust on 02078302514
BarbaraWren, OccupationalHealth Psychologist, Royal Free HampsteadNHS Trust on 02078302514
For further information on these initiatives, or any other aspect of mental health at work, contact
Health at Work m the NHS on 02074131873
Further copies of this pubhcatlonare availablefrom.
HEA Customer Services
Marston Book Services
PO BOX 269
Abingdon
Oxon OX144YN
Tel: 01235465565
Fax 01235465556
@ Health EducationAuthority, 2000
Health EducationAuthorny
Trevelyan House
30 Great Peter Street
London SWI P 2HW
www heaorg.uk
ISBN O 7521 18641
2m 3/00 001

4. —
Contents
Foreword v
Forewords by the Trusts vi
Birmingham Children’s Hospital NHS Trust 1
The initiative: a new health at work strategy 1
Putting It mto practice 1
A new stress audit tool 2
The results 3
Lessons learnt 4
Community Health ShefField 5
The mltlatwe: the Workplace Wellbeing Serwce (WWB) 5
Putting it mto practice 6
The results 7
The future 7
Lessons learnt 8
Royal Free Hampstead NHS Trust 9
An overview 9
Putting It into practice 10
The future 10
Lessons learnt 11

5. Foreword
I am dehghted to have been asked to introduce the fourth of the series of stress management case-
studles to be pubhshed by Health at Work in the NHS. This publication follows The North East Essex
Mental Health Trust Organisational Stress pdot: A case study pubhshed m 1998 and 2 sets of Work
re/ated stress initiates three case studies pubhshed m March 1999 and January 2000. This fourth
set of case studies demonstrates how NHS Trusts are taking positive steps with an emphasis on
orgamsatlonal influences that can be taken to support a healthy workplace. The three inltlatwes have
varied alms and approaches, but the common theme of taking on and addressing their speclflc
concerns in a period of continuing uncertainty will, I believe, provide valuable mslghts that WIII be
recogmsed by many other NHS organisations.
81rmmgham Chddren’s Hospital NHS Trust introduced a new health at work strategy following a move
to a new site offering expanded serwces. A range of mltiatwes had been undertaken over the last few
years to Identify and manage issues around organisational stress and this effectwely reformed the move.
However as a proactwe orgarmatlon Birmingham conducted a study which Identlfled some subsequent
changes which the strategy was, m part, developed to address.
Community Health Sheffield has had a Workplace Wellbeing Service in placesince 1995 It is a well-
established confidential counseling service with an anonymous feedback mechanism that enables the
orgamsatlon to take action to address concerns expressed by service clients. An evaluation of the service
was undertaken to assess its effectiveness m practice and underpin Its ongoing development.
Royal Free Hampstead NHS Trust’s occupational health team reviewed the serwces being offered wlthln
the Trust and decidedto pdot a scheme whereby a full time occupational health psychologist will be
employed for 2 years (1999–2001 ), partly funded by Royal Free and partly funded by the Nuffield Trust
The case study describes the early stages m setting up and begmnmg to estabhsh the new role.
We very much appreciatethe openness of all three participating organlsatlons that has enabled this
series. It IS through contmumg mnovatlon of this kind and a willingness to share real hfe experiences
that we can further develop a knowledge base of good practice in the effective management of
work-related stress.
Richard Parish
Chief Executive HEA/HDA
v

6. Forewords by the Trusts
The last few years of the Millennium were sigmflcant for the Blrmmgham Children’s Hospital NHS Trust
Not only did the whole hospital move, together with 100 of our sickest chddren, but over these years
the budget increased from f30m to over f80m. That meant more services to be dehvered, more staff
recruited and more children needing our help. This provided us wkh many opportumtles, If not a
few challenges.
We recognised the need to consider the Imphcations of such development for our staff and
therefore were keen to undertake research that might tell us how everyone was feeling throughout
the whole process
We have learnt much through this exercise and value highly the support of all members of staff and
the contribution they continue to make towards the success of our organisation Two key areas of
development have been the adoption of a Health at Work strategic approach and the creation of a
team support programme.
We are pleased to be able to share our experiences wkh others within this case study series. The Trust
is committed to translating this work mto recogmsable benefits and posltwely influencing the health
and wellbeing of Its staff. In short, meetmg the alm of mvestmg m Its workforce and becoming ‘Fit to
face the future’.
Colm Hough
Chief Executwe
Birmmgham Chddren’s Hospital NHS Trust
vi

