Wellbeing in the workplace

In November 2009, the National Institute for Health and Clinical Excellence (NICE) published guidance for employers on promoting mental wellbeing through productive and healthy working conditions.1 Excess work related stress harms employees’ physical and mental health. From an economic perspective, impaired efficiency at work associated with mental health problems costs the United Kingdom £15.1bn (€16.9bn; $22.5bn) a year.2 From a health perspective, stress at work is consistently associated with increased total mortality and acute myocardial infarction.3 4

Ideally, the guidelines should outline discrete steps that could easily be implemented, improve the efficiency and satisfaction of workers, and ultimately be shown in a randomised controlled trial to improve morbidity and mortality. Although the guidance falls short of this ideal, business managers and human resources departments may still benefit from the advice.

Unfortunately, some of the advice is so general that it is almost useless. For example, the first recommendation in the guidance is to: “Adopt an organisation-wide approach to promoting the mental wellbeing of all employees, working in partnership with them. This approach should integrate the promotion of mental wellbeing into all policies and practices concerned with managing people, including those related to employment rights and working conditions.” This reads more like a mission statement than a discrete step that a responsible business manager could implement. Other recommendations are more practical, however; examples of how to monitor mental wellbeing (such as attitude or satisfaction surveys, and data on absence rates and employee turnover) are reasonable and appropriate for different sized businesses. Other advice, such as allowing workers flexible hours, and that managers “respond with sensitivity to employees’ emotional concerns” may seem to lag behind policies already in place in many human resource departments.

Perhaps the lack of concrete guidance comes from the diverse and changing nature of stress. Stress is not easy to measure—after all, it is subjective. The NICE guidance defines stress as “the adverse reaction people have to excessive pressure or other types of demand placed on them,” meaning that, by definition, workplace stress is excessive. Other major causes of chronic disease—physical inactivity, smoking, poor nutrition, and excessive alcohol use—are at least quantifiable, so it is easier to study the effects of specific interventions.5

Physical inactivity can be measured using a pedometer, which can be provided to each employee with encouragement to walk for 30 minutes every day. Smoking can be measured by cotinine concentrations and banned on premises, and there could be a ban on hiring smokers (allowable in 39 US states). Unhealthy eating and obesity can be monitored through body mass index, waist size, and portion sizes. People can be advised to eat five servings of fruits and vegetables a day, and the organisation can help them do this by making healthy food available and unhealthy food less so. Alcohol intake can be quantified.

Evidence shows that programmes to manage stress in the workplace have beneficial effects. Much of the best work in this field comes from Japan, where workplace stress is high—more than 60% of Japanese workers report high levels of anxiety and stress.6 Two recent randomised controlled trials showed that single session educational programmes for supervisors, compared with no programme, can significantly improve knowledge,7 reduce psychological distress in workers, and improve job performance.6 8 One programme that taught stress management in hospitals decreased the frequency of malpractice claims (arguably a proxy in the United States for preventable medical errors) in 22 hospitals by 71% compared with a 3% decrease in hospitals without a stress management programme.9 Such a programme also decreased physician (and nurse) burnout and improved physician (and nurse) satisfaction with work.10 11

The NICE guidance implies that the difficulty in measuring stress should not deter organisations from trying to reduce it. Organisations will be more successful if employers help their workers to manage stress.9

The science of reducing stress in the workplace is in its infancy, and completing the circle from business policies to improved clinical outcomes is far away. In the meantime, the NICE guidelines can provide some basic advice for businesses wishing to make an impact on productivity and their employees’ health.