International Journal of Workplace Health Management

The “Management Standards” for stress in large organizations

Nadine Mellor Phoebe Smith Colin Mackay David Palferman
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IJWHM
6,1
The “Management Standards”
for stress in large organizations
Nadine Mellor and Phoebe Smith
Health and Safety Laboratory (HSL), Buxton, UK, and
4
Colin Mackay and David Palferman
Health and Safety Executive (HSE), Bootle, UK

Abstract
Purpose – In Great Britain, the ‘”Management Standards” were launched in 2004 and
formally published in 2007 by the Health and Safety Executive to help organizations manage
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work-related stress. The purpose of this paper is to examine how these Standards are translated into
organizational practice.
Design/methodology/approach – The research uses case studies carried out in five large
organizations drawn from the public and private sectors in Great Britain.
Findings – Senior management commitment and worker participation are key to managing work-
related stress and are commonly reported across organizations, although to variable form and depth.
The solution chosen to identify stress issues is a short assessment of all staff via annual staff surveys,
coupled with in-depth assessments of groups at risk. Common practice also includes combining
individual and organizational interventions. One significant challenge emerges as the translation from
identified stress issues to focussed interventions and their evaluation.
Research limitations/implications – The implementation processes outlined in this study are by
no means exhaustive due to the small sample size but are consistent with previous research.
Practical implications – The findings suggest that the HSE Management Standards approach
for dealing with stress issues is do-able. Refining the information in the HSE guidance on
implementing and evaluating interventions and broadening the current focus on organization-level
interventions is needed.
Originality/value – Publication of case studies of the implementation of the Management
Standards has been limited. This paper illustrates the efforts made by large organizations to
integrate national guidance on stress and this could be used for guiding and improving stress
management in similar work settings.
Keywords United Kingdom, Occupational health and safety, Stress, Large enterprises, Evaluation,
Qualitative research, Health and safety, Risk management, Workplace health
Paper type Case study

Introduction
Despite the significant amount of research and increased awareness of organizations
and individuals regarding work-related stress, this issue still generates high levels of
ill-health and sickness absence in the workplace. In Great Britain, in 2008/2009 the
estimated incidence of stress-related cases stood at 230,000 and there were 11.4 million
stress-related absence days (Health and Safety Executive (HSE), 2009).
To tackle stress at work, the HSE, the national regulator for health and safety at
work, developed extensive guidance on stress risk assessment and management,
known as the Management Standards approach (HSE, 2007). Launched at the end of
International Journal of Workplace 2004, this approach involves encouraging employers and employees to work together
Health Management
Vol. 6 No. 1, 2013
to identify psychosocial risks and adopt solutions to minimize these risks. Stress is
pp. 4-17 defined as “the adverse reaction people have to excessive pressures or other types of
r Emerald Group Publishing Limited
1753-8351
demand placed on them” (HSE, 2007). The Management Standards refer to good
DOI 10.1108/17538351311312295 management practice with regard to six main psychosocial risks in the workplace: job
 demands, control, support from management and peers, relationships at work, clarity Management
of role and organizational change. Theoretical underpinnings justifying the focus Standards
on these particular job characteristics as well as practical developments of the
Management Standards have been fully reported in studies by MacKay et al. (2004) for stress
and Cousins et al. (2004).
The regulatory framework in Great Britain requires employers to assess the risks
posed by workplace factors and implement solutions to mitigate these risks. 5
Employers can adopt the Management Standards to help them carry out their
assessment or they can use alternative approaches as long as they carry out a
sufficient risk assessment on stress.
The aim of this paper is to identify how employers have implemented the
Management Standards in large organizations, the organizations for which the
national stress policy guidance was originally developed. An understanding of the key
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activities, and of the enabling or hindering processes occurring at each of the five steps
of the risk assessment method, will provide insights as to what constitute the strengths
and weaknesses of such an approach for stress prevention and reduction.

