Royal Free Hospital NHS Trust - stress case study

Who are they?

The Royal Free Hospital NHS Trust is an acute Trust and teaching hospital, with approximately 900 beds and 700,000 patients a year from all over the world.

No of employees:: 4,600
Business Sector:: Health
Location:: North London

Why the Royal Free Hospital NHS Trust decided to manage stress using the Management Standards:

To establish best practice
To implement an evidence-based framework for organisational level activities of the Occupational Health Psychology Service (brief therapy, consultancy, coaching, training, mediation and organisational development services for staff).

How did they do it?

The Management Standards implementation

The Hospital reviewed organisational data quarterly to identify ‘hot spots’ which needed stress risk assessment interventions. Other areas were offered a different kind of intervention. Training on the Management Standards approach and the topic of work related stress was then provided to managers in these areas. Stress risk assessment questionnaires, based on the HSE Indicator Tool questions, were then completed by all members of staff using the Psychology Service.

What next? – Action plans

A mediation service was set up to tackle the conflict that was often the underlying factor in work stress. Training for managers on stress management was put in place.

Main Challenges

Due to high workloads, one of the biggest challenges for the National Health Service was to find the time to identify and tackle stress problems and get those on board who most needed the help. The Psychology Service within the hospital also faced the challenge of ensuring that stress-related organisational issues were addressed without compromising individual confidentiality. Finally, resources needed to address all stress-related needs were not always available to the hospital.

What worked well?

The steering group for the stress and well being policy was instrumental in raising the awareness of senior managers to the impact of stress on the organisation, developing action plans and increasing options to tackle the problem of stress.

The promotion of the link between well-being and risk outcomes also proved to be an important step because risk management is a high priority for NHS trusts. Another success was the extensive training for managers, which explained the links between well-being and effectiveness, and also helped them to think more systemically about organisational problems and the handling of difficult conversations with staff. Using the stress risk assessment framework with staff proved to be extremely fruitful.

Finally, the development of a Consultancy Service for managers, which assisted them to formulate a problem with regard to stress and evaluate a range of different solutions, helped to skill up managers and reduce referrals.

"I used to get a lot of calls from managers saying, you know, I’m thinking about referring this person, they’ve got this problem, that problem and I used to say, well why don’t you come instead and tell me about it. And then we could kind of pin down a bit where there was something else going on within the team and that’s where the consultancy service came from. In helping managers to kind of… actually trying to teach managers how to formulate a problem. And understand a problem and understand their relationship to it and also the fact that they may in fact be contributing to it."
Barbara Wren – Consultant Lead Psychologist in Occupational Health

Benefits

Increased employee commitment and increased well-being has been noticed. Individuals feel valued after using the Psychology Service and feel as if the organisation is working on their behalf.
The Management Standards approach provides a very coherent framework for understanding stress and helping people to think about the components of the job that are really pressurising them. It helps to make stress a bit more manageable and provides a starting point for interventions. When managers feel quite overwhelmed by an issue they can use this framework to look at the job in more detail and identify small changes, which can make a big difference.
The line management competencies for managing stress, proposed by HSE, are seen as valuable as they carry the implicit idea that managers can really change their behaviour to become more effective.

"It allowed me time to discuss my work situation in more depth and put the emphasis back on things that I was able to change. It gave me back control over how things are and helped me to distinguish between those things that I have some influence on and those I don’t have the ability to change."
A Manager who used the consultancy service