7. FOREWORDS BY THE TRUSTS
I am dehghted to have this opportumty to share with colleagues throughout the Health Serwce
our experience of developing our Workplace Wellbeing Service. As a large community health Trust
employmg 3500 staff, we believe that a healthy workforce IS vital to achlevmg our goals of provldmg
the best possible health promotion and care services to the people of Sheffield. This proJecthas enabled
us to develop a counseling and consultation service that IS highly valued by staff At the same time
it has strengthened us as an organlsatlon It helps us to be able to Identify how we can best promote
health and wellbeing for our staff, but also to be alert to ways m which we may beat risk of
contributing to their all-health. I behevethis service enables us to be better reformed about the needs
of our staff and to actwely work to prevent avoidable pressures affecting thew health I am proud that
we have developed the Workplace Wellbeing Service, which I regard as a key strength in our efforts
to develop a healthy workplace. I hope this case study WIII be valuable to others who are keen to move
m the same dlrectlon.
Barbara Walsh
Chief Executive
Commumty Health Sheffield
vii

8. FOREWOROS BY THE TRUSTS
Underlying the Royal Free Hampstead NHS Trust’s human resources strategy IS the fact that the quahty
of care and serwce we give our patients depends fundamentally on the knowledge, skills and attitudes
of the staff who come mto contact with them and the support they receive from others in mdlrect roles.
The work of the Trust’s Occupational Health and Safety Umt has an Important role to play in that
through ensuring staff’s health and well being.
The 1998 Nufheld Trust Report on ‘Improvmg the Health of the NHS Workforce’ (all of whose
authors are part of the Royal Free’s Occupational Health and Safety Umt) Identlfled a slgmflcant gap
in the evidence base behind current approaches to stress management m the NHS The Imtiatwe
described m our case study IS designed both to help close that gap and to Improve staff’s working lives
by reducing dysfunctional stress within the organisation. We hope that, whatever results are obtained,
the lessons which WIII be learnt from it WIII be widely helpful in shaping patterns of future stress
management provlslon
Martin Else
Chief Executwe
Royal Free Hampstead NHS Trust
...
Vlll

9. Birmingham Children’s Hospital NHS Trust
When Blrmmgham Chddren’s HospRal NHS Trust that the involvement they had experienced
moved from lts former site m Ladywood to before the move had not been mamtamed
Improved accommodation m the centre of the
cky 18 months ago, it expanded Its servces and The initiative: a new health at
staff at the same time Not surprisingly, the work strategy
move was a potent[al source of stress Unusually
though, in some areas stress levels seem to have These fmdmgs were one of the triggers for
risen after the move rather than before It. This IS a new health at work strategy early last year
now begmnmg to be resolved, partly as a result (1999). This attempted to bring together all
of a co-ordmated health at work strategy. the elements of health at work (including
occupational health, mfectlon control, health
However, the chddren’s hospital is not an promotion and health and safety) within one
example of a health organisation which IS overall framework and to provide a clearer hne
waking up too late to the Issues of stress m its of command to board level.
workforce In fact It has been deeply involved
m organlsatlonal stress issues for the last five ‘The alm was to address the pressures that
years. What the organlsatlon’s experience shows staff were under at both a personal and an
is how complex these issues can be and that organisational level’, explains Jackie Cobb. But
sometimes progress is a matter of two steps there was also a strong feeling that it was time
forward and one step back. to translate the wealth of evidence on stress
at work into posmve action.
In 1994 the hospital becameinvolved m the HEA’s
Health at Work m the NHS study which looked, Putting it into practice
among other things, at organlsatlonal approaches
to workplace stress. The study comcldedwith The new strategy was agreed m March 1999
mcreasmglyconcertedpreparations for the site and publicly launched at the start of July with
move and only ended a few months before the a week of actwmes, which included stress
actualtransfer m 1998 management courses, aromatherapy, massage
and aerobics sessions. There was also the
Partly as a result of the work engendered by launch of a number of key human resource
the HEA study, the move Itself was handled (HR) pohcles such as smoking at work and
remarkably successfully. A research study by drugs and alcohol.
Blrmmgham Umverslty’s Health Services
Management Centre assessed the perceptions The strategy IS directed by a health at work
of staff before and after the move, and group headed by acting HR director, David
concluded that most staff felt positively Holmes, who reports dwectlyto the board.
revolved m the move and were enthusiastic A number of groups, such as health and
and optimistic about the prospects safety, health promotion, infection control,
occupational health and staff side, feed back
Nevertheless, a detailed study of one group to this umbrella body. ‘The strategy group now
of nurse managers by health promotion acts as a focal point for all health at work
co-ordmator Jackie Cobb, SIX months after the Issues’, says David Holmes. Just as Importantly,
move, painted a different picture Some exhlblted the hnk with the board means that any
low levels of job satisfaction, morale and mformatlon with Implications for staff support
motlvatlon, combmedwith a sense of guilt WIII be fed back into the orgamsatlon
about the way work Impmged on their home hfe
In addltlon, there was a feeling of anti-climax
1

