Handbook of Research on Stress and Well-Being in the Public Sector 2019956537, 9781788970358, 9781788970341

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HANDBOOK OF RESEARCH ON STRESS AND WELL-BEING IN THE PUBLIC SECTOR

Silvia and I would like to dedicate this book to our dear friend Ron Burke, who has inspired us and many more academics and colleagues throughout the world. He was not only a great scholar but a kind and gentle human being, whose work and encouragement touched many people in many countries. Rest in peace dear friend, we will all miss your enthusiasm, kindness, humor and support. Cary L. Cooper and Silvia Pignata

Handbook of Research on Stress and Well-Being in the Public Sector Edited by

Ronald J. Burke Formerly Professor Emeritus, Schulich School of Business, York University, Canada

Silvia Pignata Senior Lecturer, School of Engineering, University of South Australia, Australia

Cheltenham, UK • Northampton, MA, USA

© The Editors and Contributors Severally 2020

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical or photocopying, recording, or otherwise without the prior permission of the publisher. Published by Edward Elgar Publishing Limited The Lypiatts 15 Lansdown Road Cheltenham Glos GL50 2JA UK Edward Elgar Publishing, Inc. William Pratt House 9 Dewey Court Northampton Massachusetts 01060 USA A catalogue record for this book is available from the British Library Library of Congress Control Number: 2019956537 This book is available electronically in the Business subject collection DOI 10.4337/9781788970358

ISBN 978 1 78897 034 1 (cased) ISBN 978 1 78897 035 8 (eBook)

Contents

List of figuresvii List of tablesviii List of contributorsix PART I

INTRODUCTION

1

Introducing the collection Silvia Pignata

2

Increasing well-being of workers in the public sector: research and practice Ronald J. Burke

3

Trade unions and stress at work: the evolving responses and politics of health and safety strategies in the case of the United Kingdom15 Miguel Martínez Lucio

4

Psychosocial factors and worker health: comparisons between private and public sectors in Australia Tessa S. Bailey, Mikaela S. Owen and Maureen F. Dollard

PART II

2

4

33

STRESS AND WELL-BEING IN VARIOUS PUBLIC SECTOR OCCUPATIONS

5

Stress and well-being of first responders 58 Dessa Bergen-Cico, Pruthvi Kilaru, Rachael Rizzo and Patricia Buore

6

Managing boredom and motivation: the unusual case of stress in firefighting Maude Villeneuve, Pierre-Sébastien Fournier and Caroline Biron

7

Nurses’ experiences of workplace mistreatment Zhiqing E. Zhou, Xin Xuan Che and Wiston A. Rodriguez

8

Emotions in nursing Gillian Lewis and Neal M. Ashkanasy

9

The impact of emotional intelligence on daily work life 122 Keri A. Pekaar, Arnold B. Bakker, Dimitri van der Linden and Marise Ph. Born v

74 88 106

vi  Handbook of research on stress and well-being in the public sector 10

Stress and well-being in prison officers Andrew J. Clements, Gail Kinman and Jacqui Hart

137

11

Well-being in academic employees – a benchmarking approach Gail Kinman and Siobhan Wray

152

12

Stress, well-being and aging in the Italian banking sector: evidence and future perspectives 167 Gabriele Giorgi, Giulio Arcangeli, Jose M. Leon-Perez, Massimo Fioriti, Eleonora Tommasi and Nicola Mucci

PART III CASE STUDIES OF EFFORTS TO BRING ABOUT ORGANIZATIONAL CHANGE 13

Applications of psychological capital in the public sector 182 Carolyn M. Youssef-Morgan, Barbara L. Ahrens, Kristi Bockorny, Lanell Craig and Matthew Peters

14

The benefits of individual proactive and adaptive performance: an organizational learning perspective Mindy Shoss, Clair Kueny and Dustin K. Jundt

15

Building a health and safety culture: actions, commitment, and perceptions216 Sybil Geldart and Christine Alksnis

16

An organizational perspective on well-being in the health sector: a focus on leadership, systems, and culture Peter Spurgeon

200

232

PART IV ORGANIZATIONAL INITIATIVES AND CHANGING WORKPLACE ENVIRONMENTS 17

Developing nurse leaders for well-being and performance Margaret M. Hopkins and Deborah A. O’Neil

248

18

Introducing a National Well-being Service for emergency responders in the United Kingdom Ian Hesketh and Cary L. Cooper

19

Occupational health and safety: in crisis, or in charge? Renae Hayward and John Durkin

275

20

Stress in Australian universities: initiatives to enhance well-being Silvia Pignata

294

260

Index309

Figures

3.1

Levels and dimensions of trade union responses to the question of stress

19

4.1

Job demands for public and private sectors 2014–15

43

4.2

Rates of bullying in the public sector, private sector, and nationally

44

4.3

Job resources for public and private sectors 2014–15

45

4.4

Health and motivational outcomes for public and private sectors

46

4.5

The PSC extended JD–R model for public and private workers in Australia

49

5.1

Stress response for first responders

60

5.2

Development and impact of traumatic stress

67

11.1

Mean scores for work-related hazards 2008–14 with HSE benchmarks156

14.1

Feedforward and feedback loops in public sector organizations

202

16.1

The OSM model

236

16.2

The typology of organizational pressures and individual strains

238

16.3

Staff distributions and stressed clusters of staff

239

18.1

The four pillars of the National Police Well-being Service

262

vii

Tables

4.1

PSC-12 benchmark standards and prognosis

42

4.2

PSC-12 benchmark standards for public sector, private sector, and national AWB samples

42

4.3

T-test results for differences in job demands between public and private sectors

44

4.4

T-test results for differences in job resources between public and private sectors

45

4.5

T-test results for differences in health and motivation outcomes between public and private sectors

46

4.6

Correlation matrix for psychosocial factors 2014–15

47

4.7

Fit indices for model fit of the proposed model of the PSC extended JD–R model for public and private workers in Australia

48

5.1

Manifestations of stress among first responders

68

10.1

Comparison of survey findings with targets

141

11.1

Sample characteristics 2008–14

156

17.1

Individual strategies for developing well-being in nurse leaders256

viii

Contributors

Barbara L. Ahrens (PhD, Bellevue University, Nebraska) is a Business Education Instructor at Waukee High School, Iowa, USA, and Chief Negotiator for the Waukee Education Association representing over 500 teachers in collective bargaining. Prior to an educational career, she worked in project management for over ten years at Unisys Corporation, Des Moines, Iowa. Her primary research area is gratitude and its relationship with work stress. Christine Alksnis is an Associate Professor in the Psychology program at the Brantford Campus of Wilfrid Laurier University, Canada. She received her PhD in Applied Social Psychology from the University of Guelph, Canada in 2000 and joined Wilfrid Laurier University in 2003. Her main area of research involves investigating how stereotyping at work can influence performance evaluations and salary allotments. She has also undertaken research on health human resources, work stress, and courtroom dynamics in sexual assault cases. Giulio Arcangeli was born in Florence, Italy, in 1953. He obtained a master’s degree in Medicine and Surgery at the University of Florence, a Specialization in Occupational Medicine at the University of Florence, a Specialization in Pulmonology at the University of Florence, and a Specialization in Sports Medicine at the University of Bologna. He received the title of Radiation Protectionist Physician at the Ministry of Labour and Social Policies of the Italian Republic. He obtained the professional certification of European Ergonomist at the Centre for Registration of the European Ergonomists (CREE). Currently, he is the Head of the School of Specialization in Occupational Medicine at the University of Florence, and the Head of the Occupational Medicine Unit of the Careggi University Hospital in Florence. He is the author of numerous scientific publications of international relevance. Neal M. Ashkanasy, OAM, PhD is Professor of Management in the UQ Business School at The University of Queensland, Australia. He studies emotion in organizations, leadership, culture, and ethical behavior. He has published in journals such as the Academy of Management Journal and Academy of Management Review, the Journal of Management, and the Journal of Applied Psychology. He served as Editor-in-Chief of the Journal of Organizational Behavior and Associate Editor for the Academy of Management Review and Academy of Management Learning & Education. He is currently Associate Editor for Emotion Review and Series Editor for Research on Emotion in Organizations. He is the founder and administrator of the Emonet Listserv. In 2017 he was awarded a Medal of the Order of Australia (OAM). Tessa S. Bailey, is a registered psychologist and completed her PhD focusing on psychosocial safety climate (PSC) and psychosocial factors at work. She has expeix

x  Handbook of research on stress and well-being in the public sector rience working in the areas of human resource management, injury prevention, and injury management. Tessa has assisted with coordinating the Australian Workplace Barometer project since 2011, which has collected data on working conditions, worker health, and productivity outcomes for 7331 participants across Australia. Tessa’s current appointment as a Research Associate involves examining PSC as a leading indicator for worker well-being and organizational safety through both research and applied practice projects. Arnold B. Bakker is Full Professor of Work and Organizational Psychology in the Department of Psychology, Education & Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, the Netherlands, Distinguished Visiting Professor at the University of Johannesburg, and Extraordinary Professor at North-West University, Potchefstroom, South Africa. His research interests include work engagement, job demands–resources theory, job crafting, work–family interface, sports psychology, and student engagement. Dessa Bergen-Cico, PhD, is a Professor of Public Health and Coordinator of the Addiction Studies Program at Syracuse University, USA. She is an Affiliated Research Investigator at the Veterans Administration Center for Integrative Healthcare and a Fellow of the American Academy of Health Care Providers in the Addictive Disorders. Dessa has earned two Fulbright Research Scholarships and she is the author of more than 45 scholarly publications, including the book War and Drugs: The Role of Military Conflict in the Development of Substance Abuse (2012, Routledge). Caroline Biron is an Associate Professor of Occupational Health and Safety Management at Laval University, Quebec, Canada. Her work has been funded, among others, by the Social Sciences & Humanities Research Council of Canada, the Institut de recherche Robert-Sauvé en santé et sécurité du travail, and the Fonds de recherche du Québec – Société et Culture. Her research interests include presenteeism, managerial quality, organizational health interventions, and the evaluation of processes and contextual factors influencing the implementation of interventions. She has edited and co-edited three volumes on these topics, and published several articles, book chapters, and practitioners’ guidelines. She is actively involved in several organizations to support and evaluate implementation of interventions to reduce stress, improve well-being, and organizational performance. Kristi Bockorny (PhD, Bellevue University, Nebraska, USA) is an Assistant Professor of Management at Northern State University, Aberdeen, South Dakota, USA. She has more than a decade of business teaching experience. She earned a master’s degree in Management from Bellevue University and bachelor’s degrees in Finance and Business Education at Northern State University. Her research interests include courage, psychological capital, and entrepreneurship. Marise Ph. Born is Full Professor of Personnel Psychology in the Department of Psychology, Education & Child Studies, Erasmus School of Social and Behavioural

Contributors  xi Sciences, Erasmus University Rotterdam, the Netherlands, and Extraordinary Professor at Optentia and Faculty of Economic and Management Sciences, North-West University, South Africa. Her research interests are in the domains of personnel selection, cross-cultural psychology, test development, and personality and individual differences. Patricia Buore, MA is a Chief Inspector of the National Police Service in Kenya. Patricia has over eight years of experience in program development, capacity building, peace advocacy, conflict mitigation and analysis. In 2017, Patricia was selected to become a Rotary International Peace Fellow and she has participated in post-conflict reconstruction in Eastern Central Africa in Dar es Salaam, Tanzania. She conducts coaching, training, and facilitation in gender-based violence and democracy and good governance. In addition, Patricia is a part-time lecturer at Maseno University and Laikipia University in Kenya in the Departments of Psychology, Sociology, and Anthropology. Ronald J. Burke passed away during the preparation of this book. He was Professor Emeritus of Organization Studies, Schulich School of Business, York University in Toronto, Canada. His most recent research interests included creating psychologically healthy workplaces, women in management, occupational health and safety, and work and health. The Founding Editor of the Canadian Journal of Administrative Sciences, he served on the editorial boards of numerous journals. Ron was a Fellow of the Canadian Psychological Association, and received a distinguished scholar practitioner award by the Academy of Management in 2017 in recognition of his long-term and significant contributions for scholarly work that affected the practice of management. Dr. Xinxuan Che is an Assistant Professor in the Industrial and Organizational Psychology program at Florida Institute of Technology. Her research interests are in the areas of organizational citizenship behaviors, occupational health psychology, leadership and teams, workplace safety, and patient safety and quality of care in health care. Andrew J. Clements, PhD is a Senior Lecturer in Organizational Psychology at the University of Bedfordshire, UK. His research interests include well-being in the prison service and police service, motivational processes in career behavior, and identity and belonging at work. As well as engaging in research, Andrew performs consultancy work with organizations in the public, private, and charity sectors on issues such as well-being, recruitment and selection, and employee relations. Professor Sir Cary L. Cooper, CBE is the 50th Anniversary Professor of Organizational Psychology and Health at the Alliance Manchester Business School, University of Manchester, UK. He is also President of the Chartered Institute of Personnel and Development, the professional body for HR professionals for the UK, Ireland and globally; the immediate past President of the British Academy of Management; and Co-Chair of the National Forum for Health and Well-being at

xii  Handbook of research on stress and well-being in the public sector Work, comprising 37 global employers. He has many honorary doctorates from universities and was knighted by the Queen in 2014 for his contribution to the social sciences. Lanell Craig is a PhD candidate at Bellevue University, Nebraska, USA. Her areas of interest include psychological capital and work–life balance. She is currently an officer in the United States Air Force. She earned a Bachelor of Science degree in Applied Meteorology from Embry-Riddle Aeronautical University in 2011 and a Master of Arts degree in Management from the American Military University in 2013. Maureen F. Dollard is Professor of Work and Organizational Psychology and Co-director of the Centre for Workplace Excellence at the University of South Australia. Her research concerns workplace psychosocial factors and she has published five edited books and 170 papers/book chapters (~ 11 500 citations). Maureen is on the board of the International Commission on Occupational Health, the editorial board for Work and Stress, the Journal of Organizational Behavior, and the European Journal of Work & Organizational Psychology, and the advisory board for the Beyond Blue Workplace Mental Health Advisory Group. Dr. John Durkin is a psychologist from the United Kingdom, now living in Perth, Western Australia. As a firefighter he took an interest in the effects of critical incidents on colleagues, which later inspired his PhD research into post-traumatic growth. His experience working with post-9/11 peer-support teams at New York’s police and fire departments reoriented his approach to mass disaster and he led the crisis response to London’s 2017 terrorist incidents and Grenfell Tower fire for the Metropolitan Police Service. John is a board member of the International Critical Incident Stress Foundation and Applied Metapsychology International. He is fostering links to unify crisis response networks in the USA, Europe, and Australia by gathering empirical data to determine how early crisis intervention can prevent PTSD and facilitate post-traumatic growth. Massimo Fioriti was born in Florence, Italy, in 1989. He obtained a master’s degree in Medicine and Surgery at the University of Florence. He has achieved the specific training course in General Medical Practice organized by the Italian Region of Tuscany. Currently, he is a Resident Physician at the School of Specialization in Occupational Medicine at the University of Florence. He is the author of scientific publications of international relevance. Pierre-Sébastien Fournier is a Full Professor and Chair of the Department of Management at Laval University, Canada. His research interests focus on intergenerational transmission of knowledge, workload, and psychosocial risk. He has contributed to numerous scientific journals, books, and international conferences. Sybil Geldart is an Associate Professor of Psychology at Wilfrid Laurier University – Brantford Campus (Ontario), Canada, with research interests broadly based in abnormal and health psychology. She has published research papers related to workplace incivility, worker perceptions of workplace health, and organizational

Contributors  xiii factors influencing safety. Sybil previously served as Associate Editor of the international journal European Review of Applied Psychology and continues to serve as a long-time member of the university’s Research Ethics Board. Sybil became registered as a clinical psychologist in 2014. Both in her teaching and part-time practice, Sybil equips adults and young people with a ‘toolbox’ of coping and life skills to help deal with the stressors we all face in occupational and other settings. Gabriele Giorgi was born in Florence, Italy, in 1979. He obtained a master’s degree in Psychology at the University of Florence, and a PhD in Work and Organizational Psychology at the University of Verona, Italy. He has carried out numerous research experiences in different countries, including Middlesex University London, the University of Bergen, Norway, and the Tokyo Gakugey University, Japan. Currently, he is an Associate Professor of Work and Organizational Psychology at the University of Rome, and the head of the international research laboratory Business@​Health. He is the author of numerous scientific publications of international relevance. Jacqui Hart, PhD is a researcher associated with the University of Bedfordshire, UK and is currently involved in the evaluation of an intervention program to improve the well-being of domestic violence survivors. Although her primary research interest is in trajectories from adverse childhood experience and psychological distress to negative outcomes, her previous experience as a human resources officer resulted in a keen interest in occupational psychology – in particular, workplace stress, resilience, and well-being. Dr. Renae Hayward is a clinical psychologist registered in Australia and the United Kingdom and is driven by a keen interest in mental health, resilience, and personal growth. She has a breadth of experience, having worked as an organizational consultant, clinical practitioner, and academic researcher in a variety of contexts. She utilizes a client-centered approach with a range of evidence-based interventions tailored to individual and organizational needs. Renae has combined her human resources, clinical practice, and research expertise with a decade of work in emergency response, including the health and university sectors. Her background has persuaded her that academic knowledge can only be effective with real-world confirmation of its utility through the design and implementation of effective prevention strategies, early intervention, and treatment. Dr. Ian Hesketh is the Well-being Lead at the UK College of Policing and the Senior Responsible Owner (SRO) for the National Police Well-being Service in the UK. Ian also supports the National Forum for Health and Well-being at Manchester University Alliance Business School. He is an Honorary Researcher at Lancaster University Management School and a Visiting Fellow at the Open University Business School. He holds a PhD in Management and Social Psychology and an MBA from Lancaster University. His research interests are centered on well-being, resilience, and transformation in the context of policing, and most notably he introduced the concept and phenomenon of leaveism to explain human behaviors associated with workplace workload and stress. Ian is a Member of the Society for Education and Training,

xiv  Handbook of research on stress and well-being in the public sector a Fellow of the Chartered Management Institute, and a Fellow of the Royal Society of Arts. Margaret M. Hopkins is a Professor of Management in the College of Business and Innovation (COBI) at the University of Toledo, USA. Her research is focused on leadership, leadership development, and women in leadership. She has been widely published in journals such as the Journal of Business Ethics, Human Resource Management, Journal of Management Education and Journal of Applied Behavioral Science. She earned her undergraduate degree from Boston College and her master’s and doctoral degrees in Organizational Behavior from Case Western Reserve University, USA. Dustin K. Jundt is an Associate Professor of Industrial-Organizational Psychology at Saint Louis University, USA. He earned his PhD in Industrial-Organizational Psychology from Michigan State University, USA, in 2009. His research interests include dynamics of goal choice and pursuit, individual and team adaptive performance, and discretionary workplace behaviors. His work has been published in a number of peer-reviewed journals, including Academy of Management Journal, Annual Review of Psychology, Applied Psychology: An International Review, Human Resource Management Review, Journal of Management, and Organizational Behavior and Human Decision Processes. Pruthvi Kilaru, MPH, is a graduate of Syracuse University, USA and an Emergency Medical Technician (EMT). Gail Kinman is Professor of Occupational Health Psychology at the University of Bedfordshire and Visiting Professor at Birkbeck, University of London, UK. She is a Chartered Psychologist, a Fellow of the British Psychological Society, and a Fellow of the Academy of Social Sciences. Gail has a long-standing research interest in the working conditions of people who do emotionally demanding and knowledge-intensive work and how they influence well-being, work–life balance, and job performance. She has an international reputation for her work that examines the work-related well-being of academic staff working in UK Higher Education Institutions. Further interests are developing interventions to enhance emotional resilience and build ‘e-resilience’ to help people manage technology in a healthy and sustainable way. Clair Kueny is an Assistant Professor of Psychological Science at Missouri University of Science and Technology, USA. She earned her MS (2014) and PhD (2016) in Industrial/Organizational Psychology at Saint Louis University, USA. Clair’s research interests include studying impacts of and reactions to employee discretionary behaviors, including proactive behaviors and counterproductive work behaviors. Additionally, Clair specializes in research-based and practice-based work with health care organizations, including the application of organizational psychology and theories to unique issues that health care organizations and teams face. Her work has been published in a number of journals, including Human Resource

Contributors  xv Management Review, Journal of Occupational Health Psychology, and Journal of Hospital Administration. Jose M. Leon-Perez received his BSc in Psychology (2005), his MSc in Human Resources Management and Development (2008), and his PhD in Human Resources (2011) from Universidad de Sevilla, Spain. In 2012, he joined the Business Research Unit at the ISCTE-Instituto Universitario de Lisboa (Portugal). In 2015, he returned to Universidad de Sevilla, where he is currently an Associate Professor of Social Psychology. His research focuses on occupational health psychology, with specific interests in conducting interventions and assessing their effectiveness, addressing psychosocial risks at work, and promoting healthy behaviors at different levels. Jose has published in top management and psychology research outlets such as Journal of Business Ethics, European Journal of Work and Organizational Psychology, and International Journal of Stress Management, among others. His work has also been covered in books published in English, Spanish, and Portuguese. Gillian Lewis is a teaching-focused academic at the Australian Catholic University in Queensland, Australia. After a 25-year career in clinical nursing practice and nurse education in the public and private sector, a background in teaching professional nurses led to a career in tertiary education. An interest in emotion management derived from clinical experience led to a PhD research study focusing on emotional intelligence and affective events in nurse education. Currently in the final year of her PhD study, Gill’s research interests include emotional intelligence, leadership, and emotions in health care organizations. Gill’s purpose is to inspire, empower, and motivate nursing students as Queensland’s future nursing professionals. Miguel Martínez Lucio studied politics and economics at the University of Essex, UK. His PhD from Warwick University, UK was in industrial relations. He has worked at various universities and is currently a Professor at the University of Manchester in the UK. He co-founded the University of Manchester’s Work & Equalities Institute. He works on the changing nature of employment relations and the transformation of work, with a focus on the changing role of the state in relation to work, employment and labor markets. He has also studied the transformation of trade unionism and the emergence of new forms of organizational forms and strategies within and beyond them. The core of this work is comparative in nature and deals with how the regulatory context impacts on the politics and nature of industrial relations. He is interested in questions of equality, social inclusion and health and safety, especially in terms of their evolution and change. Nicola Mucci was born in Lucca, Italy, in 1981. He obtained a master’s degree in Medicine and Surgery at the University of Pisa, a Specialization in Occupational Medicine at the University of Florence, and a PhD in Occupational, Environmental, and Social Medicine at the Catholic University of Rome. He received the title of Radiation Protectionist Physician at the Ministry of Labour and Social Policies of the Italian Republic. He obtained the professional certification of European Ergonomist at the Centre for Registration of the European Ergonomists (CREE). Currently, he is

xvi  Handbook of research on stress and well-being in the public sector an Associate Professor of Occupational Medicine at the University of Florence and a Medical Executive in the Occupational Medicine Unit of the Careggi University Hospital in Florence. He is the author of numerous scientific publications of international relevance. Deborah A. O’Neil is a Professor of Organizational Behavior and Director of the Executive Master of Organization Development (EMOD) program in the Department of Management, College of Business, Bowling Green State University, USA. Deborah’s research has been published in venues such as Human Resource Management, Journal of Business Ethics, Journal of Applied Behavioral Science, and Career Development International. Deborah earned a PhD from the Weatherhead School of Management at Case Western Reserve University, an MS from American University, and BA degrees from the University of Rhode Island. Mikaela S. Owen completed her PhD exploring the health and well-being of working students, with a focus on psychosocial factors both in the workplace and university environment. Mikaela has been involved in a variety of projects, including the Australian Workplace Barometer, a national surveillance tool for Australian workers. She has also been involved in exploring the workplace conditions of frontline health care workers, along with investigating the factors contributing to well-being of higher degree research students. Her overall research interests include addressing the poor environmental conditions that contribute to poor well-being for both workers and university students. Keri A. Pekaar is a post-doctoral research fellow in the Human Performance Management Group, Department of Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, the Netherlands. Keri completed her PhD in Positive Organizational Psychology at Erasmus University Rotterdam, the Netherlands. Her research interests include emotions, emotional intelligence, and motivational processes. Matthew Peters is a PhD student at Bellevue University, Nebraska, USA. He is currently a Senior HR Consultant at Fairfax County Government, Washington, DC, USA. For over 20 years, he led a wide variety of training, talent management and human resources projects and teams across the government, public, non-profit and military spectrum, including the Navy, Washington Metropolitan Area Transit Authority (WMATA), Defense Intelligence Agency (DIA), and others. Silvia Pignata, PhD is a Senior Lecturer in Aviation (Human Factors) within the School of Engineering at the University of South Australia. She has research expertise in workplace psychosocial factors and organizational interventions. Her other research interests include aviation psychology, the psychosocial aspects of occupational health and safety, and the interaction of people and socio-technical systems within the work environment. Her research has been published in top-tier journals and presented at national and international conferences.