Five-step risk assessment

As summarized in Mellor et al. (2011), the HSE guidance on risk assessment for
managing stress is based on five steps assuming senior management commitment to
support the approach and worker involvement to implement need based interventions
is present:
. Step 1 requires organizations to get an understanding of the psychosocial risk
factors. Each of the Standards is defined essentially by desirable states to be
achieved so as to mitigate against stress risks. For instance, regarding
organizational change, the Standard is that the employees indicate that the
organization engages them frequently when undergoing an organizational
change, and systems are in place locally to respond to any individual concerns.
The states to be achieved are that the organization provides employees with
timely information to enable them to understand the reasons for proposed
changes; employees have access to relevant support during changes, etc.
. Step 2 is about deciding who might be harmed and gathering data. To compare
the desirable conditions with their actual work environment, organizations can
use the HSE “Indicator Tool”, which is a 35-item survey questionnaire,
measuring the six job characteristics mentioned earlier. The data collected
enables a score to be calculated for each Standard, which can be compared to an
HSE benchmark (average score obtained by multiple organizations) to inform
employers about which areas to prioritize within their organization. The use of
other data such as sickness absence, staff satisfaction surveys, staff turnover,
occupational health referrals and return to work data is also highly
recommended to fully and reliably identify problem areas.
. Step 3 concerns the evaluation of risks, exploring issues and developing
solutions by ideally holding focus groups with employees to discuss survey
results, unravel specific local issues and suggest practical solutions.
. Step 4 involves taking the suggestions from the previous step and developing a
prioritized and agreed action plan.
 IJWHM . Step 5 has to do with reviewing the action plan(s) and assessing the effectiveness
6,1 of interventions. A period of 12-18 months is suggested for re-assessment of the
workforce (Mellor et al., 2011).
Defining implementation processes
The activities organizations carry out at each step of the implementation of
a programme is useful information but of equal importance is how they do it. As noted
6 by Weiner et al. (2009) a pure description of a step-by-step procedure is not sufficient
to explain implementation success. Attention should be paid to how and why
implementation activities (e.g. planning, training and resource allocation) generate
observed or desired programme use (e.g. employee participation), why some factors
are more important than others under different conditions and facilitate or undermine
success in organizations (Weiner et al., 2009).
The how and why an intervention works refer to processes as opposed to outcomes
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of an intervention. Processes are defined in various ways but they mainly refer to
“individual, collective or management perceptions and actions in implementing any
intervention and their influence on the overall result of the intervention” (Nytrø et al., 2000,
p. 214). Implementation processes therefore are about understanding the how and why of
the design and delivery of interventions covering intervention setting, resource planning,
collaborations, delivery and macro-level socio-economic contexts (Egan et al., 2009).

The present study

This study is set out to identify organizational practice in two public and three
private sector organizations through a case study method. The case study method
is recommended when attempting to uncover how a phenomenon, over which there is
little or no control, is produced and when the impact of context is important (Yin, 2003).
The study will inform the extent to which current stress guidance is useful for
employers and identify potential refinements. It will extend previous research (Mellor
and Hollingdale, 2006; Cox et al., 2007a; Tyers et al., 2009), which has looked at the
effect of this approach at the very early stage of its adoption. Organizations in this
study will have several years of experience in using the method. Moreover, by
identifying implementation processes of interventions of corporate scope as opposed to
individual health-related change intervention, this study adds to the relative small
body of research in this area (National Institute for Health and Clinical Excellence
(NICE) Guidance, 2009).

Method
Qualitative data were collected between 2009 and 2010 using 14 semi-structured
interviews with 21 organizational members and documentary evidence from five
organizations comprising two healthcare trusts, one central government department
and two private sector organizations. Two implementers per case study (except only
one in one case) were interviewed. In one case study, the views of trade unions and
managers could also be sought. The intention was to gather the views of the
implementers not the employees to understand how the HSE guidance was interpreted
and followed. The respondents were occupational health professionals, trade unions,
health and safety representatives, all at the forefront of the implementation of the
Management Standards approach in their organization. Documentary evidence helped
to balance the singularity of the views given by few implementers. In two cases (cases
1 and 5), the first author was involved for more than a year with the organization as
 a consultant and a researcher, respectively, and therefore gained in-depth knowledge Management
of the implementation process. A purposive sample (Miles and Huberman, 1994) Standards
was used in order to include “typical” cases, i.e. large public and private sector
organizations from different sector and locations. We identified organizations through for stress
professional networks. We selected five of them on the basis that they had fully
implemented the Management Standards approach for longer than a year, had a
reasonable amount of activities undertaken within the period and could provide 7
documentary evidence of their activities.
The interview questions were open-ended and asked about the activities carried out
during the risk assessment, their successes and challenges aiming to uncover the
enabling and inhibiting factors to implementation. Where possible, stress policies,
minutes of steering group meetings, action plans for interventions and outcome data
were collected as further evidence of activities undertaken within organizations.
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Qualitative data analysis relied mainly on full transcripts of the interviews when
these could be tape-recorded. A cross-case analysis was applied to the data using
qualitative content analysis (Miles and Huberman, 1994). This involves a number of
steps including familiarization with the interviews’ transcripts and documentary
evidence, summarizing the data and drawing up an analytical framework based on the
HSE guidance on implementation, i.e. comparing activities that should be carried at
each step of the risk assessment against what was actually done by each organization,
how was it justified if it was done differently, was it reported as being effective or not
and highlighting similarities and differences across cases.

