Tense? Anxious? Talk to the boss

A pilot programme at three NHS hospitals aims to reduce stress among employees by encouraging managers to listen to staff gripes. By Paul Gosling

Hospitals make you ill, especially if you work in one. The NHS has one of the worst records for sick leave of all work sectors, as well as exceptionally high levels of smoking and alcoholism among staff. Seeing people die and trying desperately to save lives is, after all, a stressful business, with pressures heightened by recent health reforms.

Which is why a pilot programme being pioneered between three NHS trusts and the Health Education Authority is aimed at reducing stress. The measures are as much about making management more inclusive, by improving consultation and information, as they are about encouraging healthy lifestyles.

The approach is backed by the results of a recent survey of 8,500 NHS staff, which found that the single most effective way to improve staff health would be for managers to listen more to their employees. The second- best method would be if managers behaved sensitively to staff. The more obvious step of improving health screening of employees came third.

It is a legal, as well as a moral, duty to promote staff mental health, a factor that will weigh more heavily as British management fully digests the implications of European health and safety law. It is also something that exercises more managers' minds as a result of the John Walker case, which reached the High Court 18 months ago. Mr Walker's employers, Northumberland social services, were found to be responsible for his two nervous breakdowns, after they made him work too hard. The council's financial problems were not considered an excuse for its failures.

This judgment has assisted the HEA, a government quango, to encourage employers to improve staff health, focusing in particular on mental health. The first pilot employer has been the Worcester Royal Infirmary, whose trial programme ended last week.

The programme was overseen by Opus management consultants, whose managing director, Lionel Stapeley, says: "You can treat a member of staff for stress, and that is not wrong, stress counselling is very helpful, but unless you locate the cause within an organisation it will recur. It is not so easy to find the cause within an organisation. What is the dynamic in an organisation? What are the organisation's defences?

"In the NHS there is considerable tension regarding the changes that are occurring, with people clinging on to the old ways of doing things, and others trying to change. You end up with managers being branded as devils with horns, and clinicians seen as angels, neither of which is accurate. It is polarised and stressful on both sides, and they have got to work together."

It is not only senior staff who feel the tension, and all grades want to be consulted and informed. At another participating NHS trust, in Oldham, the internal newsletter publishes letters from staff, under the headline "Is it true?", in which workplace rumours can be repeated and answered.

"We have been piloting the programme in the NHS because that is where we have got the funding to do it," says Jane Huntley, account manager for the health at work programme at the HEA. "We would like to do it in the private sector, but we can't find the money, and are looking for a sponsor.

"The lessons would apply anywhere, they are certainly transferable. We are looking to transfer the learning from acute and community health into general practice very soon."

Ms Huntley accepts that employers need to have confidence in their management skills before they can turn to their staff for criticism. "It is a brave thing to do," she says, "but it is part of the approach of an organisation that is committed to improving. We insist that the chief executive is involved. It always needs to be backed up by management training."

But while the programme requires investment by employers, the benefits are obvious. The Worcester pilot cost pounds 35,000, including developmental overheads. For the subsequent pilots, and for any further organisations that now sign up, the programme costs about pounds 20,000. It is a sum that will be quickly repaid within a large organisation by a comparatively small reduction in sickness absence. As a side-effect, the workplace should also be a happier and more productive environment.