Contributors  xvii Rachael Rizzo, MSUP, MPH is an urban planning and public health specialist in New York, NY, USA. She was a fellow of Columbia University’s Urban Community and Health Equity Lab during her graduate studies. Her work focuses on the impact of the built environment on individual and community health outcomes. She conducts interdisciplinary research using a social justice framework to understand the intersection of public health, public policy, and urban planning. Wiston A. Rodriguez is a PhD student in the Industrial and Organizational Psychology program at The Graduate Center/Baruch College, City University of New York, USA. His research interests include occupational health psychology, leadership, and diversity. Mindy Shoss, PhD is an Associate Professor in the Department of Psychology at the University of Central Florida, USA. She conducts research in the areas of work stress, counterproductive work behavior, job insecurity, adaptive performance, and the changing nature of work. Her work has appeared in top outlets, including Journal of Applied Psychology, Journal of Management, Journal of Organizational Behavior, and Human Resource Management Review. Mindy earned her PhD in Industrial/Organizational Psychology from the University of Houston, USA. Professor Peter Spurgeon is a previous Director of the Health Services Management Centre, University of Birmingham and Founding Director of the Institute for Clinical Leadership at the Medical School, University of Warwick, UK. He has worked for several years in the field of medical leadership and medical engagement, leading to a new text Medical Leadership: The Key to Medical Engagement and Effective Organizations (2018, CRC Press). Currently he is working with the Academy of Medical Royal Colleges in developing a new patient safety educational curriculum for all staff in the UK NHS. Eleonora Tommasi was born in Viareggio (Lucca), Italy in 1987. She obtained a master’s degree in Medicine and Surgery at the University of Florence. She has achieved the specific training in General Medical Practice organized by the Italian Region of Tuscany. Currently, she is a Resident Physician at the School of Specialization in Occupational Medicine at the University of Florence. She is the author of scientific publications of international relevance. Dimitri van der Linden is Professor of Work and Organizational Psychology in the Department of Psychology, Education & Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, the Netherlands. His research interests are on individual differences and on states such as stress, fatigue, or flow. Maude Villeneuve recently completed her doctorate on the subject of workload variations in firefighting at the Faculty of Business Administration at Laval University, Canada. Her research focuses on organizational health management and conflict management at work.

xviii  Handbook of research on stress and well-being in the public sector Siobhan Wray, PhD, is Programme Lead Business Psychology and Senior Lecturer in Organizational Behavior at the University of Lincoln, UK. Her research focuses on work-related stress and work–life balance and the effect of work on the physical and psychological well-being of employees. Much of her work has focused on the well-being of frontline staff, including academic staff, health care workers, teachers and in the ambulance service. Siobhan is a member of the British Psychological Society and the European Academy of Occupational Health Psychology. Carolyn M. Youssef-Morgan (PhD, University of Nebraska, Lincoln, USA) is the Redding Chair of Business at Bellevue University, Nebraska, co-author of Psychological Capital (2007, OUP) and Psychological Capital and Beyond (2015, OUP), and a leading researcher, author, speaker, and consultant on positivity in the workplace. Her research has been published in top-tier journals and prestigious edited volumes, presented at national and international conferences and applied in organizations worldwide. Dr. Zhiqing E. Zhou is an Assistant Professor in the Industrial and Organizational Psychology program at Baruch College, City University of New York, USA. His research interests include occupational health psychology, workplace mistreatment, work–family interface, and organizational climate.

PART I INTRODUCTION

1. Introducing the collection Silvia Pignata

This international collection addresses stress and well-being among workers across a variety of public sector roles and occupations. The public sector provides critical services to community members and there is a strong need for it to be effective, with human resource management being a significant contributor to its organizational success. In the private sector, there remains a perception that public sector employees have an easy life, and it is hoped that this collection will go some way to changing that perception. In reality, public sector organizations face ongoing and new challenges such as cost cutting, pressures to improve performance, changes in societal and workplace demographics, and increasing levels of stress among their employees. The current collection of empirical research, literature reviews, and case studies aim to draw greater attention to these and other challenges, and to provide practitioners with insights into how they can be managed. By doing so, the contributors hope to enhance the health and well-being of public sector employees, and the sector’s performance and contribution to society.

STRUCTURE OF THE BOOK The contributions in this book are from international experts in the field of work and organizational psychology, organizational studies, personnel psychology, management, clinical psychology, occupational health and safety management, health psychology, public health, clinical nursing practice, and policing and trauma. The diversity of countries represented (Australia, Canada, Italy, the Netherlands, United Kingdom (UK), United States (US)) reflects worldwide interest and efforts in this area. The book is divided into four parts. In Part I, after this introduction, Chapter 2 provides an overview of well-being issues associated with the nature of work in the public sector and the need to embrace the characteristics of high-performing organizations. The role of UK trade unions in raising the nature of stress at work and how to respond positively within society is then examined in Chapter 3. Chapter 4 compares psychosocial factors and worker stress and well-being in the Australian private and public sectors and highlights the need for regular psychosocial risk assessments in both sectors. Part II considers international research on the work, well-being, and treatment of workers in diverse public sector occupations (first responders, firefighters, nurses, prison officers, university faculty). The authors of Chapters 5–11, respectively, assert the need to foster resilience; address motivation issues; address mistreatment; manage emotions; consider the role of emotional intelligence in emotion manage2

Introducing the collection  3 ment; identify and target well-being interventions; and use benchmarking approaches to enhance the health and quality of work life in academia. Current and emerging risk factors in the Italian public banking sector are then examined in Chapter 12. Part III presents writings on successful public sector organizations, including case studies of efforts to bring about organizational change that also benefits individuals. The authors of Chapter 13 discuss the application of multidimensional psychological resources (i.e., psychological capital) in four contextual case studies – a fire department, the air force, a public school, and a university. Chapter 14 then considers the organizational benefits of developing and promoting proactive and adaptive individual performance such as efficacy training. In Chapters 15 and 16, researchers from Canada and the UK then detail the actions and commitment involved in building a health and safety culture and focusing on leadership and systems in health care settings. Part IV emphasizes well-being, stress prevention, and the need for targeted and innovative initiatives to bring about effective change in workplaces. Successful practices are highlighted in case studies in order to inform policy on improving and sustaining worker health and well-being in both the public and private sectors (e.g., focusing on strategies to enhance positive relations, growth and purpose in order to develop nurse leaders in Chapter 17; detailing a new evidence-based well-being service for emergency service responders with interventions that include psychological screening, trauma risk management, and peer support programs in Chapter 18; initiating early peer counseling for first responders in Chapter 19; and reducing stress levels in the university context by developing and promoting targeted multilevel organizational interventions in Chapter 20).

ACKNOWLEDGMENTS It is difficult to imagine a collection like this occurring without Ron Burke’s immense contribution. I would also like to thank all the contributors who kindly agreed to share their work and their experiences in this handbook.

2. Increasing well-being of workers in the public sector: research and practice Ronald J. Burke1

WORK AND WELL-BEING IN THE WORKPLACE There is an increasing body of evidence that both individual factors and workplace experiences are linked with individual and family well-being and organizational health. This spills over into the wider society in terms of emotional, physical, and financial tolls. Thus, organizations today are grappling with the increasing prevalence and costs of stress-related injuries and illnesses. Surveys conducted by the American Psychological Association (2016) have documented increasing levels of stress among working women and men in the US. We know a lot about the ‘causes’ of these negative outcomes and are learning more about interventions that address these outcomes and bring benefits to individuals and organizations. Organizations, to be effective and successful, rely on an engaged workforce. Thus, examining the effects of work experiences on well-being has potential benefits to employees, organizations and society at large. In addition, the costs of health care continue to rise, putting demands on an already stretched sector. Therefore, it is vital to engage in preventative initiatives in the workplace as well as support individual employees and their families. There is an increasing body of research evidence and research-based interventions showing that healthy people lead to healthy workplaces. Healthy employees are more productive, take less time off work, use the health care system less, and reduce health care costs (Lencioni, 2012; Lowe, 2011). Work and working can produce satisfaction or distress. A large and growing body of research has found that workplace stress is associated with reduced individual and family health, job performance, and organizational effectiveness. Quick and Cooper (2003) wrote that workplace stress is related to eight of the ten leading causes of death in the developed world – heart disease, cancer, stroke, injury, suicide, chronic liver disease, emphysema, and chronic bronchitis. In a meta-analysis, Goh, Pfeffer and Zenios (2015) examined the combined effects of ten stressors (unemployment, lack of health insurance, shift work, long work hours, job insecurity, work–family conflict, low job control, high job demands, low social support, low organizational justice) on individual mortality and health care costs. They concluded that about 120 000 deaths and about 5–8 percent of annual health care costs were directly associated with these stressors and indirectly associated with ways that workplaces manage their employees. Hansard et al. (2018), collating all the data they could find in various countries and languages, estimated costs to range from US$221 million to US$187 billion, with productivity losses representing the bulk of these costs at between 70 4

Increasing well-being of workers in the public sector: research and practice  5 and 90 percent, with health care and medical costs representing between 10 and 30 percent. Workplace stress affects workplace health and safety as well as employee well-being. An increasing number of specialists in workplace safety agree that there is a direct association between increased levels of worker stress and increases in workplace accidents. In fact, researchers with the National Institute for Occupational Safety and Health (NIOSH) have long advocated accident reduction through stress management initiatives (Murphy, DuBois, & Hurrell, 1986). Countries including Australia, Canada, Sweden, the UK, and the Netherlands have passed legislation making the audit of workplace risks to health and well-being mandatory (Leka et al., 2011; World Health Organization, 2010a, 2010b). As the legislation typically addresses both risk prevention and health promotion, suggested interventions address both reducing negative outcomes and increasing positive outcomes, followed by evaluations to learn how to achieve these results. In addition, enforcing compliance with such legislation should be increased, as some countries (e.g., China, Mexico) fall short. Increasing levels of workplace stress are associated with changes in organizations, including heavier workloads, longer working hours in more demanding jobs, closer monitoring of performance, less control, more business travel, greater pressure to reduce costs, and increasing job insecurity as firms reduce staff (Worrall, Mather, & Cooper, 2016). Public sector employees experience all of these stressors as well as the threat of privatization of services.

THE PUBLIC SECTOR What is the public sector? The public sector refers to ‘businesses and industries that are owned or controlled by the government’ (Cambridge Dictionary, n.d.). The sector comprises non-profit public services and enterprises that are critical to the well-being and functioning of societies. The range of services is diverse, encompassing defense, policing, law enforcement agencies, firefighting, correctional services, education, public hospitals, ambulance services, social welfare programs, child protection, tax collection, mail delivery, utility providers (e.g., electricity, water, waste management), environmental protection, and social services for the homeless and the abused (Burke, Allisey, & Noblet, 2013). Public enterprises operate in areas of basic or strategic importance that require significant investments beyond the scope of private enterprises. The public sector can be differentiated from private and business sectors on the basis of goals (public purpose versus profit making) and ownership. The public sector exists in every country in the world, though countries differ widely in the size, levels of resources, and skill levels of their workforces. There are obvious and important differences in public sector occupational groups in terms of the types and levels of risk and stress experienced in their jobs (Burke et al., 2013). For example, police officers, firefighters, and first responders face more dangerous risks than teachers, university faculty, and government bureaucrats. Public sector

6  Handbook of research on stress and well-being in the public sector workers face stress and strains that are similar (in some areas) to their private sector colleagues. These include burnout, workplace incivility, lack of social support, and low levels of work engagement (European Risk Observatory, 2014). The following North American examples provide evidence on the current state of psychosocial demands in some public sector organizations: ●● At the time of writing, the Ontario Hospital Association (OHA) planned to go to the government to describe a serious problem of hospital overcrowding and longer wait times. The OHA was asking for more funds for the 2018–19 year as occupancy rates at some hospitals reached 140 percent, with patients housed in any available space (Boyle, 2017). ●● Contract university professors (precarious workers) have increased by 200 percent since 1999 in Canada, while regular faculty increased by only 14 percent over this time. Contract faculty get paid less, teach more courses, and the average contract length is one semester (Canadian Association of University Teachers, 2017). ●● Firefighters in California were busy from October to December 2017 battling several major blazes that destroyed tens of thousands of homes and businesses, forced tens of thousands of people to leave their homes, caused many human deaths, and killed horses. Some firefighters were overcome by both heat and smoke (Bromwich, 2017). Stress and Well-being in the Public Sector West and West (1989) were among the first to highlight the concerns of job stress in public sector occupations. They focused on three ‘high-stress’ public sector (or government) jobs: nurses, police officers, and air traffic controllers. They began by illustrating the huge costs of workplace stress in terms of health problems, work attendance and performance, workers’ compensation claims costs, and health care. The authors cite these as between US$100 billion and US$150 billion a year in 1989 and earlier. They then developed a list outlining the stressors in these three occupations that fell into four categories: extra-organizational, organizational, task-related, and individual. They list differences across the three occupations, with examples of each of the four types of stressors indicated. Some of the general stressors were common in the three groups (e.g., high levels of responsibility). They developed a table showing symptoms of stress in these occupations and outlined three categories of symptoms: physical, psychological, and behavioral. While some common symptoms were noted, there was considerable variability across the three occupational groups. They concluded with a number of recommendations for human resource managers in the public sector that could reduce stress levels and their costs. These include recruitment to improve person–job fit, selection to match the individual with the right job, socialization into the job and organization, offering career planning and development programs, the importance of high levels of social support, and the provision of counseling resources to deal with stress issues. These were relevant, in their

Increasing well-being of workers in the public sector: research and practice  7 view, to all three occupations, and likely to apply to other public sector occupations and employees (doctors, teachers, garbage collectors) as well as to private sector employees and occupations. Research on the demanding public sector occupations of nursing staff and medical professionals, police officers, firefighters and first responders is examined in the following section. High-stress Occupations Nursing staff Trivellas, Reklitis and Platis (2013) examined the relationship of job stress and job satisfaction among hospital nursing staff in Greece. Data were collected from 271 nurses. Job stressors included workload, conflict, interpersonal relationships, career development, management style, and the physical work environment. Heavy workload, conflict, and lack of job autonomy were negatively related to job satisfaction. Khamisa et al. (2015) studied job stressors, burnout, job satisfaction and the overall health of nursing staff in South Africa. Data were collected from 895 nurses working in four hospitals. Five stressors were included: patient care, staff issues, supervisor and management issues, overtime hours, and job demands. Staff issues were positively correlated with levels of all three burnout dimensions (emotional exhaustion, depersonalization, lack of personal accomplishment) and negatively with levels of job satisfaction. In addition, burnout levels were negatively associated with psychological and physical health (e.g., somatic symptoms, depression). Their reference list includes studies of job stressors and burnout among nursing staff in Israel, China, Hungary, Greece, and South Africa. Some studies have compared levels of burnout in South Africa with eight other countries – Armenia, Canada, Germany, Japan, New Zealand, Russia, the UK, and the US (Klopper et al., 2012; Poghosyan, Aiken, & Sloane, 2009). Medical professionals Chou, Li and Hu (2014) studied burnout among different medical professionals (doctors, nurses, physician assistants, medical technicians, administrative staff) in a large teaching hospital in Taiwan. Data were collected from 1329 respondents (101 physicians, 68 physician assistants, 570 nurses, 216 medical technicians, 374 administrative staff). Burnout was highest in nurses, followed in turn by physician assistants, physicians, administrative staff, and medical technicians. Job strain, overcommitment, and low social support predicted burnout levels. Police officers There are over 800 000 serving police officers in the US (Department of Justice, 2019) and some have suggested that police work is one of the most stressful occupations. Police stressors are of two types: (1) job content – work schedules, long work hours, shift work, overtime hours, courtroom appearances, and traumatic events

8  Handbook of research on stress and well-being in the public sector such as seeing dead bodies and abused children; and (2) job context – organizational stressors such as bureaucracy, co-worker relations, and culture. Several recent reviews of research on the stress and well-being of police officers have been undertaken (Burke, 2017; Violanti et al., 2017). Violanti and colleagues examined empirical research on workplace stress, shift work, traumatic stress disorder, and psychological and physiological health and well-being. They drew the following conclusions: ●● Traumatic workplace incidents produce post-traumatic stress disorder (PTSD) and psychological distress. ●● Traumatic events reduce sleep quantity and sleep quality. ●● Traumatic events reduce the job performance of officers. ●● Male officers commit suicide at higher rates than female police officers. ●● Organizational stressors increase negative psychological and physiological responses. ●● Shift work reduces sleep quantity and sleep quality. ●● Work stressors have a negative effect on family, increasing work–family conflict. Firefighters and first responders Kim et al. (2016) considered the relationship of job stress and occupational injuries in a nationwide Korean sample of firefighters. Data were collected from 25 616 firefighters. Job stressors included job demands, job control, interpersonal conflict, job insecurity, and organizational features such as support, communication and conflict, organizational culture, rewards, the organizational system and the overall workplace environment. Job stress was positively correlated with the occurrence of injuries and the frequency of injuries. First responders face particular challenges, often developing negative psychological and physiological responses as a result. Wisnivesky et al. (2011), using data from over 27 000 World Trade Center (WTC) rescue and recovery employees, observed higher rates of both physical and psychological health outcomes. In the September 11 attack on the WTC, over 400 first responders died, with hundreds more severely injured. The Rand Corporation (2012) identified several methods to better equip, support, and train first responders. These include provision of personal protective equipment, more detailed information about the situation responders are entering, improved site management structures, and better training to increase their personal protection. Human Resource Processes in the Public Sector Human resource management (HRM) processes play an important role in not only reducing levels of stress experienced by employees but also increasing their psychological and physical well-being and the performance of organizations. HRM processes and strategies have only recently become important elements in public

Increasing well-being of workers in the public sector: research and practice  9 sector management (Harris, Doughty, & Kirk, 2002). Public sector organizations are thus facing increasing pressure to improve the management of their human resources (Truss, 2009). Traditional management approaches in the public sector embrace paternalism, bureaucracy, top-down approaches, and risk aversion, which conflict with managing staff as resources. The diverse range of stakeholders also makes it difficult to determine HRM strategies and processes, as well as larger organizational goals and priorities. Public sector managers often lack the skills and readiness to fulfill the newly emerging vision of the human resources function (Lawler & Mohrman, 2003; Ulrich & Brookbank, 2005). Achieving High Performance in the Public Sector Why cannot the public sector perform like the private sector? This question assumes that private sector organizations perform at generally higher levels. An interest in improving public sector organizations has grown over the past 25 years and was first captured by the phrase ‘new public management’ (Pollitt, 2012). Efforts have been made over the past 25 years to improve their performance, with mixed success (de Waal, 2010). de Waal proposes that one approach to improving performance in public sector organizations is to have them embrace the characteristics of high-performing organizations in general. Based on a review of published research, he concluded that public sector organizations worldwide scored significantly lower on these high-performance organization (HPO) factors than did high-performing private sector organizations. de Waal (pp. 90–91) reviewed HPO research and publications, 290 articles in total, and identified the following six improvement themes for public sector organizations: ●● ●● ●● ●● ●● ●●

identifying the profile of an excellent public sector manager; strengthening the resoluteness of management, becoming more action oriented; excelling in the core competence of providing high levels of client dedication; improving the performance management processes in these organizations; improving the management of processes in the organization; increasing the quality of employees.

de Waal (2010) argues that public sector organizations that improve on these characteristics would increase their performance and their contributions to society. An overarching strategy would involve the use of performance management that makes objectives, performance, and resources transparent. The author asked 2601 individuals working in about 1300 organizations to rate their organization on 35 HPO items as well as providing financial and performance information on how their organizations compared with competitors. The 35 items loaded on five factors: high quality of management; an openness coupled with an action orientation; long-term commitment; a focus on continuous improvement and renewal; and a high-quality workforce. Public sector organizations worldwide scored significantly lower on

10  Handbook of research on stress and well-being in the public sector these dimensions than ‘excellent (predominantly private sector) organizations do’ (de Waal, 2010, p. 81). The performance of public sector organizations depends on the performance of their employees. When problems occur, it is likely due to poor training and management of these employees. Thus, there is a link between human resource management policies and practices and organizational performance. From a global perspective, public sector organizations face unprecedented future challenges that ‘have significant implications for the size and profile of the public sector workforce, the conditions in which employees work and the manner in which HR are managed in this sector’ (Burke et al., 2013, p. 4). Surprisingly, there has been relatively less research undertaken in the public sector than in the private sector in terms of management, employee work experiences, and employee and organizational health and performance.

