Psychosocial factors

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Some statements about hours of work

Hours of work

Sleep deprivation lasting 24 hours has a measurable, negative impact on performance. The same level of impairment occurs after being awake for 17-19 hours as having a blood alcohol level at the legal limit for driving.

Working (during the day) more than about 55–60 hours per week over an extended period is likely to lead to significant health effects

Extending a working week from 65 to 70 hours (i.e. by 5 hours) will have more of an impact than extending it by the same amount of time but from 40–45 hours.

Hours-of-work limits for day work will be different from those for night work.

Night work

Shiftworkers lose, on average, 1 to 1.5 hours sleep each 24- hour period, resulting in a sleep debt of six hours after four nights and with significant consequences for health and safety.

The effects of working nights and extended hours are interactive.

Extended hours and night work

Sleep deprivation, coupled with long hours of work over a prolonged period of time (approximately 12 months) has both a short-term impact on performance and, in the long term, will lead to cardiovascular, mental health, behavioural and productivity losses.

Opportunities for recuperation

In the long term the average sleep period required for continued health and alertness is between 7 and 9 hours.

A minimum of six hours of consecutive sleep in a 24-hour period is the min-imum needed to keep alert for the next 24 hours, but assumes a 0 sleep debt.

The length of the break required to sleep well depends on the amount of time the person spends getting to and from work and the time they take in eating, getting ready to sleep, toileting and dressing.

Two consecutive full nights sleep, with a normal day pattern, is required after 3-4 nights’ work for full recovery.

Breaks during work

Providing breaks within the working period allows the restoration of alertness and the relief of boredom & monotony.

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Stress – Summarising the DOL Healthy Work Guideline

Key principles	Key actions	Key messages and tools from the Healthy Work guideline
Making work healthy will benefit employees and the organisation.	Use the tools in the Department of Labour Healthy Work Guide to promote healthy work (Table 1.2). Look for ways to increase job satisfaction (section 1.7).	Table 1.2 suggests things for employers and employees to consider re the development of healthy work. Tables 7.1–7.3 are tools to promote dialogue.
Take employee reports of ‘stress’ at face value.	Investigate these reports. See the six-step approach in section Employers don’t have to agree with employees over the outcome, but they are required to investigate employee concerns in good faith.	Section 2 outlines a sample process for responding to reports of ‘stress’, without committing employers to agreeing with the employee.
Stressors should be dealt with as with any other workplace hazard.	Be proactive in identifying, assessing and controlling stressors. In some work, harm from stress is foreseeable. Apply the standard approach of eliminate, isolate and minimise to control.	Table 1.1 lists common factors associated with workplace dissatisfaction. Section 3 refers to four categories of work. Employers whose work is Category Four should assume that intrinsic stressors will need to be controlled, see Tables 7.4–7.6.
Stress management (whatever that is) won’t work by itself.	If you implement a stress programme, the Department suggests you do it according to the published evidence.	Primary (making work healthy), secondary (improving the fit between the person and the job) and tertiary prevention (stress management) should all be used. Sections 4 and 5 outline Healthy Work programmes for large and small business respectively.
Detect impairment.	Take reasonably practicable steps to detect impairment and its resulting fatigue.	Section 6 refers.
This is not rocket science.	Employers are required to take steps that are reasonably practicable. They are not required to ‘cocoon employers from stress and upset’ or to be ‘guarantors of health and safety’.	Work should be enjoyable. Creating healthy work is a shared responsibility that requires co-operation and accommodation between employers and employees.

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Morale, Distress and Healthy Work

We all experience stress at different times, to varying degrees. But we need to tell the difference between two types of it - challenging and threatening.

When we feel that work is leading to concrete, achievable and worthwhile goals, we almost always rise to the occasion, even with severe difficulties. Where there are urgent deadlines, work overload, poor relationships or where other things cause stress, we mostly cope - if there is a return to ‘normal’ in a reasonable time.

But, when a ‘stressful’ situation is ongoing and/or severe and/or causes mental or physical illness, then it becomes a concern. In these extremes the Health and Safety in Employment Act 1992 Act requires the situation to be managed.

Morale & Challenge

Morale is valuable in every workplace.

It comes when we feel a sense of purpose in our work, where there is enthusiasm, a supportive team climate, when work is interesting and rewarding and where realistic challenges exist.

Challenges - 'opportunities to win' - motivate us to accomplish things, and can be a ‘good’ kind of stress.When morale is high, we tend to get on with the job, persist until the challenge is met and have positive thoughts. Optimism, self-restraint and humour are also present and we enjoy others’ company at work.

Morale seeps downwards, so it is the CEO’s responsibility.

