DEFINITION OF STRESS

HSE's formal definition of work related stress is:

"The adverse reaction people have to excessive pressures or other types of demand placed on them at work."

Stress is not an illness – it is a state. However, if stress becomes too excessive and prolonged, mental and physical illness may develop.

Work is generally good for people if it is well designed, but it can also be a great source of pressure. There is a difference between pressure and stress. Pressure can be positive and a motivating factor, and is often essential in a job. It can help us achieve our goals and perform better. Stress occurs when this pressure becomes excessive. Stress is a natural reaction to too much pressure.

Balancing demands and pressures with skills and knowledge

A person experiences stress when they perceive that the demands of their work are greater than their ability to cope. Coping means balancing the demands and pressures placed on you (i.e. the job requirements) with your skills and knowledge (i.e. your capabilities). For example, if you give a member of your team a tight deadline on a project they feel they have neither the skills nor ability to do well, they may begin to feel undue pressure which could result in work related stress.

Stress can also result from having too few demands, as people will become bored, feel undervalued and lack recognition. If they feel they have little or no say over the work they do or how they do it, this may cause them stress.

Factors in stress

Stress affects people in different ways and what one person finds stressful can be normal to another. With each new situation a person will decide what the challenge is and whether they have the resources to cope. If they decide they don't have the resources, they will begin to feel stressed. How they appraise the situation will depend on various factors, including:

• their background and culture;
• their skills and experience;
• their personality;
• their personal circumstances;
• their individual characteristics;
• their health status;
• their ethnicity, gender, age or disability; and
• other demands both in and outside work.

As a manager you have a duty to ensure that work does not make your team ill. Understanding how to spot the signs of stress in your team, and then know what to do to reduce stress, will help you achieve this.

"For me it was a new boss. I found myself crying 'cos I couldn't keep up suddenly. Stress is where you can't cope, there's too much and you don't know what to focus on any more."
(Employee, London)

Causes of Stress

HSE has identified six factors that can lead to work related stress if they are not managed properly.

It is important to understand each of the six factors and how they are related to each other, as this can influence the amount of stress an individual experiences.

Management Standards

Demands:

Employees indicate that they are able to cope with the demands of their jobs.

Control:

Employees indicate that they are able to have a say about the way they do their work.

Support:

Employees indicate that they receive adequate information and support from their colleagues and superiors.

Relationships:

Employees indicate that they are not subjected to unacceptable behaviours, e.g. bullying at work.

Role:

Employees indicate that they understand their role and responsibilities.

Change:

Employees indicate that the organisation engages them frequently when undergoing an organisational change.

All:

Systems are in place locally to respond to any individual concerns.

Key information about the six factors:

• A person can reduce the impact of high demands if they have high control over their work.
• The impact of high demands and low control can be reduced by having high levels of support, either from colleagues or from you as a manager.
• Relationships can be one of the biggest sources of stress, especially problems like bullying and harassment
• Problems with role are probably the easier problems to solve.
• Change does not have to be at an organisational level to have an impact on individuals or teams, for example, changes in team members, line managers or the type of work or technology used by the team can be just as stressful.

Understanding that these six factors can cause stress for employees can help managers and employees to answer the questions:

• Does my organisation or team have a problem with stress?
• If 'yes', what do I need to do or change to reduce stress in my team?
• If 'no' what do I need to do to prevent stress being a problem in the future?

We have established good practice guidance for each of these factors. We hope that this helps everyone take a proactive approach to preventing and managing stress in your workplace.

Signs and Symptoms

Stress can cause changes in those experiencing it. In some cases there are clear signs that people are experiencing stress at work and if these can be identified early, action can be taken before the pressure becomes a problem. This may make it easier to reduce and eliminate the causes.

It is important that everyone looks out for changes in a person's or a group's behaviour. However, in many cases the changes may only be noticeable to the person subject to the stress and so it is also important to look at how you are feeling and try to identify any potential issues you may have as early as possible and take positive action to address them; this may be raising the matter with a line manager, talking to an occupational health professional or your own GP.

Stress can show itself in many different ways - see below. Some of the items in this list may not be signs of stress if people always behave this way. Managers may need to manage staff exhibiting some of these signs differently. You are particularly looking for changes in the way people behave that could be linked with excessive pressures.

Stress can cause changes in those experiencing it. In some cases there are clear signs that people are experiencing stress at work and if these can be identified early, action can be taken before the pressure becomes a problem. This may make it easier to reduce and eliminate the causes.

