Chronic stress can have significant impacts on physical and mental health, being implicated in heart disease, early mortality, depression and a wide variety of psychosocial disorders. In effect, NHS staff are more likely than the rest of the working population to become patients, increasing demands on the system they work in.
Moreover, the Care Quality Commission says poor staff health and wellbeing in NHS provider organisations is associated with poorer-quality patient care, lower levels of patient satisfaction and high levels of absenteeism. The ability of staff to pay close attention to patients, to have empathic responses and take intelligent action to help is detrimentally affected by high and chronic levels of stress.
What are we to do? One solution is to introduce health and wellbeing strategies for stressed staff, offering massage, yoga, mindfulness, exercise and dietary advice. But although these are worthy interventions, they do not address the root causes of the problem.
Research has shown that the most important factor contributing to stress is workload, with staff simply being asked to manage too much work. Another is a lack of clear roles – knowing what the objectives, requirements and limits of their responsibilities are. Other factors include bullying and harassment (particularly by managers and other staff), discrimination, lack of resources, conflict, and dealing with pain and suffering. These core problems are to do with organisational culture and processes, so the solutions need to address organisational causes. We cannot just rely on health and wellbeing strategies as ‘fig leaves’ for inaction around management, structures and culture.
If we are to address the causes of stress at work then we need to nurture cultures that ensure a focus on providing the high-quality, compassionate care that NHS staff wish to provide. This means that leaders must have an unwavering focus on ensuring commitment to quality of care. As I have said before, absolutely key to this is developing, selecting, promoting and empowering leaders to nurture such cultures. But we also need to move swiftly away from unhealthy command-and-control cultures and this requires a comprehensive and wholesale change in the way in which leadership is developed and understood in the NHS.
It is not enough simply to aim to reduce staff stress levels. We should be promoting the idea that humans can flourish in the workplace, by ensuring that staff have opportunities for growth and development, the experience of supportive relationships at work, work environments that promote their physical health, and leaders who provide the resources that enable them to cope effectively with the demands of their work.
There are some organisations in the NHS that are making progress towards understanding how to reduce stress levels and promote staff wellbeing, and others should be striving to do the same. But NHS organisations must also look beyond the sector for outstanding examples of organisations – both nationally and internationally – that have shown how to create positive work environments and promote human health and wellbeing, rather than damage their staff. It is right that the NHS should aspire to be a model in this regard, rather than the bad example it currently is.