Findings
Table I provides an overview of the individual cases. The following is a summary of
what was done at each step of the risk assessment across all five organizations derived
from interviewees’ accounts and documentary evidence. It also reports participants’
views on enabling and inhibiting factors.

Preparatory work and step 1: identify the stress risk factors

The main drivers for implementing the stress approach in the organizations were
compliance with health and safety law, reducing sickness absence, improving
other human resources or occupational health indicators, putting in place preventative
measures to address root cause of the stress issues and adopting best practice.
Across all case studies, senior management support was perceived as a key enabler
to move the strategy forward and this was demonstrated in various ways, i.e. through
resources allocation, chairing the stress strategy steering group or being exemplar in
managing their own stress. Persuading senior management to accept stress as
an important business issue or implementing a well-being corporate strategy was often
the first obstacle to overcome.
All cases with a stress policy usually included a well-being policy comprising
preventive and remedial actions. Examples of fully detailed stress policies contained
guidance for managers on how to conduct a risk assessment at team level and when
and how to run focus groups. Integration of stress policy into corporate plans and
internal systems and procedures (human resources, etc.) was perceived as giving clear
priority to the stress issue. Some policies acknowledge the responsibility of the
organization as well as the responsibility of the employee in managing stress.
In all cases except case 5, a permanent steering group including multiple
stakeholders (e.g. human resources, health and safety, occupational health, unions,