It is important that everyone looks out for changes in a person's or a group's behaviour. However, in many cases the changes may only be noticeable to the person subject to the stress and so it is also important to look at how you are feeling and try to identify any potential issues you may have as early as possible and take positive action to address them; this may be raising the matter with a line manager, talking to an occupational health professional or your own GP.

Stress can show itself in many different ways - see below. Some of the items in this list may not be signs of stress if people always behave this way. Managers may need to manage staff exhibiting some of these signs differently. You are particularly looking for changes in the way people behave that could be linked with excessive pressures.

Male

• Head and mental health
• Heart, lungs and circulation
• Skin
• Metabolism
• Muscles and joints
• Digestive system and gut
• Reproduction and growth
• Immune system

Female

• Head and mental health
• Heart, lungs and circulation
• Skin
• Metabolism
• Muscles and joints
• Digestive system and gut
• Reproduction and growth
• Immune system

Signs of stress in individuals

If you are suffering from some of the following symptoms it may indicate that you are feeling the effects of stress. If you find that work or aspects of your work bring on or make these symptoms worse, speak to your line manager, trade union representative or your HR department. It may be that some action taken at an early stage will ease the stress and reduce or stop the symptoms.

Emotional symptoms

• Negative or depressive feeling
• Disappointment with yourself
• Increased emotional reactions – more tearful or sensitive or aggressive
• Loneliness, withdrawn
• Loss of motivation commitment and confidence
• Mood swings (not behavioural)

Mental

• Confusion, indecision
• Can’t concentrate
• Poor memory

Changes from your normal behaviour

• Changes in eating habits
• Increased smoking, drinking or drug taking ‘to cope’
• Mood swings effecting your behaviour
• Changes in sleep patterns
• Twitchy, nervous behaviour
• Changes in attendance such as arriving later or taking more time off.

Please note these are indicators of behaviour of those experiencing stress. They may also be indicative of other conditions. If you are concerned about yourself please seek advice from your GP. If you are concerned about a colleague try to convince them to see their GP.

Signs of stress in a group

• Disputes and disaffection within the group
• Increase in staff turnover
• Increase in complaints and grievances
• Increased sickness absence
• Increased reports of stress
• Difficulty in attracting new staff
• Poor performance
• Customer dissatisfaction or complaints

It is not up to you or your managers to diagnose stress. If you or they are very worried about a person, recommend they see their GP. It is up to you and your managers to recognise that behaviours have changed, be aware that something is wrong and take prompt action. Take care not to over react to small changes in behaviour. You and your managers need to act when these behavioural changes continue. Use these symptoms (both individual and group) as clues.

Introduction To Human Factors

Reducing error and influencing behaviour (HSG48) is the key document in understanding HSE’s approach to human factors. It gives a simple introduction to generic industry guidance on human factors, which it defines as:

• "Human factors refer to environmental, organisational and job factors, and human and individual characteristics, which influence behaviour at work in a way which can affect health and safety"

This definition includes three interrelated aspects that must be considered: the job, the individual and the organisation:

• The job: including areas such as the nature of the task, workload, the working environment, the design of displays and controls, and the role of procedures. Tasks should be designed in accordance with ergonomic principles to take account of both human limitations and strengths. This includes matching the job to the physical and the mental strengths and limitations of people. Mental aspects would include perceptual, attentional and decision making requirements.
• The individual: including his/her competence, skills, personality, attitude, and risk perception. Individual characteristics influence behaviour in complex ways. Some characteristics such as personality are fixed; others such as skills and attitudes may be changed or enhanced.
• The organisation: including work patterns, the culture of the workplace, resources, communications, leadership and so on. Such factors are often overlooked during the design of jobs but have a significant influence on individual and group behaviour.

In other words, human factors are concerned with what people are being asked to do (the task and its characteristics), who is doing it (the individual and their competence) and where they are working (the organisation and its attributes), all of which are influenced by the wider societal concern, both local and national.

Human factors interventions will not be effective if they consider these aspects in isolation. The scope of what we mean by human factors includes organisational systems and is considerably broader than traditional views of human factors/ergonomics. Human factors can, and should, be included within a good safety management system and so can be examined in a similar way to any other risk control system.

