Research into NHS stress

City University researchers have identified characteristics of ‘fit’ and ‘unfit’ managers to help address the stress some managers experience in NHS hospital trusts, a report released this week shows.

The report, by the University’s Department of Psychology, indicates 46.8% of the 109 general healthcare managers surveyed in one NHS Trust reported significantly high levels of stress.

The research, carried out in a large hospital trust in 2001-2002, identified the risk factors contributing to the high levels of stress and the personality traits that helped managers cope in a pressured working environment.

Professor Stephen Palmer said: “The levels of stress among managers in the NHS is a concern, particularly given the important job they do. This research highlights that there are similarities between the pressures experienced by those managers who are coping effectively in their roles and those who are suffering an unacceptably high level of stress. Despite experiencing high levels of pressure in their jobs, some managers remain ‘fit’ and express great confidence in their effectiveness. Others experience considerable fatigue and stress related symptoms.

“The research explores how some managers manage the risks associated with workplace stress and stay healthy. It raises the importance of the vocational aspect for managers of working in the NHS, doing a job that’s meaningful, satisfying and of direct benefit to patient care. Their values of commitment, duty and obligation to high levels of patient care underlie their acceptance of heavy workload and long hours. Having support in the workplace is important for them to be able to do this.

“The impact of stress is widely acknowledged in today’s workplaces and it is known to impact significantly on an individual’s health, as well as having a knock-on effect for staff morale and how efficiently an organisation operates.

“This research shows stress resides neither solely in the environment nor in the individual, but a combination of the two. It is essential that this relationship is explored so the stress levels among NHS managers can be addressed.”

The main predictors of stress in the NHS hospital trust were perceived job pressure and a lack of support. Organisational restructuring was confirmed as a time of particular stress, challenge and uncertainty.

The research showed the most severe work-related stressors to be: a lack of staff, fellow workers not doing their job, frequent interruptions and coping with crises.

Specific job-related stressors included meeting deadlines, working overtime and interruptions.

The research showed that, under similar environments, some managers reported lower levels of stress. These ‘fit’ managers displayed similar traits, including:

• Being a ‘people-person’
• Having access to a trustworthy, supportive line manager
• Being aware of hazards and stress symptoms in the workplace
• Being aware of their own stress symptoms and limits of tolerance
• Being realistic about what can and cannot be achieved
• Taking action to control and manage the risks to his/her health in the workplace.

So-called ‘unfit’ managers also displayed similarities, including:

1. A denial of stress-related symptoms
2. A lack of support from their line manager
3. Accountability without authority, or a perceived low control level
4. Interpreting the managerial contract literally, that is working as many hours as it takes to complete tasks
5. Setting no boundaries on workloads, with a lack of home/life balance
6. Having unrealistic expectations of themselves as a manager
7. Being particularly angered by organisational issues.

Professor Palmer said: “The research points to people skills as a valuable resource in improving resilience to stress. It also raises concern that unexpressed and expressed anger, which may result from stress, has negative implications for the individual manager and entire workplace.

“It is hoped these results will be taken on board to ensure a culture of trust is developed in which asking for help and support is encouraged. Adequate training will also help ensure managers are aware of their roles and symptoms of stress should it arise. ‘Unfit’ managers may benefit from specific coaching or training focusing on setting boundaries, controlling anger and developing realistic expectations of themselves.”

Future research may test some of the findings of the qualitative research, for example relationships between personality and stress, anger and stress, using validated questionnaires. An assessment of managers’ stress levels following stress reducing interventions in the workplace, particularly support, would be appropriate in line with stress risk assessment procedures.