10. WORK RELATEDSTRESSINITIATIVES
The strategy has already engendered a number A new stress audit tool
of mltlatwes. A bimonthly newsletter was
launched m the summer of 1999, wkh the aim Help may be at hand m the shape of the stress
of brmgmg all staff up to date on health at nsk assessment tool - a means of audit that the
work Issues. A new accident reporting system Trust IS currently developing with an outside
has also been introduced which encourages consultancy – that should be m operation wlthm
staff to think beyond traditional areas such as the next year
needlestlck mjurles and to include anything that
has an impact on the working environment. The tool alms to provide managers with a
Staff are also gwen feedback on how their barometer of the levels of stress among their
concerns are being followed up staff, as well as a lever to getting somethmg
done about It The questionnaire, which will be
A number of exwmg schemes have also come distributed to all staff wlthm designated areas,
wlthm the amblt of the health at work group includes sections on sickness absence, turnover
One of the most enterprmng IS the team and wastage but also tries to Identify other nsk
support programme, which has been running factors such as role clarity, relationships,
since April 1995. The programme, run by the management style and family-fnendly practices
chmcalpsychology department, offers support
and advice to wards or departments facing Most Importantly, because all the mformatlon
stress at work Issues. It also provides debriefing provided IS anonymlsed, It can be fed back mto
following a particularly traumatic incident. the rest of the Trust and reflect trends that may
have an Impact on some of the organlsatlonal
The team, led by consultant chmcalpsychologist factors responsible for high levels of stress
Judkh Houghton, WIII only intervene at the
request of the manager; the scope of the Health and safety adviser Phil Smith, who IS
mterventlon also depends on the manager’s likely to be involved m Implementing the tool,
wishes Most commonly It revolves a stress hopes It will help highlight a range of Issues
audit, focus group meetmgs and a confidential such as staffing levels, skill mix, sickness
questionnaire to all staff followed by a final Ilst absence and whether staff are getting thew
of recommendations. required breaks during the working day
‘The counselors try to look at the complex The blg advantageof this approach, he
nature of stress and recommend a practical tool observes, is that it fits into a risk management
to address the Issues’, says counselor Karm perspectwe and IS a legal document, which
Qureshl She IS keen to feed some of the obhges the Trust to take action on Its findings -
general themes from this work mto the new although he hopes It WIII take a proactwe
strategy group, but the fact that the work IS approach. Another potential benefit, according
confidential means the mformatlon IS fairly to Jackie Cobb, is that it offers staff and
hmked. ‘If people are going to sign up to thts managers the chance to control their
they have got to feel safe In fact, I would environment and influence the declslon-makmg
suggest one of the most Important things we process. ‘It doesn’t just look at cold data.
offer IS confldentiahty. Of course you lose It looks at the broad picture and presents
something as a result but you have got to keep mformatlon m a wider context’
these boundanes’
2