Categorising human failure

It is important to remember that human failures are not random; there are patterns to them. It is worth knowing about the different failure types because they have different causes and influencing factors and as a consequence the ways of preventing or reducing the failures are similarly different.

There are three types of human failures (unsafe acts) that may lead to major accidents:

Unintentional errors:

• Errors (slips/lapses) are “actions that were not as planned” (unintended actions). These can occur during a familiar task e.g. omissions like forgetting to do something, which are particularly relevant to repair, maintenance, calibration or testing. These are unlikely to be eliminated by training and need to be designed out.
• Mistakes are also errors, but errors of judgement or decision-making (“intended actions are wrong”) - where we do the wrong thing believing it to be right. These can appear in situations where behaviour is based on remembered rules or familiar procedures or unfamiliar situations where decisions are formed from first principles and lead to misdiagnoses or miscalculations. Training is the key to avoiding mistakes.

Intentional errors:

• Violations differ from the above in that they are intentional (but usually well-meaning) failures, such as taking a short-cut or non-compliance with procedures e.g. deliberate deviations from the rules or procedures. They are rarely wilful (e.g. sabotage) and usually result from an intention to get the job done despite the consequences. Violations may be situational, routine, exceptional or malicious as outlined below.
• Routine violations: a behaviour in opposition to a rule, procedure, or instruction that has become the normal way of behaving within the person’s peer/work group.
• Exceptional violations: these violations are rare and happen only in unusual and particular circumstances, often when something goes wrong in unpredicted circumstances e.g. during an emergency situation.
• Situational violations: these violations occur as a result of factors dictated by the worker’s immediate work space or environment (physical or organisational).
• Acts of sabotage: these are self explanatory although the causes are complex - ranging from vandalism by a de-motivated employee to terrorism.

• There are several ways to manage violations, including taking steps to increase their detection, ensuring that rules and procedures are relevant/practical and explaining the rationale behind certain rules. Involving the workforce in drawing up rules increases their acceptance. Getting to the root cause of any violation is the key to understanding and hence preventing the violation.

The attached handout outlines Human Failure Types  in more detail, along with examples and typical control measures.

The likelihood of these human failures is determined by the condition of a finite number of ‘performing influencing factors’ , such as distraction, time pressure, workload, competence, morale, noise levels and communication systems. Given that these factors influencing human performance can be identified, assessed and managed, potential human failures can also be predicted and managed. In short, human failures are not random events.

The key message here is that human errors and rule breaking are largely predictable and therefore, can be identified and, most importantly, managed. We seek to encourage industry to tackle error reduction in a structured and proactive way, with as much rigour as the technical aspects of safety and make it an integrated part of their safety management system. One of the Key Topics, Managing Human Failures^[6], includes a 7-step approach to identifying and managing human failures that many organisations have found useful.

Managing human failures: Common pitfalls

There is more to managing human failure in complex systems than simply considering the actions of individual operators. However, there is obvious merit in managing the performance of the personnel who play an important role in preventing and controlling major incidents, as long as the context in which this behaviour occurs is also considered.

There are several mistakes that major hazard sites commonly make when assessing human performance. These include:

• Treating operators as if they are superhuman, able to intervene heroically in emergencies
• Providing precise probabilities of human failure (usually indicating very low chance of failure) without documenting assumptions/data sources,
• Assuming that an operator will always be present, detect a problem and immediately take appropriate action,
• Assuming that people will always follow procedures,
• Stating that operators are well-trained, when it is not clear how the training provided relates to major accident hazard prevention or control and without understanding that training will not effect the prevention of slips/lapses or violations, only mistakes,
• Stating that operators are highly motivated and thus not prone to unintentional failures or deliberate violations,
• Ignoring the human component completely, failing to discuss human performance at all in risk assessments, leading to the impression that the site is unmanned,
• Inappropriate application of techniques, such as detailing every task on site and therefore losing sight of targeting resources where they will be most effective,
• Producing grand motherhood statements that human error is completely managed (without stating exactly how).

Companies should consider whether any of the above apply to how their organisation manages human factors.

Sick Building Syndrome

Sick building syndrome (SBS) is a combination of ailments (a syndrome) associated with an individual's place of work (office building) or residence. A 1984 World Health Organization report into the syndrome suggested up to 30% of new and remodeled buildings worldwide may be linked to symptoms of SBS. Most of the sick building syndrome is related to poor indoor air quality.