Table I.
Overview of five
individual case studies
Step 1 (including preparatory
Case type work)
Utility company Senior management
commitment via substantial
financial resources invested
Departmental leadership
involved
Corporate stress steering
group and policy in place
Health services Senior management
trust commitment via resource
allocation
Senior management own
stress levels assessed by job
satisfaction, working hours
and sickness absence
Well-being steering group
and policy in place
Manufacturing Senior management
goods company commitment via provision of
compassionate leave, budget
for counselling on issues at
work, etc.
HR executive team, group OH
manager form the well-being
steering group
Well-being policy requires
annual site risk assessment to
monitor stress levels. States
responsibilities for both
employers and employees
Major organizational change
(restructuring) within some
parts of the organization
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Step 2 (gather data)
Use of the HSE Indicator Tool
surveying all staff in one department
after another over a 2-year period. The
latter year has seen a major
organizational change
Some of the HSE Indicator Tool
questions included in annual staff
opinion survey
Use the Tool more fully in some
departments to identify risk factors
Most of the Standards show
improvement after one year except job
control and peer support which stay the
same or slightly decrease respectively.
Job demands have moved from a high
risk to a medium risk category
Some of the HSE Indicator Tool
questions include in annual staff
opinion survey
Conduct a stress survey using the Tool
fully each year on all sites
Use health surveillance indicators to
distinguish work-related disorders
(e.g. mental health and asthma) from
non-work-related issues
Use the HSE Indicator Tool also at
individual level in a one to one
conversation to help individuals deal
with stress
Control is a risk factor for shop floor
workers whereas demands is a risk
factor for staff in functional project role
Step 3 (explore problems and
develop solutions)
A total of 40 focus groups (with on
average of 4 in each department) run
across the organization
Issues voiced on poor communication
regarding organizational change. These
were subsequently addressed in
interventions. Focus group provided
richer information on organizational
change than the survey itself
Annual events to discuss staff survey
results and suggestions for
improvement
Subsequent to this event, action plans
devised for each individual department
Additional focus groups run at
departmental level
Survey results communicated to staff
at local team briefings
Briefing sessions are hold with
managers and employees to discuss
survey results in place of focus groups
Action plans designed by line
managers, TU and OH representatives
8
6,1
IJWHM
Step 4 (develop and implement Step 5 (monitor and review action
action plan(s)) plan/s and assess effectiveness)
Organizational interventions: Review meeting for each department
job re-design within the call centre to check action plans progress
department Decrease of 11% in sickness absence
Created better communication channels overall
throughout the business
Higher visibility of senior managers
at team briefs
Individual interventions:
wider availability of OH services
Organizational interventions: Regular review meetings by the
job re-design and change in shift patterns steering group
Transformational leadership training Decrease from 31 to 27% staff reporting
programme offered to managers feeling “unwell due to stress”
Line managers training to develop Complaints cases have significantly
competency for managing stress decreased, e.g. bullying by half their
Support systems in place to deal with number and grievances by 5 times
violence and bullying
Training for managers on implementation
of specific policies (e.g. managing
attendance, mental health at work,
work-related stress, appraisal)
Training on building resilience for all staff
Individual interventions:
coaching and mentoring
OH support services
Organizational interventions: Review action plan deadlines and
job re-design by introducing lean annual re-assessment
manufacturing programme where Decrease in “stress cases” for which
employees have a say in the work work was the most significant cause
decisions Company gain better defence in claims/
Created learning centres to develop new tribunals
skills and gain qualifications for low Reduced absence costs for stress
skill workers estimated to be equivalent to 4 weeks
Proactive support given to team on wages, which represents about 40
12 h rotating shifts weeks of absence since the policy
Training of managers on stress, was introduced
management styles, dignity at work, Stress levels decreased year on year
substance abuse, etc.
Mapped the line management stress-
related competencies onto the company
competency framework
Individual interventions:
health promotion activities
OH support
Introduced procedure for managing
individual cases of stress, for line
(continued)

Step 1 (including preparatory
Case type work)
Health service Senior management
trust commitment. Both the chief
executive and the staff side
chair sit on the stress
management steering group
Some senior managers and
consultants are trained as
mediators
Stress group has 10 members
and meet bi-monthly
Stress/well-being policy
states both responsibility of
employer and employee
Government Senior management
department commitment to an overall
well-being strategy including
stress, well-being and health
promotion
Stress well-being policy states
both responsibility of
employer and employee
Table I.
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Step 2 (gather data)
Use some of the HSE Indicator Tool
questions in their annual opinion
survey as organizational risk
assessment
Identify organizational “hot spots” via a
stress-mapping tool including absence
levels, turnover rates, OH counselling
referrals, disciplinary or grievance
cases, violent incidents, reports of
conflict, changes to working practices
or systems
The Tool is then used fully at
departmental or team level when hot
spots are found or simply at a local
manager own initiative to follow good
practice
Use the Tool questions as a focus group
guide with teams fewer than 12 people
Use a reduced version of the Tool at
individual level as interview guide
Corporate level annual survey monitor
stress using a subset of the HSE
Indicator Tool
Other local based surveys on well-being
and health promotion supplemented
this assessment and are at the initiative
of local senior managers supported by
external OH professionals
Step 3 (explore problems and
develop solutions)
Survey and focus groups results fed
back to staff
Focus groups are held within two weeks
of the risk assessment exercise
Focus groups serve to specifically
unravel bullying issues
Survey results feedback to staff via
intranet or local presentations
Focus groups are held at the initiative of
senior local manager, thus of variable
frequency within the organization
as a whole
Continuous improvement networks
Step 4 (develop and implement
action plan(s))
managers, HR and occupational health
professionals
Organizational interventions:
job re-design, shifts patterns change,
education leaflets
Team development/team conflict
resolution interventions
Issued guidelines and train managers
about how to conduct risk assessment
at team level
Trained managers on stress and line
management competencies, and on
improving well-being and handling
conflicts
Link the Standards to the internal
competency framework for use in
the selection of new recruits
Individual interventions:
OH support (counselling, mediation,
building resilience promoting positive
coping, etc.)
Organizational interventions:
job re-design, systems in place to counter
bullying and harassment from customers
Individual interventions:
OH support (counselling, mediation,
building resilience, healthy lifestyles, etc.)
Step 5 (monitor and review action
plan/s and assess effectiveness)
The overall level of sickness absence
has reduced from 5.27% in 2007 to
4.85% in 2008 based on a 12-month
rolling average figure
Self-reported stress has decreased from
35 to 28% and then 24% two years after
Positive feedback from assessments by
the HSE and the National Health
Service Litigation Authority
Won excellence award in Human
Resource Management for managing
stress
Referrals are up because managers are
referring more people to occupational
health
Proactive teams carried out stress risk
assessment in advance of change
occurring
Critical care unit has seen conflict and
claims of bullying and harassment
reduced and the staff turnover rates
improved
All five leading causes of sickness
absence decrease between 2008/2009
and 2007/2008 with the most significant
downward trends being stress, anxiety,
depression and mental health. There
was 8.9 average working days lost in
2008/2009 a decrease of 1.2 days. The
number of long-term sick leave has been
cut by a third
Stress levels show that job control,
demands and change are more critical
risk factors in recent years whereas
management and peer support as well
as role clarity have been well above
average in the last 5 five years
Health and safety award won attesting
of achievements in occupational health
and safety systems, as well as stress/
well-being and attendance management
Management
for stress
Standards
 IJWHM senior management) was set up to coordinate the initiative. The remaining case had a
6,1 local-based strategy for spearheading the management of stress/well-being comprising
senior management and occupational health professionals. The steering group
expertise with a mixed representation of stakeholders was seen as helpful to address
multiple aspects of the risk assessment process. Having professional internal resources
(either occupational health services, human resources or a health and safety team)
10 to support managers to carry out their risk assessment was vital as there would
have been fewer activities or no follow-up actions carried out if managers did not
receive this support.