11. BIRMINGHAM CHILDREN’S HOSPITAL
The audit tool wdl initially be pdoted m selected The Trust is refmmg Its stress indicators all the
areas, butltls hoped that eventually ltwdlbe time Department heads now recewe monthly
rolled out to every department in the Trust. In sickness absence reports. A staff attitude survey
some situations It might also hnk across to the IS also planned for Spring 2000 to provide
team support programme, hlghhghtmg areas baseline reformation on satisfaction and stress
that the climcal psychology department could levels against which further activities and
follow up in more detad, but this would need to mterventlons can be measured
be handled carefully, points out Jackie Cobb
Although David Holmes admits there are
The results problems in establishing accurate gauges of
organlsatlonal health, most of the accepted
Most mdlcators suggest the team support measures of stress are encouraging Sickness
programme has been a blg success Most of the absence across the Trust E relatwely low at
nurses in Jackie Cobb’s survey were full of praise 3 8% last year, rising to 4.2?4. this year with
for the programme. And quantltatwe measures Improved reporting. At the same time staff
paint a slmdar picture Staff turnover among turnover IS falhng.
semor staff is reasonably low and sickness
absence rates have gone down m some of Yet, despite this, he does not behevethat
the areas visited by the chrmcal sychology
p morale is particularly high – mamly because of
department. Increased workload and lack of resources This IS
the challenge for the health at work strategy
Karm Qureshl has also detected more tolerance ‘Whaleacknowledging the reahty of the current
and greater flexlbhty in working practices. chmate of workload pressure wlthm the NHS,
‘1think It IS happening but, m any situation how people are treated, managed,
where change IS a constant, It IS dfhcult to communicated with and valued IS extremely
see the benefits because It can be perceived by important and WIII go a long way to
mdwlduals as a threat to their role’. determmmg how staff feel about their work.’
It IS of course too early to know whether the
new health at work strategy is having an
impact, but first signs are encouraging. Jackie
Cobb says recent feedback from the managers
m her survey mdlcates both indwldual and
orgamsatlonal stressors have become more
manageableand they are now better able to
separate work and home hfe But she
.. acknowledges there IS still room for
Improvement.
3

12. WORK RELATEDSTRESSINITIATIVES
Lessons learnt
q Good communications between all groups wkhin the Trust are vital, as IS feedback to staff to
let them know what has happened to their suggestions or complaints
q It is Important not only to prepare fully for a major event such as a hospital move but to
follow this up and offer support for some time after the move.
q Evidence on stress must be translated into action If you are to have credlbditywkh staff groups.
q Care needs to be taken to ensure stress interventions and courses are accessible to all staff
q A voice at board level IS vital for a successful health at work strategy.
q Bringing together all aspects of health at work within one co-ordinated strategy has helped to
provide a sharper focus and avoid duphcatlon
q Middle managers ‘bridge the gulf’ between strategy and operational actwltles and are key to
successful health at work mkiatlves.
q Blrmmgham’s team support programme has proved hugely popular with most managers and staff
who have used It. Being voluntary and confidential are two crucial mgredlents m that success.
4

