Stress? I'll give you stress!

Work-related stress emanates from a multitude of causes and manifests itself in a variety of symptoms. Regrettably, many people who have not suffered illness as a consequence of stress are often sceptical of those who do.

In a recent case, in which the PDA was involved, a junior manager insisted, as was his right, that his company conducted a stress audit because he was unhappy with the workload and the impact it was having on his health; he was also concerned that this could affect patient safety.

Enquiries were made within the business by his line manager who had no experience of these matters; the reaction of a senior manager was inadvertently forwarded to the junior manager which read; “Stress! I’ll give him stress!”. This typical, macho remark was an expensive mistake; a settlement of £64,000 was negotiated by the PDA rather than the employer facing the ignominy of going to an employment tribunal for constructive dismissal.

Employers have a duty of care towards their employees and can be held accountable under health and safety legislation if stress-related illnesses can link causation with working conditions that an employer can control.

What does the law say?

The Health and Safety at Work Act 1974 states that ‘every employer should ensure, so far as is reasonably practicable, the health, safety and welfare at work of all their employees’.

The Management of Health and Safety at Work Regulations 1992 includes stress as a work hazard and requires employers to adopt modern risk management techniques such as:

• Identifying any hazards.
• Reviewing risk assessments at regular intervals particularly after adverse events.
• Providing health surveillance where a risk assessment shows that the health of employees can be affected by poor work conditions.
• Applying risk management principle eg. combating risks at source, introducing improved working methods and technologies, and incorporating risk prevention strategies as part of a coherent policy.

What is stress?

We all need pressure to motivate us or to give us an edge, however, what may be one person’s excitement may be another’s stress. In addition, different employees have different thresholds (One day may not be the same as the next for instance), different pre-dispositions to mental ill-health and different coping strategies.

A definition that most people understand, therefore, is that stress is unwanted or unrealistic pressure and can be different for different people. This makes measuring stress difficult.

Why do we need to tackle stress?

The Health and Safety Executive (HSE) has researched the impact of work-related stress for many years and has concentrated on the effects it has on the individual worker’s health and, as a consequence, the staggering loss to businesses because of absenteeism.

David Palferman, a psychologist with HSE, speaking at the BPC, PDA session in September, indicated that there were estimated to be 13.8 million days lost to stress-related illness in the UK in 2006 - a significant cost to British industry. “But what is even worse,” he said, “is that we don’t know how many hours of productive work are lost in ‘presenteeism’ which is new jargon referring to people who are at work with work-related stress symptoms and are not functioning properly as a result”.

The PDA is in the process of conducting a survey among its members using the HSE model and has incorporated additional questions so as to assess the impact pharmacists’ perceived stress levels have on patient safety.

“I was impressed with the HSE model,” said John Murphy, General Secretary of the PDA Union, “they take out any variables that are immeasurable, such as predisposition to mental health and domestic and personal stress inducers; they have concentrated on measuring management and organisational behaviour against national standards; however, it is important, because of the role we play in the health sector, that we introduce the dimension of patient safety, something which has not been well researched”.

The PDA stress audit

Nearly 2,000 pharmacists have already replied to the PDA stress audit and were asked to rate the stress of their job on a grading system. Early indicators are shown in Figure 1.

In analysing and comparing the HSE management standards, results showed that no group of pharmacist employee or locum respondents thought that the standard of management and organisational behaviour was above the national norms. It would appear that collectively, employers within the community pharmacy multiples sector came out worse than other sectors.

To gain pharmacists perceptions of the level of stress in their job, they were invited to classify it in one of six categories:

• LEVEL 5
  Extremely stressful to the point at which I feel I cannot cope and want to give up.
• LEVEL 4
  Extremely stressful to the extent that I am losing sleep and/or making myself ill.
• LEVEL 3
  Stressful enough to leave me frequently worrying about whether my patients are safe.
• LEVEL 2
  Stressful enough to leave me occasionally worrying about whether my patients are safe.
• LEVEL 1
  Very occasionally stressful but not sufficiently frequent to unduly concern me.
• LEVEL 0
  No stress at all.

Over 54% of members rated the stress of their job in the top three and a third (32%) in the top two most stressful categories (Figure 2). Less than 1% said that they experienced no stress at all. It is accepted that level 1 is a ‘good place to be’ for good performance.

Some of the most disconcerting statistics that came out of the audit include:

81.6% of all pharmacists say that they have to work intensely either always or often, and 69% of pharmacists say that they have to work “very fast” always or often.

Both these results are perceived as highly stress-inducing.

It is significant that 40% of pharmacists who perceive that their stress levels are in level 5 (and 34% in level 4) said that they had been subjected to ‘bullying’ and only 53% of all pharmacists say they get the respect that they feel they deserve from other colleagues. This is a trend that PDA can attest to anecdotally based on the type of cases it handles.

In correlating the effects that stress have on absenteeism, results showed that a third of pharmacists (32%) who perceived their stress levels to be at level 4 have had time off for diagnosed symptoms of work-related stress in the past five years.

This may be the tip of the iceberg because over the past 12 months, 60% of the same group had taken time off for any (not necessarily work-related stress) illness.

Despite the advice given to pharmacists to the contrary, the vast majority still believe that they are under pressure not to take rest breaks (Figure 4) and yet over two-thirds still recognise that they could have put their patients at risk at some time as a result of not doing so.

What next?

The PDA intends to be proactive to the results of this audit and will encourage employers to work with it to undertake a stress audit using the HSE management standards model as part of their duty of care towards employees.

Our agenda is to address work related stress head on and we will lobby for new research to be funded to assess:

• The affect on pharmacists’ health and the commercial impact on organisations as a consequence of unreasonable demands placed on pharmacists.
• The impact of ineffective management behaviour on pharmacists’ well-being to produce management development models.
• Working environment influences on stress.
• The impact of work-related stress suffered by pharmacists on patient safety.

The PDA calls upon employer’s to help address this malaise; the anecdotal evidence was already compelling that stress is a major issue and this audit gives it even more authority. We say to employeer’s that we would rather tackle this with you but if that’s not possible we will tackle it without you!

We urge as many pharmacists as possible to participate in the survey which will continue to be active until 31 December 2008, at which time we will produce a full analysis.

Click here for more details.