Step 2: decide who might be harmed and how – gather data

To identify who might be harmed, a common option chosen was to survey all staff
using a subset of the questions from the HSE Indicator Tool or equivalent questions in
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annual staff opinion surveys. In case 1, the Tool with its 35 questions was administered
in each department separately from the annual opinion survey as a good practice
exercise but was not re-conducted the following year. Instead stress-related questions
were included in the annual survey to reduce time and costs involved. Organizations
which used an abridged version of an equivalent version of the tool, as suggested by
HSE guidance, did not reject the Indicator Tool but wished to avoid survey fatigue and
redundancy with existing survey tools which had equivalent questions. In addition, all
organizations rely on their health surveillance systems to assess groups most at risk.
With data such as absence levels, staff turnover rates, occupational health counselling
referrals, disciplinary or grievance cases, violent incidents, reports of conflict, changes
to working practices, the “hot spots” or groups most at risk were identified and a full
risk assessment carried out for these populations. One justification for the latter is that
conducting a full risk assessment for all staff each year is time consuming and resource
intensive whilst acting on “hot spots” is more appropriate.
Good practice and areas for improvement were identified by comparing whether
the survey results were above or below a threshold defined by the HSE external
benchmark or by the average results obtained in other parts of the organization
(internal benchmark). In three organizations, the assessment tool (shortened version)
was also used at an individual level as a question guide in one-to-one conversations
between the manager or the occupational health professional and the employee who
reported stress issues. In using the Management Standards and the risk assessment
process, the main causes of stress were said to be easier to identify. However, in case
5 where an annual survey was used with equivalent questions to the Standards but
fewer of them, managers were not convinced that stress was particularly well identified
and some found the need to conduct their own survey at team level to uncover issues.
The incorporation of the Management Standards into organizational policy helped to
manage complex cases and to distinguish work from non-work factors associated with
common mental health problems.