13. Community Health Sheffield
Commumty Health Shefheld’s Workplace They were helped m their efforts by the
Wellbeing Service (WWB) has been running for enthusiastic support of chief executwe Barbara
nearly four years. Its success over that time can Walsh. Without her support from the start,
be measured by the number of staff It has admits Morag Maddocks, the scheme might
supported, the organlsatlonal change It has well not have been taken forward. Instead,
helped mstltute, and the fact that what began WWB received approval to run as a pdot scheme
as a pilot is now a permanent service. for three years early m 1996 and was officially
launched m April 1996. The initial annual costs
Things were very dfferent when the serwce was of f 71,000 were met through the Trust’s service
first mooted in 1994/5. At that time the Trust development programme.
had just been created as a result of the
amalgamation of three smaller units As human The initiative: the Workplace
resources (HR) director Paul Harrison recalls, the Wellbeing Service (WWB)
Trust was mcreasmgly aware that workplace
stress was a major problem and that much The WWB is run by Psychological Health
sickness absence was related to mental health Sheffield, an agency hosted by, but at arms
problems. ‘It was clear there needed to be some length from, Commumty Health Sheffield.
sort of response, but at the time we didn’t have The service is led by consultant psychologist,
any handle on what the real Issues were wlthm Diana Shapiro, who E responsible for four
the orgamsatlon.’ part-time staff – two workplace counselors,
an administrator and a research assistant
The new community trust is extremely She m turn reports to Morag Maddocks
fragmented, its 3500 staff being spread across
some 90 sites. In addmon to facing enormous The central tenets underpinning the service
structural change, many of Its staff were also are that
coming to terms with the move from hospkal
to residential care. Few serwces were avadableto q Its counseling services are completely
stressed staff at the time A small number made confidential;
use of the occupational health serwce, whale q Its counselors are accreditedprofessionals
others turned for help to chnlcalstaff within the who have experience of the health serwce
trust, thus creating potential conflicts of interest. and the environment m which staff work; and
q It Is, and E seen to be, standing apart from
So, when the head of organisational psychology normal management within the Trust.
Morag Maddocks approachedthe Trust’s clmlcal
policy group in 1995 with a proposal to set up a Its work includes mdwldual and group
staff support service, she recewed a sympathetic counseling; consultancy work, especially with
response Members particularly welcomed the managers; and a variety of trammg on stress
Idea that the service would not simply respond Issues. But the most innovative part of the
to stress but try to /earn lessons from it. scheme is probably the ‘feedback’ loop whereby
the information gathered from counseling and
‘The one thing we were adamant about was consultancy IS fed back to the trust in an
that It wasn’t just going to support staff at arms anonymlsed form to alert managers to some
length’, says Paul Harrison. ‘If we weren’t of the causes of staff stress.
changing the workplace as a result, then all we
would see were the same Issues rephcatedover The main mechanism for this feedback is a
and over again. We had to use the reformation relatively informal quarterly meetmg between
m a sensltwe and effectwe way to change the the chief executwe, the HR director, the head of
way the organisation works.’ the WWB and the head of organisational
5

14. WORK REIATEO STRESSINITIATIVES
psychology The WWBacts asan advocatefor other group work In another case a manager
the staff in these meetmgs, explains Morag suggested a group.session because of problems
Maddocks ‘Iseeour role aspresentmg to the of commumcatlon wlthm the department
Trust the staff’s perceptions of how things are m
the workplace Wewdlsay there seems to bean Organisational interventions
Esue for staff around such and such Then we
explore that.’ At an orgamsatlonal level, the WWB has
hlghhghted a number of Issues that have led
In addition the serwce circulates annual reports to changes
to all directorates and wdl arrange meetings
where there Isa particular lssuetodlscuss q The WWB encountered several cases where
ethmc mmority clients experienced
The other fundamental element of the project is harassment or felt disadvantaged m
the commitment to research and evaluation recruitment or promotion. The Trust decided
This means the service mamtams up-to-date to take action on this, partly as a result of the
information about all Its actwltles, which can WWB’S report to management, and has since
then be fed back mto the Trust. It has also appointed a dwersity adviser as well as
commissioned ‘before and after’ evaluations of setting up a network of officers to provide
the staff’s perception of the service as well as a point of contact for any member of staff
their levels of stress and job satisfaction with a grievance or concern
q Counselors also hlghhghted the fact that
Putting it into practice several relatively young and mexpenenced
nurses were fmdmg it very stressful working
Individual counseling alone with large numbers of support
workers. Th6 was instrumental m a declslon
The counseling service has been extremely to set up a nurse adviser post for one
successful, with all staff groups well represented Isolated group of nurses.
among clients A survey of 50 consecutive chents q A number of community nursing staff m
suggests that, m the majority of cases, their health newly integrated self-managed nursing teams
Improved slgnlflcantly following mterventlon The identified difficulties m managmg their chmcal
popularity of the service is also mcreasmgwith and administrative roles. The Trust has now
3.3?4. of staff using It during the launch period, recognised the need for a more actwe
nsmg to 4?40m 1997 and 4.3?40 in 1998. support role from managers m handling
admmlstratwe and managerial Issues
Group consultations q The WWB IS also putting together guidehnes
for staff m vulnerable situations after It
One of the most common forms of mterventlon encountered several examples of staff commg
is debriefing following a traumatic episode such back from long-term leave and facing undue
as the sudden death or suicide of a patient, the pressure ‘We’ve had a lot of people who
sexual or physical assault on a member of staff have had stress on returning to work from
or dlfflcult team relatlons following disciphnary things hke maternity leave or going part-time,
action. General feedback on the impact of these for instance’, says Diana Shapiro. ‘Because of
sessions E posltwe, although there has been no managerial decisions about cover m their
formal evaluation. absence, staff may be suddenly pitched back
to a workslte or a team they’ve not known
Individual chents, proposing team counseling to before ‘ The guldelmes WIII help managers
examme some of the workplace problems that consider the Impact of such work practices
were Identlfled m their sessions, have triggered for staff undergoing these hfe transitions
6