COMPARING THE WORK AND WELL-BEING OF PRIVATE SECTOR AND PUBLIC SECTOR EMPLOYEES There are two points of view on whether public sector and private sector employees should report similar work experiences, as well as similar well-being and health outcomes. The generic or similarity position would be that all organizations are the same in terms of organizational processes (e.g., management functions, values). The difference position builds on differences in market forces, bureaucratic processes, legal factors, and political pressures. The Health and Safety Executive (2015) in the United Kingdom reported that work-related stress symptoms were higher in the public sector than in the private sector. More public sector employees came in to work when ill, and negative symptoms were higher among public sector employees who had greater personal contact with the public, such as in education, health care, and policing (Johnson, 2015). Thus, protecting and supporting the well-being of public sector employees has now become a more important area of research, not only for employees themselves but also because of the effects that stress has on the job performance of employees and the quality of services provided to their clients (e.g., Aiken et al., 2002). However, other studies have found no differences in the workplace stress experienced by public and private sector employees. Two studies attempted to compare work stressors and overall stress levels as well as well-being among public and private sector employees. Macklin, Smith and Dollard (2006) collected data from 84 public sector employees and 143 private sector employees in Australia. The two groups were compared on seven measures: job demands, job control, work environment, peer support, supervisor support, job satisfaction, and psychological distress. Only one significant difference was found – public sector employees indicated greater job control than private sector employees – the key finding being similar levels of job satisfaction and psychological distress. I conclude that it makes more sense to try to better understand

Increasing well-being of workers in the public sector: research and practice  11 the work stress and well-being consequences of public sector employees working in specific public sector occupational groups. Public sector organizations face diverse and ongoing challenges. Organizational efforts to improve the performance of public sector organizations should embrace the characteristics of high-performing organizations in general, in order to improve the well-being of public sector employees and the sector’s performance and contribution to society.

SOME CONCLUDING THOUGHTS In my earlier career, I undertook research on nurses, doctors, police officers, teachers, and women and men who ran correctional institutions in Ontario. I studied them because they were of interest to me. I also studied employee experiences in the private sector as well (e.g., public accounting firms, banking sector). This collection has required me to consider the effects of being in the public sector and individual well-being. There are some obvious sector differences. Public sector organizations are typically ‘managed’ by elected or appointed officials who control and work within a budget. There are always one or more unions in public sector organizations and the use of collective bargaining and strikes is more common than in private sector organizations. Public sector organizations provide services or products that have an individual focus and rely heavily on interpersonal contacts. I would hope that this collection encourages more research specifically on factors in the public sector that affect stress levels and worker well-being, as well as unit effectiveness and quality of service to clients. It may be that the public sector occupations given more attention here do in fact have higher levels of stress than the typical private sector organization. High levels of stress exist in many public sector workplaces and these levels in some cases (e.g., police, military, nursing) seem higher than levels one might expect to see in most private sector workplaces. Public sector organizations also seem to be under more scrutiny, perhaps reflecting the importance of meeting the needs of citizens who pay the bill. When public sector organizations fall short, citizens or the media complain, and these complaints become public, almost by definition. Although a number of interventions have been successful in improving the work experiences of public sector employees in some workplaces, relatively little research and intervention work has been undertaken in most public sector workplaces (police organizations, military, transit operators, postal workers). It is also vital that better research devotes attention to the root causes of the stressors and health outcomes. Reversing the damage rather than controlling the damage needs to be our priority. Readers interested specifically in performance improvements in the public sector will find a wealth of information in Spurgeon, Burke and Cooper (2012) and Burke et al. (2013). We know what effective public sector organizations look like, having characteristics of high-performing organizations (Leggat, 2012). This involves individual and organizational leaders creating environments that harness the potential

12  Handbook of research on stress and well-being in the public sector and talents of their workforces and more holistic approaches rather than fragmented and inconsistent change efforts. Bringing about successful change will not be easy; however, we need to concentrate our efforts now.

NOTE 1. Preparation of this chapter was supported in part by York University, Toronto, Ontario, Canada.

REFERENCES Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., & Silber, J.H. (2002), ‘Hospital nursing staff and patient mortality, nurse burnout, and job dissatisfaction’, Journal of the American Medical Association, 288, 1987–1993. American Psychological Association (2016), 2016 work and well-being survey. Washington, DC: American Psychological Association. Boyle, T. (2017), ‘Province warned hospitals are “on the brink”: crowding becoming a crisis as wait times get longer, hospital association says’, Toronto Star, 13 December, A2. Bromwich, J.E. (2017), ‘Dozens of horses killed by California fires’, Toronto Star, 9 December, A16. Burke, R.J. (2017), Stress in policing: sources, consequences and interventions. New York: Routledge. Burke, R.J., Allisey, A.F., & Noblet, A.J. (2013), ‘The importance of human resource management in the public sector, future challenges and the relevance of the current collection’. In R.J. Burke, A. Noblet, & C.L. Cooper (Eds.), Human resource management in the public sector. Cheltenham, UK and Northampton, MA, USA: Edward Elgar Publishing, pp. 1–13. Cambridge Dictionary (n.d.), ‘The public sector’. Accessed 10 August 2019 at https://​ dictionary​.cambridge​.org/​dictionary/​english/​public​-sector. Canadian Association of University Teachers (2017), ‘By the numbers: contract academic staff in Canada’. Accessed 2 May 2019 at https://​www​.caut​.ca/​bulletin/​2017/​10/​numbers​ -contract​-academic​-staff​-canada. Chou, L.P., Li, C., & Hu, S.C. (2014), ‘Job stress and burnout in hospital employees: comparisons of different medical professions in a regional hospital in Taiwan’, British Medical Journal, 4, 1–7. Department of Justice (2019), ‘Department of Justice releases reports focused on improving safely and wellness of the nation’s 800 000 law enforcement officers’, Justice News, 17 April. Accessed 2 May 2019 at https://​www​.justice​.gov/​opa/​pr/​department​-justice​-releases​ -reports​-focused​-improving​-safety​-and​-wellness​-nation​-s​-800000​-law. de Waal, A.A. (2010), ‘Achieving high performance in the public sector: What needs to be done?’, Public Performance and Management Review, 34(1), 81–103. European Risk Observatory (2014), Calculating the cost of work-related stress and psychosocial risks: European Risk Observatory literature review. European Agency for Safety and Health at Work. Accessed 2 March 2019 at https://​osha​.europa​.eu/​en/​publications/​ calculating​-cost​-work​-related​-stress​-and​-psychosocial​-risks/​view. Goh, J., Pfeffer, J., & Zenios, S.A. (2015), ‘The relationship between workplace stressors and mortality and health costs in the United States’, Management Science, 62, 608–628.

Increasing well-being of workers in the public sector: research and practice  13 Hansard, J., Teoh, K.R.H., Visockaite, G., Dewe, P., & Cox, T. (2018), ‘The cost of work-related stress to society: a systematic review’, Journal of Occupational Health Psychology, 23, 1–17. Harris, L., Doughty, D., & Kirk, S. (2002), ‘The devolution of HR responsibilities: perspectives from the UK’s public sector’, Journal of European Industrial Training, 26, 218–230. Health and Safety Executive (HSE) (2015), Stress-related and psychological disorders in Great Britain. London: HSE. Johnson, S. (2015), ‘NHS staff most stressed public sector workers, survey finds’, The Guardian, 12 June, 7. Khamisa, N., Oldenburg, B., Peltzer, K., & Ilic, D. (2015), ‘Work related stress, burnout, job satisfaction and general health of nurses’, International Journal of Environmental Research and Public Health, 12, 652–666. Kim, Y.K., Ahn, Y.S., Kim, K.S., Yoon, J.H., & Roh, J. (2016), ‘Association between job stress and occupational injuries among Korean firefighters: a nationwide cross-sectional study’, British Medical Journal, 6, 1–9. Klopper, H.C., Coetzee, S.K., Pretorius, R., & Bester, P. (2012), ‘Practice environment, job satisfaction and burnout of critical care nurses in South Africa’, Journal of Nursing Management, 20, 685–695. Lawler, E.E., & Mohrman, S. (2003), ‘HR as a strategic partner: what does it take to make it happen?’, Human Resource Planning, 26, 15–31. Leggat, S.G. (2012), ‘The contribution of “best-practice” HR management to better organizational performance’. In P. Spurgeon, R.J. Burke, & C.L. Cooper (Eds.), The innovation imperative in health care organisations: critical role of human resources management in the cost, quality and productivity equation. Cheltenham, UK and Northampton, MA, USA: Edward Elgar Publishing, pp. 63–78. Leka, S., Jain, A., Iavicoli, S., Vartia, M., & Ertel, M. (2011), ‘The role of policy for the management of psychosocial risks at the workplace in the European Union’, Safety Science, 49, 558–564. Lencioni, P. (2012), The advantage: why organizational health trumps everything else. San Francisco, CA: Jossey-Bass. Lowe, G. (2011), Creating healthy organizations. Toronto: University of Toronto Press. Macklin, D.S., Smith, L.A., & Dollard, M.F. (2006), ‘Public and private sector work stress: workers compensation, levels of distress and job satisfaction, and the demand-control-support model’, Australian Journal of Psychology, 58, 130–143. Murphy, L.R., DuBois, D., & Hurrell, J.J. (1986), ‘Accident reduction through stress management’, Journal of Business and Psychology, 1, 5–18. Poghosyan, L., Aiken, L.H., & Sloane, D.M. (2009), ‘An analysis of data from large scale cross-sectional surveys of nurses from eight countries’, International Journal of Nursing Studies, 46, 894–912. Pollitt, C. (2012), New perspectives on public services: place and technology. Oxford: Oxford University Press. Quick, J.C., & Cooper, C.L. (2003), Stress and strain. Oxford: Health Press Ltd. Rand Corporation (2012), The long shadow of 9/11: America’s response to terrorism. Santa Monica, CA: Rand Corporation. Spurgeon, P., Burke, R.J., & Cooper, C.L. (2012), The innovation imperative in health care organisations: critical role of human resource management in the cost, quality and productivity equation. Cheltenham, UK and Northampton, MA, USA: Edward Elgar Publishing. Trivellas, P., Reklitis, P., & Platis, C. (2013), ‘The effect of job related stress on employees’ satisfaction: a survey in health care’, Procedia: Social and Behavioral Sciences, 73, 718–726. Truss, C. (2009), ‘Effective human resources processes in local government’, Public Money and Management, 29, 167–174.

14  Handbook of research on stress and well-being in the public sector Ulrich, D., & Brookbank, W. (2005), The HR value proposition. Boston, MA: Harvard Business School Press. Violanti, J.M., Charles, L.S., McCanlies, E., Hartley, T.A., Baughman, P., & Andrew, M.E., … Burchfiel, C.M. (2017), ‘Police stressors and health: a state-of-the-art review’, Policing, 40, 642–656. West, J.P., & West, C.M. (1989), ‘Job stress and public sector occupations: implications for personnel managers’, Review of Public Personnel Administration, 9, 46–65. Wisnivesky, J.P., Teitelbaum, S.L., Todd, A.D., Boffetta, P., Crane, M., Crowley, L., … Landrigan, P.J. (2011), ‘Persistence of multiple illnesses in World Trade Center rescue and recovery workers: a cohort study’, The Lancet, 378, 888–897. World Health Organization (2010a), WHO healthy workplace framework and model: background and supporting literature review. Geneva: World Health Organization. World Health Organization (2010b), Healthy workplaces: a model for action for employers, workers, policy-makers and practitioners. Geneva: World Health Organization. Worrall, L., Mather, K., & Cooper, C.L. (2016), ‘The changing nature of professional and managerial work: issues and challenges from an empirical study of the UK’. In A. Wilkinson, D. Hislop, & S. Coupland (Eds.), Perspectives on contemporary professional work: challenges and experiences. Cheltenham, UK and Northampton, MA, USA: Edward Elgar Publishing, pp. 60–65.

3. Trade unions and stress at work: the evolving responses and politics of health and safety strategies in the case of the United Kingdom Miguel Martínez Lucio

INTRODUCTION If one were to review the work on stress in the UK of the Labour Research Department (LRD), an independent, trade union-based research organization, it would be evident that its publications have evolved in terms of their complexity and detail. Stress at Work, published in 1988, was a general set of recommendations comprising 22 pages; published in 2016, Stress and Mental Health at Work is a more detailed 64-page document focusing on the law, the use of state recommendations, and a range of union strategies (LRD, 1988, 2016). This anecdotal point illustrates the way there has been increasing engagement with this issue; virtually all the major unions have a range of detailed texts related to stress and mental health. The agenda on these issues has therefore expanded, prompted by a growing awareness of their increasing presence at work, which is, in part, due to the ongoing increases in work intensification and related issues such as bullying and violence. Trade unions have therefore begun to take a more proactive stance, as the issue of stress and mental health is an emerging and significant part of their engagement with health and safety more generally, an area that has been a focus of trade union strategies and engagement with employers and the state for some time. It is also an issue that increasingly links to other trade union concerns such as workplace equality and working time, for example. The chapter aims to outline how trade unions in the UK are responding to the question of stress at work and issues of mental health. The chapter mainly discusses the public sector. Whilst the UK is not seen as one of the most regulated or coordinated of regulatory systems – being typically classified as a liberal market economy by some (Hall & Soskice, 2001) – in terms of health and safety strategies it has seen major innovations in the role of state agencies, trade union strategies, and various employer responses. This has particularly been the case within the public sector, as can be seen by the more regulated nature of industrial relations and the more extensive presence of trade unionism in the sector, which position issues of health and safety more centrally in terms of negotiations and collective bargaining.1 So, even if the UK may not be one of the most advanced examples of health and safety regulation in Europe, it is a good example for considering innovative strategies on emergent issues. 15

16  Handbook of research on stress and well-being in the public sector This chapter will focus on the evolution of health and safety discourse within trade unions, and the general underpinnings of an increasing engagement with the question of stress and mental health. The chapter will outline why trade unions have been highly innovative and why this innovation is of interest. The chapter will then outline some of the features of health and safety regulation and discussion in relation to stress and mental health in the public sector, looking at the tension between established pluralist industrial relations traditions of dialogue between management and trade unions, and the emergent pattern of unitarist behavior and unilateral action by employers and management at various levels. This section will also focus on the emerging level of conflict within the public sector in relation to health and safety issues, especially those related to stress and mental health issues brought about by increasing workloads and economic austerity measures. The main and penultimate section of the chapter will outline various dimensions of the response of trade unions to these issues in terms of engaging with the state and regulation, seeking collective responses to stress and related problems, engaging with individual spaces and issues, and the involvement of trade unions in more socially based responses such as engagement with civil society organizations. All these responses have limitations and face challenges, which will be briefly discussed in the next section. The conclusion will draw attention not only to the growing richness and complexity of trade union roles, but also to the increasingly politicized nature of the discussion on stress within industrial relations.

THE CONTEXT OF THE PUBLIC SECTOR AND ITS CHANGES There are many mixed and negative views about the state of industrial relations in the UK and the sheer decline of collectivism and labor rights standards (see Brown & Wright, 2018). The extent of anti-trade union employer strategies has been significant (Dundon & Gall, 2013). However, within the public sector there remains – although there are major changes – a broader level of social dialogue and institutional relations between management and trade unions compared to the private sector. These public sector traditions are seen by some to correspond to a pluralist approach to industrial relations (see Budd & Zagelmeyer, 2010 for an outline of the different perspectives on industrial relations). The notion of the public sector as a ‘good employer’ (Bach & Winchester, 2003) is under pressure, but, in the main, has sustained some of its characteristics. In terms of this tradition, the roles of health and safety committees and worker representatives are pivotal. One could argue generally that, within such a context, trade unions are seen as providing a positive contribution to the development of health and safety initiatives at work. This has continued with more recent initiatives related to mental health and stress, as later sections will outline.2 Thus, while, as we will see, issues of stress have reached an alarming level in the UK public sector, the structures for discussing them and for sustaining responses and initiatives

Trade unions and stress at work  17 to alleviate such levels of stress continue to exist, albeit under increasing pressure, as the chapter will discuss. The problem is that various developments have steadily challenged this consensus. The economic challenge to the stability and structures of the public sector has intensified since the mid-1980s due to a growing emphasis on commercialization and greater privatization, with the period since the onset of the global financial crisis in 2008 having seen significant pressures emerging from a politics of austerity and cutbacks. Within this context, the consensus surrounding the role of social dialogue has been steadily undermined and there has emerged a greater degree of work intensification and performance management in the public sector (see the extensive work by Carter et al., 2011, 2013 on the UK civil service). This has also been linked to a growing concern with the advent of so-called ‘new public management’ practices within the work and employment relations of the public sector (Diefenbach, 2009) and management attempts to ‘colonize’ the workplace (Edwards, 2009). For some time, a growing radicalization of the public sector’s trade unions due to factors such as concerns and mobilizations on pay issues has been supplemented or paralleled by a growing concern with issues of work intensification, greater precariousness at work, and the related problems of stress, and thus a more conflict-based model has been emerging. There exists greater individual conflict within the public sector as workers begin to challenge their treatment and the lack of support from management and the employing organizations generally – individual grievances brought by workers against their managers regarding stress and the lack of support for mental health have steadily increased in recent years. Health and safety-related tensions, broadly speaking, are therefore quite significant within this conflict model of industrial relations in many parts of the public sector. To some extent, this reflects an ‘overloading of issues’ and struggles over rights that have been evolving for some time (Martínez Lucio & Simpson, 1992) as working conditions deteriorate within the workplace of the public sector. Questions of equality, fairness, pay gaps and others overlap with those relating to health and safety, working time, workload and bullying issues – issues such as heavy workloads and the intensification of work, and the link to stress, have undermined and interrupted consensual labor relations (Carter et al., 2011). Stewart et al. (2009) have seen health and safety issues emerge as a major source of conflict and as the basis of a much broader set of tensions within organizations due to the growing use of practices such as lean production and lean service delivery. To some extent, this is part of a drawn-out development of politicization within industrial relations in the context of a greater decentralization and fragmentation of the public sector (Fairbrother, 1994) that has continued to intensify with greater subcontracting and precarious forms of labor contracting. Within this longer-term shift, the question of stress is paramount. Mirroring this – or, indeed, in great part contributing to it – is a shift in managerial philosophy and a practice of a unitarist nature that has increasingly bypassed or undermined the collective voice of workers (although this has been more visible in the private sector). This shift has various dimensions. The first appears to be somewhat more direct and consists of a downplaying of traditional health and safety-related

18  Handbook of research on stress and well-being in the public sector committees and representative structures, especially in the way management has opposed the attempts by trade unions to link the causes of stress to work intensification issues in various cases. Many managerial bodies of literature on stress in the public sector have not referenced the role of trade unions in any significant manner. The role of occupational health structures has been steadily bypassed or underfunded – these structures being central to demands from trade unions for worker support on health and safety. The more indirect ways in which management challenges the role of a more inclusive and collective form of social dialogue around health and safety relates to the development of a primarily managerially oriented approach in terms of well-being campaigns and forms of communication on health and safety – and stress, especially. These forms of communications and campaigns place the onus on the individual and how they must assume responsibility for problems such as stress. For many, this has become a ‘cover’ within contemporary capitalism and a substantial knowledge industry that presents the employer as caring but avoids any systematic discussion about the structural causes of stress. The details of these issues and struggles concerning stress will be outlined in detail later. Although not complete, the steady erosion of the consensual pluralist model and framework within public sector industrial relations has therefore also seen a change in the character of trade unionism. Hyman (2001) speaks generally of various models of trade unionism: market-oriented unionism with its emphasis on union–management relations; class-based unionism with its more traditional and conflict model approach to industrial relations; and social models where unions have a broader social reach and identity. These can vary and overlap in various ways but it could be argued that, in the case of the UK public sector, trade unions have moved towards more class- and social-based models due to the changing (neoliberal) nature of the state, as well as the emerging issues around workloads, violence, stress, and other related topics in the workplace (see Ironside & Seifert, 2003; Mather, Worrall, & Seifert, 2007; Seifert, 1992).

THE LEVELS AND ARENAS OF TRADE UNION RESPONSES TO QUESTIONS OF STRESS The way trade unions have responded to the problem of stress in public sector workplaces in the UK is varied and has developed various strategic characteristics. This section outlines four areas of trade union engagement, although one must accept that these do overlap to a great extent (Figure 3.1). The first subsection deals with the way trade unions attempt to influence the role of the state in the regulation and control of stress-related factors at work, and how trade unions have, in turn, invoked regulatory features of the state in their workplace strategies. Second, there are collective responses that work through broader inclusive structures of representation within the workplace and employing organization more generally. The third space or arena is that of the individual and how workers are supported in terms of their concerns or complaints – for example, by trade unions. There is a significant overlap between

Trade unions and stress at work  19 the collective and individual spaces, especially as the latter have become much more politicized and are the focus of greater regulation and interventions by the state (Howell, 2005) – trade unions are addressing these individual spaces and issues as part of their broader health and safety agendas. The fourth subsection addresses the social and civil society spaces of trade union intervention, given that the question of stress is a subject of concern for many civil society organizations, community bodies, and consultancy firms. The four-dimensional approach to trade union responses allows us to map the way trade unions have sought to address stress at work as an increasingly prevalent industrial relations issue.

