Benchmarking the psychosocial environment: using a simple survey, EAPs can develop a thumbnail sketch of the psychosocial environment of the workplace and identify problems that may require further analysis and possibly intervention
Many surveys of various kinds, conducted not only in Canada but in Europe and the United States, have documented that workplaces doing the same kinds of work can vary enormously in terms of how the work is organized and designed. For example, two sawmills performing identical work can be managed and governed in quite different ways–and, not surprisingly, can experience very different health outcomes in terms of both mental and physical health and also accident rates.
What seems to be crucial in the differences in the organization and management of work has been narrowed down to a few factors that seem disproportionately important. These are described in terms of demand, control, effort, and reward. Demand refers to how much work you’re required to do in a given period of time; control refers to the amount of influence you have over the way you do your work; effort refers to psychological effort, with the downside being the mental fatigue that results from being required to put out too much mental effort; and reward refers to respect and appreciation for the work performed.
The first two factors, demand and control, were isolated as long ago as 1979 and were first identified in connection with higher rates of cardiovascular disease. In jobs characterized by high demand and low control, researchers found that people were suffering two to three times the normal rate of heart attacks. Over time, much higher rates of all sorts of adverse health outcomes were identified in relation to high demand and low control, including higher rates of anxiety and depression, substance abuse (particularly prescription drug use), and even certain types of cancer.
During the last 10 years or so, the effort-reward imbalance model has popped up as another major method of characterizing workplaces. Together, these four elements offer a useful way of making a thumbnail sketch of the characteristics of a workplace in terms of what I would call its psychosocial climate. The organizational climate, in turn, can be viewed as a determinant of, or influence on, the probability that an EAP will be needed and used and also the likelihood of a successful return to work after an EAP has been utilized, assuming that some sort of time away from work is necessary.
Earlier this year, lawmakers in the United Kingdom introduced criteria for demand and control into their occupational health and safety legislation, and they say they can measure these variables quite effectively at several levels. But you can actually measure them very simply with what’s called a first-pass filter, which means you use a few questions to get a roughly accurate idea of what’s going on, like a preliminary diagnosis. If you find there’s a problem based on this first pass, you then go to another level of analysis that tries to extract more details on these variables.
I use a first-pass filter that some departments of the Canadian government have adopted. It’s called a stress satisfaction offset score, and it’s really a set of four questions based on demand, control, effort, and reward. It yields a score ranging from -2 to +2. Minus 2 means high stress and low satisfaction–high stress due to high demand and effort, and lack of satisfaction due to low control and reward. A score of +2 means more satisfaction and less stress, for the opposite reasons.
Researchers have found that these scores correlate very highly with health outcomes, particularly mental health outcomes but also all sorts of productivity-related outcomes, including the ability to concentrate and learn new things, to be creative, to remember–all the things that have to do with the capacity of an organization to function competitively and well. These factors are eminently measurable within a probability level, meaning you can’t say that if a person has a certain score s/he will or won’t get sick, but you can say that a workforce is going to see a higher rate of people succumbing to various types of problems. This is especially true of mental health and substance abuse problems, because anxiety and depression are almost direct functions of these kinds of work conditions and substance abuse is, in all likelihood, an attempt to cope with them.
One additional element that has been revealed in the last five or so years is fairness, because these conditions of work appear to be more damaging in situations that are perceived as unfair. Work conditions tend to be seen as unfair when they’re seen as resulting from choices that managers could have made otherwise. For example, if you see me as imposing high demand on you and you think I could have done otherwise, and if you perceive me as withholding control when in fact I could have given you a lot more discretion and you could have gotten the job done just as well if not better, then you tend to see that as unfair.
I should make clear that in most companies, high stress and low satisfaction do not result from malicious intent. In many cases, workplaces essentially “slide” into situations where these negative factors prevail, and then EAPs start seeing the consequences. What I often see is a constant renegotiation of the EAP contract to either push the caps up or bring them down, depending on who’s arguing about the costs of them.