Sick building causes are frequently pinned down to flaws in the heating, ventilation, and air conditioning (HVAC) systems. Other causes have been attributed to contaminants produced by outgassing of some types of building materials, volatile organic compounds (VOC), molds (see mold health issues), improper exhaust ventilation of ozone (byproduct of some office machinery), light industrial chemicals used within, or lack of adequate fresh-air intake/air filtration (see Minimum Efficiency Reporting Value).

Symptoms are often dealt with after-the-fact by boosting the overall turn-over rate of fresh air exchange with the outside air, but the new green building design goal should be to avoid most of the SBS problem sources in the first place, minimize the ongoing use of VOC cleaning compounds, and eliminate conditions that encourage allergenic, potentially-deadly mold growth

Symptoms

Building occupants complain of symptoms such as sensory irritation of the eyes, nose, throat; neurotoxic or general health problems; skin irritation; nonspecific hypersensitivity reactions; and odor and taste sensations.

Several sick occupants may report individual symptoms which do not appear to be connected. The key to discovery is the increased incidence of illnesses in general with onset or exacerbation within a fairly close time frame - usually within a period of weeks. In most cases, SBS symptoms will be relieved soon after the occupants leave the particular room or zone. However, there can be lingering effects of various neurotoxins, which may not clear up when the occupant leaves the building. Particularly in sensitive individuals there can be long-term health effects.

Causes

The contributing factors often relate to the design of the built environment, and may include combinations of some or all of the following:

Buildup of potentially hazardous gases

Carbon Dioxide, as well as carbon monoxide, combined with a relative lack of oxygen, may be a major cause of SBS

Moisture buildup and mold growth

Buildings often contain a large number of hidden internal cavities which are formed from skeletal construction methods. These cavities commonly exist inside walls and ceilings constructed using joists and trusses, and may also include attic, crawlspace, and drop-ceiling spaces. Such locations may have very low direct ventilation, but air does infiltrate in and out of these spaces as ambient atmospheric pressure changes occur.

Older building construction from before the development of insulation, moisture barriers, and composite materials tended to be drafty, cold, and wasteful of heating, but they also suffered few moisture problems. For example, before plywood was commonly used for floor construction, home floors were typically constructed with two layers of narrow boards laid at 90 degree angles from each other, and 45 degrees from the general lay of the floor joists. These boards had typically had rough gaps between them, which allowed air to seep freely in and out of wall and ceiling joist air spaces. Modern plywood floor construction is nearly impermeable by comparison, and allows no airflow into the joist spaces.

Moisture can be trapped and hidden within these cavities where it builds to 70% and 95% moisture saturation by weight. Moisture buildup can occur for example inside the wall cavities surrounding a high-humidity kitchen, bathroom, or bathing area that is poorly ventilated. There are few if any, mechanisms that operate to dry out these internal wall cavities once they become saturated with moisture. Ventilation of joist spaces is typically not considered important, though it could be accomplished during construction by drilling large vent holes inside each wall cavity, through the floor and ceiling plywood sheeting.

If such airflows are of hot, humid air, this moist, warm air may reach a dewpoint surface, especially if indoor temperatures are maintained much below about 78 °F (26 °C). At this degree of moisture saturation, in this dark, undisturbed wall cavity space, most all molds, including stachy, thrive. Molds and bacteria rarely coexist. Molds produce generally toxic substances that create unwelcome, unhealthy environments for bacteria and insects, as well as human beings. The toxic substances generated by mold growth may become aerosolized, released and distributed to a much greater range by these unintentional airflows through the building's matrix until they may be inducted into the air conditioning and heating distribution systems and ultimately discharged into the breathing zone. These unintentional airflows create the toxicity and obscure the true source of toxicity and earthy odors as they distribute it.

Mechanical ventilation in a hot, humid climate may deliver water vapor into a building at the rate of approximately one pound of water per day for each cubic foot per minute per day of unconditioned outdoor ventilation air delivered.

Radon mitigation by mechanical ventilation in hot humid climates, (Florida) is known to create gradual increases in moisture saturation that suddenly lead to mold problems when moisture saturation of a favored mold food material reaches 70% by weight. This increasing moisture saturation process may take a few months or as long as four or more years.

The uninformed or poorly informed assume that the air conditioner will successfully remove such moisture, and it may if it is operating efficiently. Many air conditioners do not, and almost all of them decline in their ability to dehumidify efficiently over time. Residual moisture remains and soaks into materials as if they were sponges, on a march toward full saturation. In hot, humid climates, the worst months for mold are October, November, December and early spring...when air conditioners rarely operate and moisture saturation increases most rapidly.