Step 3: evaluate the risks – explore problems and develop solutions

The stress risk assessment results were fed back to staff in various ways via leaflets,
team meetings or e-mail messages. Worker involvement more particularly through
focus groups or other discussion group methods held after the survey results was
perceived as an important medium for obtaining local and practical solutions and
motivating employees in contributing to the approach. However this stage was seen as
a time-consuming exercise. As a result, fora to discuss problem areas and to elicit
 suggestions from staff vary in form and depth. Some organizations hold systematic Management
focus groups after each risk assessment as advised in the HSE guidance, others use Standards
team briefings (case 3) to discuss the findings or annual large group events with a
convenient sample of staff (case 2) to gather suggestions for improvement. In case 5, for stress
this step was under the responsibility of local senior managers to take actions. Some
managers were seen as more active than others leading some interview participants
(managers) in this particular organization to doubt the effectiveness of the approach. 11
One common result across all cases was that organizations seldom report
comparing their results with the states to be achieved as prescribed in the HSE
guidance taking the data collected as sufficient indication of what is achieved to carry
out the next steps.

Step 4: record your findings – develop and implement action plan/s

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Action plans are derived from the consultation exercise conducted at step 3 with
actions at local and corporate level. Carrying out the actions within the set timescales
following the risk assessment (i.e. focus groups, action plans, review) can be delayed by
manager unavailability and this was seen as one of the most significant barriers to
effective implementation. Initiatives carried out at corporate level to ensure prevention
systems were put in place to reduce stress included systems and procedures to counter
issues of violence and bullying, management of absence and return to work and
extensive leadership training. In some organizations (cases 3 and 5), stress falls under
the umbrella of a wider well-being strategy, which aims not only to reduce stress but
also to enhance psychological and physical health through preventive and treatment
interventions. In case 2, a positive culture change was expected through training
managers in effective leadership behaviours to reduce stress and enhance well-being.
In this organization, all senior managers were trained in transformational leadership
and evaluated through a 360-degree feedback to ensure these effective behaviours were
truly enacted. Across case studies, as part of action plans or the preparation stage,
training of line managers on stress management or leadership was frequently mentioned.
The role of line managers and their commitment in the process was seen as key especially
at this step where they needed to ensure that action plans were in place. Training them
on stress risk assessment was vital to enhance their skills but ensuring that all line
managers received this training was challenging due to their unavailability. A target
driven culture and constant organizational changes were invoked as being barriers to
availability. Action plans included specific job re-design activities (e.g. shift work, changes
in the physical environment) as well individual-level options such as support services,
counselling, mediation and resilience training to address stress reduction.

Step 5: monitor and review action plan/s and assess effectiveness

The support from senior management was said to be “vital for action plans to move
forward” or “critical to the implementation of the strategy”. As shown in Table I,
organizations in this sample saw a decrease in stress levels and/or sickness absence over
the years, some were aware that more was needed to ascertain whether the interventions
put in place were causing the positive outcomes. Additional HSE guidance was said to be
needed on how to proceed for this type of more rigorous evaluation.