15. COMMUNIm HEALTH SHEFFIELO
The results He also beheves staff perceptions can be as
Important as objective outcomes. ‘If you were to
A survey of staff attitudes to the scheme ask staff about the serwce you would get a very,
showed that awareness had risen from 30% to very posltlve response and they’d see It as a
68% in the first three months of the scheme’s really mnovatwe initiative to help and support
existence, and most staff were positive about It. them That’s worth a lot in itself They know
there’s somewhere they can turn when they
Another independent study found levels of requre support that’s independent and where
stress among staff had remamed fairly slmdar they WIII be hstened to’
between 1996 and 1998, although there were
slgmflcant changes wlthm particular staff The future
groups. Semor managers showed the biggest
Improvement Conversely, nursing assistants had Diana Shapiro would hke to extend the range of
consistently poorer mental health, higher levels counsellmg services avadableto staff so that a
of stress and lower job satisfaction In the greater range of their needs can be met She
second survey. also wants to ‘deepen’ some of the serwce’s
work There IS a danger, she points out, that
It has been dlfflcult, observes Diana .Shaplro, to having hlghhghted an area, the team may not
make direct correlations between the WW8’S then have the capacityto follow It through, For
work and the general mental health of staff. It instance, she would like to be more proactive m
has not been possible, for instance, to Imk their supporting staff on acute psychiatric wards who
organisational interventions to reduced sickness face hugely stressful condmons. She E in the
absence rates However, it may be slgnlflcant process of drawing up a training packagefor
that sickness rates among nursing assistants this purpose
dechned m the last year, at a time when they
have been makmg greater use of the service She also hopes to redesign the evaluation
process to bring It mto line with the Clmlcal
Nevertheless, the signs are that it is becoming Outcomes m Routine Evaluation system devised
embedded m the organlsatlon’s culture, she by Leeds Umversky. This would not only enable
says ‘More and more people are coming them to measure chmcaleffectiveness, but also
because a friend or manager suggested us, and to compare their fmdmgs with other trusts that
this IS also reflected m group requests which are use the same system,
becornmg more sophisticated. They’ll nng and
say. “1think this IS the kmd of thing you can Finally, the serwce IS keen to disseminate
help us with”, rather than: “Is there anything reformation about its work to other trusts.
you can do?’” Diana Shapiro recogmses there could be some
economies of scale if the WWB service was
Paul Harrison thinks that mtroducmg a research extended to other trusts, but warns of potential
base to the service is quite an achievement problems if they had dnYerent priorities,
in itself. ‘When we started it was an mtuklve standards or expectations It could be, she
understanding of the Issues. But now we suggests, that an alternate approachWIII be to
have hard information, which I think few provide consultancy and support to other trusts
organisations have m a systematic way. We have wishing to develop their own services.
a process in place to capture that information
and feed it back mto the orgamsation.’
7

16. WORK REMTED STRESSINITIATIVES
Lessons learnt
q The support and involvement of the chief executwe is vital, both at the start and on an .
ongoing basis
q It IS Important to have a steering group m the formative stages and some sense that the trust,
Including the staff side, owns the project.
q Counselors should be accreditedand knowledgeable about the workplace m which they
are operating
q In setting up a service of this kmd It E important to allow ~me in the early stages both for ,
team budding and reflecting on the best model of practice, avoldmg pressure to become
involved m day-to-day counseling too soon.
q The VVWB emphasises that It E not an emergency service, but many clients stall expect to be
seen at once If their need is urgent, it may be necessary to point them to other services
q It IS sometimes ddicult to mamtain the balance between group and mdwldual work,
particularly if a number of group requests come at the same time. -
q Fmdmg the resources to mamtam momtormg and evaluation can be problematic If there are
pressures on the budget there wdl be a temptation to cut this rather than direct staff support
8

