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Stress: How do we Know Rail is Coping?

This year’s Mental Health Awareness Week has stress as the key campaign focus.  We know stress is a major concern for rail and this has led to much collaborative work to understand the causes and to reduce the impact on rail workers and enhance our ability to deliver safe and reliable railways. Can better use of occupational health (OH) expertise be the next step toward to easing the organisational and human burden of workplace stress?

I recently moved into rail after 17 years of working as an occupational health nurse specialist for the NHS. The health and social care sectors have the highest prevalence of workplace stress in the UK, followed by education and other public services (HSE 2017) and so I have seen too many people across many organisations struggling due to stress as well as the effect on productivity and delivery of performance objectives.

The job roles, team structures, working patterns and work environments for rail workers are obviously different to those I have looked after previously such as those of a surgeon in a busy operating theatre or city-centre A & E nurse on a Saturday night shift and so it may appear unreasonable to compare stress management in my previous NHS work to the rail industry. This may be true. However, the factors that can contribute to harmful levels of stress are universal across workplaces and can be assessed using the HSE risk management standards in any UK workplace.

 

ORR has been supporting rail to improve stress management for several years and has useful guidance on undertaking the risk assessments and using the HSE standards to manage and help reduce preventable stress in rail workplaces. Yet in rail, stress remains a major concern for employers and unions and we have little data to help us make sense of what is happening or to see how effective we are at a company level and across the industry. I recognise the unique structure of rail including franchising cycles and outsourcing of corporate functions and support services don’t make it easy to put an accurate jigsaw together to help reveal the complete picture of stress, but this shouldn’t prevent the industry from seeing what pieces of the jigsaw they already have or identifying those who may be able to give additional pieces.

Across the NHS, occupational health services have demonstrated improvements in their assessment of work-related stressors through self-audit using a clinical benchmarking tool called MoHaWK (this stands for Measurement of Health at Work Knowledge. Also, there have been national audits of NHS OH practice in assessing workplace stressors that may have contributed to long-term sickness absence or be barriers to return to work. These audits have driven substantial improvements in data capture and reporting capabilities by OH services and helped improve the flow of accurate aggregated data from OH departments to their organisations. This means robust evidence of employee protection is available for the NHS inspection body, the Care Quality Commission. There is no clearly defined national set of measures for OH providers to report upon for rail that would help us form a picture for the entire rail sector and this could also mean that OH providers to rail have not had a similar external stimulus to drive ongoing improvements in OH data collection, analysis and reporting.

So what is this telling us? Firstly, this highlights how difficult it is for us to know if rail is coping with stress at a structural level in that there is no systemic collection, analysis and reporting of stress-related data for the rail sector. On joining RSSB, I was pleased to see that the need for industry benchmarking has been recognised and that much work is already in progress that may help rail improve its capability to do this. 

How do we know if all the pieces of the jigsaw are there at your company to give you the whole picture?

First and foremost, the biggest pieces of the jigsaw are your policies and procedures that describe work-related stressors and the assessment and management of risk from them to meet your legal duty. Having these and ensuring everyone who should apply them trained in their use will go a long way to managing stress. Secondly, ensure that these are consistently applied so there are both organisational and individual stress risk assessments to support and guide management action for protecting employees. OH reports often give advice to managers when an updated stress risk assessment may be necessary for an individual and failing to do when it is advised may out an employee’s health at risk and create an unnecessary liability for the employer. 

Even if you have an outsourced OH service, actively share your risk assessment data with your OH providers so they can use the information to help you proactively address any areas of concern. Ensure managers meet with their employees to update their individual risk assessment if signs of stress are observed or reported especially if there is sickness absence due to stress or a mental health condition or if the employee is undergoing any formal company process. Good manager-employee relationships can mean signs of stress are spotted early with managers being able to talk about stress confidently with their employees and take action to help them cope. Managers don’t necessarily have to refer an employee to OH and wait for a report before undertaking the stress risk assessment, in fact completing the stress risk assessment may either negate a need for an OH referral or may help an OH assessment if the findings are shared with OH as part of a referral (subject to employee consent).

 

The next pieces of your jigsaw come from within your company and are data driven. Relevant data may include reasons for sickness absence, absence rates between teams and across the company, accident and incident data and aggregated data such as grievances and bullying and harassment reports. Again, regularly share these with your OH provider so they understand what is happening across the company. This data may help OH clinicians make better sense of clinical findings from their assessment of individuals and in some cases can help OH triangulate data to give an early warning of potential problems in particular areas or teams that may be mitigated by targeted intervention. 

OH should be able to give rail companies outcome data as an additional part of the jigsaw. OH data can be used to triangulate internal company data to get a better picture on the effect of work on employee health and also to help highlight where stressors may be present but not a primary reason for ill-health. This part of the jigsaw requires OH to record relevant information about work-related stressors during their consultations and to use this data to provide regular reports to the company on aggregated outcomes from their assessments. Reports can include a narrative to add depth to any quantitative data reported. However, if you currently only require contact performance data such as KPI data or service usage data from your OH provider you may not be getting the best value from your contract reports and your provider may not feel as though they are giving you the best value from them either.

Finally, if OH don’t currently attend company-level meetings where HR and health and safety data are discussed, consider inviting them to present their reports and talk through their findings. If you buy-in OH, the RSSB Wise Buyer guide can help you choose a provider with the capability to provide this proactive feedback.

As benchmarking for health and wellbeing measures becomes part of everyday business in rail, we should hopefully start to see how much of an issue stress truly is for the rail workforce and also see the impact of sector-wide initiatives to improve mental wellbeing for rail workers and those directed at managers. Right now, getting the best out of your OH provider may be the best step to take to help your company understand the whole picture around stress affecting the workforce and for your OH provider to know they are doing the best to help your company, managers and employees cope with stress too.

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