Figure 3.1

Levels and dimensions of trade union responses to the question of stress

Trade Union Response and the State The role of trade unions in relation to the state varies greatly between systems where there is a greater legitimacy for unions and proactive forms of institutionalization at the level of the state, and those where trade unions have few points of access and are the recipients, rather than the shapers, of state policy. In the case of the UK, the latter seems to be the case, although there have been moments when the trade union movement has shaped social and public policies, especially in relation to health and safety. The development of health and safety legislation in the 1970s saw trade unions playing an active role through the Labour Party when it was in government, but even so, at certain times right-wing parties such as the Conservative Party have responded to aspects of trade union demands. The Health and Safety Act of 1974 and subsequent developments and changes form the basis of this state role, along with a range

20  Handbook of research on stress and well-being in the public sector of further legislative interventions. Various developments linked to the European Union and to the development of health and safety legislation were based on forms of cross-national trade union lobbying of public authorities. Within bodies such as the state’s Health and Safety Executive (HSE), the trade union movement has had, on occasions, some form of representation, although this has been in relative decline in recent years (Mustchin & Martínez Lucio, 2017). The role of regulation in the realm of health and safety in comparison to other areas of industrial relations is much more advanced and affords trade unions a relatively more institutional role within the firm, where they are recognized for the purpose of collective bargaining. Hence, the state, through various forms of legislation, has established a framework of representation, expectations, and activities for the resolution of health and safety issues – especially through the health and safety representative, as we shall discuss later. The HSE also acts as a source of information and toolkits for the evaluation and resolution of health and safety issues that can be used within workplaces and form the basis of discussions between trade unions and management. In relation to stress-related issues, the HSE has developed a series of what are termed ‘Management Standards’3 regarding stress that are based on various studies led by the HSE and others (often commissioned by it). They are drawn and developed from various high-profile academic studies on issues such as the nature of job demands and the control that employees have over them (Karasek, 1979), along with other issues such as the level of support, form of relations at work, the nature of work-related roles, and the types of general organizational change. These form a framework around which management – but also trade union and non-union representatives – can raise stress-related issues and shape discussions. The state therefore provides frameworks for the conduct of action and discussion within workplaces, and this steady move to a ‘consultative’ state role is, in part, due to financial pressures on more traditional roles, but also reflects a system of regulation that is more informational, creating templates for the behavior of management and worker representatives (Martínez Lucio & Stuart, 2011). Over time, these stress-related Management Standards have begun to embed themselves as a point of reference for organizations and have formed a backdrop to various discussions on stress and its alleviation. Hence, trade unions tend to find the substantive and advisory roles of the state useful for the development of their responses for dealing with and discussing stress-related issues. In addition, these rights and frameworks for action are also relevant to strategies based on a form of mobilization and dispute. Beyond developing very direct and critical campaigns regarding the sources of stress in the workplace in relation to the effect of economic austerity and cutbacks in public services, there is also a noticeable increase in the use of the state’s employment tribunals to bring cases related to stress against employers. Specific guidelines are developed that outline the way a trade union branch can bring such a case and deal with a wide series of ‘practical propositions’ as required in various judgments (UNISON, 2017). There are various challenges and hurdles facing trade unions in bringing such cases, but they are becoming increasingly common: issues of stress are a highly visible part of legal cases related to work. However, one of the problems facing trade unions, as will

Trade unions and stress at work  21 be outlined later, is the way the state, through various formal reviews, is restricting these avenues for trade union action and reducing the role of various state agencies in relation to such matters. Whilst trade unions have politically mobilized against such growing restrictions in relation to state policy – this constituting a significant part of trade union actions on stress (James et al., 2018) – the level of the state’s supportive role has declined. It has been argued that the state has not been as far-reaching as it could be in extending the role of collective systems of worker representation in relation to health and safety, and that the extension of rights and roles for health and safety representatives has been limited following the initial reforms (Walters & Nichols, 2007). Much of the problem appears to be the general limitations and half-heartedness of employers and the state regarding consultation rights (James & Walters, 2005). Whilst the public sector has a more robust pattern of worker voice, there are still problems of reach and consistency in various organizations. The Collective Dimension of Trade Union Responses As stated earlier, differentiating the responses of trade unions to questions of stress in terms of the state-related, collective, or individual dimensions is not straightforward. However, it helps us conceptualize our understanding of such responses if we manage to outline them in this way – and if we can detect various overlaps in terms of union strategies and multilevel coordination. The collective dimension consists of various levels of activity and engagement by trade unions. First, the collective framework of negotiation can consist of agreements or joint management and union negotiations; these allow for various aspects of stress to be tackled through the adoption of concrete measures such as the undertaking of risk assessments, or for there to be forms of return-to-work measures established after stress-related illness. An example could be the way specific public sector organizations adopt criteria deemed to be based on certain notions of fairness in relation to absence management (which also covers absence due to stress-related conditions; for an overview, see Perrett & Martínez Lucio, 2006). The public sector, as stated earlier, has a more robust and extensive system of collective bargaining and joint consultation on a range of issues compared to the mainstream of the private sector – the application and extension of collective rights as enshrined in law is more extensive. The presence of specialist health and safety committees is also important at the workplace and organizational levels for discussing the reaching of agreement and developing joint initiatives for these types of issues – for example, the manner in which workload issues or various challenges emerging from significant periods of absence can be identified within performance appraisals in terms of their impact on well-being. Many of these collective structures of representation are normally underpinned by various aspects of health and safety legislation. One key feature of their activity has been the development of stress management policies, especially in relation to the HSE Management Standards on stress as mentioned earlier (see TUC, 2017 and UNISON, 2018 as examples of how these standards are discussed and used).

22  Handbook of research on stress and well-being in the public sector In more coordinated and regulated systems of industrial relations, the role of health and safety has been a central tenet of collective bargaining for some time (Gardell, 1982; Navarro, 1983) and this has allowed for such structures to be more attuned to ‘new’ forms of health-related problems, such as stress. In the UK’s public sector there is still a relatively strong collective presence and system too, albeit less developed than some of the stronger European contexts. This more coordinated aspect of the collective dimension is also visible in the role informal relations play for trade unionists in their engagement with management. High-trust contexts are sometimes known for the critical centrality of these informal relations between the trade union representatives and management (Oxenbridge & Brown, 2002). First, in various contexts, it is not unknown for health and safety representatives and collective structures to advise or update various personnel or human resource managers on aspects of the regulations, and to seek solutions to collective issues related to stress or to develop various well-being campaigns, as we will discuss later. A key dimension of the collective role of trade unions is to assist, oversee, and contribute to the discussion regarding the role of occupational health structures within an employing organization – especially in the public sector. These not only provide advice on broader stress-related policy, but also evaluate and advise on support programs for individuals suffering from stress, amongst other illnesses (for a broader discussion of occupational health, see Zanko & Dawson, 2012). However, within the public sector – and, more especially, the private sector – there is a view amongst some trade unionists that the activity of occupational health departments is steadily being contested by human resource departments and that their independent roles are being undermined.4 Second, the use of risk assessments – either by management or by trade union representatives or jointly – that focus on various areas, including workload stress assessments, has comprised large aspects of the collective response to the issue of stress at work (WorkStress Network, 2017, pp. 56–57). For example, with ever-increasing levels of work intensification in areas such as nursing, many evaluations need to take account of the impact of higher workloads, lower pay, and more intense forms of shift-working, all of which require more detailed negotiations and evaluation (McVicar, 2003). Specific investigations and studies of health and safety-related incidents in the workplace operate alongside these forms of evaluation. The role of internal inspections in relation to the specific problems also helps identify broader problems and causes of stress at work. It is common to see the use of stress-related surveys by various trade union representatives – especially, health and safety representatives – within the workplace. These surveys can either focus on entire organizations or be deployed within specific parts of the workplace. Trade union documentation is increasingly clear when conducting surveys and is precise in the conduct of investigations regarding health and safety, with stress as a key part of the questionnaire (e.g., see UNISON, 2013). The findings from these surveys and investigations can feed back into collective negotiations and consultations on health and safety policies, and frame broader organizational human resource management (HRM) policies within employers.

Trade unions and stress at work  23 Third, there are new forms of collective strategies and engagement linked to collective workplace campaigning. These campaigns are, on occasions, developed alongside management in a partnership-style approach. They may include the offer of a range of specific agreements or services from the organization as an employer – and, in some instances, the trade union – regarding aspects of health and safety or well-being, which can help workers to deal with stress-related situations and their underlying causes. For example, there may be awareness sessions or materials circulated in relation to identifying stress, or a focus on specific issues such as the development of a worker’s work–life balance that can assist in certain contexts in reducing stress at work. In terms of work–life balance, Gregory and Milner (2009) have observed significant modernization and interventions by trade unions. The development of so-called work–life balance champions and working time flexibility in Bristol City Council, UK, saw significant trade union engagement (Gregory & Milner, 2009). Although, in the main, partnership overall can be a problematic and uneven experience as a framework for such initiatives in the UK – and employers may be obsessed with the use of consultants on campaigns on work–life balance that are short term and arm’s length with their organizations – there are indications of joint working between management and trade unions in large parts of the public sector (Gregory & Milner, 2009), although some argue that the recent trade union push on issues such as work–life balance is a key factor in getting management to respond (Rigby & O’Brien-Smith, 2010). For health and safety committees in local public hospitals and local councils, the HSE’s Management Standards form a critical baseline around which management and worker representatives can discuss various issues and build a common set of points of reference. Specific campaigns on workload issues and questions of training that can assist in dealing with the underlying causes of stress are also common in education at various levels. These may also link to anti-bullying campaigns in particular, which highlight the impact of such behavior on a range of worker experiences and health issues. Such anti-bullying interventions have become much more common (see Beale & Hoel, 2011; Hoel & Beale, 2006). In this respect, many trade unions in the public sector are not just focusing on specific campaigns on stress and the identifiers, causes and solutions, but also on related topics such as bullying or greater employment uncertainty. Some local councils are also taking responsibility for agreements signed between management and trade unions on how to deal with violence towards staff – especially customer violence – through the development of ‘violence at work’ charters. This links to a broader set of developments regarding the management and regulation of balancing the pressures on working life with ongoing organizational change and restructuring (see Loretto, Platt, & Popham, 2010, for a discussion of the broader debates on change and mental health in the National Health Service). In an attempt to improve the general working conditions of their workforce and to achieve union recognition, many of the innovations in campaigning around mental health, stress, and related issues such as bullying have also been used as a platform to reach out to those public services such as social care and elderly care that have been subcontracted out to private companies.5

24  Handbook of research on stress and well-being in the public sector Fourth, many of these collective initiatives and forms of intervention are sustained by the research functions of the trade unions and their health and safety departments at the national level. The development of specific policies and information has seen a proliferation of high-quality research and policy documentation often linked with the activities of training departments. These materials and activities can create networks of health and safety representatives working on stress-related issues across employers both within and, at times, between trade unions. Key aspects of this dimension of work have been linked to the role of campaigning organizations, such as Hazards, that assist the networking of grassroots activists and national trade unionists working on health and safety. The role of annual and specific conferences and workshops, along with a broad set of publications and guidelines/toolkits, is key to such an organization. Finally, as stated earlier, the issue of stress has become a focus of greater trade union mobilization too. The impact of greater levels of stress is often tied into campaigns and mobilizations on the increasing level of workloads and deteriorating levels of pay in a range of sectors such as school teaching and university lecturing. Campaigns on pay often refer to the number of hours being worked and the impact of bullying by management, and the consequences of this for the mental health of workers. In the pensions dispute of 2018 in the British university sector, the workloads of academics emerged as a salient issue, as many would be unable to retire earlier and would have to continue dealing with greater levels of work intensification during a longer working career (see Grady, 2013, 2018 for a related discussion of pensions issues). The impacts of greater uncertainty and precariousness in the workplace, together with greater workloads, are highlighted so that stress-related problems do not become individualized by management counterstrategies or be seen as relating solely to the personal circumstances of an individual. This emerges from a concern with the way managers sometimes utilize the concept of well-being, developing communications campaigns and activities in order to defuse and decouple stress from questions of high workload or management behavior. The Dimensions of the Individual and Union Responses The collective dimension of trade union intervention is therefore broad and expansive – it has evolved along complex social and institutional lines with a strong communicative dimension. Yet, many of the collective responses or activities outlined above are often linked to supporting and assisting an individual as they encounter problems related to work-related stress. First, the health and safety risk assessment surveys in a workplace that were described earlier can pick up on individual cases and their concerns. The trawling of a workplace to evaluate the extent of stress-related issues may give rise to individual cases that can be pursued by a trade union, the practice of which has become quite common in the public sector. These surveys can also seek to understand an individual’s workplace context in terms of the impact of inequality issues and violence towards staff by customers. This scoping allows the workplace context of an individ-

Trade unions and stress at work  25 ual to be evaluated for specific problems and causes. There has also been a greater investment by trade unions in communication strategies and campaigns about stress in relation to workload levels, and the role of violence and management behavior. There have been a range of joint campaigns with management and the development or overseeing of specific support services, but specific union strategies have also tended to highlight the broader causes of the problems. There is also greater attention being paid to the support provided to individual trade union representatives in terms of their own stress levels – in particular, to the role of mentoring (Perrett, 2014). In many ways, trade unions have begun to spend more time in relation to their members, as well as looking into issues of performance evaluation and the way it is conducted. Hence, this shift towards the individual support of colleagues and the potential or real impact of stress from various work-related factors has brought a shift in some of the ways trade unions engage with aspects of the management process. The Public and Commercial Services Union (PCS), a mainly civil service union, has developed a range of initiatives regarding mentoring and support for their own representatives, given the complex pressures of work that emerge from their direct employment and their mainly voluntary work for the trade union (Perrett, 2014). UNISON has also developed mental health assistance training for its representatives and its members – there is thus recognition of the need to integrate these innovations and supports into the work of the union organization, and the significance of extending it across employing organizations. Second, much of the work of trade unions in relation to the individual revolves around their representation in grievances and disciplinary procedures, either within the employing organization or through employment tribunals in the external legal domain, where stress may be a primary or secondary factor in the case. Kirk (2018) has pointed out how this individual sphere has seen the reorganization of conflict around specific trade union interventions in terms of grievances. This mirrors a new political space around which workplace issues and conflict emerge within production and service delivery (Stewart, 2006). Trade unions, through their specialist cases at work or their more extensive legal services, have begun to mobilize around stress-related issues alongside – and linked to – cases on bullying, equality, and so on. At the individual level, trade unionists and workers have engaged more independently too, with a range of debates and initiatives around resilience and survival at work, as well as through new forms of social media and networks (for debates on resilience and the public services, see the work of Cotton, 2012 and 2017). A range of trade union and worker-friendly initiatives exists through websites and Twitter accounts aimed at raising the debate on the deeper causes of stress and mental health problems within the workplace (see Cotton, 2017).6 Finally, a key innovation that has steadily developed – although it is still at an early stage – is the figure of the mental health first aider (MHFA). The trade union movement has begun to embrace this idea of specialist individuals in the workplace who, broadly speaking, are able to advise individuals on how to seek help and support on questions of mental health. This more service- and support-oriented version of the traditional health and safety representative – one who can work alongside or, also,

26  Handbook of research on stress and well-being in the public sector even be the health and safety representative – extends the understanding of first aid and begins to provide an identifiable reference point in the workplace where workers can begin to raise their concerns and anxieties about work. On the whole, the trade union movement has positive views of these initiatives, although there are some concerns that it could individualize questions of stress and, depending on the nature of the organization and the MHFA, place the onus on the individuals involved in these new roles to resolve problems in isolation from broader organizational policies and contexts. Hence, there is a significant level of debate and concern within the trade union movement on these developments. It is known that disclosing mental health issues requires a strong occupational health support team and a culture of openness (Irvine, 2011). The problem is that the MHFA may not be able to cope with such significant questions of health and safety, whilst the onus of responsibility may be transferred to the trade union and other forms of worker representative. Nevertheless, both informally and formally, one of the main roles of trade union representatives – and health and safety representatives more generally – is to signpost individuals with stress-related problems to the various services offered by the employer. In addition, questions of absence and other outcomes can be managed, in part, with the representatives of the individual affected – although the question, as before, is how the impact of the working environment is accounted for when adjustments are made to an individual’s work. The Social and Civil Society Dimension of Union Responses A large part of the responses by trade unions has been the way a social dimension to the work being done on stress and mental health has developed. There are two aspects to this dimension. The first is the way unions such as UNITE, which has both private and public sector presences, link with various established mental health organizations when developing strategies or specific types of trade union or workplace training. These links have allowed for a greater sharing of knowledge and resources and have helped underpin the legitimacy of trade unions when working on such issues. For example, the Mental Health Foundation is an organization that engages with various private and social organizations. There is a growing link and set of collaborations between trade unions and civil society organizations that have influenced the agendas of work and employment relations (Heery, Williams, & Abbott, 2012). As stated earlier, there are already trade union-related organizations, such as Hazards, that link together various trade unions and trade unionists through campaigns and through the development of knowledge and materials related to health and safety, including stress issues. These links also serve to counter the growing use of consultants by management and, on occasions, problematic audits that are contracted by employers to conceal various problems and issues within the organization. Trade unions are becoming much more alert to the way these external relations with the ‘universe’ of mental health consultancy are used – and, unfortunately, abused – by employers. In addition, trade unions have been engaging with broader political and social campaigns and concerns in relation, for example, to the impact of cutbacks in public

Trade unions and stress at work  27 sector expenditure and increasing economic austerity measures. In many cases, trade union roles have highlighted the impact of outsourcing on working conditions (Cunningham & James, 2014). Emerging from developments such as outsourcing and the use of employment agency staff, trade unions have begun raising questions about the growing stress and high workload levels of particular groups of workers. The impact on a worker’s mental health of such a changing working environment is a visible part of many mobilizations and forms of collective action. Mobilizing around health and safety and stress in specific sectors such as the gig economy has seen issues of stress and mental health often referenced as an outcome of more precarious forms of work. Some aspects of trade union engagement with local communities in post-industrial areas, during meetings and social activities for example, have included discussions on mental health (for a discussion of the nature of community unionism as a strategy within trade unions, consult Tattersall, 2005). The need to widen the responses of trade unions beyond the workplace is visible in the case of public sector outsourcing; however, these responses require a combination of strategies working around a range of issues, and at various organizational levels, given the problems of dealing with a more fragmented working environment (Cunningham & James, 2010).

DISCUSSION: THE EXTENT OF INNOVATION AND THE EMERGENT CHALLENGES FACING TRADE UNIONS AND THEIR STRATEGIES REGARDING STRESS In the case of the UK, and in what is one of the most unevenly regulated and least trade union-friendly contexts in Europe, trade unions have been highly innovative, having developed a very sophisticated and multilevel set of responses to the issue of stress at work. The steady shift within the health and safety agenda – from the more quantitative and physical dimensions of health to a broader qualitative perspective – is visible within the practice of HRM, in the interventions from the state, and in the nature of trade union strategies. Regardless of the increasingly hostile environment, we have seen within the trade union movement a systematic attempt to widen the understanding of stress by linking it to a range of other factors, such as management behavior, bullying, increasing workload levels and the general labor market context of growing precariousness. To this extent, first, the trade unions in the UK have attempted to generate a broader and more nuanced understanding when it comes to stress. They have also developed strategies at various levels. At the level of the state, when it can, the trade union movement has lobbied for and influenced the development of health and safety legislation and forms of regulation; however, as mentioned, trade union influence at the level of the state is not as institutionalized as that of Sweden, Germany or the Netherlands, for example. In addition, trade unions have used the toolkits, standards, and related information and advice the state has provided in various ways, such as the HSE’s Management Standards on dealing with stress.

28  Handbook of research on stress and well-being in the public sector Second, the trade union movement in the case of the public sector, where collective representation still remains in place to a great extent, has developed a range of partnership strategies with management on issues related to stress in those cases where the latter has been more supportive. In addition, many trade unions have developed campaigns within and beyond workplaces highlighting the causes of stress and the ways in which workers should respond to it – these have been central to broadening the understanding of the causes of stress in the UK. Third, at the individual level, casework in relation to stress (whether in cases brought by workers or defending workers in disciplinary hearings) has seen increasing levels of trade union involvement. The use of health and safety risk assessments and the deployment of stress-related surveys in the workplace have not only allowed trade unions to identify specific problems and issues, but also how they have evolved. In turn, this has underpinned trade union work around clusters of individual workers with specific issues. There has also been a greater level of attention paid to supporting services focused on mental health assistance within and beyond the union – and, where possible, in association with management interventions. Finally, there is a broad social presence in the local community and in society as a whole around campaigns and joint working with civil society organizations. To that extent, trade unions have been pivotal in highlighting not only the impact of stress at work, but also the nature of its causes and how to respond positively within society. Nevertheless, there is an emerging series of challenges. The first is the set of challenges emerging from a more neoliberal state that is constantly limiting and fragmenting the public sector, the social and health services it provides, and the quality of employment within its workforce. The extent of mental health problems that have emerged from the changing nature of the state has created what some see as an epidemic of mental health issues in and beyond the workplace – how to respond to these positively is a significant challenge. Current economic austerity measures in the economic sphere are having major effects on the quality of life, with widespread outcomes in terms of social and economic inequality, and the impact on social protection laws on such developments has major implications in terms of work (James et al., 2018). The uncertainty over the future of the UK in relation to the European Union – which has been a source of many health and safety legal rights – has also brought a set of challenges to the stability of the regulatory framework, as has the challenge to the labor inspectorate from public sector cutbacks (Mustchin & Martínez Lucio, 2017). In addition, these developments, coupled with the anti-trade union policies of the right-wing politics of the past decade or so, have placed an enormous amount of pressure on the trade union movement – James, Tombs and Whyte (2013) have spoken of a growing ‘misleading deregulatory discourse’ emerging from the state that has undermined the fabric of consensus in health and safety regulation and practice. For example, the Trade Union Act of 2016 has meant that ballots and preparations for collective action consume much more energy not only from trade unionists, but also from their officers and activists, which can detract from more proactive interventions related to health and safety. There is a general overloading of issues within industrial

Trade unions and stress at work  29 relations – court cases, workplace hearings and conflict resolution – that can undermine the more strategic and supportive work of trade unionists in workplaces as they respond to management strategies aiming to control workplaces (Edwards, 2009). A further challenge is the way in which various employers and sets of managers are creating their own well-being campaigns – in part, to undermine trade union roles and weaken their attempts to broaden the links between stress and workload issues, for example. The deployment of consultants that individualize the issues of stress and prefer to focus on the personal traits of the individual worker is a clear challenge to attempts that try to question the behavior of management and the nature of work intensification. In some UK hospitals, the development of employee assistance programs and ‘well-being champions’ can be seen as an attempt to control the discourse of health and safety and to neutralize criticism. The use of consultants to rewrite history within a workplace and prevent management from being seen as a major cause of stress is not uncommon. What we therefore see is a new set of tensions around stress that may undermine some of the more progressive, nuanced and socially oriented strategies trade unions have been steadily developing.

NOTES 1. Collective bargaining coverage in the public sector is also substantially higher when compared to the private sector, as is trade union membership. 2. For a discussion of the role of trade unions in such terms, see Dollard and Neser (2013); see also Johansson and Partanen (2002), which studies international developments and the importance of innovative local union interventions. 3. For a link to HSE Management Standards on stress, see http://​www​.hse​.gov​.uk/​stress/​ standards/​. Accessed 4 July 2018. 4. Author’s own research. 5. Author’s own research. 6. The initiative surrounding questions of resilience at work has a strong website and policy presence through the work of Elizabeth Cotton: see https://​twitter​.com/​survivingwk​?lang​ =​en and https://​survivingwork​.org. Accessed 19 September 2018.