Identification and termination of these unintentional building matrix airflows has rarely been recognized and acted upon, hence heroic efforts to heal the sick building have been largely unsuccessful. Out of a sense of frustration with enormously expensive and ineffective healing approaches, total building destruction is sometimes selected as a way out.

With proper application of currently available instrumentation, identification of unintentional building matrix airflows is relatively easy, quick and inexpensive for a knowledgeable, experienced, building science practitioner. Pressure and micropressure management can result in immediate odor and toxics distribution system termination. With application of correct technology, and often without installation of any additional equipment, relying only on what is already there, within hours of completion a sick building can begin a gradual drying out process to heal itself completely.

As Joe Lstiburek has said, the approach of building disassembly and rebuild or destruction on one hand (expensive) or micropressure management on the other (much less expensive) is decided by who is paying. Micropressure management correctly applied has the potential to eliminate the true cause of the sick building.

The other approach rarely addresses the cause and treats the symptoms only.

• Indoor air quality (including smoking where not prohibited)
• Toxic mold
• Artificial fragrance, such as dryer sheets
• Poor or inappropriate lighting (including absence of or only limited access to natural sunlight)
• Poor heating or ventilation
• Microbial or mite contamination of HVAC systems.
• Bad acoustics or infrasound^[6]
• Poorly designed furnishings, furniture and equipment (e.g. computer monitors, photocopiers, etc.).
• Poor ergonomics.
• Chemical contamination.
• Biological contamination.

To the owner or operator of a "sick building", the symptoms may include high levels of employee sickness or absenteeism, lower productivity, low job satisfaction and high employee turnover. Clarification of the link between a sick building and employee health has and will likely continue to result in increased worker's compensation and personal injury claims. Business owners will likely find increasingly happy customers and a better bottom line with successful healing of sick buildings.

Prevention

• Roof shingle cleaning non pressure removal of algae, mold & Gloeocapsa magma.
• Pollutant source removal or modification to storage of sources.
• Replacement of water-stained ceiling tiles and carpeting.
• Use paints, adhesives, solvents, and pesticides in well-ventilated areas, and use of these pollutant sources during periods of non-occupancy.
• Increase the number of air exchanges, The American Society of Heating, Refrigeration & Air Conditioning Engineers recommend a minimum of 8.4 air exchanges per 24 hour period.
• Proper and frequent maintenance of HVAC systems
• UV-C light in the HVAC plenum
• Regular vacuuming with a HEPA filter vacuum cleaner to collect and retain 99.97% of particles down to and including 0.3 micrometres

Gender differences

There might be a gender difference in reporting rates of sick building syndrome because women tend to report more symptoms than men. Along with this, there have been studies where they found that women have a more responsive immune system and are more prone to mucosal dryness and facial erythema. Also, women are alleged by some to be more exposed to indoor environmental factors because they have a tendency to have more clerical work where they are exposed to unique office equipment and materials (example: Blueprint machines), whereas men have jobs based outside of offices

References

1. ^ "Sick Building Syndrome". United States Environmental Protection Agency. http://www.epa.gov/iaq/pubs/sbs.html. Retrieved 2009-02-19. 
2. ^ "Mold and Mildew PDF file". National Institute of Environmental Health Science. http://www.niehs.nih.gov/health/topics/agents/mold/docs/mold.pdf. Retrieved 2009-02-19. 
3. ^ Godish, Thad (2001). Indoor Environmental Quality. New York: CRC Press. pp. 196-197. ISBN 1566704022
4. ^ "Sick Building Syndrome." National Safety Council. (2009) Retrieved April 15, 2009. [1]
5. ^ Sick building syndrome and indoor climate control
6. ^ Burt (1996). "Sick Building Syndrome: Acoustic Aspects". Indoor and Built Environment 5 (1): 44–59. doi:10.1177/1420326X9600500107. 
7. ^ Godish, Thad (2001). Indoor Environmental quality. New York: CRC Press. pp. 196-197. ISBN 1566704022

Martín-Gil J, Yanguas MC, San José JF, Rey-Martínez and Martín-Gil FJ. "Outcomes of research into a sick hospital". Hospital Management International, 1997, pp 80–82. Sterling Publications Limited.