17. Royal Free Hampstead NHS Trust
As one of the biggest acute trusts in the An overview
country, with around 4500 staff, the Royal
Free Hampstead NHS Trust IS no stranger to The post has been set up on a pdot basis to
workplace stress. run from 1999 to 2001 Funded partly by the
Special Trustees of the Royal Free and partly
The Trust has an active occupational health and by the Nuffleld Trust, it is based wlthm the
safety umt to which individuals with parhcular occupational health umt In Anne Cockcroft’s
problems of stress can be referred. However, view, this IS Important because ‘If there are
recognition of signs of staff stress within the Issues about the workplace, they can be
Trust, as elsewhere m the NHS, raised awareness addressed through occupational health hamng
that more needed to be done, particularly in the with managers. It’s very dehberately not a
area of stress prevention completely separate entity’
At the same time three members of the Whale Barbara Wren is based in the occupational
occupational health team - Sian WMams, Susan health unit the Trust has also set up a high level
Michie and Shrltl Pattanl – were co-authors of a steering group that includes the HR director,
major study in 1998 pubhshed by the Nufheld the nurse director, the director of operations,
Trust which showed that, although many stress the head of occupational health and safety and
imtlatlves existed, disturbingly few had been other senior managers to oversee the project.
evaluated.
The steering group, which meets quarterly, E
In the wake of these concerns, Anne Cockcroft, vital m order to ensure that this work feeds back
the director of occupational health and safety, into the rest of the organisation, as HR director
proposed to the board that a full-time Nigel Turner explains: ‘It’s about ensunng that
occupational health psychologist should the overall drectlon of the project IS one that’s
be appointed. This person could then be consistent with the wider HR strategy And If
responsible for targeted interventions to you have organisational things that need to be
allevlate stress at an organisatlona/ rather changed, then It’s quite likely that some of these
than an mdw;dua/ level. interventions WIII require commitment and
action at a high level wlthm the Trust.’
‘We had felt for some time It was Important
not just to have a reactive “sticking plaster” At the same time the results of each
setvlce but actually to look at the causes and mterventlon will be carefully evaluated. The
preclpltants within the workplace’, she explains. most common methods WIII be comparison of
The alm was to set up a serwce that would be sickness absence and staff turnover figures
proactwe m Its approachto stress management. before and after the mterventlon as well as staff
This led to the proposal that the scheme should attitude surveys. Barbara Wren wall, where
revolve not only interventions to alleviate stress possible, also try to set up control groups of
but a series of evaluative measures to test similar wards or departments that are not
whether they worked. revolved m the intervention.
The scheme was fwst put forward in 1997 and
was finally agreed m 1999. The Trust appointed
Barbara Wren, who had previously worked in
both health and occupational psychology and
health promotion, and she began work in
September 1999.
9

