Easing the Stress

April 9, 2003
Will employers heed the doctors' advice and stop pushing employees so hard?

Is stress the Catch-22 of workplace safety and health? At the same time researchers are revealing more about how stress can contribute to rising healthcare costs, a variety of physical and psychological ailments and lower productivity, it seems as if many employers are fashioning workplaces designed to create more stress. As a Families and Work Institute report stated, "Some employers believe that pushing employees to do more and do it faster is the only way to remain competitive in the global economy."

The European Agency for Safety and Health at Work, which launched a campaign last year against workplace stress, observed that while work-related stress causes people "misery, both at work and at home," many people have "put off doing something because they see work-related stress as a very complex issue that is impossible to tackle."

Nor is the current uncertain world helping, noted Dr. Robert Yufit, a clinical psychologist at Northwestern University Medical School. "There is a lot of additional stress with the world situation," he said. "What is the world going to be like? Since 9/11, there are a lot of concerns about that. People lose money in the stock market, then gas prices go up. They get worried about financial matters that they didn't have before. All these external factors play on a person. There are a lot of people I would have to call 'vulnerable' who are very deeply affected by these kinds of things."

How pervasive is the workplace problem? In May 2001, the Families and Work Institute and PricewaterhouseCoopers released a study that found 28 percent of the employees in the United States felt overworked "often" or "very often" and 54 percent felt overworked at least sometimes in the previous three months. And 43 percent of employees who felt overworked said they feel angry toward their employers "often" or "very often" versus only 3 percent who experience low levels of feeling overworked.

Findings in Europe are similar. Work-related stress affects 40 million employees in the European Union, or 28 percent of the workforce. EU officials estimated the annual bill for job stress is $20 billion. Some 50-60 percent of absenteeism has been tied to work-related stress.

"If you look across U.S. surveys and across some European surveys, there is a clear tendency toward work becoming more intense and more demanding," said Dr. Steve Sauter, a psychologist with NIOSH and an expert on workplace stress issues.

While Sauter is cautious about drawing the conclusion that work intensification is necessarily resulting in more stress, he points out a study showing people with high levels of stress have approximately 50 percent higher health care utilization than workers with low levels of stress. When you combine stress and depression, the figure jumps to 150 percent.

Stress vs. Challenge

Stress experts are careful to make a distinction between "challenge" and stress. Challenge, says NIOSH, "energizes us psychologically and physically, and it motivates us to learn new skills and master our jobs. When a challenge is met, we feel relaxed and satisfied. Thus, challenge is an important ingredient for healthy and productive work."

Lennart Levi referred to this positive aspect of work as the "spice of life." Levi, emeritus professor of psychosocial medicine at the Karolinksa Institute in Stockholm, Sweden, said the benefits of work on health are more likely to occur when work demands are optimal, workers are allowed to exercise a reasonable degree of autonomy and when the climate of the work organization is friendly and supportive.

NIOSH defines job stress, on the other hand, as "the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources or needs of the worker." This negative aspect of high-pressure work, which Levi calls the "kiss of death," can contribute to ill health effects ranging from headaches to depression to heart disease and stroke.

In many ways, say stress experts, the quest to do more with less mirrors the American character. Americans are pressured, said Yufit. "They feel they have to achieve, advance, get promoted and make more money. Keeping up with the Jones is still a problem."

But at some point, the admirable desire to do more becomes distorted into excessive demands that harm people and organizations. Instead of creating a more efficient, profitable company, stressful working conditions create what the European Agency calls "organizational symptoms" high levels of absenteeism and labor turnover, poor safety performance, low employee morale, a lack of innovation and poor productivity.

At a time when companies extol teamwork, notes psychologist Joseph Mancusi, Ph.D., employees under stress are less likely to be team players. "When people are under stress, they tend to just guard themselves. Also, they are not having fun. When people are passionate about work, when they have fun at work, they are far better employees."

NIOSH's Sauter said one of the challenges facing stress researchers is that the workplace is changing so quickly. Downsizing, lean production and continuous improvement have swept through organizations, as have new employment arrangements such as contingent work and contract labor. Moreover, the demographics of the work force continue to shift as more women work outside the home and the workforce becomes older and more racially diverse. "All of this leads to a breakdown in expectations and communication difficulties," said Mancusi.

Managing Stress

Experts concur that while stress in the workplace is pervasive, job-related stress shares the characteristic of other workplace safety and health conditions it is preventable. NIOSH, for example, advocates a three-step process:

1) Identify the problem. Through group discussions or formal surveys, measure employees' perceptions of job conditions, stress, health and satisfaction. Companies should also examine objective data such as absenteeism, illness and turnover rates. This data can then be analyzed to determine where stress problems are located (throughout the whole company or in one department) and the job conditions that may be responsible for the problem.

2) Design and implement interventions. Actions to reduce stress will be tailored to the problems found. Some interventions, such as improved communication or stress management training, can be implemented fairly quickly while others, such as the redesign of a manufacturing process, may require more time. "Before any intervention occurs, employees should be informed about actions that will be taken and when they will occur," NIOSH recommends. "A kick-off event, such as an all-hands meeting, is often useful for this purpose."

