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my job
my manager
my team
my organisation
Rational Commitment
Emotional Commitment
Discretionary Effort
Intent to Stay
ATTRITION
PERFORMANCE
Types of Commitment:
Focal point of Commitment:
Outputs of Commitment:
•Leeds Teaching Hospitals NHS Trust •Imperial College Healthcare NHS Trust •Central Manchester University Hospitals NHS FT •University College London Hospitals NHS FT •Cambridge University Hospitals NHS FT •Royal Free London NHS FT •Mid Yorkshire Hospitals NHS Trust •Portsmouth Hospitals NHS Trust •Northumbria Healthcare NHS FT •Plymouth Hospitals NHS Trust •East Sussex Healthcare NHS Trust •Buckinghamshire Healthcare NHS Trust •Bolton NHS Foundation Trust •Mid Essex Hospital Services NHS Trust •University Hospitals of Morecambe Bay NHS FT •Ipswich Hospital NHS Trust •Salisbury NHS FT •North Cumbria University Hospitals NHS Trust •Hinchingbrooke Healthcare NHS Trust •University Hospitals Birmingham NHS FT •Salford Royal NHS FT •Countess of Chester Hospital NHS FT •East Lancashire Hospitals NHS Trust •Frimley Health NHS Foundation Trust •Royal Devon & Exeter NHS Foundation Trust •The Royal Wolverhampton NHS Trust •University Hospitals Coventry & Warwickshire NHS Trust •University Hospitals of Leicester NHS Trust •North Middlesex University Hospital NHS Trust •Norfolk & Norwich NHS Foundation Trust •South Tyneside NHS Foundation Trust
Psychological wellbeing and resilience at work
Professor Ivan Robertson
NHS Employers Workforce Summit/NHS Confederation Conference
15th June 2016
• Founded in 1999
• Specialists in psychological wellbeing, engagement and resilience
Robertson Cooper Ltd
• The focus is on helping people have good days at work… creating good days at work for everyone, everywhere
• Why is psychological well-being (PWB) important in the workplace?Personal health, work performance, impact on others
• What creates a good day at work?Work itself, Management & leadership, Organizational policies, Home-work interface
• Building PWB at workPersonal resilience and wellbeing
• Key messages and practical points
Overview
Psychological well-being (PWB)
• Low stress (NOT low pressure) and…
• The positive emotions that people experience (hedonic) and…
• The extent to which people experience a positive sense of purpose in their work (eudaimonic)
The Wellbeing ContinuumPre
ma
ture
de
ath
We
llbe
ing
Ma
xim
ised
Neutral point
No discernible illness or wellness
Illness SignsSymptoms
Awareness GrowthEducation
Source: John Travis (2004)
Longer term consequences
• Cardiovascular disease Heart attack, stroke, blood pressure, etc…
• Sugar/fat metabolismDiabetes, obesity,
• Immune systemMinor infections … serious diseases
• Health behaviour
CVD & PWB
• EvidenceMany studies link chronic stress and measures of PWB with CVD (e.g. 11/11 prospective studies predicted CVD in healthy populations)Effect sizeSome (approx 30%)**may be due to health-related behaviour … or stable personality factorsConservative effect: (risk ratio) = 1.4-1.6***
*Hemingway & Marmot, 1999; **Chandola et al., (2008; ***Kivinaki et al., 2006)
Sugar/fat metabolism & PWB
• EvidenceStudies link stress and PWB with obesity* and diabetes**Longitudinal and cross-sectional studies
• Effect sizeFewer estimates than for CVDEffect size (Odds ratio)=1.1-1.61* (reduced <0.78> with social support***)Burn out … 1.84 increase in risk of diabetes****
*Brunner et al., 2007; **Heraclides et al., 2009; ***Toker et al., 2012; ****Melamed et al., 2006
Immune system & PWB
• EvidenceStress and PWB linked to suppression of immune system; upper respiratory tract infections; poorer wound healing … but also some auto-immune diseases (excessive immune reactions)
• Effect sizeOutcomes measured are very diverseSpecific illness … biological markers (e.g. IL6, reduced lymphocyte reactions)
Protective effect of positive PWB
• Positive PWB linked to:Lower mortality rates - high vs low PWB (2 SD difference)… increased life span of 4-10 years
• Healthy behaviour … mostly cross-sectional studies
• Better cardiovascular health “Taken together, studies … demonstrate that Positive PWB protects against CVD even when controlling for typical CVD risk factors and ill-being.” (Boehm & Kubzansky, 2012)
• Immune system, diabetes, etc?
PWB and work performance?
• Measure psychological wellbeing:Standardised (self-report) measures
• Measure performance:Individual performance indicators (e.g. self-report, supervisor assessment, objective performance, etc.)Organizational performance indicators(e.g. sickness absence, presenteeism, service user satisfaction, staff retention, recruitment, etc.)