Distress and Threat

A threat at work - 'an opportunity to lose' - is the opposite of a challenge and can be unpleasant. When we face a threat we tend to avoid and delay dealing with it, have negative thoughts, and think of leaving. Of course, this spurs a lot of people into taking creative and productive action to turn the threat into a challenge.

However, if the threat is large, goes on long enough or is never spoken about, low morale and distress can result. Morale can exist alongside distress and can help people ride over it, but only so far.

Distress and low morale can come from two main sources:

• Work Experiences - things like:
• physically, mentally or emotionally tiring work
• having little control over how to do the job
• The Organisational Climate - things like:
• poor feedback about performance
• unfairness, being ignored etc

Healthy Work

Consistently, people say that the second type of work problem - the organisational climate - 'or the bureaucracy and red tape' - causes more difficulties than the first.

Fortunately, we know how to make unhealthy work healthy - and there is good evidence that healthy work results in better productivity and personal health.

What does healthy work look like?

• a balance of effort and rest
• some variety in my tasks
• a sense of control (some control over how I do my tasks) - some autonomy
• communication and collaboration
• rewards and support… and so on

Nobody pretends that all work can have all these features all the time. However, dialogue between employers and employees can lead to ideas on making work healthier.

Stress - What does it look like?

You would want to know when distress is beginning to affect your employees and the signs and symptoms of stress.

A stressed workplace might look like this:

• Low morale
• High absenteeism or turnover
• Customer complaints
• Loss of business
• Low productivity
• Poor relationships internally

Signs and symptoms of stress in individuals:

Physical: headaches, tummy upsets, poor sleep, raised blood pressure, chest pains.

Mental: anxiety, depressed mood.Behavioural: irritable, alcohol/drug use.

Cognitive: difficulty concentrating and making decisions, increased reaction times.

Interpersonal: relationships go sour.

What Might Cause These Things?

Many aspects of work are linked to reports of stress:

Relations: conflict between staff, bullying, aggressive/difficult customers, no participation, poor support/supervision

Work timing: long hours, shiftwork, time pressures, working alone

Role: task ambiguity, reporting to two bosses

Tasks: unfamiliar tasks, no training or feedback on performance, little variety, no control over work pace, hazardous work

But you can't assume that removing these stressors, if they are present, will automatically make things better!

This is because different people may view a stressor positively or negatively. In fact, there seems to be universal agreement about just two aspects of work.

See the idea in the box, and then consider these examples:

• Some staff find 'difficult customers' a challenge (they are good at turning them into satisfied customers). Others can't cope with them at all.
• Some people are challenged by a task - others give up
• Some people prefer to work alone. Others like contact with lots of people every day.

What Can Employers Do?

In a nutshell - (a) take active steps to make work healthy, (b) build morale, (c) identify stressors, talk with staff and then (d) deal with the stressors and respond to reports of stress.

Morale and Motivation

Morale seeps downwards, so it is the CEO’s responsibility. Find out your staff’s views on things like:

• Fairness, consistency, leadership and direction
• Appraisal, feedback, rewards and goal clarity

If problems are found, leadership development is key. Money is better spent on this than stress management.

Identifying and dealing with stressors

Decide what category of work your work falls into.

1. Healthy work - stimulating, enjoyable and rewarding - contains genuine challenges.

2. Stress is self induced - staff contribute to their difficulties by such as - not asking for help - refusing reasonable change or saying 'yes' when they should say ‘no’.

3. Work is badly organised - Work is free of the stressors in Category 4 - but is organised so that a number of people find it hard to cope with.

4. Work is - emotionally challenging, draining or repugnant, needs intense prolonged concentration and effort or has high consequences of error.

Tailor prevention to suit the category. There are three ways to do this:

Primary: Make work healthy - remove stressors - acknowledge, appreciate and reward staff contributions.

Secondary: Improve the fit between the person and the job by - selection - training - feedback and the application of ergonomics.

Tertiary: Helping affected people - so called 'stress management' . [There is no evidence that ‘stress management’ has any effect on anything other than a short increase in personal reports of well-being.]

Ask your staff

Asking staff or using a questionnaire are ways to identify stressors. The results need to be discussed with employees, otherwise you might remove something from a person's work that they actually find challenging, interesting and/or stimulating.

But — look out specifically for work overload. Everyone regards it as toxic and there is good evidence it can cause mental health problems.

Distinguish between the stressors people say are challenging (an opportunity to win) or threatening (an opportunity to lose). When people need help in these two situations, deal with them differently, as explained below.

How far do I need to go?

Employers are required to find a balance between the risks employees face and the safeguards they put in place. However, they are not required to ‘cocoon employees from stress and upset’ or to be the ‘guarantor of health and safety’.

When staff report stress

DOL suggests you take such reports seriously. There are many ways to do this - one is shown in the web link.

What Can Employees Do?

The key is to seek or get help. Even when people face quite serious threats, getting the right sort of help can result in satisfaction with outcomes.

