Psychosocial risk management: The UK approach

Professor Tom Cox CBE

Institute of Work, Health & OrganisationsSchool of Community Health Sciences

Changing World of Work

Changing nature of workers, work, workorganisations and working life:

– Globalisation – Free market economics– New IC technology– Unstable banking and

trading systems– Recession

Changing world of work brings new challenges to occupational health ~ psychosocial hazards

Working people

Change in age-related demography of work force

Inclusion of increasing numbers of migrant workers in work force

Increasingly multi cultural work force

Declining standards of literacy and numeracy, declining interest in science and declining ability of young people to think creatively

Work

Move from primary extractive and secondary manufacturing sectors to tertiary service sectorWork less physical and increasingly knowledge-based

Greater reliance on information and communication technology (ICT)Move to 24/7 working

More part time, temporary, flexible and mobile jobs: precarious work and increased job insecurity

Working life

Move away from linear careers to career portfolios

Changing nature of psychological and social contracts between employee and employer

Increasing requirement for self management, intrinsic motivation and creativity

Longer working hoursGreater intrusion on non work time: work life balance

Work organisations

Globalisation: free market economics

Increasingly competitive environment with continual search for innovation, increased efficiencies and increased cost effectiveness: organisational restructuring, down sizing and out sourcing

Tighter margins but greater expectation for profit and growth

Rapid development of advanced information and communication technologies

Change in requirements on human capital

Impact of change

New challenges to:

Employee health and safety

Employee motivation, trust and loyalty

Employee behaviour in relation to work

Social cohesion at work

Employee performanceEmployees’ work life balance

Risks to:

Organisational healthiness

Image and reputation

Organisational performance

Self-reported Work-related Illness in the UK (SWI 1995)

Labour Force Survey: 1990 (Hodgson et al 1993)Labour Force Survey: Fifth Wave 1995 (Jones et al, 1998)

1995 Sample 40,000 men and womenWorking or had workedHad they suffered any work-related illness in last 12 months ?

70% of those answering YES were interviewed in depth about working conditions and health

Control population asked same question about working conditions

With subjects consent, doctors asked to confirm reports of ill-health

Jones et al (1998) Self-reported Work-related Illness. Sudbury: HSE Books

Risk factors for work-related ill health

Labour Force Survey (1995)

Risk factors:– workload and work pace– work schedule– lack of support– lack of control

At risk groups:– Professional workers– Older workers

II European Survey (2000)

Physical work factors (pages 10-11): 2 pagesPsychosocial hazards: 22 pages

Nature of workWork organisationTime issuesInformation and consultation

Prevalence of work-related illness UK 2003-2004

SWI 2008 2009

Prevalence: An estimated 415 000 people (GB): annual prevalence rate of 1.4% ~ similar to that for 2007/08 and significantly lower than for 2006/07.

Incidence:An estimated 230 000 people (GB): an annual incidence rate of 0.76% ~ similar to previous years.

Days lost:An estimated 11.4 million working days (full-day equivalent) were lost of a similar order to those in earlier years.

SWI 2008 2009

At risk sectors:Public administration DefenceHuman services: health, social work and education

At risk occupations:Health and social welfare professionalsTeaching and research professionalsCorporate managersBusiness and public service professionals

Psychosocial Hazards:Failures of Work Design & Management

Content– Aversive tasks– Workload and work pace– Organisation of working hours– Control over work

Context– Organisation structure, function and culture– Role in organisation and involvement– Social climate– Job security and pay– Work-life balance

Cox, Griffiths & Rial-Gonzalezs (2000) Work Stress. Luxembourg: European Commission

Cox (1998) Work-related stress: from environmental exposure to ill health. In: McCaig & Harrington (eds) Changing Nature of Occupational Health. Sudbury: HSE Books

Self-reported Work-related Illness in the UK (SWI 1995)

Two main clinical problems (as 1993):

Musculo-skeletal disordersStress (26% of those reporting a work-related illness: prevalence estimate 500,000 employees)

Supportive findings from survey of working conditions across European Union (2000) N= 21,000:

25-33% reported musculo-skeletal problems28-29% reported stress

Jones et al (1998) Self-reported Work-related Illness. Sudbury: HSE Books

Paoli and Merllie (2001) Third European Survey of Working Conditions. Dublin: European Foundation

Mechanisms

Physical Hazards

Psychosocial Hazards: Design & Management of

Work

Direct physico-chemcial pathway

Stress (psycho-physiological)

pathway

Harm to health: physical, psychological, social & organisational

HAZARDS

Mediating pathway

HARM

Cox, Griffiths & Rial-Gonzalezs (2000) Work Stress. Luxembourg: European Commission

Psychosocial risk management

Reducing risk to employee and organisational

health from failures of work design and

management through application of evidence

based and systematic problem solving

Hazard Identification and Risk Assessment

Translation & Action Innovation Risk Reduction (control interventions) Evaluation Feedback: organisational learning Cycle of continuous improvement

Leka and Cox (2008) PRIMA-EF: Guidance on the European Framework for Psychosocial Risk Management. Geneva: World Health Organisation

Identification of psychosocial hazards

Management Standards Initiative (HSE): Indicator Tool:

Based on six factors (scales):

– Demand– Control– Support– Role – Relationships– Change

Alternative instruments: sector specific ~ Engineering and manufacturing sectors: Work Organisation Assessment Questionnaire (WAOQ)

Mackay et al (2004) Work & Stress, 3, 2-12

Griffiths et al (2006) Occupational and Environmental Medicine 63, 669-675

Management Standards UKhttp://www.hse.gov.uk/stress/standards/

Demands– this includes issues such as workload, work patterns and the work environment.

Control – how much say the person has in the way they do their work.Support – this includes the encouragement, sponsorship and resources

provided by the organisation, line management and colleagues.Relationships – this includes promoting positive working to avoid conflict and

dealing with unacceptable behaviour.Role – whether people understand their role within the organisation and

whether the organisation ensures that they do not have conflicting roles.Change – how organisational change (large or small) is managed and

communicated in the organisation.

The Management Standards represent a set of conditions that, if present, reflect a high level of health well-being and organisational performance.

TranslationLikely Risk Factors

r1

r2

r3

r4

r5

r6

rn

Clarify & Explore

Structured Account

Underlying Organisational

Pathology

Interventions: Action Innovation

Negotiating a common language for social dialogue

within organisations

Action Innovation:Organisational Interventions

Primary prevention: prevention by design

– Culture change– Organisational redesign & development– Management development,

mentoring & coaching

– Work systems design– Job redesign

– Environmental engineering– Ergonomic improvement

Action Innovation:Organisational Interventions

Secondary prevention– Management development and staff training

Tertiary prevention– Enhanced employee support– Treatment– Rehabilitation

Timely and appropriate actionBalanced approach

Employee education and engagement

Employeess are key stakeholders and active players in process of psychosocial risk management– Source of data: expert judgements– Change agents

Need to respect and draw on their expertiseNeed to encourage and reinforce engagement

Requires that workers are educated to participate in the risk management processRequires a shared language of psychosocial risk managementRequires a positive culture in relation to health and safety ~ social dialogue and trust

Conclusions

The world of work is changing and is creating new challenges to employee health among these are psychosocial risks largely associated with work-related stress

Work-related stress and musculo-skeletal disorders, both partly driven by exposure to psychosocial hazards, are the two main current challenges to employee health

These can be managed at a number of levels including organisational and policy interventions

Thank You

Professor Tom Cox CBE

Institute of Work, Health & OrganisationsSchool of Community Health Sciences