Performance & PWB:
• Individual performance*Overall performance: r=0.40 (31 samples; n=10,000+)Supervisor/Peer rating: r=0.42 (11 samples; n=1750)Self rating: r=0.41 (12 samples; n=6475)
• *Ford et al (2011)
• Organizational performance**66 different organisationsPWB (Emotional exhaustion) correlated with Client/User satisfaction (r=-0.55); Productivity (r=-0.40
• **Taris & Schreurs (2009)
Story so far…
• So … positive psychological well-being is good for:
Individual health
Individual performance
Organizational performance … recruitment, retention… service user satisfaction…etc…
Good day(s) at work
Situation Person
Work pressuresManagement & leadershipOrganizational policies & practicesHome – work interface
Underlying personalityExperiencesTraining & Development
Types of pressure
• Hindrance pressuresRole ambiguityWork RelationshipsJob insecurity
• Challenge pressuresWorkload Time pressure Job scope Responsibility
Pressure
Type of
Pressure
Strain Job satisfaction
Commitment Turnover Withdrawal
Hindrance 0.48
Challenge 0.21
Pressure
Type of
Pressure
Strain Job satisfaction
Commitment Turnover Withdrawal
Hindrance 0.48 -0.66 -0.63 0.25 0.23
Challenge 0.21 0.24 0.29 -0.06 -0.02
Podsakoff et al., 2007
Workplace factors linked to wellbeing
Demands- Cognitive- Physical- Emotional
Control Resources &Support
Achievement
The “6 essential” sources of pressure
• Resources and communication (Pressure from lack of resources or information)
• Control and autonomy (Limitations on how the job is done or freedom to make decisions)
• Balanced workload (Peaks and troughs in workload, difficult deadlines, unsocial hours, work life balance challenges)
• Job security & change (Pressure from change and uncertainty about the future)
• Work relationships (High pressure relationships with colleagues, customers, bosses)
• Job conditions (Pressure from working conditions or pay and benefits)
What are the Underlying Issues in NHS ?NHS Employers Research in 2014/5 indicated that 4 things seems to make a difference for NHS Staff:
• Am I able to make a difference?
• Is my workload fair and manageable?
• Do my colleagues help me do a good job?
• Is my health as important to me as my patients?
Commuting
• Time spent 1997 the average worker in Britain commuted for 48 min per day2011 54 min, or 12% of a standard full-time working week
• Female-Male differences in impact
• Mode of transport may be a moderator
Roberts et al., (2011), ONS, (2014)
Frequent travel (away from home)
• Travellers versus non-travellers:
• General medical claims are higher
• Psychological illness claims are 3 times higher!
• Claims from spouses of travellers are 16% higher (over 30% higher for psychological problems)
• Young children are negatively affected
• Poor scores on Psychological well-beingwith average scores in the worst 20-25% for Manager/professionals
Dimberg et al., 2006, Liese et al., 1997, Espino et al., 2002
Westman & Etzion, 2002
Working hours
• Working more than 11 hours a day consistently
Likelihood of depression – 250% higher than people working fewer hours
Virtanen et al., 2012; NISER, 2012
Working patterns
• Flexitime: when to begin and end work.
• Compressed hours: reallocation of work into fewer and longer blocks during the week.
• Annual hours: the total number of hours to be worked over the year is fixed
• Working from home: workers regularly spend time working from home.
• Mobile working/teleworking.
• Career breaks: extended periods of leave
• Zero hours
Organizational context: Management & leadership
1. The (UK) Foresight review of “Mental Capital”
2. The UK government’s Health, Work and Well-being initiative - Dame Carol Black
3. The National Institute for Clinical Excellence (NICE, UK) guidelines on mental well-being at work
4. All based on expert testimony and research evidence…
Management & leadership*
• Management/leadership behaviour related to:BurnoutHealth complaintsPsychiatric disturbance
Even when controlling for: age, health practices, support from other people at work, support from home, stressful life events, and stressful work events.
*Gilbreath and Benson (2004); Barling & Carson (2008); Gilbreath et al, (2012)
Personal resilience:What is it?
• Psychologically positive and healthyResilience protects psychological well-being and health
• Behaviourally effective and capableResilience helps to retain a focus on what matters and supports effective behaviour
Where does resilience come from?
• My experience?Early life experiencesExposure to pressure
• Me?Underlying psychological make-up (Personality)
Building resilience and PWB at work (Protecting yourself)
• Focus on the “six essentials”
• Respite
• Workplace purpose – meaning and purpose at work
• Challenge & Mastery - Experiencing tough challenges - Stretch … but not Panic zone!
• Recognise and develop strengths
• Develop optimistic thinking styles (How to make positive attributions)
• Enhance physical well-being
Resilience: The role of physical activityLow physical activity:
• More likely to experience stress
• Poorer positive psychological well-being
• React to stressors more extremely
Physical activity Odds ratio for stress
Low – sedentary or less than 2 hrs per week
1.0
Moderate – 2-4 hrs per week
0.42
High – more than 4hrs/several times per week
0.40
Jogging 0.27Schnohret al., 2005
Resilience: The role of physical activity
Taking up exercise
• Impact of exercise is equivalent to Cognitive Behaviour Therapy (CBT)
Physical activity Odds ratio for stress
No change - Sedentary 1.0
No change - Active 0.32
Sedentary - Active 0.50
Active - Sedentary 0.72
Lawlor & Hopker, 2009
Lunch is served in the Exhibition Hall
13.00: Welcome and introductionsAnita Anand, BBC presenter and journalist
13.15: Opening Keynote addressRT Hon Stephen Dorrell, Chair, NHS Confederation
13.45: Local liaisons: Health and care partnerships built to last
14.30: Networking, exhibition viewing and refreshments
Supported by
Supported by
Ruth May - Nurse Director, NHS Improvement
Kathy McLean - Medical Director, NHS Improvement
Andrew Rowland – Partner, Capsticks LLP
Danny Mortimer - Chief Executive, NHS Employers
Supported by
Danny Mortimer - Chief Executive, NHS Employers
Stephen Moir - Chief People Officer and Head of Profession: NHS
HR, NHS England
Deborah Tarrant - President, HPMA
Nicky Ingham - Director of Workforce and Organisational
Development, Blackpool Teaching Hospitals NHS Foundation Trust
17:00 International keynote speaker Jason Helgerson, Medicaid Director, State of New York
17:30 Communities of interest: People-powered health and care
18:15 Exhibition viewing and refreshment break
19:00 NHS Confederation member and partner reception An exclusive networking reception for members and
Associate Partners of the NHS Confederation hosted
by the Lord Mayor of Manchester. Supported by