In some cases, the problem underlying a psychosocially unsafe work environment is systemic across the organization, perhaps as a result of a policy of selecting managers of a certain type. If there’s a managerial culture that favors instrumental versus expressive types of behavior–for example, a philosophy of getting the job done at any cost–then EAPs will find they’re working uphill and can’t do much to change the environment. The more common situation, however, is where a large employer may have a couple of units that have gone sour. If the EAP is doing its monitoring well, it can report back to management that it’s seeing clients coming out of these units at a higher rate than would be expected. This monitoring should be performed across at least two or three quarters so an EAP can be sure it’s seeing a chronic situation, not just a spike over three or four months.
A first-pass filter performs quite well for these purposes. I did some work with a utility company in British Columbia that used this approach. The company administered a two-page survey containing about 15 questions (including the four about demand, etc.) to the customer relations department, which has about 25 units in it, and found quite a bit of variance in terms of perceptions of how they were being managed. The EAP undertook this initiative because they could see there were some problems and wanted to get a handle on them, so they administered the survey and found that about half a dozen of the 25 units were problematic in terms of their scores. They repeated the survey every three months and found the scores weren’t changing, so they decided to perform an intervention.
This seemed to work quite well, to the point where–and I think this was going a bit too far–they began to use these measurements as a way of benchmarking managerial performance, which is a tricky thing because a lot of things can affect these scores. What the questions are really meant to do is signal there’s a problem, but not say what the problem is.
As a rule, every nine months or every year is the optimal frequency for administering these surveys, though it really depends on the circumstances. The nice thing about nine months is that it tends to be within a reporting year, so you can see changes within a reporting year and then across reporting years. It also allows you to provide some sort of containment within the time frame.
My experience is that four times out of five, the intervention will work very quickly and very effectively. Take, for example, the six hot spots that were identified within the utility company in British Columbia. Of the six, four responded positively in short order. That’s just one example, but other interveners have reported to me that the four-out-of-six success ratio is quite common. That’s an attractive ratio for what is really a very minimal involvement, and I think it reveals that people are very willing to do the right sort of thing once they realize they’re doing the wrong thing.
As I stated earlier, most of these situations don’t arise out of malicious intent; they arise, at worst, from carelessness and very often from too much pressure because of too much work, and the expressive side of management is the first casualty Supervisors stop listening to employees, they stop consulting employees, they stop rewarding employees, and this little survey is like holding up a mirror to them. When you hold up a mirror and show them what’s occurring, it’s a shock to a lot of them. Most people are good people, and when they realize they’ve made mistakes, they try to correct them.
However managers or supervisors manifest these corrections, whether through small acts or large, what seems to make the difference is the visibility of the intention to try to do better and turn things around. I think the reason is that a lot of this hinges on fairness. If you’ve been giving me a hard time for the past 18 months and I don’t know why, and then finally we have an opportunity to safely talk about the distribution of demand and control, I’m likely to start understanding very quickly where you’re coming from and you’re likely to understand where I’m coming from.
ABILITY TO PREDICT OUTCOMES
Many companies administer employee satisfaction surveys all the time, and if you look carefully at them you’ll often find they contain questions about demand, control, effort, and reward. The problem is that the surveys aren’t scored or analyzed in such a way as to bring these dimensions to the surface. They’re just sort of buried in more general reports about employee satisfaction.
The wording of demand/control/ effort/reward surveys is important, but it’s not so critical that you couldn’t simply take an existing employee satisfaction survey that you may be conducting for a company and pull those dimensions out. And EAPs should pull them out, because they’re important for their ability to predict health outcomes and, therefore, the potential need for an EAP and also the likelihood of success of the EAE These surveys are a very handy thing for an EAP to have in its toolbox so it can benchmark the psychosocial environment and determine whether more complex analyses are indicated.
Martin Shain is founder and director of the Neighbour at Work Centre (www.neighbouratwork.com), dedicated to the promotion of fairness and reasonableness in employment and other contractual working relationships. He is also a senior scientist at the Centre for Addiction and Mental Health in Toronto, cross-appointed with the Department of Public Health Sciences in the faculty of medicine at the University of Toronto, and scientific advisor to the Global Business and Economic Roundtable on Addiction and Mental Health.
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