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4. Psychosocial factors and worker health: comparisons between private and public sectors in Australia Tessa S. Bailey, Mikaela S. Owen and Maureen F. Dollard

Worker health and well-being is important for the positive impact it can have on employees and their families, productivity outcomes for employers, and the economic implications for the wider population. Having a job has the potential to bring many benefits into a person’s life, such as financial security, positive social interaction, and a sense of achievement. However, there are times when workplaces are not safe and can cause harm to a worker’s health. While in some instances these issues are minor and can be easily resolved, there is the possibility that attending work can have a detrimental effect on a person’s physical or mental health. For instance, Australian research has shown that employees experiencing certain working conditions such as low levels of job control, high demands, job insecurity, and unfair pay, show a greater decline in mental health compared to people who are unemployed (Butterworth et al., 2011). Therefore, the potential positive benefits of being employed can be dependent upon a person’s experiences in the workplace and their quality of work. Stress at work is defined as harmful physical and psychological responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker, which can then lead to poor health, illness, or injury (Sauter et al., 1999). In Australia, workers have the right to be protected from harm, and it is the employer’s responsibility to provide safe working conditions. If harm does occur, a worker can seek compensation for the costs associated with injury or illness that arise while performing their duties in paid employment. Workers’ compensation frequency statistics show the rate of serious claims (incapacity that results in a total absence from work of one working week or more) has declined by 33 percent between 2000–01 and 2014–15, suggesting that there are positive trends towards safer work environments in Australia. However, the only conditions to show an increase in the frequency of serious claims since 2000–01 are mental disorders (SafeWork Australia, 2017). Therefore, further efforts are necessary to prevent workplace conditions that impact employee psychological health. Research studies in work psychology have made significant contributions towards better understanding factors that impact worker health and well-being. In particular, psychosocial factors at work are gaining national and international interest due to growing evidence showing their detrimental effect on employee health and the associated organizational, social, and economic costs (Leka & Jain, 2010). Psychosocial 33

34  Handbook of research on stress and well-being in the public sector factors at work such as job demands, resources, and supports are defined as ‘work design and the organization and management of work, and their social and environmental contexts that have the potential for causing psychological or physical harm’ (Cox, Griffiths, & Rial-González, 2000, p. 14). In general, it is the interaction between job demands and job resources that influences worker health and motivation, thus impacting upon health, safety, and productivity outcomes. Job demands include a variety of aspects within a work environment such as workload, time pressure, and emotional labor. Resources and supports assist workers to manage their demands and achieve their goals. For example, job control provides the capacity for an individual to influence decisions relating to their position and general work activity, which is an important resource to buffer the impact of demands on overall worker well-being (Häusser et al., 2010; Karasek, 1979; Karasek & Theorell, 1990). However, not all demands at work cause stress. A sense of challenge in an environment where workers feel supported and have adequate access to resources can be energizing, providing employees with motivation to learn and grow (Sauter et al., 1999). When the demands of the job role cannot be met, however, that same sense of satisfaction can turn into feelings of inadequacy, exhaustion, and stress, thus placing workers at greater risk of illness and injury. The well-known job demands–resources model (JD–R; Demerouti et al., 2001) for work stress takes into consideration a wide range of factors in the working environment and their impact on worker health and motivation. There are two main tenets of the JD–R model. First, psychosocial work conditions – in particular, job demands (e.g., workload, emotional demands, bullying) – are significant predictors of employee health via a health erosion pathway. Coping with chronic job demands leads to depletion of a worker’s energy reserve. In turn this leads to negative responses (such as psychological distress), and in the longer term, to psychological injury and health problems, including cardiovascular disease or musculoskeletal disorders (Schaufeli & Bakker, 2004). Second, the motivational pathway proposed by the JD–R model suggests that adequate resources (e.g., control, support, rewards, procedural justice) are motivating and lead to engagement, and in turn to positive organizational outcomes such as improved performance (Bakker & Demerouti, 2007). Cross-links between the health erosion and motivation pathways have theoretical and practical importance because they may explain, for example, how work performance can be impaired through the reduced health of workers (Schaufeli & Bakker, 2004). Some recent investigations into the origins of psychosocial factors (job demands and job resources) that are related to work stress include organizational factors such as policies and procedures that enable communication about psychosocial risk factors so they can be prevented. Evidence is mounting that these organizational aspects create risk and contribute to hazards (Dollard & Bakker, 2010). These organizational conditions are considered to be more effective targets for prevention and intervention as they capture the origin of hazards and provide targets for intervention to reduce risk so that hazards can be more effectively managed (D’Aleo et al., 2007; Dollard & Bakker, 2010). Therefore, measures that capture organizational processes that con-

Psychosocial factors and worker health: private and public sectors in Australia  35 tribute to the creation of psychosocial factors within job design need to be included in psychosocial risk assessments. The psychosocial safety climate (PSC) framework is conceptualized as both an organizational- and individual-level construct that represents shared experiences and perceptions between workers regarding the organizational climate that precedes psychosocial risk factors (Dollard & Bakker, 2010). PSC is determined by organizational policies, practices, and procedures for the protection of worker psychological health and safety (Dollard & Bakker, 2010). It reflects senior management commitment, participation, and consultation in relation to stress prevention and safety at work (Dollard & Bakker, 2010). It captures the organizational climate for employee psychological health, well-being, and safety. PSC theory builds on earlier work that identifies a link between work safety and work stress (for example, Glendon, Clarke, & McKenna, 2006); however, it is more specific to the psychological health of workers than other organizational climate constructs (Dollard & Bakker, 2010). The research to date supports PSC as an extension of the well-known JD–R model of work stress that takes into consideration a range of organizational aspects within factors in the working environment (Demerouti et al., 2001). Australian and international researchers have found that the PSC is a leading indicator or predictor of a wide range of psychosocial factors (implied in the JD–R model), including workplace demands and job-related resources as well as worker health and organizational productivity (Dollard & Bakker, 2010; Dollard & Karasek, 2010; Hall, Dollard, & Coward, 2010; Idris et al., 2011). For instance, previous evidence shows that PSC predicts workplace demands, including work pressure and emotional demands (Dollard & Bakker, 2010), workload (Dollard et al., 2012), and social relational demands such as workplace bullying and harassment (Law et al., 2011). PSC also predicts a number of work-based resources, including skill discretion (Dollard & Bakker, 2010), work rewards (Law et al., 2011), job control, and supervisor support (Dollard et al., 2012). Evidence also shows that PSC predicts employee health outcomes, including psychological distress, emotional exhaustion (Idris et al., 2012), sickness absence (Dollard & Bakker, 2010), anger and depression (Idris & Dollard, 2011), exhaustion and cynicism (Idris, Dollard, & Winefield, 2011), and worker performance and engagement (Idris et al., 2011; Law et al., 2011). Best practice in the field of psychosocial risk management states that psychosocial factors must be regularly measured so that hazards can be targeted for prevention and intervention (Houtman, Jettinghoff, & Cedillo, 2007). National surveillance of psychosocial factors at work provides the opportunity to identify groups at risk and to better understand how psychosocial factors impact worker health and well-being outcomes. Measurement techniques such as national surveillance and benchmarking allow organizations and governing bodies to assess the prevalence of risk factors and identify hazards and/or groups of workers that are at high risk. One example of a national approach to psychosocial risk surveillance in the Asia-Pacific region is the Australian Workplace Barometer (AWB) project, which has collected data since 2009 on working conditions for over 7000 employees across Australia. This resource provides a comprehensive scan of the Australian workforce

36  Handbook of research on stress and well-being in the public sector by directly interviewing workers at home via telephone regarding their working conditions. The AWB is underpinned by the PSC framework and can therefore provide an evidence-based resource for the investigation of psychosocial factors, including their origins and impact on workers within certain industries and/or sectors of employment. It offers an excellent source for assessing the differences in psychosocial risk factors between the public and private sectors.

PSYCHOSOCIAL FACTORS IN PUBLIC VS PRIVATE SECTORS There have been numerous investigations into the different work environments within public sector and private sector organizations. For example, the Public Sector Motivation (PSM) construct was developed based on the theory that there are unique aspects of performing public service that motivates individuals (Perry, 1996). Working for the government can be viewed by employees as the best place to help people and serve one’s country (Light, 1999). In comparison, the driving function of the private sector is the pursuit of profits. These differences are reflected in research of the importance placed on certain values within each of the sectors (Wal, Graaf, & Lasthuizen, 2008). For example, workers in the public sector place greater value on lawfulness, incorruptibility, expertise, reliability, effectiveness, and impartiality. In contrast, private sector values are driven by profitability with a focus on accountability, reliability, effectiveness, expertise, and efficiency (Wal et al., 2008). In addition, prior international research has revealed that workers in government-based organizations embrace stronger ethical values than their private sector counterparts (Fryxell & Lo, 2001). For instance, Svensson and Wood (2004) found that codes of ethics in the Swedish public sector appear to have a more positive approach, are more nurturing, with greater concern for staff development, and in general are less regulatory than private sector organizations. Further, a study of the ethical maturity of 448 Iranian workers showed that working in a government organization was a significant indicator for higher business ethics scores (Mujtaba, Tajaddini, & Chen, 2011). Australia is described as a neoliberal economy in which human well-being is considered to be best supported through individual entrepreneurial freedom that exists within free markets and free trade (Harvey, 2005). These free market principles lead to increased organizational competition whereby managers attempt to extract further productivity from their workforce while reducing the provision of resources. While policies and practices within organizations in the private sector are established upon these principles, these values are also apparent within the Australian public sector where greater productivity is highlighted as underpinning the current government’s agenda for the public sector (Australian Public Service Commission, 2018). This is evidenced by the Australian public service workforce being at its lowest staffing level since 2006, while managing a greater volume of transactions.

Psychosocial factors and worker health: private and public sectors in Australia  37 Since government representatives have an obligation to consider the latest innovations in science when developing public policies, it is expected that greater awareness of the latest evidence-based practice in relation to psychosocial hazard management will exist within the public sector. It is therefore expected that systems in these public sector organizations will enact policy and practice that will ensure reasonable demands, adequate resources, and reduce psychosocial risk. Yet, prior examination of the AWB data collected in 2010 found that public sector workers in Australia report significantly higher levels of emotional demands, work pressure, work–family conflict, bullying, harassment, and organizational change compared to workers in the private sector (Bailey, McLinton, & Dollard, 2013). However, public sector workers also reported significantly higher levels of resources that support them to manage their demands. In particular, workers in the public sector reported higher levels of organizational rewards, justice, decision authority, skill discretion, and support from supervisors. By contrast, private sector workers reported significantly higher levels of physical demands in 2010 compared to public sector employees, but also significantly higher levels of macro-decision latitude where they can influence decisions made by their work team or department, acting as a resource (Bailey et al., 2013). In relation to PSC, public sector workers report greater organizational participation and organizational communication regarding worker psychological health at work, while private sector workers were found to have higher levels of management commitment to stress prevention and priority for psychological well-being. In relation to the general psychological health of workers, significantly higher rates of exhaustion and psychological distress were found in the public sector, while depression was more prevalent for private sector employees. The implications from this research (Bailey et al., 2013) is that for public sector workers, low levels of PSC and high demands contribute to exhaustion and distress, regardless of access to supports and resources. For private sector workers, low levels of PSC and low resources were likely to contribute to higher rates of depression. The researchers concluded that psychosocial hazard management strategies that focus on aspects such as employee involvement with major organizational decisions, perceptions of fairness within the organization, co-worker support and levels of work pressure, as well as strategies to reduce emotional exhaustion, are likely to improve mental health outcomes and reduce stress claims for both public and private sectors. The ongoing surveillance of psychosocial factors in Australia and examination of current differences between public and private sectors is warranted to evaluate work quality and the impact it has on employee health and motivation.

THE PRESENT STUDY Prior analysis of AWB data by Dollard et al. (2012) highlights the importance of identifying the origins of the psychosocial working conditions that contribute to poor

38  Handbook of research on stress and well-being in the public sector worker health. The present study uses the latest wave of AWB data (Dollard et al., 2014) to make comparisons between psychosocial factors in the public and private sectors based on more recent data. We also test potential pathways to investigate whether significant differences exist between public and private sectors based on the PSC extended JD–R model for worker well-being. The results may inform strategies to address psychosocial factors in both sectors that can lead to better health, safety, and productivity outcomes. Method Participants Data were collected via the AWB, a longitudinal survey on a wide range of working conditions with the third wave (2014–15) respondents representing all states and territories across Australia. Participants were recruited randomly from the Australian Electronic White Pages and a directory of Australian mobile phone numbers. Participants were sent letters informing them of the study’s purpose and the interview procedure. Participants were required to be aged over 18 and employed. A total of 4242 respondents provided data in the 2014–15 wave. The sample comprised more females (57 percent) than males (43 percent), with an average age of 49 years. The public sector 2014–15 sample included 1571 respondents that consisted of 66 percent females and 33 percent males, with an average age of 50 years. The private sector sample comprised 2260 participants, including 47.4 percent females and 52.6 percent males, with an average age of 47 years. Measures PSC PSC was measured using the Hall et al. (2010) PSC-12 scale, a 12-item questionnaire encompassing four subscales: management commitment, management priority, organizational communication, and participation. Each subscale consists of three questions with responses scored on a five-point Likert scale, ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). An example item relating to management priority is ‘Senior management clearly considers psychological health to be as important as productivity’. The following PSC benchmarks have been established for predicting employees’ poor health and well-being outcomes (Bailey, Dollard, & Richards, 2015; Dormann et al., 2017): ●● ●● ●● ●●

low risk (PSC scores ≥ 41); medium risk (PSC scores < 41 and > 37); high risk (PSC scores ≤ 37 and > 26); and very high risk (PSC scores ≤ 26).

Psychosocial factors and worker health: private and public sectors in Australia  39 Job demands Job demands were measured using the Karasek Job Content Questionnaire 2.0 (JCQ 2.0; Karasek et al., 1998; www​.jcqcenter​.org) across three domains: psychological, emotional, and physical. Responses were scored on a four-point Likert scale, ranging from 1 (Strongly Disagree) to 4 (Strongly Agree). The AWB instrument utilizes a modified version of the JCQ with 12 items. An example item relating to physical job demands is ‘My job requires lots of physical effort’. Higher scores are indicative of excessive demands. Organizational harassment Organizational harassment was measured using Richman, Flaherty and Rospenda’s (1996) scale. Types of harassment measured include sexual, gender, racial, swearing, humiliation, and physical assault. Responses were scored on a five-point Likert scale, ranging from 1 (Very Rarely/Never) to 5 (Very Often/Always). An example item relating to organizational harassment is ‘I have experienced unwanted sexual advances’. Workplace bullying Workplace bullying was measured by providing a definition of bullying from the General Nordic Questionnaire for Psychological and Social Factors at Work (Lindström et al., 2000), followed by four questions relating to the nature of any bullying experienced – for example, frequency of bullying. The frequency and duration of bullying is combined to create an overall bullying score, which is followed by a different definition of bullying and another item regarding whether the participant has been bullied. Work–family conflict Work–family conflict was measured using Netemeyer, Boles and McMurrian’s (1996) scale to assess levels of interference between work demands and home life. Responses were scored on a seven-point Likert scale, ranging from 1 (Strongly Disagree) to 7 (Strongly Agree). An example item relating to work–family conflict is ‘The demands of my work interfere with my home and family life’. Organizational change Five items from the new Karasek JCQ 2.0 (Karasek et al., 1998; www​.jcqcenter​.org) were used to measure organizational change, an example being ‘In your company/ organization, there have been changes such as restructuring, downsizing, and layoffs that have significantly affected your job’. All items were measured on a four-point Likert scale, ranging from 1 (Strongly Disagree) to 4 (Strongly Agree). Job control Job control was measured using the Karasek JCQ 2.0 tool (Karasek et al., 1998; www​ .jcqcenter​.org), encompassing three subscales: skill discretion (six items), decision authority (three items), and macro-decision latitude (three items). Responses were

40  Handbook of research on stress and well-being in the public sector scored on a four-point Likert scale, ranging from 1 (Strongly Disagree) to 4 (Strongly Agree). An example item relating to skill discretion is ‘I get to do a variety of different things in my job’. Social support Social support was measured using the Karasek JCQ 2.0 tool (Karasek et al., 1998; www​.jcqcenter​.org), encompassing two subscales: supervisor support (three items) and co-worker support (three items). Responses were scored on a four-point Likert scale, ranging from 1 (Strongly Disagree) to 4 (Strongly Agree). An example item relating to supervisor support is ‘I am treated with respect by my supervisor/ manager’. Organizational justice The organizational procedural justice items were based on the Karasek JCQ 2.0 (Karasek et al., 1998; www​.jcqcenter​.org). Four items measured procedural justice, an example item being, ‘In my company/organization, procedures are designed to provide opportunities to appeal or challenge a decision’. Items were measured on a four-point Likert scale, ranging from 1 (Strongly Disagree) to 4 (Strongly Agree). Reward Organizational rewards were measured based on four items from the Effort–Reward Imbalance scale (ERI; Siegrist, 1996), which is derived from one item from the esteem reward component, ‘Considering all my efforts and achievements, I receive the respect and prestige I deserve at work’; two items from the job promotion reward component, for example, ‘Considering all my efforts and achievements, my job prospects are adequate’; and one item from the job security reward component, ‘My job security is poor’. Items were measured on a four-point Likert scale, ranging from 1 (Strongly Disagree) to 4 (Strongly Agree). Engagement Engagement was measured using the nine-item abridged version of the Utrecht Work Engagement Scale (UWES-9; Schaufeli, Bakker, & Salanova, 2006), encompassing three subscales: vigor (three items), dedication (three items), and absorption (three items). Responses were scored on a seven-point Likert scale, ranging from 1 (Never) to 7 (Every day). An example item relating to dedication is ‘My job inspires me’. Emotional exhaustion Emotional exhaustion was measured using the five-item Maslach Burnout Inventory (MBI; Schaufeli et al., 1996). Responses were scored on a seven-point Likert scale, ranging from 1 (Never) to 7 (Always). An example item relating to emotional exhaustion is ‘I feel used up at the end of the workday’.

Psychosocial factors and worker health: private and public sectors in Australia  41 Psychological distress Psychological distress was measured using the Kessler-10 scale (Kessler & Mroczek, 1994), consisting of ten items. Responses were scored on a five-point Likert scale, ranging from 1 (Never) to 5 (All of the Time). An example item relating to psychological distress is ‘In the past four weeks, about how often did you feel nervous?’ Depression Depression was measured using the Patient Health Questionnaire 9 (PHQ-9; Kroenke, Spitzer, & Williams, 2001). Responses were scored on a four-point Likert scale, ranging from 1 (Not at All) to 4 (Nearly Every Day). An example item relating to depression is ‘During the last month, how often were you bothered by little interest or pleasure in doing things?’ Data Analyses Correlations and t-tests were conducted to determine associations between psychosocial factors along with differences between public and private workers in Australia. According to Cohen (1992) the size of a Pearson correlation (r) will indicate the strength of a relation whereby .10, .30, and .50 are small, medium, and large effect sizes respectively. For the t-tests, Cohen’s d gives an indication of the strength of the difference whereby a small effect = 0.2, medium effect = 0.5, and a large effect = 0.8. We used structural equation modeling in AMOS (Version 25.0) (Arbuckle, 2017) to test the PSC extended JD–R model for both the public and private sectors in Australia. The model consisted of three latent variables and 19 observed variables. The latent variables were job demands, job resources, and health. The observed variables were PSC, emotional demands, organizational change, psychological demands, physical demands, work–family conflict, harassment, bullying, co-worker social support, supervisor social support, skill discretion, decision authority, rewards, macro-decision latitude, organizational justice, engagement, exhaustion, distress, and depression. To test the proposed model, we used the following fit indices: the chi-square index (χ2); normed fit index (NFI); comparative fit index (CFI); root mean square error of approximation (RMSEA) with p close of fit (PCLOSE); and Hoelter 0.05. To demonstrate a fit between our data and the proposed model we expect a small χ2 at a non-significant level (p < 0.05). However, χ2 is sensitive to sample sizes in that χ2 is often significant with large sample sizes, leading to erroneous conclusions of poor model fit. The cut-off used to demonstrate good model fit for both CFI and NFI fit indexes is > 0.90 (Kenny, 2015). Alongside a PCLOSE > 0.05, values < 0.08 for RMSEA indicate mediocre fit between the proposed model with data, while < 0.05 indicates good model fit (Kenny, 2015). Finally, Hoelter 0.05 indicates the sample size needed to be non-significant χ2 at α = 0.05. The cut-off used for the Hoelter 0.05 index is > 200 (Kenny, 2015).

42  Handbook of research on stress and well-being in the public sector To compare Australian workers employed in the private sector with those employed in the public sector, we used multigroup analysis, along with the estimand function with bootstrapping of 2000 iterations. In addition to moderating the individual pathways by sector (private versus public), we again used the estimand function to test the mediation pathways for the public and private sectors separately. Results PSC for public and private sectors based on benchmarks The following benchmarks in Tables 4.1 and 4.2 have been established for risk to worker psychological health based on PSC scores (Bailey et al., 2015; Dormann et al., 2017). Table 4.1

PSC-12 benchmark standards and prognosis

PSC Standards

Range

Prognosis

12–60 Low-risk PSC (high PSC)

≥ 41

Performing well, improvements in PSC levels might be noted; increased leader performance in PSC

Medium-risk PSC

< 41 and > 37

Steady state, need more enacting of

High-risk PSC

≤ 37 and > 26

Need to increase PSC levels to avoid

PSC principles detrimental impact on worker health and well-being Very high-risk PSC

≤ 26

Urgent action required to prevent

(very low PSC)

further dramatic increases in depressive periods, worsening conditions (e.g., increased bullying)

Source: © T.S. Bailey & M.F. Dollard (2019), reprinted with permission from Dollard, M.F. & Bailey, T.S. (2019), ‘PSC in practice’. In M.F. Dollard, C. Dormann, & A. Idris, Psychosocial safety climate: a new work stress theory. Cham, Switzerland: Springer Nature Switzerland AG.

Table 4.2

PSC-12 benchmark standards for public sector, private sector, and national AWB samples Range

Public Sector (AWB

Private Sector (AWB

National Sample

12–60

2014–15)

2014–15)

(AWB 2014–15)

N = 1442

N = 1937

N = 3753

Number (%)

Number (%)

Number (%)

≥ 41

769 (53.3)

1192 (61.5)

2205 (58.8)

Medium-risk PSC

< 41 and > 37

114 (7.9)

143 (7.4)

311 (8.3)

High-risk PSC

≤ 37 and > 26

388 (26.9)

387 (20.0)

798 (21.3)

Very high-risk PSC

≤ 26

171 (11.9)

215 (11.1)

439 (11.7)

PSC Standards

Low-risk PSC (high PSC)

(very low PSC)

Source: © T.S. Bailey & M.F. Dollard (2019), reprinted with permission from Dollard, M.F. & Bailey, T.S. (2019), ‘PSC in practice’. In M.F. Dollard, C. Dormann, & A. Idris, Psychosocial safety climate: a new work stress theory. Cham, Switzerland: Springer Nature Switzerland AG.

Psychosocial factors and worker health: private and public sectors in Australia  43 Results show that public sector workers experienced lower levels of PSC compared to private sector employees. An independent samples t-test found significantly lower levels of PSC in the public sector (M = 39.80, SD = 10.33) compared to the private sector (M = 41.30, SD = 10.19), t (3377) = –4.20, p < 0.001, with an effect size of –0.146. Public sector workers showed higher percentages in all the higher-risk categories (medium, high, very high). Psychosocial factors for public and private sectors Job demands, resources, health and motivation outcomes were converted into scores out of 100 to provide a balanced visual representation in Figures 4.1–4.4.