18. WORK REMTED STRESSINITIATIVES
Putting it into practice start of work, and issuing them all with name
badges slmdar to those worn by other trust
The post has only been m operation for a few staff Barbara Wren behevesthat, If this
months so far, but already It is generating much intervention proves to be successful, It could
interest. Nlgel Turner wrote to all departmental be a useful model to apply m a number of
managers when Barbara Wren was appointed, other areas m the Trust
explaining what she would be doing and
inviting managers who wished to participate Another alm of the work IS to demonstrate Its
to make contact. value and accessibility to staff ‘People have got
to see what’s m it for them early on, particularly
A number have already responded posltwely m the NHS where there IS a high turnover of
to that mvltatlon and have arranged meetmgs staff and high stress levels’, she says ‘You’re
to discuss their problems. The ways m which always working against that feeling that we’ve
Barbara Wren seeks to tackle them can take a seen It all before and nothing changes.’
number of forms, from one-to-one consultation
with an lndwidual manager to a team approach The future
where she wdl slt down with the whole ward or
team over a number of sessions to try to resolve The pilot project continues for another 18
a problem. She also works m a more faclhtatlve months, but it IS hoped that by the end of this
role with some managers, and has input into period Barbara Wren will have proved herself so
other more systemic mterventlons that are Indispensable that the Trust WIII decide to make
taking place m the Trust. the post permanent.
There are a number of elements to the work, Barbara Wren has no doubt that the shape of
including some time devoted to one-to-one the project wdl change over Its two years
counseling and also running trammg sessions. duration m response to particular Issues. Initially
But the mam aim is to Identify areas where she will work with those managers who are
organisational mterventlons are appropriate, and motivated to participate. However she notes,
to Implement and evaluate those interventions ‘it is often the people who need most help who
The reasons for the intervention also vary They may be those who least recognise it’. As the
may be In areas of high sickness absence, or work develops it is planned to extend successful
where the staff identify themselves as stressed Inltlatives to less accessible groups
or are undergoing a major restructuring
Another issue IS how to make the best use of
The project that is furthest advancedIS a her time as the post becomes better known
programme with a group of ancdlarystaff, and the demands for her services grow. One
which began before Barbara arrived Sickness posslbhty may be to create and spread models
absence rates are high m this area, as are of good practice rather than Intervening
referrals to occupational health The alm of the personally m every case. She is also exploring
intervention - conducted with the co-operation the Idea of offering tralnmg sessions to
of the umons – has been to increase staff’s managers in practical skills such as problem
feelings of control over thew environment, to solving, stress management and supporhng staff
Improve social support and to help them feel
more valued. To that end a number of small Nlgel Turner IS understandably wary about any
but significant changes are being mstlgated. talk of expanding the scheme at this stage. But he
These have included Improvmg their rest rooms, adds ‘If we Identty interventions that are going
giving them the opportunity to fraternise with to make a difference, we’ll need to look at the
colleagues by getting them to sign in at the staffing requred to maintam those interventions’.
10

19. ROYAL FREE HAMPSTEAO NHS TRUST
Much depends of course on the perceived the project are keen to disseminate the lessons
success of the mterventlons. The work is being to other trusts. ‘Part of our purpose in doing
designed to identify factors that contribute to this E not only that we’re interested in taking
the success or fadure of each intervention. this on at the Royal Free but we hope It wdl be
Where there are success stones, the leaders of of use to other trusts’, says Anne Cockcroft
Lessons learnt
Occupational health IS a good Iocatlon for an orgamsatlonal approach to stress. But to be
effective the mitiatwe must also have support at board level
Evaluation IS essential m assessing whether an nmtiatwehas been successful This needs to be
budt mto the programme from the start.
q If evaluation IS to be effective it must be seen through m one location before putting It mto
practice elsewhere
Interventions must be appropriate and carefully matched to the needs of a particular situation.
Small changes to people’s working conditions can have a significant impact on their outlook
11

20. OUR l
HEALTHIER
NATION
iedth ut Woh
I' INTHE NHS' 1
Work related stress initiatlves,
Set 3:
T h r e e c a s e dud&
Work related dm$s initiatives, Set 3 : 3
T, ,
.
2.
,
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details three mom initiativesc s t r t f d o
have &cWto tadde staff stress within their organis
Each case study outlin$ghe background behind the
inlatiw, the aims and appf@ches@ken, the results, and
a summary of I e p m learnt:,The three examples focus i,
.$ , 2
on different I s s d s : one deschbasJp d w e b p m e n t of a
new health a t work strategy and the iniQativesthat ha
developed;the second detalis the benefhprovided b
workplace well being service; and t h e third outlines the . '
impact of introducing an occupationalhealth psychologist
to the occupational health unit.
:q
t-
, ,
This publication will prove an invaluable
information to those concerned with p r o
Executiw? mental health.
,
,-. . # ,
This is the fourth in a series of mental health case ,
studies p &by Health at Work in the NHS. It &
r
o d f
NE €faex Mental H & Trust or@nisatimal stress e t :
A case study, W& related s t r e s s initiatives: ,Three c
&
studies and W?x% w ; s t Y e s s initiatives, Sei 2
r : ;
1
T&
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case st#d
klEALtH E W C A r l O H AUTHORITY
T W E ~ Y A N o w 3 0 GREAT T E R STREET
H PE
LONWN S W l P 2HW
www.hmorg.uk
I S B N 0 7521 1814 t