Help may need to be of two sorts -

• Emotional support —when facing emotional difficulties— E.g. when threats are being faced.
• Practical help - for example, when a challenge is being worked through. Provide resources and help to overcome specific barriers.

Free Publications On www.osh.dol.govt.nz

1. Healthy Work - Managing Stress and Fatigue in the Workplace. 2003.
2. Stress and Fatigue: Their implications for health and safety in the workplace. 1998.
3. Healthy Work: Managing shifwork to minimize fatigue. 2007.
4. Healthy Work: Morale, Distress and Productivity. DoL, 2008.

See: www.osh.govt.nz/order/catalogue/stress/index.shtml

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Bullying

What is bullying?

There is no set formula for recognising bullying. Not all unpleasant behaviours or experiences in the workplace can be called bullying.

Bullying may range from the ‘vertical’, by people in positions of power, through to the ‘horizontal’ - amongst colleagues or co-workers.

Some workplace practices may amount to ‘corporate bullying’. Research shows that ‘giving too much work’ is cited as a common manifestation of bullying.

The many definitions of bullying have these elements in common:

• Unwanted
• Unwarranted
• Repeated
• Health endangering

Bullying, when extreme, is likely to have elements of repeated, prolonged and deliberate behaviour. A person may feel deliberately targeted, intimidated, isolated, degraded and humiliated.

What is the effect of bullying?

Workplace bullying can have several types of effect:

• isolation
• lost confidence
• feelings of not being able to cope
• feelings of having few options
• the thought of being less able to cope in the future.

It can affect home life and may also affect the organisation through increased staff turnover and lower productivity (e.g. through, presenteeism, absenteeism, low morale or unsafe work practices).

Common features in the New Zealand bullying experience have emerged over the last few years:

• A string of resignations
• Complaints to senior management are met with indifference, dismissal or indecision
• The bullied person leaves, the bullier stays
• Mediation is cited as of little help to the bullied person
• A person becomes isolated - and is left to their fate.

Difficulties exist in telling the differences between legitimate workplace activities, mostly connected with performance appraisal, and bullying.

What should Employers do?

Employers have a duty under the Health and Safety in Employment Act 1992 to take all practicable steps to ensure that employees are not harmed while at work. That includes ensuring that an employee does not harm others.

An employee also has a duty to look after their own safety and health and to ensure that they do not harm others. This is also an implied duty as part of the employment relationship. Addressing bullying is the responsibility of everyone in an organisation.

The prevention of workplace bullying can be most helped from the top - by an employer who makes it clear by actions as well as words that bullying is unacceptable.

This may mean establishing clear, formal, anti-bullying policies and procedures, assigning resources in the form of training for employees and management, giving management time to execute actions effectively and giving access to specialist advisers when these are required.

The employer should appoint a contact person, establish a zero tolerance policy and encourage reporting, investigate all complaints and respond promptly where this is required. More than one contact person may be needed, to allow for bullying by a manager.

An employee who perceives they are being bullied should document incidents of bullying behaviour and bring the problem to the attention of their employer.

A distressing feature of some instances of workplace bullying is when a person becomes isolated and loses or does not gain the support of colleagues.

Well recognised skills of a ‘competent’ bully are (a) to pick, in advance, people to bully who won’t get support from colleagues and (b) to select people and groom them to support his/her agenda.

Employees therefore have a role in looking out for each other.

If the employee does not feel comfortable approaching the employer in person, they may outline their concerns and request action via a letter.

If the employee belongs to a union or has another form of representative, (e.g. workplace health and safety representative) they can ask for appropriate help that way.

If the employee or employer believes that a discussion about bullying is not productive they may wish to consider attending mediation provided by the Department of Labour.

Mediation, while voluntary, is the primary mechanism for resolving employment relationship problems and should be considered before any further steps are taken. Mediation may be useful in assisting both parties to identify whether the issue is bullying or another underlying problem. Mediation can also assist where the problem is between co-workers or colleagues.

You can contact the Department with requests or seek guidance for managing a mediation involving bullying.

Visit: http://www.dol.govt.nz/er/services/mediators/index.asp for further information.

However, there is good evidence that mediation is not suitable for instances where bullying is advanced and where the individual feels badly affected. In these cases mediation offers yet another way for the bully to oppress the bullied.

When extreme cases of bullying are raised, particularly where it involves someone in a position of power or authority, or a person skilled in exploiting situations to the disadvantage of others, senior managers or business owners will need to be involved. They will need to take the lead in confirming that a person said to be a bully actually is one (or is not), assessing the degree of risk posed to others, and devising appropriate responses.

It is important that these extreme dimensions are communicated if discussing options or seeking assistance from the Department of Labour.