Job demands

Figure 4.1

Job demands for public and private sectors 2014–15

Results for the independent samples t-tests for differences in job demands between public and private sectors are presented in Table 4.3. Significantly higher levels of organizational change and emotional demands were found in the public sector with a moderate effect. A small effect was found for significantly higher rates of psychological demands and harassment in the public sector. The effect size showing greater physical demands in the private sector was small. The greater levels of work–family conflict in the public sector were a very small effect size.

44  Handbook of research on stress and well-being in the public sector Table 4.3

T-test results for differences in job demands between public and private sectors

Emotional demands

df

t

Effect Size (d)

3191.60

15.74***

0.53

Organizational change

3714.00

18.29***

0.61

Psychological demands

3084.59

10.09***

0.34

Work–family conflict

3829.00

4.16***

0.14

Physical demands

3485.36

–6.02***

–0.20

Harassment

2879.74

10.47***

0.35

Note: *** p < 0.001, ** p < 0.01, * p < 0.05, † p < 0.10.

Bullying Assessment of workplace bullying was based on a specific definition that involved offensive behavior that is repeated over time where the target had difficulty defending themselves.

Figure 4.2

Rates of bullying in the public sector, private sector, and nationally

An independent samples t-test found significantly higher levels of overall bullying (frequency × time) in the public sector (M = 1.11, SD = 3.33) compared to the private sector (M = 0.55, SD = 2.33); t(2612) = 0.56, p < 0.001, with an effect size of 0.20. While there is significantly more bullying in the public sector, overall the difference is a weak effect.

Psychosocial factors and worker health: private and public sectors in Australia  45

Job resources

Figure 4.3

Job resources for public and private sectors 2014–15

Results for the independent samples t-tests for differences in job resources between public and private sectors are presented in Table 4.4. Table 4.4

T-test results for differences in job resources between public and private sectors df

t

Effect Size (d)

Co-worker support

3317.77

1.63

0.05

Supervisor support

3121.94

–2.52*

0.08

Skill discretion

3829.00

10.75***

0.35

Decision authority

3829.00

–2.50*

0.08

Organizational reward

3829.00

–3.30**

0.11

Organizational justice

3829.00

–3.73***

0.12

Macro-decision latitude

3829.00

–6.83***

0.22

Note: *** p < 0.001, ** p < 0.01, * p < 0.05, † p < 0.10.

There was no significant difference for co-worker support between public and private sectors. Overall, the difference in resources and support between public and private sectors is very small. However, a moderate effect was found showing public sector workers experience higher levels of skill discretion.

46  Handbook of research on stress and well-being in the public sector Health and motivation outcomes

Figure 4.4

Health and motivational outcomes for public and private sectors

Results for the independent samples t-tests for differences in health and motivational outcomes between public and private sectors are presented in Table 4.5. Table 4.5

T-test results for differences in health and motivation outcomes between public and private sectors df

t

Effect Size (d)

Engagement

3480.07

1.523

0.05

Exhaustion

3829.00

2.81*

0.09

Distress

3520.940

–0.42

0.01

Depression

3829.00

–0.05

0.01

Note: *** p < 0.001, ** p < 0.01, * p < 0.05, † p < 0.10.

No significant differences were found between public and private sector workers for engagement, distress, and depression. The slightly higher levels of exhaustion in the public sector are a very weak effect. Model Analysis Table 4.6 shows the correlations between all the variables for both public and private sector workers. As expected, PSC had a significant negative relation with all job demands and significant positive relations with all resources. It also had a significant

justice

14. Organizational

social support

13. Co-worker

social support

12. Supervisor

latitude

Macro-decision

11.

authority

10. Decision

2

0.65**

0.28**

0.57**

0.60**

0.34**

0.19**

0.30**

0.20**

0.33**

1

5

0.02

0.34**

0.37**

1

6

–0.04*

0.17**

1

7

0.13**

1

8

0.49**

1

9

–0.13** –0.27** –0.28** –0.31** –0.18** 0.25**

–0.07** –0.32** –0.25** –0.21** –0.14** 0.30**

–0.18** –0.18** –0.15** –0.16** –0.03*

–0.15** 0.01

0.16**

0.05**

0.19**

0.09**

1

4

–0.24** –0.20**

–0.07** –0.27** –0.25** –0.22** –0.19** 0.19**

–0.07** –0.081** –0.14** –0.13** –0.16** –0.17** –0.09** 0.29**

–0.20** –0.19**

–0.18** –0.18**

–0.06** –0.09**

0.19**

0.44**

0.25**

–0.31** 0.17**

–0.26** 0.45**

0.44**

0.38**

0.16**

1

3

–0.34** 0.33**

–0.35** 0.37**

–0.11** 0.17**

–0.26** 0.49**

–0.29** 1

1

1

Correlation matrix for psychosocial factors 2014–15

9. Skill discretion 0.20**

conflict

8. Work–family

7. Bullying

harassment

6. Organizational

change

5. Organizational

demands

4. Physical

demands

3. Emotional

demands

2. Psychological

safety climate

1. Psychosocial

Table 4.6

0.33**

0.26**

0.36**

0.50**

1

10

0.60**

0.22**

0.42**

1

11

0.44**

0.43**

1

12

0.23**

1

13

1

14

15

16

17

18

Psychosocial factors and worker health: private and public sectors in Australia  47

3

–0.28** 0.22**

–0.29** 0.23**

0.24**

0.27**

0.39**

–0.07** –0.06**

–0.28** –0.26**

2

–0.35** 0.41**

0.37**

0.50**

1

6

7

8

9

0.10**

0.12**

0.16**

0.18**

0.21**

0.27**

0.25**

0.26**

0.32**

0.21**

0.24**

0.20**

0.28**

0.29**

0.47**

0.32**

0.37**

0.45**

11

0.27**

0.45**

12

0.22**

0.34**

13

0.31**

0.46**

14

0.32**

1

15

1

16

17

18

–0.13** –0.19** –0.25** –0.21** –0.11** –0.23** –0.30** –0.31** 0.54** 0.79**

–0.12** –0.21** –0.25** –0.24** –0.14** –0.23** –0.32** –0.32** 0.57** 1

–0.05** –0.19** –0.28** –0.26** –0.16** –0.28** –0.35** –0.35** 1

–0.06** –0.17** –0.12** –0.11** –0.12** 0.35**

0.35**

10

22317.45***

M0 Null model

*** p < 0.001.

2555.72***

χ2

306

248

df

0.43

0.92

GFI

0.00

0.90

CFI

0.15

0.05

RMSEA

< 0.001

0.013

PCLOSE

54

379

Hoelter 0.05

(M0 vs M1)

19761.73***

∆ χ2

Fit indices for model fit of the proposed model of the PSC extended JD–R model for public and private workers in Australia

M1 Proposed model

Note:

5

–0.16** –0.36** –0.28** –0.24** –0.29** 0.23**

4

** Correlation is significant at the 0.01 level (two-tailed); * correlation is significant at the 0.05 level (two-tailed).

Table 4.7

Note:

19. Depression

distress

18. Psychological

exhaustion

17. Emotional

engagement

16. Work

rewards

15. Organizational

48  Handbook of research on stress and well-being in the public sector

Psychosocial factors and worker health: private and public sectors in Australia  49

positive relationship with engagement and negative relationships with psychological health outcomes, including exhaustion, distress, and depression. Using the multigroup analysis function in structural equation modeling in AMOS we tested the PSC extended JD–R model for both public and private workers in Australia, in which pathways and factor loadings were free to vary. Using the model fit indices, we found adequate support for the proposed model, with the majority of fit indices meeting the cut-off criteria (refer to Table 4.7). While chi-square test was significant (χ2 (248) = 2555.72, p < 0.001), indicating a discrepancy between the model and the data, the chi-square is sensitive to large sample sizes. Specifically, large samples can cause the chi-square to be significant even if there is a good fit between the data and proposed model (Schermelleh-Engel, Moosbrugger, & Mueller, 2003). Using the Hoelter 0.05, we can see that our sample would have to drop below 379 to reach a significant chi-square, which exceeds the 200 cut-off for good model fit. Both goodness of fit index (GFI) and CFI met or exceeded the cut-off of 0.90 and RMSEA was below 0.08. As such, there is support for the proposed PSC extended JD–R model for public and private workers in Australia. The individual pathways were all significant and in the anticipated direction for workers in the public and private sectors in Australia (refer to Figure 4.5). High levels of PSC corresponded with low levels of job demands and high job resources in the working environment. In turn, high job demands linked with symptoms of poor health and low engagement levels, and high job resources linked with low symptoms for poor health and high engagement levels. Finally, symptoms of poor health were negatively associated with engagement levels in both public and private workers in Australia.

Note:

Results are displayed for public/private.

Figure 4.5

The PSC extended JD–R model for public and private workers in Australia

50  Handbook of research on stress and well-being in the public sector

Using the estimand function in AMOS with bootstrapping 90 percent bias corrected confidence interval (one-tailed) with 2000 iterations, we tested the separate mediation pathways concurrently for public and private workers and found full support across both groups of workers. Job demands significantly mediated the association between PSC with both health outcomes and workers’ engagement levels. Similarly, job resources significantly mediated the link between PSC and workers’ health and their engagement with work. As such, high levels of PSC perceived by workers corresponded to low symptoms of poor health and high engagement through low levels of job demands and high job resources in the work environment respectively. Finally, workers’ health symptoms mediated the relationship between job demands and workplace engagement. That is, high levels of demands were significantly linked with low engagement levels through workers’ symptoms of poor health. Finally, using the estimand function in AMOS with bootstrapping 90 percent bias corrected confidence interval with 2000 iterations, we tested the moderation of sector – public versus private – upon the individual pathways within the PSC extended JD–R model. The majority of pathways were similar for both public and private workers in Australia with one exception. The pathway between workers’ job demands and symptoms of poor health were significantly moderated by sector. Job demands had a significantly stronger impact on poor health outcomes for workers in the private sector in Australia (β = 0.66, p < 0.001) compared to public sector workers (β = 0.60, p < 0.001).

DISCUSSION We investigated the differences in psychosocial factors between public and private sectors and the pathways whereby those factors impact worker health and motivation outcomes. The results show significantly lower levels of PSC in the public sector, suggesting less prevention of worker mental health problems and promotion of well-being for these workers compared to the private sector. There are significantly higher levels of demands in the public sector, including emotional demands, organizational change, work pressure, and harassment. Other significantly higher demands in the public sector include work–family conflict and bullying, but these were a small effect. Moderately higher levels of physical demands are reported in the private sector. In relation to resources, significantly higher levels of supervisor support, organizational justice, macro-decision latitude, decision authority, and rewards are found in the private sector, although the effect sizes were small. Significantly higher levels of skill discretion are reported in the public sector, suggesting that these workers are able to apply their skills in creative ways and to develop their own abilities to a greater degree than those working in the private sector. There are no significant differences in co-worker support, showing that workers in both sectors have comparative levels of assistance and respect from their

Psychosocial factors and worker health: private and public sectors in Australia  51

co-workers. Results for health and motivation outcomes show significantly higher levels of exhaustion in the public sector. However, the effect size was small. There were no other significant differences between the sectors in reported levels of distress, depression, or engagement. The results for differences in demands are consistent with prior research (Bailey et al., 2013) showing that higher rates for most job demands within the public sector compared to the private sector are a long-term trend. Of concern for public sector workers is that they no longer report significantly higher resources and support. The previous analysis by Bailey et al. in 2013 found that public sector workers reported significantly higher levels of rewards, justice, decision authority, supervisor support, but this is no longer reflected in the current investigation. Our current analysis revealed only skill discretion as being significantly higher for workers in the public sector. It appears that private sector workers are receiving greater levels of resources and supports, including decision authority, macro-decision latitude, supervisor support, justice, and rewards, compared to public sector employees, although most are as a weak effect. It is likely that the greater demands and lower resources within the public sector compared to the private sector are contributing to the higher levels of emotional exhaustion for these workers. The higher levels of PSC in the private sector are influencing the greater levels of resources and lower levels of demands reported by private sector employees. The results show that private sector workers report a greater consideration for their psychological health and well-being within their working environments. This is supported by the pathway analysis, which found that the PSC extended JD–R model for worker health and motivation applies to both public and private sector workers. The model demonstrates how higher levels of PSC are related to lower levels of demands and higher levels of resources. The lower levels of PSC in the public sector are related to higher levels of demands. This indicates that a lack of enacting policies, practices, and procedures related to the protection of worker mental health in the public sector is leading to greater exposure to a wide range of psychosocial risks – in particular, emotional demands, work pressure, harassment, and organizational change. These factors are then having a significant impact on their health and motivation. The only significant difference between the private and public sectors in the PSC extended JD–R model was the impact of demands on workers’ health. This implies that when demands occur in the private sector they are having a greater impact on the mental health of their employees compared to public sector workers. It may be that policy and practice in the public sector provide greater support to manage health issues after exposure to their higher rates of demands. However, the low levels of PSC are placing public sector workers at greater risk for poor health with greater exposure to detrimental psychosocial conditions. Therefore, greater efforts at prevention, such as improving PSC, are necessary to reduce these risks, particularly within the public sector. While private sector

52  Handbook of research on stress and well-being in the public sector

organizations also need to consider strategies to increase the prevention of risk factors, they must also consider improving the management of these hazards should they arise.

LIMITATIONS The cross-sectional nature of the analysis limits our capacity to infer causality. However, other longitudinal models support these pathways and we would therefore expect to see these relationships in these directions over a longer period of time. Also, the analyses are based on individual self-report perceptions. Analysis of differences between groups such as teams, units, and organizations within each of the sectors would give a more accurate reflection of the working environment. However, other multilevel analyses of these models reflect the same results for these pathways and we would therefore expect similar outcomes.

CONCLUSION The climate for psychological health in all workplaces influences levels of demands and resources, which then impact worker health and well-being. Specifically, higher levels of PSC will lead to lower levels of demands, which then promote better health and motivation outcomes. In addition, higher levels of PSC will lead to higher levels of resources, which then lead to greater worker engagement and well-being. The PSC extended JD–R model is therefore relevant to the protection of worker health and the promotion of well-being for both private and public sector employees. In the public sector there is a particular need to increase prevention of exposure to psychosocial hazards by improving practices that protect worker mental health. It is likely that the principles of the neoliberal economy are eroding the resources previously enjoyed by public sector workers while requiring ever-increasing levels of productivity. This certainly raises concerns for the future health of these workers and is likely responsible for high rates of psychological injury claims amongst some public sector organizations (Mitchell, 2018). An additional focus on improving the PSC for these workers would be beneficial, such as ensuring policy is clear about setting reasonable levels of demands and that management is held accountable for ensuring that they convey worker mental health as a priority equal to or above productivity outcomes. Private sector workers would also benefit from improving the climate as per the PSC extended JD–R model. For these workers, in addition to the prevention of psychosocial risks, a greater emphasis on recognizing when the psychosocial conditions are having a detrimental impact by encouraging workers to raise these issues through supportive systems, and addressing any stigma associated with mental health, would also be beneficial. This could include greater

Psychosocial factors and worker health: private and public sectors in Australia  53

communication to improve awareness of symptoms that indicate psychosocial distress, exhaustion or depression, and policy to support workers when these issues arise. For both sectors, regular psychosocial risk assessment, such as the implementation of the PSC measure, will provide evidence-based guidance for prevention and intervention strategies. The key message is that the PSC framework can be used as an effective evidence-based method for reducing psychosocial risk and improving worker health. By improving the climate for worker psychological health, both public and private sector organizations can expect to see an improvement in worker health, well-being, and engagement.

REFERENCES Arbuckle, J.L. (2017), AMOS (Version 25.0). [Computer program]. Chicago: IBM SPSS. Australian Public Service Commission (2018), ‘State of the service report 2017–18: chapter 6 – organisational performance and efficiency’. Accessed February 2019 at https://​www​.apsc​.gov​.au/​state​-service​-report​-2017​-18​-chapter​-6​-organisational​ -performance​-and​-efficiency. Bailey, T.S., Dollard, M.F., & Richards, P. (2015), ‘Assessing a national work health and safety policy intervention using the psychosocial safety climate framework (PSC): PSC 41 as the benchmark for low risk of job strain and depressive symptoms’, Journal of Occupational Health Psychology, 20(1), 15–26. Bailey, T.S., McLinton, S.S., & Dollard, M.F. (2013), ‘Differences in psychosocial risk factors and the nature of stress claims in the public and private sectors’. In R. Burke, A. Noblet, & C. Cooper (Eds.), Human resource management in the public sector. Cheltenham, UK and Northampton, MA, USA: Edward Elgar Publishing, pp. 63–88. Bakker, A.B., & Demerouti, E. (2007), ‘The job demands–resources model: state of the art’, Journal of Managerial Psychology, 22, 309–328. Butterworth, P., Leach, L.S., Strazdins, L., Olesen, S.C., Rodgers, B., & Broom, D.H. (2011), ‘The psychosocial quality of work determines whether employment has benefits for mental health: results from a longitudinal national household panel survey’, Occupational and Environmental Medicine, 68(11), 806–812. Cohen, J. (1992), ‘Quantitative methods in psychology’, Psychological Bulletin, 112, 155–159. Cox, T., Griffiths, A., & Rial-González, E. (2000), Research on work-related stress. Luxembourg: Office for Official Publications of the European Communities. D’Aleo, N., Stebbins, P., Lowe, R., Lees, D., & Ham, D. (2007), ‘Managing workplace stress: psychosocial hazard risk profiles in public and private sector Australia’, Australian Journal of Rehabilitation Counselling, 13(2), 68–87. Demerouti, E., Bakker, A.B., Nachreiner, F., & Schaufeli, W.B. (2001), ‘The job demands–resources model of burnout’, Journal of Applied Psychology, 86(3), 499–512. Dollard, M.F., & Bailey, T.S. (2019), ‘PSC in practice’. In M.F. Dollard, C. Dormann, & A. Idris, Psychosocial safety climate: a new work stress theory. Cham, Switzerland: Springer Nature Switzerland, pp. 411–430. Dollard, M.F., Bailey, T.S., McLinton, S.S., Richards, P., McTernan, W.P., Taylor, A., & Bond, S. (2012), Australian Workplace Barometer (AWB) results: report on psychosocial safety climate and worker health in Australia. SafeWork Australia. Accessed 18 November 2019 at https://​pdfs​.semanticscholar​.org/​18e6/​637ae84be8fa4​ cd89094849c6ab97a8d4206​.pdf.

54  Handbook of research on stress and well-being in the public sector Dollard, M.F., & Bakker, A.B. (2010), ‘Psychosocial safety climate as a precursor to conducive work environments, psychological health problems, and employee engagement’, Journal of Occupational and Organizational Psychology, 83, 579–599. Dollard, M.F., Hall, G., LaMontagne, A.D., Taylor, A.W., Winefield, A.H., & Smith, P. (2014), Australian Workplace Barometer (AWBQ2014). Adelaide: University of South Australia, Centre for Applied Psychological Research. Dollard, M.F., & Karasek, R. (2010), ‘Building psychosocial safety climate: evaluation of a socially coordinated PAR [participatory action research] risk management stress prevention study’. In J. Houdmont, & S. Leka (Eds.), Contemporary occupational health psychology: global perspectives on research and practice. Chichester, UK: Wiley-Blackwell, pp. 208–234. Dormann, C., Owen, M.S., Guthier, C., & Dollard, M.F. (2017), ‘Translating cross-lagged effects into incidence rates and risk ratios: the case of psychosocial safety climate (PSC) and depression’, Work & Stress, 32(3), 249–261. Fryxell, G., & Lo, C.W.H. (2001), ‘Organizational membership environmental ethics: a comparison of managers in state-owned firms, collectives, private firms and joint ventures in China’, World Development, 29(11), 1941–1956. Glendon, A.I., Clarke, S.G., & McKenna, E. (2006), Human safety and risk management (2nd ed.). Boca Raton, FL: CRC Press. Hall, G.B., Dollard, M.F., & Coward, J. (2010), ‘Psychosocial safety climate: development of the PSC-12’, International Journal of Stress Management, 4, 353–383. Harvey, D. (2005), A brief history of neoliberalism. Oxford: Oxford University Press. Häusser, J.A., Mojzisch, A., Niesel, M., & Schulz-Hardt, S. (2010), ‘Ten years on: a review of recent research on the job demand-control-support model and psychological well-being’, Work Stress, 24, 1–35. Houtman, I., Jettinghoff, K., & Cedillo, L. (2007), Raising awareness of stress at work in developing countries: a modern hazard in a traditional working environment – advice to employers and worker representatives. Protecting Workers’ Health Series No. 6. [Booklet]. Geneva: World Health Organization. Idris, M.A., & Dollard, M.F. (2011), ‘Psychosocial safety climate, work conditions, and emotions in the workplace: a Malaysian population-based work stress study’, International Journal of Stress Management, 18(4), 324–347. Idris, M.A., Dollard, M.F., Coward, J., & Dormann, C. (2012), ‘Psychosocial safety climate: conceptual distinctiveness and effect on job demands and worker psychological health’, Safety Science, 50(1), 19–28. Idris, M.A., Dollard, M.F., & Winefield, A.H. (2011), ‘Integrating psychosocial safety climate in the JD–R model: a study amongst Malaysian workers’, South African Journal of Industrial Psychology, 37, 1–11. Karasek, R.A. (1979), ‘Job demands, job decision latitude, and mental strain: implications for job redesign’, Administrative Science Quarterly, 24(2), 285–308. Karasek, R.A., Brisson, C., Kawakami, N., Houtman, I., Bongers, P., & Amick, B. (1998), ‘The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics’, Journal of Occupational Health Psychology, 3(4), 322−355. Karasek, R.A., & Theorell, T. (1990), Healthy work: stress, productivity, and the reconstruction of working life. New York: Basic Books. Kenny, D.A. (2015), ‘Measuring model fit’, DavidKenny.net, 24 March. Accessed March 2017 at http://​davidakenny​.net/​cm/​fit​.htm. Kessler, R., & Mroczek, D. (1994), ‘Final version of our non-specific psychological distress scale’, 10 March. [Memo]. Ann Arbor, MI: Institute for Social Research.

