Supported by

Supported by

Supported by

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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:

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•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

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Supported by

Supported by

Robertson Cooper

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

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llbe

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Ma

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Neutral point

No discernible illness or wellness

Illness SignsSymptoms

Awareness GrowthEducation

Source: John Travis (2004)

Why does Wellbeing Matter to Individuals?

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

Pressure and Performance

StressDisengagement

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?

Other pressures

• Travel and commuting

• Time spent working

• Working patterns

• Management

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)

Managers: Balancing Challenge & Support

StressDisengagement

Management & leadership

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)

The “resilience prescription”Charney (2007)

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

Expert Individual Reports

i-resilienceResilience Snapshot

Leadership Impact

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

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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