Discussion
The aim of this study was to gain insights on how national policy guidance on work-
related stress can be translated into organizational practice. The HSE stress-related
 IJWHM guidance stipulates what is expected at each stage of a stress risk assessment. It is
6,1 apparent that the accounts from the five organizations suggest diverse interpretations
of the guidance. This is expected since guidance is not a set of rules and the
risk assessment activities work best when tailored to the context of each organization.
However, the findings suggest that there may be some steps that need either more
effort on the part of the organizations for interventions to achieve better results, or,
12 further clarification in the HSE guidance. There were commonalities but also
differences across the five case studies chosen for this research. There was notable
confidence in handling the first two steps of the risk assessment method whilst more
uncertainties and larger variation were noticeable in steps 3 and 4.
The first two steps are based on the principles of senior management commitment
and readiness for implementing the stress management approach. Although variable
in its form and depth, commitment from top management was commonly reported.
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It also emerged that the Management Standards approach was generally embedded
in existing organizational plans and systems (e.g. staff opinion survey, leadership
training, competency framework, recruitment and appraisal procedures) and
sometimes in policies such as a well-being policy or other corporate programmes.
Such practice is highly recommended for most effective results (Murphy and Sauter,
2003). At step 2, shorter assessments of all staff via annual staff surveys coupled with
in-depth assessments of groups at risk emerge as the chosen solution for tackling
stress risks whilst making good use of organizational resources. Some organizations
can be considered exemplar in the range of data they collect at this stage. They do not
limit themselves to data emanating from stress surveys but use a range of occupational
health- or HR-related indicators.
With regard to steps 3 and 4, organizations are advised to compare their results
against the ideal conditions or states to be achieved. None of the cases were explicitly
doing so. Some authors have pointed out that the states to be achieved as they are
defined are too broad and can be hard to interpret (Kompier, 2004). This point
may need further clarification in the HSE guidance. The risk assessment results (via
quantitative and qualitative data obtained from staff consultation) as well as the
definition of what states should be achieved can provide sufficient detail for designing
interventions. A large variation was reported at this step on how workers were
involved in suggesting local solutions. Some organizations do not run extensive staff
consultation due to time, resources constraints and overload of consultation exercise. In
others, this step is left to the initiative of local senior managers and is therefore variable
in being enacted. This may prevent organizations from translating the issues raised via
the quantitative data collected into interventions. With a lack of worker involvement,
the true issues reflecting employees’ needs may not be represented. Consequently
interventions may not be tailored sufficiently to their needs and rendered irrelevant.
As noted by Steckler and Linnan (2002), a consultative process with the workforce
is crucial, the more the solutions address the real needs the more likely these will
be effective. It was unclear in some of the narrative comments whether the interventions
enumerated were derived from the risk assessment or part of a wider strategy to
establish systems to enhance employee health as a whole. Advising organizations
to focus on a reduced set of interventions, which tackle the issues identified, and taking
into account desirable targets to meet, could generate a greater impact and facilitate both
their implementation and evaluation. However, implementing “clusters of interventions”
instead of single interventions is also seen as a better way of overcoming the current
pressures and possible resistance to change (Colarelli, 1998). So, whether single or
 multiple, interventions need to be relevant to staff needs. There was insufficient Management
information in these case studies to conclude that interventions were not tailored to staff Standards
needs but at least in one case, interviewees were of the view that more could be achieved
at this step with higher levels of managers’ initiatives and worker involvement. for stress
The Management Standards approach is based on the recognition that
organizational-level interventions have a greater likelihood of tackling the sources
of stress than interventions focusing on changing individual behaviours. However, 13
the present findings suggest that organizations commonly used individual and
organizational focused interventions, both preventive and reactive. Some organizations
also make other use of the Management Standards by using an abridged version of the
HSE Indicator Tool for risk assessment in a one-to-one interview to identify what
the problems are when an individual employee reports stress-related issues. This
application emerged as common practice but the HSE guidance was not intended to be
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used this way. This may indicate that the approach needs a broader focus to equip
organizations with individual and organizational-level diagnosis tools but also with
recommending both levels of interventions, i.e. person focused and organization
focused. This practice is echoed in the literature. Noblet and La Montagne (2006) note
that the Management Standards had little focus on individual-level interventions
and that job stress needed to be embedded in health promotion activities for a more
comprehensive approach. A recent review (La Montagne et al., 2007) found that when
organizational interventions are the dominant approach, integrated with individual
interventions, these are the most effective in addressing the organizational and
individual impacts of job stress. It is argued that if both the sources of job stress
and the symptoms of distress are addressed, it is more likely to lead to long-term
outcomes (Kompier and Kristensen, 2000; Michie and Williams, 2003; Bond, 2004).
Lastly, in relation to the final step of the risk assessment, despite the assumption
that preventive programmes may reduce workplace absence, based on previous
research (Kompier et al., 1998), the need to evaluate the true impact of interventions
still remains. In the present case studies, action plans were very detailed with a large
number of interventions to put in place, which makes it harder to measure their impact
on sickness absence. Even if the number of actions is reduced, it is difficult to isolate
the effects of the interventions with concurrent initiatives and other changes. This is
why organizations often rely on a range of “softer” outcomes (e.g. employees’
satisfaction) (Jordan et al., 2003). Whilst the field of workplace health promotion (e.g.
Grossmeier et al., 2010; Weiner et al., 2009) seems to produce clear definitions of how to
measure process, impact and outcomes with regard to changing lifestyles and health-
related behaviours through individual-level interventions, the literature is less well
structured with regard to evaluating organizational-level interventions using process
evaluation. Some empirical studies have just started to provide examples of how to
carry out a qualitative post-intervention process evaluation (e.g. Randall et al., 2007) or
a quantitative process evaluation, assessing for example line managers’ attitudes
and actions, exposure to intended intervention, employee involvement, readiness for
change and intervention history (e.g. Randall et al., 2009). Future research should look
at the feasibility for organizations to carrying out such process evaluation activities
and form part of policy guidance.