3) Evaluate the interventions. NIOSH suggests both short- and long-term evaluations to check whether interventions are producing the desired improvements. "Employee perceptions are usually the most sensitive measure of stressful working conditions and often provide the first indication of intervention effectiveness," NIOSH points out. "Adding objective measure such as absenteeism and health care costs may also be useful."

NIOSH says stress prevention is an ongoing process, not a program that ends with evaluation. Evaluation should serve as a way to fine-tune or redirect the intervention activities.

Tackling workplace stress usually involves two avenues stress management programs and organizational change. Stress management services, often offered through employee assistance programs, help employees deal with issues on and off the job that may be bothering them. Approximately half of the major companies in the United States offer stress management programs

Health experts note that people vary widely in their ability to cope with stress. "Some people are more flexible in handling their problems," observed Yufit. "If you are flexible and things go badly, you figure tomorrow is going to be another day or you figure out what you can do to make it better."

For people with stress problems, seeking a balance in their life is key, according to Yufit. "Many people work too much and don't play enough. They don't have enough leisure time."

Supervisors can create a stressful work environment in a number of ways. Yufit said they may have unrealistically high expectations, communicate ineffectively or fail to recognize employees when they do a good job. "Many bosses are afraid if they tell people they are doing a good job, the next thing that will happen is the person asks for a raise and they don't want to give the person a raise because of their financial condition," he explained. "It is a very vicious circle. If they don't get the recognition, the employee feels they are not doing their job well." That in turn, said Yufit, can lead to depression in the employee.

Recognition does not have to be expensive, our respondents noted. It can be just a pat on the back or citing employees for doing a good job at a recognition lunch. "We often do a bad job in thanking people," said Mancusi. "With praise, self-esteem rises. The employee feels they are really part of the team."

Beyond stress management training and counseling, however, job health experts say companies need to examine the role of the organization in producing stress. Managers may be uncomfortable with this aspect of stress management, notes NIOSH, because "it can involve changes in work routines or production schedules, or changes in the organizational structure." Still, NIOSH and other authorities say this is what companies should make their top priority because it deals with the root cause of stress in the workplace.

Mancusi said the causes of chronic stress frequently are cumulative. The threat of unemployment, terrorism, the drop in the stock market, child care hassles all contribute to employees' stress and most are beyond the ability of an employer to solve. But, said Mancusi, "People spend the majority of their time and get a lot of rewards about who they are as people at work. It is very important that we set up the workplace so it reduces stress, not enhances it."

Sidebar: Watch Out for the Boss

Ask clinical psychologist Joseph Mancusi what the number one cause of stress on the job is and he'll tell you with great certainty: "The boss."

While companies wouldn't dream of letting a supervisor introduce a virus that destroys 10 percent of their computer system's productivity, Mancusi said, they routinely allow supervisors to destroy 10 to 30 percent of their workers' productivity through bad management.

During his work with 20 companies, Mancusi surveyed employees and asked them a series of questions, including, "Do I trust my boss?"

Mancusi reports that a woeful 39 percent of the employees said they didn't trust their immediate manager, supervisor or team leader. "A company cannot be successful with four out of 10 people more concerned about their backs than about productivity," said Mancusi, the president of the Center for Organizational Excellence, Sterling, Va.

Lack of trust undermines the entire workplace relationship, said Mancusi. Without trust, employees show little commitment to supervisors and little regard for their success. At the same time, employees feel greater amounts of stress because they think the supervisor either is out to get them or to impede their effectiveness. Even honest dealings are undermined, said Mancusi, because, "No matter what happens, if I don't trust you, I won't believe you."

A supervisor's job is that of a leader who needs to take care of all the company's assets, not just machinery and inventory but especially the people. "You have to make sure you don't have a destructive manager who is sexually harassing people, yelling and screaming at people, communicating in negative ways or who refuses to positively reinforce people," Mancusi said.

While companies can't control all sources of stress, they can take steps to reduce the stress in the workplace, where people spend much of their time. Mancusi said companies should set clear expectations, offer an employee assistance program and reduce ergonomic stressors. He also emphasizes the need for effective teamwork. "Human beings were meant to work on teams," he noted, adding that companies need to create an environment where there is open communication and employees are made to feel they are a useful, valuable part of the team.

Sidebar: Factors Associated with Work-Related Stress



Work Context

Organizational culture and function

Poor communication, low levels of support for problem-solving and personal

development, lack of definition of organizational objectives.

Role in organization

Role ambiguity and role conflict, responsibility for people

Career development

Career stagnation and uncertainty, under- or over-promotion, poor pay, job insecurity,

low social value to work

Decision "latitude"/control

Low participation in decision-making, lack of control over work (control, particularly

in the form of participation, is also a context and wider organizational issue).

Interpersonal relationships at work

Social or physical isolation, poor relationships with superiors, interpersonal conflict,

lack of social support.

Home-work interface

Conflicting demands of work and home, low support at home, dual career problems.

Work Content

Work environment and work equipment

Problems regarding the reliability, availability, suitability and maintenance or repair

of both equipment and facilities.

Task design

Lack of variety or short work cycles, fragmented or meaningless work, under-use

of skills, high level of uncertainty.


Work overload or underload, lack of control over pacing, high levels of time pressure.

Work schedule

Shift working, inflexible work schedules, unpredictable hours, long or unsocial hours.

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