Northumbria Healthcare NHS Trust - stress case study

No of employees:

6,000

Business Sector:

Health

Location:

North East England

Who are they?

Northumbria Heathcare NHS Foundation Trust is a large acute and community trust. It covers the widest geographical area of any trust in England with 3 district general hospitals and 7 community hospitals. It provides healthcare to over half a million people across North Tyneside and Northumberland.

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

• To have a preventive framework for managing stress.
• To have a clear understanding of what stress means.
• To find ways of dealing with the root causes of stress issues rather than just dealing with the effects.

"The NHS is a public emergency service which can place high demands on the resilience of its staff. We already provide good support services for staff to help them cope with these pressures but it is also very important that we have processes in place to identify and reduce stress at source"
Ann Stringer – Director of HR and OD

How did they do it?

The Management Standards implementation

The strategy for implementing the Management Standards and addressing stress hot spots was presented to the Executive Team. A steering group was then set up, chaired by the Chief Executive with senior management and union membership.

A revision of the well-being policy took place and training events were organised for managers on stress risk assessment and stress management. In addition, articles were posted in the Trust magazine and a new stress website was developed for staff.

"In June 2004 a UNISON poll revealed that most employers had taken no action and over half were not aware of the new Management Standards for stress, since then the Trust has worked hard to equip managers and staff with the tools needed to effectively manage stress. Top level involvement is key to a cultural change in managing stress. Both the Chief Executive and the Staff Side Chair sit on the Stress Management Steering Group. Training courses on Managing Well-being at Work are provided for both managers and staff side representatives."
Cas Rodrigues - Acting Staff Side Chair

A stress-mapping tool was used to identify organisational ‘hotspots’ or areas of high stress levels. If a ward had 2 or 3 of the indicators a team stress risk assessment using the HSE Indicator Tool was advocated.

Stress risk assessments (SRA)

Three risk assessments were possible:

1. Organisational risk assessment - the organisational indicators were examined and the hot spots identified through a staff opinion survey and the stress mapping tool. A stress report was then developed and presented to business units outlining which ones had the highest stress across the organisation.
2. Team risk assessment - managers ran the stress risk assessment for the ‘hot spot’ teams in their own areas using the HSE indicator tool and focus groups.
3. For individual risk assessment, where people had been on sick leave due to stress-related issues or had informed their manager of stress at work, managers were encouraged to carry out an individual stress risk assessment. For use at individual level, the HSE Indicator Tool has been cut down to 2 or 3 questions [DOC, 67KB] on each of the Management Standards and served as an interview guide when managers (and Occupational Health staff) sat down with an individual. The Indicator Tool was also used as a guide in focus groups.

What next - Action plans?

Training was rolled out to all managers on how to manage stress in their team and to give them guidance about how to conduct stress risk assessments. Some of the Management Standards and line managers’ competencies are linked to the leadership behaviours and managers were getting 360 degree feedback on these. Effort was also made to embed the Management Standards with other Trust systems and departments such as, HR, Health and Safety and Audit. There were also plans to link it to the internal Knowledge, Skills and Framework for use in the selection of new recruits.

Main challenges

Implementing the stress Management Standards and conducting SRA's is a time consuming business if done properly. There can be uncertainty and keeping managers in general interested, supported and informed about the stress risk assessment and stress management processes also proved challenging. Solving conflicts within teams was also a challenge tackled by providing mediation and training.

"The big challenge is not seeing it (the Stress Risk Assessment) as one sector owned thing. It is not just an HR issue, it is not just an OH issue, it is an issue for the whole organisation. Everyone has a responsibility."
Teresa Jennings - Occupational Health Psychologist

What worked well?

The creation of a stress steering group with the Chief Executive as Chair and senior management reps as members was critical to the implementation of the strategy. Promoting ownership of the stress risk assessment by the whole organisation was important. The management training proved successful with positive feedback from managers about how useful the framework was for understanding the main causes of stress. It was also important to feed data back to the business units and to make sure that action plans were developed and monitored for improvements.

"I believe that a healthy workforce is essential in the provision of high quality of care for patients. We also know that healthcare is, at times, a stressful environment in which to work. Understanding the risk of workplace stress, and then managing this risk, is therefore an integral part of good management practice and should be given the focus and attention it deserves. We have already seen significant benefits from this approach and I'm confident we will continue to do so."
Jim Mackey - Chief Executive of Northumbria Healthcare NHS Foundation Trust

"My learning from this whole thing about stress risk assessment is that it should not be underestimated how much support and guidance managers need in doing this. It is not just a simple case of dishing out questionnaires to people. Managers are key players in reducing stress in their teams and they need support, guidance and training too”.
Teresa Jennings - Occupational Health Psychologist

"The framework developed for managing stress within the Trust has enabled the issue to be addressed at all levels in a proactive way. A key component of this is the training and support provided for managers and the ongoing monitoring via the Stress Management Steering Group."
Margaret Walker - Head of Human Resources

Benefits

• Sickness absence figures have decreased on the whole 7% to approx. 5%. However there is the need to measure more precisely the reasons for sickness absence going down.
• Staff survey self-report of stress levels have been coming down.
• Referrals have been going up because managers are referring more people to Occupational Health as they have identified the need earlier.
• Some teams have been proactive and have carried out stress risk assessment in advance of change occurring.
• The Critical Care Unit has seen an improvement in relationships and a reduction in staff turnover.
• One of our services won a bid from the Strategic Health Authority to provide training to staff using the information from the Stress Risk Assessment.
• The NHS Litigation Authority (NHSLA) has been assessing how trusts are reducing risk to patients and part of this is about work environment and health and safety including stress. Northumbria reached the NHSLA level 2 standard for stress this year, which requires a trust to put in place a process for assessing stress.
• Positive feedback has been received from an HSE inspection (February 2008).