Psychosocial factors and worker health: private and public sectors in Australia  55 Kroenke, K., Spitzer, R.L., & Williams, J.B.W. (2001), ‘The PHQ-9: validity of a brief depression severity measure’, Journal of General Internal Medicine, 16, 606–612. Law, R., Dollard, M.F., Tuckey, M.R., & Dormann, C. (2011), ‘Psychosocial safety climate as a lead indicator of workplace bullying and harassment, job resources, psychological health and employee engagement’, Accident Analysis and Prevention, 43(5), 1782–1793. Leka, S., & Jain, A. (2010), Health impact of psychosocial hazards at work: an overview. Geneva: World Health Organization. Light, P.C. (1999), The new public service. Washington, DC: Brookings Institution Press. Lindström, K., Elo, A. L., Skogstad, A., Dallner, M., Gamberale, F., Hottinen, V., Knardahl, S., & Ørhede, E. (2000), User’s guide for the QPSNordic: General Nordic questionnaire for psychological and social factors at work, Copenhagen: Nordic Council of Ministers. Mitchell, R. (2018), ‘Stressed public servants fuel compo claims’, The West Australian, 15 October. Accessed February 2018 at https://​thewest​.com​.au/​news/​health/​stressed​ -public​-servants​-fuel​-compo​-claims​-ng​-b88988530z. Mujtaba, B.G., Tajaddini, R., & Chen, L.Y. (2011), ‘Business ethics perceptions of public and private sector Iranians’, Journal of Business Ethics, 104(3), 433–447. Netemeyer, R.G., Boles, J.S., & McMurrian, R. (1996), ‘Development and validation of work–family conflict and family–work conflict scales’, Journal of Applied Psychology, 81(4), 400–410. Perry, J.L. (1996), ‘Measuring public service motivation: an assessment of construct reliability and validity’, Journal of Public Administration Research and Theory, 6, 5–22. Richman, J.A., Flaherty, J.A., & Rospenda, K.M. (1996), ‘Perceived workplace harassment experiences and problem drinking among physicians: broadening the stress/ alienation paradigm’, Addiction, 91(3), 391−403. SafeWork Australia (2017), Australian workers’ compensation statistics 2015–16. Accessed October 2017 at https://​www​.safeworkaustralia​.gov​.au/​collection/​australian​ -workers​-compensation​-statistics. Sauter, S., Murphy, L., Colligan, M., Swanson, N., Hurrell, J.J., Scharf, F.J., … Tisdale, J. (1999), Stress at work. National Institute for Occupational Safety and Health (NIOSH) Publication No. 99-101. Accessed July 2017 at https://​www​.cdc​.gov/​niosh/​docs/​99​ -101/​default​.html. Schaufeli, W.B., & Bakker, A.B. (2004), ‘Job demands, job resources, and their relationship with burnout and engagement: a multi-sample study’, Journal of Organizational Behavior, 25, 293–315. Schaufeli, W.B., Bakker, A.B., & Salanova, M. (2006), ‘The measurement of work engagement with a brief questionnaire: a cross-national study’, Educational and Psychological Measurement, 66, 701–716. Schaufeli, W.B., Leiter, M.P., Maslach, C., & Jackson, S.E. (1996), ‘The Maslach Burnout Inventory – general survey’. In C. Maslach, S.E. Jackson, & M.P. Leiter (Eds.), Maslach Burnout Inventory manual (3rd ed.). Palo Alto, CA: Consulting Psychologists Press, pp. 19–26. Schermelleh-Engel, K., Moosbrugger, H., & Mueller, H. (2003), ‘Evaluating the fit of structural equation models: tests of significance and descriptive goodness of fit measures’, Methods of Psychological Research Online, 8(8), 23−74. Siegrist, J. (1996), ‘Adverse health effects of high-effort/low-reward conditions’, Journal of Occupational Health Psychology, 1(1), 27–41. Svensson, G., & Wood, G. (2004), ‘Codes of ethics best practices in the Swedish public sector: a PUBSEC-scale’, The International Journal of Public Sector Management, 17(2), 178–195.

56  Handbook of research on stress and well-being in the public sector Wal, Z., Graaf, G., & Lasthuizen, K. (2008), ‘What is valued most? Similarities and differences between the organizational values of the public and private sector’, Public Administration, 86(2), 465–482.

PART II STRESS AND WELL-BEING IN VARIOUS PUBLIC SECTOR OCCUPATIONS

5. Stress and well-being of first responders Dessa Bergen-Cico, Pruthvi Kilaru, Rachael Rizzo and Patricia Buore

INTRODUCTION When we think of first responders, an image of emergency medical services (EMSs), emergency medical technicians (EMTs), paramedics, police, and firefighters may come to mind. However, military personnel, health care workers, mental health first aid workers, and even laypeople may also operate as first responders in emergency situations. They are often the front line in public safety – the primary providers of urgent medical and mental health care that is often on-site, pre-hospital or ambulance-based care. In addition to responding to medical emergencies and human-made disasters, police and military personnel may also be deployed as first responders in instances of natural disasters such as the earthquakes in Japan in 2011 and Nepal in 2015. In this chapter we will examine the physical and psychological impacts of stress and trauma on first responders, broadly defined here as people who respond to natural disasters, human-made tragedies, and everyday emergencies. First responders experience work-related physical and psychological stressors in communities both big and small from repeated exposure to traumatic accidents, shootings, drug overdoses, and emotionally challenging calls (Benedek, Fullerton, & Ursano, 2007). They often work under immense time pressure to respond to crises, with limited control over their workflow. Not only are first responders faced with day-to-day acute stressors related to the nature of their work, but many also experience chronic stress associated with job strain, lack of workplace support, and sleep deprivation. The nature of their work requires round-the-clock coverage, thus their work schedules necessitate day and evening assignments that can lead to sleep deprivation, fatigue, and disruption of circadian rhythms. Sleep deprivation is common among shift workers and crisis response personnel and they often rely on stimulants such as caffeine and nicotine to stay alert and depressants such as alcohol to facilitate sedation and sleep. The cyclical use of stimulants and/or depressants to regulate attention and sedation can lead to habituation and dependency. The 24-hour nature of shift work required of first responders has also been associated with varying degrees of depression, isolation, and even suicidal risk. It takes a certain type of person to choose the type of crisis-oriented high-stakes work of first responders. These are people who knowingly and willingly enter situations in which someone’s life may depend on their ability to respond, and such pressures can take a toll on their well-being. In fact, compared to any other 58

Stress and well-being of first responders  59 profession, first responders have higher rates of depression and post-traumatic stress disorder (PTSD) (Benedek et al., 2007; Violanti et al., 2006). Research suggests that personal histories may also play a role in the impact that work-related stress has on first responders, whereby exposure to adverse childhood experiences (ACEs) is a risk factor for development of anxiety disorders among people exposed to work-related trauma (Benedek et al., 2007; Otte et al., 2005). In the subsequent sections of this chapter we will explore ways in which these and other factors may influence how first responders are impacted by the inherent stress of their work and explore ways to effectively mitigate stress and trauma.

SOURCE, SETTING, AND SUPPORT INFLUENCE STRESS AMONG FIRST RESPONDERS The source of the crisis, work setting, and available support systems greatly influence the extent of the stress response for first responders (Figure 5.1). First responders are called into service for everything from minor injuries and accidents to human-made disasters (for example, terrorism, military conflict) and natural disasters (for example, earthquakes, hurricanes, flooding). Natural disasters, while extreme, are generally time limited, whereas human-made disasters are likely to be ongoing and imbued with moralistic injury of ‘man’s inhumanity to man’. Thus, the root cause and nature of the incidents they respond to can play an important role in how the stressors are perceived and they also shape the impact these experiences will have on first responders. Whereas both human-made and natural disasters can be unpredictable and beyond one’s control, some research suggests that human-made disasters are likely to be more psychologically damaging than natural disasters (Blaikie et al., 2014; Jinkerson, 2016). Setting plays an important role in the type and pace of cases the first responders engage with. Working in a fast-paced urban environment, first responders are more likely to experience chronically high volumes of calls in which the source of the crisis involves interpersonal violence and trauma. The prevalence of traumatic stress among first responders varies widely across settings and studies; the rates of PTSD range from 8 percent to 32 percent depending on the source of critical incident, be they major natural disasters or human-made disasters (Alexander & Klein, 2001; Benedek et al., 2007; Bennett et al., 2004; Bergen-Cico et al., 2015; Guenthner, 2012; Haugen, Evces, & Weiss, 2012; Rabjohn, 2013). The variation in rates of traumatic stress are also associated with the intensity, frequency, and duration of the traumatic events and the extent to which there are restorative support systems to support recovery in response to each incident. Supportive colleagues, friends, and family can do much to foster resiliency and counter the risks inherent in this line of work.

60  Handbook of research on stress and well-being in the public sector

Figure 5.1

Stress response for first responders

CHARACTERIZATION OF FIRST RESPONDERS’ WORK AND ROLES As previously noted, first responders include EMS personnel, EMTs, paramedics, police, firefighters, military personnel, health care workers, mental health first aid workers, and even laypeople. In this section we describe some of the key sources of stressors and the impact they have on first responders in these various emergency response positions. Non-hospital-based Emergency Medical Personnel Emergency medical personnel (EMPs) encompass the designation of volunteer EMS personnel, professional EMTs and paramedics. In this chapter we will use the term paramedic to collectively and interchangeably refer to non-hospital-based emergency medical personnel. Paramedics are most likely to be the first to respond on-site to medical emergencies, ranging anywhere from helping someone suffering from a panic attack to dealing with a mass casualty event in which victims must be triaged and treated against the clock. Due to the variability in the situations and settings where paramedics work, it is not possible to standardize the nature of what they may witness and treat. Paramedical personnel typically work 12-hour shifts and well over 45 hours per week, and these factors are associated with increased health and safety risks (Caruso,

Stress and well-being of first responders  61 2014; Williamson et al., 2011). Unfortunately, in some countries, they are forced to take additional or double shifts, resulting in 24-hour continuous shifts. As these shifts occur on a regular basis they lead to sleep deprivation and fatigue that can alter the physical health and mental well-being of paramedics, thus further increasing the likelihood of injuries and mistakes. Professional paramedics and first responders have structured shift work, whereas rural communities are often staffed by volunteer EMS personnel who respond to calls whenever they arise, thus further complicating the fatigue factor and conditions under which they may be operating. The fatigue factor associated with the round-the-clock nature of their work increases health and safety risks, which in turn increases work-related stress. Common occupational hazards for EMTs and paramedics include sharps injuries from needles or knives, leading to cuts and infections; falls from transporting patients, leading to head, neck, and spine injuries; and interpersonal violence between unruly patients and first responders (Garus-Pakowska, Szatko, & Ulrichs, 2017). In the United States, there are over 21,000 non-fatal injuries annually among paramedics and emergency medical professionals, a rate three times more than any other US industry (Maguire & Smith, 2013; Weaver et al., 2015), while occupational fatalities among paramedics in the US are more than twice that of all other professions (Maguire et al., 2002). In Australia, the rate of injuries among paramedics increased 53 percent between 2001 and 2014 (Maguire, 2018), is seven times higher than the national average, and their risk of fatality is six times higher (Maguire et al., 2014). There are rising levels of hostility directed toward paramedical personnel, and aggression toward paramedics is a substantial factor in work-related injuries and stress (Garus-Pakowska et al., 2017; Suserud, Blomquist, & Johansson, 2002). The abuse directed toward emergency medical personnel usually comes from the patient, a relative, or a friend of the patient. An Australian study found that 82 percent of paramedics reported being verbally abused (Boyle et al., 2007), while a study in Sweden found that 80 percent had been threatened and 67 percent subjected to physical violence (Suserud et al., 2002). Injuries among emergency medical personnel can be severe, putting first responders out of work from anywhere between two and six weeks and costing upwards of US $ 55,000 per incident (Maguire, 2018). In addition to the physical stressors and risks of injury inherent in emergency paramedical work there are some unique gender and societal stressors. For example, female paramedical personnel experience disproportionately higher rates of work-related injuries, harassment, and stressors. In Australia, 32 percent of the paramedic workforce is female, whereas 42 percent of assault cases affect female paramedics (Maguire, 2018; Maguire & Smith, 2013). Work-related harassment is commonplace in this field, yet notably higher among female paramedics (89 percent female vs 80 percent male) and sexual assault disproportionately affects female paramedics (38 percent female vs 10 percent male) (Maguire, 2018). These data illustrate how the setting in which paramedics work and the absence of support may increase the risk of stress, particularly among female paramedics. Paramedics (as well as firefighters and police) are increasingly called on to respond to incidents of self-harm and drug overdose fueled by the opioid epidemic. Instances

62  Handbook of research on stress and well-being in the public sector of self-harm often result in multiple contacts with first responders and they may be called to revive the same person more than once in a given year in the communities they serve (Rees, Rapport, & Snooks, 2015). Ten percent of patients administered naloxone by paramedics and revived will die within a year, and 50 percent of those will die within one month of being revived (Ray et al., 2018). The number of opioid overdose deaths has quadrupled in the US in recent years (O’Donnell, Gladden, & Seth, 2017), with more than 70,000 drug overdose deaths in 2017 (Hedegaard, Warner, & Miniño, 2017). Each subsequent overdose response for an individual increases the chance of death, which is highly stressful and can increase the risk of burnout for the first responders. The risk of assault, injury, and death, coupled with the inherent pressures of this work, contribute substantially to physical and psychological stress among emergency medical personnel. The cumulative impact of these stressors is reflected in the mental health status of paramedic personnel, with nearly one-third of paramedics having contemplated suicide (Newland et al., 2015). One study found that 18 percent of paramedics met criteria for anxiety, 47 percent for depression, and 33 percent for PTSD; moreover, researchers determined that PTSD predicts poor mental health, sleep problems, neural dysregulation, higher percentage of body fat, and greater musculoskeletal pain (Bergen-Cico et al., 2015). Firefighters The nature of the work firefighters perform is similar in some ways to EMS/EMT and paramedic work with regard to responding to medical emergencies, but with less medical equipment and the additional primary role responsibility of combatting fires. Many firefighters are exposed to injury and death, some of which can be particularly gruesome. The life-threatening nature of firefighters’ work facilitates forming closer bonds with each other to help them cope, a concept commonly known as ‘brotherhood’ among firefighters and other first responders (Carey et al., 2011). Injuries are common among firefighters, with nearly 40 percent of their injuries due to volatile explosions (Reichard & Jackson, 2010). Because these injuries typically occur in dangerous situations, the perceived threat from these events can increase the risk of developing PTSD (Benedek et al., 2007; Grieger et al., 2003). Work-related injuries are disruptive and inherently stressful, with the most common types of injuries being sprains and strains to the lower trunk, ankle, knee and neck (Reichard & Jackson, 2010). Police and Law Enforcement The role of police may encompass responding to medical crises in addition to their role as law enforcement. A number of studies have found higher rates of physical and psychological health problems among police compared to other categories of first responders. Some studies found that police demonstrated higher rates of psychopathology than paramedics, firefighters, and coastguard/water rescue workers

Stress and well-being of first responders  63 (Benedek et al., 2007; Ward, Lombard, & Gwebushe, 2006). Police also have higher rates of depression, PTSD, and carotid artery parameters than any other population (Asmundson & Stapleton, 2008; Benedek et al., 2007; Violanti et al., 2006). In the US, law enforcement officers have 1.5 times more injuries that require emergency medical treatment than firefighters, despite their labor force being one-third smaller than that of firefighters (Reichard & Jackson, 2010). One-quarter of work-related injuries to law enforcement personnel are the result of assault or violent acts in the line of duty (Reichard & Jackson, 2010). Common stressors reported by police include shift work, courtroom appearances (as witnesses), physical danger, and frequent conflict. In Australia, about 13.5 percent of police reported having moderate to extremely severe stress symptoms; though older female police officers were more likely than male police officers to report symptoms of stress, their rates and severity did not differ significantly by sex (Richmond et al., 1998). Suicidal ideation amongst police in the US (24 percent) is almost double that of the general population (13.5 percent), with male and female officers experiencing similar levels of suicidal ideation (Violanti et al., 2008). However, female police officers have rates of depression (12.5 percent) that are more than double that of male police officers (6.2 percent) and the general population (5.2 percent) (Violanti et al., 2008). As noted earlier, shift work not only disrupts sleep, it can also impact mental health and is associated with depression, isolation, and even suicidal risk. These risks also appear to vary by sex. Researchers found that male police officers who primarily work night shifts had a higher prevalence of suicidal ideation than those who worked the day shift, which was attributed in part to a decreased sense of peer support or brotherhood as a construct of evening shift work environments. Overnight shifts are often isolated from the main organizational workings and male peer interactions, which may perpetuate feelings of disconnection from the larger group (Violanti et al., 2008). This same study found that female police officers who work day shifts tend to have a higher prevalence of suicidal ideation than those who work evening shifts. This has been attributed to more unease and stress stemming from frequent peer and public interaction in what remains a male-dominated work environment during day shifts. Day shifts expose female police officers to considerably more male officers, administration, and public scrutiny than evening and overnight shifts (Violanti et al., 2008). The nature of crimes in the evening shifts are more likely to involve interpersonal violence compared to day shifts that constitute high levels of drug violations, larceny/ theft, property crimes, and citizen complaints (Violanti et al., 2008). Extended 12-hour shifts may also increase safety risks due to fatigue. To reduce these risks, alternative shift structures such as eight-hour shifts for 21 out of 28 days (totaling 168 hours) rather than 12-hour shifts for 14 out of 28 days (totaling 168 hours) are being explored to reduce fatigue and increase social interaction to combat feelings of isolation and lack of communication between co-workers and supervisory staff (Violanti et al., 2008).

64  Handbook of research on stress and well-being in the public sector It has been noted that substance use and abuse among police has a particularly important social component to it because they are tasked with enforcing liquor licensing legislation, preventing sales of cigarettes to minors, as well as serving as role models in the community (Richmond et al., 1998). Moreover, death related to alcoholic liver disease among law enforcement personnel is twice that of the general population in Australia (Richmond et al., 1998). Research in Australia found that alcohol abuse is prevalent among police, with nearly 50 percent of police officers drinking alcohol to excess. Rates are highest among officers under 40 (52 percent of males and 43 percent of females) compared to the national averages of 10.5 percent of men and 7 percent of women (Richmond et al., 1998). Excessive drinking amongst female officers is attributed to ‘a pressure to emulate their male colleagues’ and drinking at the end of the day is seen as an important part of the overall police culture. Tobacco use is also prevalent amongst police, with 27 percent of male and 32 percent of female officers reporting regular tobacco use (Richmond et al., 1998). Military Personnel and Veterans Substance misuse is also disproportionately prevalent among military personnel and veterans for many of the same reasons that it is higher among police officers than among the general population. The use of alcohol and other drugs by military first responders to manage the physical and psychological stressors of their work are accepted but not well-understood facts (Bergen-Cico, 2012; Bergen-Cico et al., 2016). Among military personnel and veterans with PTSD the majority have been diagnosed with an alcohol use disorder, a rate double that of the general population, while one-third have been diagnosed with other drug abuse or dependence, a rate more than three times that of the general population (McFall & Cook, 2006). The diagnosis of PTSD was established following the Vietnam War in response to the mental health and substance abuse problems and public awareness of the consequence of war for soldiers. PTSD is characterized by clusters of symptoms that include but are not limited to: (1) intrusive memories and re-experiencing the traumatic event; (2) negative changes in cognition and mood; (3) increased arousal, hyperarousal and startle response; and (4) emotional numbing and avoidance of stimuli and reminders associated with the event. Emotional numbing is often achieved through the use of alcohol and other drugs because they provide a relatively predictable and reliable means of suppressing PTSD symptoms. Military First Responders Although there are distinct differences in the professional roles and responsibilities of first responders, the nature of the stressors impact them in ways similar to that of military personnel. Police and military personnel are both likely to be subject to similar threats of violence from other human beings in situations where weapons and lethal force are anticipated. Military personnel, and therefore military first responders, are especially likely to have international roles and responsibilities by the nature

Stress and well-being of first responders  65 of their missions. Whether deployed domestically or internationally, first responders in the military are engaged in socially and politically charged circumstances that require specialized training. One such example is the deployment of Kenyan military and police who were called upon to respond to post-election violence in 2007, 2008, and 2017. Many Kenyan police and military personnel developed PTSD in response to the interpersonal conflict and death that ensued. During the post-election violence in 2007–08 there were 1,133 people killed and a further 350 000 people internally displaced as a result of the election-related violence (Okia, 2011). The military were dispatched to not only quell the violence but also to carry out duties reserved for wartime. In the line of carrying out their duties they had to retrieve and bury the dead, which included innocent men, women and children. They also rescued displaced families and provided them with security and resettlement in internally displaced persons (IDP) camps. Within the IDP camps they were called upon to address issues of interpersonal violence, including rape perpetrated by civilians and some military members (Cooke, 2009; Okia, 2011). Mental Health First Aid Workers First responders are often the first persons to have contact with people in crisis and they are in a position to provide psychological first aid to reduce the initial distress of the traumatic event and thus promote adaptive functioning and coping (Pekevski, 2013). To provide psychological first aid, first responders must understand the impact of traumatic events on the mental health and well-being of themselves and the people they serve (Kronenberg et al., 2008). There are also mental health first aid workers and laypeople who fill the need for street-based on-site mental health support in some communities, particularly where professional mental health support may not be readily available. A case example in the US is the Trauma Response Team (TRT) in Syracuse, New York, a group of mostly volunteer residents living in the neighborhoods with the highest murder rates who partner with local police, emergency medical response teams, and health care organizations to respond to the emotional needs of community members impacted by violence. The TRT strategies are based on the insight that the trauma that neighborhood residents experience fuels the vengeance that inspires future retaliatory homicides. Research indicates that para mental health service workers like the TRT are effective in reducing retaliatory violence and providing the first line of emotional support to people living in violent communities (Jennings-Bey et al., 2015). However, mental health first aid workers and community volunteers filling the need for psychological support to traumatized communities also need support, and such support is rarely available. Moreover, research conducted in the community served by the TRT first responders found rates of PTSD of more than 50 percent among the civilian population (Lane et al., 2017). This underscores the risk of stress and trauma among first responders conducting this type of mental health first aid where community members are the source of the vio-

66  Handbook of research on stress and well-being in the public sector lence and the setting in which they are operating is so highly stressed and traumatized that support can be limited.

DEFINING STRESS AND TRAUMATIC STRESS Stress is defined as an event or events in which environmental demands or internal demands both tax or exceed the adaptive resources of an individual’s physiological and psychological systems. Responding to human tragedies is associated with PTSD among first responders (Bergen-Cico et al., 2015; Levy-Gigi & Richter-Levin, 2014). The stress of their work results in hormonal changes (for example, cortisol dysregulation) that can directly and indirectly strain the body’s tissue systems and contribute to weight gain, hypertension, sleep problems, musculoskeletal pain and poor mental health (depression, anxiety, traumatic stress). Traumatic stress refers to the stress associated with tragedies and life-threatening events such as those often witnessed by paramedics, police, military personnel, and firefighters. The physiological problems that often accompany the type of traumatic stress first responders experience may contribute to disability and include neuroendocrine changes, depressive symptomology, and post-traumatic stress (Bergen-Cico et al., 2014, 2015; Stam, 2007a, 2007b). PTSD is associated with both physical and mental health problems among first responders. Studies have shown that PTSD predicts anxiety and depression (Bergen-Cico et al., 2015) and that decreases in PTSD symptoms using mind–body therapies can yield significant concomitant reductions in depression (Possemato et al., 2016) among military veterans. Research also shows that first responders and veterans with PTSD have dysregulated cortisol awakening response (CAR), which is an indication of hypothalamic pituitary adrenal (HPA) axis dysregulation (Bergen-Cico et al., 2014, 2015), musculoskeletal pain, and high body mass index. Figure 5.2 illustrates what happens when traumatic stress develops and its impact on neural dysregulation, psychological and physical health. PTSD is a debilitating mental health condition triggered by witnessing or experiencing a traumatic or life-threatening experience. It is associated with significant functional impairment, bodily pain, and poor physical and mental health (Gillock et al., 2005; Rauch, Shin, & Phelps, 2006). As mentioned above, diagnostic criteria of PTSD encompass four key clusters of: (1) re-experiencing the traumatic event; (2) negative changes in thinking; (3) hyperarousal; and (4) emotional numbing and avoidance (APA, 2013). Physiological problems that accompany the type of post-traumatic stress first responders experience may contribute to disability and include neuroendocrine (hormone) changes that can result in poor sleep quality, hypertension, anxiety, depression, and increased health risk behaviors such as heavy use of tobacco and alcohol (Chida & Steptoe, 2009; Juster, McEwen, & Lupien, 2010; McEwen, 2000).

