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Gwent Healthcare NHS Trust - stress case study

Collage of images from the Gwent NHS trust
No of employees:
Business Sector:
South East Wales

Who are they?

Gwent Healthcare NHS Trust delivers a wide range of acute, community and mental health services, has 17 hospitals, 38 health centres and clinics and serves a population of 600.000. Staff employed by the Trust deliver a wide range of expertise and include doctors, nurses, therapists, scientists, porters, catering staff and a range of corporate support staff.

Why Gwent Healthcare NHS Trust decided to manage stress using the Management Standards:

How did they do it?

The Management Standards implementation

The Trust was encouraged to undertake a rolling programme of stress audits. As a first step in 2007 a one year pilot project, involving 6 Trust services, was launched. It was anticipated that this approach would support organisational learning about using the HSE Indicator Tool and identify future uses. A steering group, chaired by the Chief Executive, planned how the approach should be rolled out across the Trust. A step-by-step guide was created with a shortened version of the HSE guidance and an overview of the approach was briefed to managers.

The HSE Indicator Tool survey was then sent to all staff in the six pilot Services. Response rates varied from 36% to 91% with an average of 66%. Once the results have been presented to managers and focus groups, actions for improvement were discussed. A procedure for informing all staff of the results was also launched, in addition they were informed about Employee well being and Counselling services so if any issues arose as a result of the process they could get help on an individual basis.

What next? - Action plan

Telephone interviews were conducted with managers involved in the pilot project, in which they were asked about the process and what had changed as a result. Interventions introduced included changing demanding rotas, improving mechanisms for appointing locum staff and providing better access to IT equipment.

"I often wondered who would make a good facilitator – I believe a range of skills is essential. I have learnt from my two colleagues and I hope they have learnt from me! As a Health and Safety Manager I have brought something different to the audit process especially in areas where staff felt vulnerable in terms of low security. By identifying this some positive measures were implemented immediately. "
Judith McEwan, Health and Safety Manager

"The interventions and certainly my thinking about my job is that clearly we offer individual support, staff counselling etc. but if we don’t address the systemic workplace issues then you know we’ve got a problem…"
Jan Hill-Tout, Head of Employee Well-Being

Main Challenges

Gaining the support of senior and lower management and ensuring that they had a good understanding of the results and necessary actions was critical for a successful project. There were a few challenges with the analysis of the HSE Indicator Tool but changes were made to the Tool to correct this. In addition, many Trust staff could not readily access the internet so paper questionnaires were used which was more labour intensive. The focus groups were extremely valuable but time consuming, and a skilled facilitator was necessary. Research evidence showed links between employee well-being and organisational data, like sickness absence and grievances, but there was a concern about whether the data collected by the Trust would be robust enough for this.

What worked well?

The audit tool enabled us to profile the softer aspects of organisational life and be able to talk to managers using coherent data. Those who attended the focus groups said that it was good to have a chance to talk about this aspect of their working lives and some said they found it cathartic. The focus groups also proved to be useful in giving practical suggestions for making simple organisational improvements. Having a way of highlighting bullying was also very helpful and enabled us to quantify a problem that is often invisible.

"I think that the HSE Management Standards approach to work place stressors could play a major role in creating and sustaining a working environment that promotes well-being. We need to be able to understand where the organisation contributes to work place stress and to do what we can to make improvements. I recognise that this approach needs clear leadership if it is to succeed and see my role as chair of the steering group as pivotal to its implementation in the Trust."
Andrew Cottom, Chief Executive

"I have learned that you have to be very tight to time with everything...These surveys can just drift on and on so at the beginning of the process we’ve had a very clear diary, right we’re doing this now. The questionnaire’s back by then, focus groups by then, closing report then and now we’ve reached closure point 1, which is the report on the pilot for the Executives. now part 2 is the thinking about how to roll it out but that has been quite important for us so it’s quite circumscribed really."
Jan Hill-Tout - Head of Employee Well-Being

"I’ve learned so much from this pilot – from both my colleagues, with whom I undertook the audits, as well as from the staff who took the time to actively engage in the process. From a staff perspective I felt that they valued knowing that they were being listened to and that their opinion counted. I was concerned about raising expectations, you know what it’s like – you fill a questionnaire in and never hear anything but this process, followed correctly, offers real opportunities."
Elaine Lewis - Occupational Health Nurse Manager


Updated 2010-09-24