Study limitations and implications

The implementation processes outlined in this study are by no means exhaustive
due to the small size of our sample. However, they are consistent with previous
 IJWHM research related to the evaluation of the Management Standards approach especially
6,1 with regard to what constitutes enablers and barriers to implementation. The main
enabling processes reported indicate that progress is made when there are supportive
contexts, commitment from senior management, individuals are active in their roles
especially line managers, sufficient level of expertise and efficient coordination of
activities in the steering group, staff consultation and suggestions, and perceived
14 usefulness of the method itself. Challenges reported in this sample revolve around the
commitment of line managers to agreed actions, the time consuming aspect of the
method, the integration of constant organizational change and demonstrating the true
impact of interventions.
The findings are also consistent to some extent with previous research reporting
similar processes in stress management interventions (Kompier et al., 1998; Saksvik
et al., 2002; Nielsen et al., 2007; Randall et al., 2009; Egan et al., 2009) and in relation
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to the Management Standards approach in particular (Mellor and Hollingdale,

2006; Cox et al., 2007a, b; Cox et al., 2009; Tyers et al., 2009; Mellor et al., 2011).
The results corroborate research findings into organizational-level interventions
where it is acknowledged that one of the more clear-cut lessons from evaluation
practice is that intervention programmes are characteristically difficult to implement
(Lipsey and Corday, 2000).
Refining the HSE Management Standards guidance on implementing and evaluating
interventions would help organizations to realize whether the benefits realized are due to
their effort and investment or other factors within the organization. Broadening the
current scope of the type of interventions needed to tackle stress is important. A sole
focus on preventive organizational-level interventions is limited and individually tailored
interventions are necessary additions as illustrated by these case studies.

Conclusion
This study was designed to examine the implementation of the Management Standards
for work-related stress as defined in the HSE guidance. Findings suggest that the HSE
approach is do-able. It can work in different ways, according to organizational style,
incidence and prevalence of stressors. It can mesh with internal arrangements for stress
reduction already in place. Key principles for an effective implementation of this
approach are senior management commitment and worker involvement, which were
commonly reported across case studies although to variable form and depth. Stress
management that combines individual and organizational interventions was common
practice suggesting a broader focus for the Management Standards approach where the
initial focus is on organizational-level interventions. The present paper illustrates the
efforts made by large organizations and this could be used for guiding and improving
stress management in similar work settings.

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Further reading
Bartram, D.J., Yadegarfar, G. and Baldwin, D.S. (2009), “Psychosocial working conditions and
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Work and Stress, Vol. 22 No. 2, pp. 96-107.

About the authors

Dr Nadine Mellor is an Occupational Psychologist working for the Health and Safety Laboratory
since 2003. Her research includes the design of preventive health and well-being strategies at the
workplace, and the role of health and safety leadership in high-risk work environments. She worked
previously in France within the training department of an international company as management
trainer and consultant, focusing on coaching and developing professionals and managers. Dr Nadine
Mellor is the corresponding author and can be contacted at: Nadine.mellor@hsl.gov.uk
Phoebe Smith is a Chartered Psychologist with 19 years’ experience of research in human factors.
Since joining the Health and Safety Laboratory in 1998, she has worked on a diverse range of projects,
from writing health and safety guidance for the call centre industry through to investigating safety
culture in the high hazard sector, both in support of HSE inspection and also on a consultancy basis.
 She worked closely with the Health and Safety Executive developing and implementing the Management
Management Standards, including training industry stakeholders and local authority inspectors.
Proffessor Colin Mackay is a Psychologist working for the HSE. He has been instrumental in
Standards
initiating the national policy on stress in Great Britain. He has published several articles on the for stress
theoretical basis of the Management Standards approach.
David Palferman is a Psychologist working within the human factors, ergonomics and
psychology unit of the HSE, which he joined in 2004. Since the launch of the HSE Management 17
Standards approach, he has been providing training and technical support to HSE and local
authority inspectors, HSE policy staff and to organisations.
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