In certain serious situations, the Department of Labour can intervene to ensure safety in the workplace under the provisions of the Health and Safety in Employment Act 1992.

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Violence to Caregivers

Key principles	Key actions	Key messages and tools
Take a comprehensive approach to health and safety management		This should be a given – based on the idea that it will be impossible to provide high quality client/ patient care unless staff are safe and feel so.
Take all the reasonable and practicable steps to prevent harm	Expanded in key messages. Refer to the Department of Labour publication Managing the Risk of Workplace Violence to Healthcare and Community Service Providers.	Taking all practicable steps – the usual caveats apply Client information: Current information about each client/patient should be available and patient/client care plans should address issues of violence, if there is the need. Facility design: Provide safe interview/assessment rooms; Consider lighting, space, noise, thermal comfort and security. Selection of staff: Identify: people who are suitable for the work; their levels of training and experience; immune status and background – before they begin work. Relationships: Permit care of clients/patients only if within organisation’s capabilities. Negotiate realistic expectations with stakeholders. Job design: Match employee skills to client/patient needs. Rotate staff, provide a variety of tasks, use buddying and provide feedback on performance. Security and emergencies: Provide safety glass and walls where needed; use security equipment (CCTV, mirrors, cameras, safe rooms) as appropriate. Staff numbers: Have enough people to do the work in a healthy and safe manner. Behaviour management: Aim to establish the concept that violence is unacceptable and preventable.
Provide information and training in relation to hazards of violence	Induction and ongoing training will be needed about specific and general hazards – at all levels so that expectations may be developed and implemented	For all staff, general training for: orientation to the work, the workplace environment and management health and safety policies, procedures and obligations skill in the use and interpretation of patient care plans calming and restraint training self-defence, where appropriate. Specific training to do with improving: ability to identify violent situations capacity of event appraisal, coping and problem solving dealing with people with different needs and backgrounds see Guideline for a complete discussion.
Monitor staff health	If significant hazards remain, monitor staff exposures and health and safety in relation to them. (Monitoring should include apprehension about the prospect of a violent assault, if that is necessary.)	There should be feedback to management about any instances of violence to caregivers
Provide first aid and rehabilitation	Provide first-aid after injuries, and rehabilitation plans if people are off work.	Trained first-aiders should be available. Developing a rehabilitation plan may require specialist assistance.
Assign responsibilities	Assign management, employee and patient and family responsibilities.	This is part of establishing a violence-free culture.

 

Counties Manukau District Health Board and the Department of Labour have jointly published a Guideline about preventing violence to caregivers.

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Fatigue and shiftwork

Key principles	Key actions
Communication and Commitment	All parties need to commit to making the shiftwork system work well. Shiftwork can have major effects on long and short term health, as stated in the 12 principles on page 5 of the DOL Guide: Managing Shiftwork to Minimise Workplace Fatigue and as explained in more detail on pages 11 – 16.
Policies	Corporate and operational polices will be needed.
Review hours of work	Management should provide enough people to do the work safely. The fatigue consequences of the shift working arrangements should be assessed. The actual hours of work should also be assessed.
Risk management	Identify fatigue hazards and avoid doing risky tasks when people are tired.
Training and education	Provide information, training and supervision to employees doing shiftwork.
Monitoring and evaluation	Monitor employee reactions to shiftwork.Evaluate shiftworking arrangements as an integral part of shiftwork management.

References

Managing Shiftwork to Minimise Workplace Fatigue.
Department of Labour.
Wellington. 2007.

Visit http://www.wws.princeton.edu/ota/ns20/alpha_f.html to view

• Biological Rhythms: Implications for the Worker September 1991).

Although it is now over 14 years old, this publication by the visionary Office of Technology Assessment in the USA remains one of the best summaries of the issues available.

Key messages and tools

• Shiftwork management should take a comprehensive approach.
• Looking for the perfect roster is a ‘wild goose chase’.
• A system of shiftworking is, inevitably, a balancing of interests that will require accommodation and flexibility from all parties.
• Features of successful shiftworking systems include:
• employee involvement and control
• training (including families if possible)
• a single co-ordinator for shiftworking arrangements.

A corporate policy establishes intent. An operational policy describes how the system will operate in practice.
Standard suggestions exist for the design of shift rosters.

A fatigue assessment should be made of the (a) planned hours of work and (b) the actual hours worked. Software exists for this purpose, but other methods can be used.

The differences between (a) and (b) can be – informative.
The risks posed by hazards need to be identified and placed in priority order.

There are tools in the Department’s guideline about training topics and the evaluation of employee knowledge on the hazards of shiftwork. From the results of its use, a training programme to address gaps can be developed.

Employee reaction to shiftwork should be monitored to detect impairment and longer term health effects.

Systems of shiftwork will never be perfect, but they can be improved – through monitoring and evaluation.

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