Stress and well-being of first responders  67

Figure 5.2

Development and impact of traumatic stress

IMPACT OF UNADDRESSED TRAUMA AND STRESS ON THE WELL-BEING OF MIND AND BODY Addressing stress, particularly traumatic stress, should be recognized as a strength and protective measure against the potential deleterious impact on psychological (mind) and physical (body) health of first responders. Table 5.1 illustrates the major health and behavioral symptoms associated with the types of workplace stress and post-traumatic stress professional first responders may experience. Laypeople and volunteer first responders may also experience these types of stressors but may be less prone to workplace stressors because of the context in which they are operating. Given the similarities and crossover in symptoms it can be difficult to determine the source of stress in order to take corrective action. Fortunately, there is evidence that cognitive behavioral/mindfulness-based stress reduction practices reduce the physiological and psychological impact of stress regardless of the source (Flynn, 2016; Kaplan et al., 2017; Possemato et al., 2016). We address this in the next section. Physiological measures of musculoskeletal pain, blood pressure, cholesterol, resting heart rate, and cortisol can provide clinical markers and evidence of the toll stress takes on first responders (McFarlane, Williamson, & Barton, 2009). Cortisol (a glucocorticoid) has both protective and damaging effects on the body and is one of the primary hormonal mediators of the stress response. During periods of acute stress, cortisol is essential for adaptation, maintenance of homeostasis (balanced body chemistry), and survival (allostasis) (Chida & Steptoe, 2009). However, ongoing chronic stressors lead to dysregulation of cortisol output, exacting an allostatic load

68  Handbook of research on stress and well-being in the public sector Table 5.1

Manifestations of stress among first responders

PTSD Symptoms

Workplace-related Stress Symptoms

Anxiety

Anxiety

Depression

Depression

Suicidal ideation

Suicidal ideation

Increased alcohol, tobacco and other drug use

Increased alcohol, tobacco and other drug use

Changes in eating behavior

Changes in eating behavior

Increased risk for cardiovascular disease, e.g.,

Increased risk for cardiovascular disease, e.g.,

hypertension

hypertension

Difficulty sleeping and distressing dreams related to traumatic events Recurrent, unwanted distressing memories of traumatic events

Difficulty sleeping Emotional reactivity, irritability

Withdrawal, loneliness, and isolation

Withdrawal, loneliness

Physical aches and pain

Physical aches and pain

Dysregulation in cortisol output

Increased cortisol output

Emotional reactivity, irritability, outbursts or aggressive behavior (hyperarousal) Always on guard for danger (hypervigilance) Being easily startled or frightened (startle response) Self-destructive behavior (e.g., heavy drinking, risk taking)

(cost) that can accelerate disease processes (Juster et al., 2010; McEwen, 2000). The allostatic load model demonstrates that multisystemic physiological dysregulation in response to chronic stress contributes to adverse effects on both physical and psychological health and is reflected in cortisol output. There is a bidirectional relationship between cortisol dysregulation and sleep, weight gain, anxiety, and depression, and an increase in the risk of chronic diseases such as metabolic syndrome, type II diabetes, cardiovascular disease, hypertension, and poor mental health (Bergen-Cico et al., 2014; Kales et al., 2009). Healthy diurnal cortisol levels rise upon awakening and then fall throughout the day in response to sleep–wake cycles. There is an interactive relationship between stress, cortisol output, and sleep changes, and poor sleep quality often accompanies anxiety, depression, and post-traumatic stress (PTSD). Likewise, poor sleep quality can exacerbate anxiety, depression, and trauma. Although it can be difficult to determine the temporal order of sleep disturbances, cortisol dysregulation, anxiety, and depression, our research found that post-traumatic stress was the most significant predictor of physical and mental health problems among first responders (Bergen-Cico et al., 2015). Therefore, it is important to screen for and address traumatic stress among first responders because stress is a risk factor for many physical and psychological health problems.

Stress and well-being of first responders  69

PREVENTION AND RECOVERY First responders face physical and mental stress on a daily basis. Stress, particularly traumatic stress, can impede information processing and reaction times, which are crucial to safety and survival of first responders and the people they are helping. Preoccupation, distraction, and disorganized cognition stemming from stress and trauma can reduce reaction time and increase error rates. These stress-related factors can further compound trauma, stress, and self-judgment. To reduce the risks stemming from the nature of the stressful work environment and the trauma that is inherent in their work, some first responders are integrating mindfulness-based practices into training and self-care for their teams and staff. Research has shown that mindfulness-based practices not only foster resiliency and lower stress but also increase focused attention, which may mean the difference between life and death. Mindfulness-based training also leads to an increase in non-reactivity, a crucial mechanism for not engaging in impulsive reactions to experiences (Kaplan et al., 2017). Increasing the non-reactivity in first responders can mitigate negative health outcomes and is significant in the reduction of the effects of occupational stress by moderating the relationship between occupational stressors and perceived stress (Flynn, 2016; Kaplan et al., 2017). Non-reactivity has been shown to be more effective than traditional awareness practices. Other benefits of mindfulness-based training include decreases in sleep disturbance, anger, fatigue, burnout, difficulties with emotion regulation, general stress, and operational stress (Christopher et al., 2015; Surguladze et al., 2018). Although traumatic stress symptoms may become immediately apparent, more often they manifest over time and emerge in association with major life stressors and events such as bereavement, social isolation, and chronic medical illness. A positive work environment, one that is conducive to establishing supportive work relationships, is protective and fosters resiliency. Some research asserts that a sense of ‘brotherhood’ among firefighters promotes psychological well-being, whereas a low level of social bonding and connection is correlated with poor mental well-being (Carey et al., 2011).

CONCLUSION Stress and trauma can affect first responders’ work performance, relationships, morbidity, and mortality. First responders’ work often requires ongoing exposure to injuries, violence, death, and destruction. The psychological responses among first responders vary based on the setting and source of the crisis, their support, their professional training, and their personal characteristics. Most first responders experience mild to moderate transient distress such as sleep disturbance, increased alcohol or tobacco use, physical aches and pains. These first responders are generally able to continue working and return to normal function without formal treatment but would benefit from support and psycho-educational interventions. A smaller subgroup

70  Handbook of research on stress and well-being in the public sector may develop PTSD, clinical depression, insomnia, or substance use disorders and require clinical intervention. This level of impact would likely affect work, personal relationships, psychological well-being, and physical health (Benedek et al., 2007). Among first responders who develop traumatic stress, without resiliency and support it can dysregulate their neurophysiology and negatively impact their psychological and physical health. Community support and cognitive behavioral strategies have demonstrated efficacy in fostering resiliency for first responders and people exposed to traumatic incidents (Ursano & Friedman, 2006). Cognitive behavioral therapy is an evidence-based clinical treatment, while mindfulness-based programs and cognitive behavioral approaches to stress reduction are evidence based for the prevention and recovery of trauma and stress (Asmundson & Stapleton, 2008; Possemato et al., 2016). Psychological first aid is emerging as a model for early intervention and prevention through social support, decreased arousal, cognitive reframing, and stress reduction techniques (Benedek et al., 2007). First responders place themselves in harm’s way and often put their lives at risk so that others may live. In order to remain effective in the workforce and have a healthy quality of life, it is imperative that first responders are afforded the same psychological support and care that they provide to others.

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6. Managing boredom and motivation: the unusual case of stress in firefighting Maude Villeneuve, Pierre-Sébastien Fournier and Caroline Biron

WAITING FOR ACTION: THE CHANGING NATURE AND CONTEXT OF FIREFIGHTING Firefighting is exceptionally challenging. For those practicing the profession, it entails an unsettling number of physical, psychological, and organizational risks. The increasingly broad range of situations in which firefighters intervene include residential, industrial or forest fires, car accidents, chemical or oil spills, drownings, worksite accidents, avalanches, and building collapses (Apud & Meyer, 2011; Prati et al., 2013; Regehr & Bober, 2005). Firefighters are thus at risk of multiple types of injuries, including burns, cuts, fractures, collapses, chemical and fume inhalation and, in the worst case, death (Cloutier & Champoux, 2000; Gordon & Larivière, 2014). Repeated exposure to such critical situations has a significant psychological cost: post-traumatic stress syndrome (PTSD) has been well documented in firefighters, as have alcohol and drug abuse disorders, pathological gambling, major depression, and attempted suicide (Heinrichs et al., 2014; Saijo, Ueno, & Hashimoto, 2008, 2012; Wagner, Heinrichs, & Ehlert, 1998). Despite these numerous risks, the traditional heroic image of firefighting and its portrayal in the media has captured our collective imagination and this inspires new recruits to join the service (Childs, 2005). However, that portrait describes only a part of the firefighter’s reality. This chapter aims to discuss dynamics in the more routine aspects of fire prevention that present risks of a different nature for firefighters. Technological advances in residential and industrial fire prevention have significantly reduced the frequency and severity of fires (Ramsden et al., 2018). Improving the strategic workforce planning of fire safety services has also decreased the time it takes for firefighters to reach the scene of emergencies, also reducing the severity and duration of several types of field operations (Carvalho et al., 2006; Kloot, 2009). Simply put, firefighters spend less and less time putting out fires and increasing time doing other activities at fire stations. This side of firefighting activities is rarely investigated. As a result, there are little data with which to understand the dynamics triggered by this evolution in work demands. In Australia, this type of work has been labeled ‘clean work’, and it includes the various daily activities that firefighters carry out besides putting out fires (Childs, Morris, & Ingham, 2004). According to Childs et al. (2004), as much as 90 percent of firefighters’ time could be dedicated to activities at the station, such as 74

Managing boredom and motivation: the unusual case of stress in firefighting  75 vehicle and tool maintenance, residential and industrial fire prevention, training, and waiting for alarms. Firefighting is not as unpredictable and as challenging as it seems. Under the principles of new public management (NPM), the context of firefighting management has also changed. The fundamental goal of NPM is to transform public organizations and the people working for them to resemble private sector enterprises – that is, market oriented, performance driven and cost-effective (Verbeeten & Speklé, 2015). The typical control systems of this form of governance are expected to improve accountability, increase transparency, and lead to a more efficient allocation of resources (Kloot, 2009). However, a large and growing body of literature shows that this form of governance does not deliver on its ambitious promises (Diefenback, 2009; Kirkpatrick, Ackroyd, & Walker, 2005). NPM promotes high levels of cost-effectiveness, which contradicts the fundamental logic of essential services such as fire prevention. Kirkpatrick et al. (2005) argue that these services are a universal right and should be provided regardless of the severity of citizens’ needs, costs, or ability to pay. As essential services are subject to unpredictable demands, a desire to reduce the supply of services to the minimum required for optimal efficiency implies high safety risks for the population during disasters (Kong, Suyama, & Hostler, 2013). Besides cost reduction, increased accountability is a central tenet of NPM. This results in a (Carvalho et al., 2006) great need for reports and administrative work, including management by indicators or objectives. At fire stations, such work is expected to make fire safety services more profitable, as firefighters are spending a decreasing share of their time in the field. While it may keep officers busy with paperwork, little attention has been given to the impacts of these tasks on work motivation. Simply put, this type of clean work can be boring, especially for firefighters, and could decrease their motivation (Mael & Jex, 2015). Workplace boredom is increasingly investigated as a significant organizational risk for employee health and performance (Harju, Hakanen, & Schaufeli, 2014; Mael & Jex, 2015; Skowronski, 2012; Van Hooff & Van Hooft, 2014). Van Tilburg and Igou (2012, p. 191) have argued that ‘Boredom. . .involves feeling restless and unchallenged at the same time, while thinking that the situation serves no purpose’. In the context of firefighting, the definition of a purposeful activity is straightforward: the more an action is directly related to emergency relief and public service, the more likely it is to be perceived as meaningful (Regehr & Bober, 2005). There is evidence showing that firefighters may be especially vulnerable to the effects of workplace boredom, displaying symptoms of weariness, lethargy, fatigue and emptiness, restlessness, irritability, and anxiety (Fisher, 1993; Harju et al., 2014). Given the unpredictable nature of firefighting work, and despite a typically decreasing alarm volume, they never know when they will have to answer a call during their shift: they must be highly alert at all times in anticipation of a potential emergency. Watt (2002) hypothesizes that this ‘hurry up and wait’ type of environment could be particularly harmful for individuals such as firefighters. In addition, Salters-Pedneault, Ruef and Orr (2010) show that the typical personality profile of firefighters is characterized by a higher need for stimulation, which could diminish

76  Handbook of research on stress and well-being in the public sector their ability to motivate themselves in boring contexts. These difficulties could be aggravated during periods of rest immediately following the overstimulation of a field operation (Grech et al., 2009). Feelings of restlessness and meaninglessness may be particularly intense for firefighters, who train for years expecting to help citizens in critical and dangerous contexts (Malek, Mearns, & Flin, 2010; Prati et al., 2013). The reality of waiting for hours and filling time with maintenance tasks impacts their motivation and gives rise to powerful manifestations of workplace boredom. In sum, it seems that prolonged periods of work underload, specifically long periods without field operations, could threaten firefighters’ work motivation, health, and performance. As we have suggested, there is a confluence of factors creating conditions in which workplace boredom at fire stations is more likely than ever. We argue that self-determination theory (Deci, Olafsen, & Ryan, 2017) could further explain why firefighters’ current work context is especially boring to them.

SELF-DETERMINATION THEORY (SDT): UNDERSTANDING FIREFIGHTERS’ INTRINSIC AND EXTRINSIC MOTIVATIONS SDT assumes that people are active and self-motivated, curious and interested by nature, as success itself is personally satisfying and rewarding. The theory acknowledges, however, that people can also be alienated, passive, and disaffected (Deci & Vansteenkiste, 2004). SDT accounts for these differences in terms of the types of motivation, which result from the interaction between people’s inherent active nature and the social environments that either support or thwart that nature (Gagné & Deci, 2005). Self-determination relates to the satisfaction of three innate psychological needs, namely the need for competence, which concerns succeeding at optimally challenging tasks and attaining desired outcomes; the need for autonomy, which is defined as experiencing choice and feeling like the initiator of one’s own actions; and the need for relatedness, which is understood as establishing a sense of mutual respect for and reliance on others (Deci & Ryan, 1985). Social contexts that facilitate the fulfillment of these three basic psychological needs support people’s inherent activity, promote better motivation, and yield the most positive psychological, developmental, and behavioral outcomes. In contrast, social environments that thwart the fulfillment of these needs yield less motivation and have negative effects on a wide variety of well-being outcomes (Deci et al., 2017). Self-determination is a continuum that ranges from amotivation and four types of extrinsic motivation to intrinsic motivation. Amotivation is the state of lacking the intention to act. When amotivated, people either do not act at all or act without intent; they just go through the motions. The three types of internalized extrinsic motivation – introjection, identification, and integration – along with external regulation (that is, the type of motivation focused on by operant academics), are part of a continuum in the sense that the degree of autonomy is reflected in their behaviors (Deci & Ryan,

Managing boredom and motivation: the unusual case of stress in firefighting  77 2002). Behaviors regulated by introjects, although more autonomous than behaviors regulated externally, are still quite controlled, and behaviors are performed to avoid guilt or anxiety, or to promote a sense of pride. Behaviors regulated by identifications are more autonomous than are those regulated by introjects; individuals accept or personally own their actions as important (Deci et al., 2017). Finally, behaviors regulated by integrations are the most autonomous type of extrinsic motivation. As such, integrated regulation is similar to intrinsic motivation, as both are accompanied by a sense of volition and choice. Nevertheless, the two types of motivation differ in that intrinsic motivation is based on interest in the behavior itself, whereas integrated extrinsic motivation is based on the person having fully integrated the value of the behavior (Deci et al., 2017). In the context of firefighting, we suggest that the three basic needs are manifested in the following ways. Autonomy is nuanced in firefighting, considering that fire suppression is fundamentally a very autocratic procedure in which hierarchical control is crucial and desirable. As such, autonomy in firefighting is having freedom to choose the behavior most likely to bring the expected results within the constraints of the chain of command. It is also expressed by the ‘desire to be causal agents of one’s own life and act in harmony with one’s integrated self’ (Deci & Vansteenkiste, 2004, p. 25). In other words, firefighters want the opportunity to act according to their public service values and be helpful to citizens. Competence in firefighting is straightforward and related to opportunities to maintain and develop emergency intervention skills. Competence is also related to self-efficacy, that is, the belief in being able to master skills and attain performance objectives. Relatedness in firefighting is directly related to team cohesion, which relates both to the interpersonal attraction between team members and their commitment to the tasks they must achieve collectively (Carless & De Paola, 2000). While firefighters’ intrinsic motivation is based on field operations and public service, it is not clear how extrinsic motivation can be nurtured in firefighting when the alarm does not ring. Given the lack of emphasis on firefighters’ ‘clean work’ in previous studies, this chapter draws on SDT to further our understanding of this aspect of the firefighting profession and how it can influence firefighters’ motivation at work as well as perceptions of workplace boredom.

METHOD The study aimed to understand the variation factors of firefighters’ workloads as well as the strategies they apply to maintain a balanced workload (Villeneuve, 2018). Using an ethnographic approach, the data combined participant observations and interviews with firefighters working at five fire stations located in two different cities in Quebec. The study documented over 400 hours of observation of firefighters at work and 17 interviews were conducted to gain a deeper understanding of the nature of their workload.

78  Handbook of research on stress and well-being in the public sector The data produced in this study were the subject of a dual qualitative analysis. First, the observations revealed how the actions of firefighters are part of a recursive relationship, where past learning experiences influence reactions to current events and these reactions in turn influence subsequent action (Rabardel et al., 2002). The accumulation of these work sequences experienced by different firefighters in a wide variety of situations allowed for a general understanding of firefighters’ work activities and their meaning (Theureau & Jeffroy, 1994). A thematic cross-sectional analysis was added to this first sequential analysis. Here, the material from the observations and interviews was analyzed to identify the most relevant theoretical and empirical themes (Barbier, 2000). This second analysis helped illustrate the meaning of actions and circumstances, as well as the impact of individual and collective factors in work perceptions. While the first analysis provided an understanding of how things were done at the fire stations, the second allowed the researcher to understand why they were done this way. Motivation emerged as a critical factor of workplace boredom perceptions.

RESULTS – FIGHTING AMOTIVATION AND INERTIA IN FIREFIGHTING Amotivation and Workplace Boredom in Firefighting Not surprisingly, firefighters got very bored at fire stations where call volume was typically very low. As a conversation starter, they openly stated that nothing happened at their stations and they just passed the time. While this observation seems like common sense, there were actually many concurrent (de)motivational processes interacting behind workplace boredom at fire stations. Simply put, for the firefighting teams that displayed the highest levels of boredom, all fundamental motivational needs were unmet. Autonomy As stated before, autonomy in firefighting is slightly different than in most professions, as firefighters are accustomed to and enjoy being in high-pressure and low-control situations. Whether in a forest fire, a car pile-up or a petrol spill, firefighters need to be clearly told what to do to rescue victims and ensure their own safety. Firefighters are taught that their autonomy is framed within the constraints of the chain of command: they can choose the behavior most likely to bring the expected results within that structure. Given this training, it is not surprising that complete freedom to choose how to occupy their waiting time was not motivating for firefighters. At low-volume stations, where there were very few emergency situations that framed firefighters’ actions, and where firefighters were free to do as they pleased most of the time, they typically did not do much at all.

Managing boredom and motivation: the unusual case of stress in firefighting  79 Officers had a crucial role in providing a structure at the station as well as in the field. However, providing this framework depended on the officer’s own motivation. In many instances observed in this study, the officers’ amotivation trickled down to their teams. When officers themselves spent most of their available time napping or watching TV, firefighters did exactly the same. Moreover, even if individuals or groups of firefighters tried to be proactive during their waiting periods, they were actively encouraged to stop and conform to passive behaviors. Further, since autonomy also refers to opportunities to enact a person’s values, waiting at stations was especially frustrating, as the few clean work tasks that firefighters did have were rarely directly related to their fundamental value of public service. For instance, in several cities in Quebec, firefighters are increasingly called upon to act as first responders. While these opportunities allow firefighters to help the public in a significant and meaningful way, and are thus fulfilling, they can also hinder firefighters’ motivation. Firefighters expressed a certain role ambiguity with paramedics, in which the latter tended to use firefighters as assistants instead of partners. Firefighters felt diminished when they perceived that their presence was not needed or desired on the scene. While these calls could fill time, they could also hinder motivation if they were not properly filtered, or if roles were not clearly defined. Competence When the alarm does not ring, firefighters cannot maintain or update their emergency intervention skills as easily as if there were fires every day. Common sense suggests that more active training should be required of stations with low or very low call volumes. In reality, firefighters in these contexts typically were not motivated to train at all because they did not consider these exercises useful or important. They attended workshops, especially theoretical ones, because they had to, but these sessions were not perceived as contributing to enhancing their skills. As one firefighter stated: ‘The less we do, the less we want to do’. Furthermore, there were no requirements to keep a minimum threshold of physical fitness after a firefighter was hired. There were neither standards nor follow-ups, and physical training at the station itself was not always allowed, as firefighters could hurt themselves. This context decreased motivation even more, as there was no incentive for firefighters to maintain their most important asset – themselves. This finding seems a bit paradoxical since training should be motivating, especially if it relates to exciting new techniques. Our analysis found that firefighters who worked in low-volume settings developed low self-efficacy in their skills: their confidence in their ability to master these new skills or attain their performance objectives was low. Since low self-efficacy is uncomfortable, some firefighters displayed nonchalance towards interventions, believing that their experience was enough to predict how events would unfold in a critical event. But such events are never the same. Such complacency is dangerous, as firefighters may find themselves unable to act in a crucial moment, thus putting their safety or that of their colleagues at risk.

80  Handbook of research on stress and well-being in the public sector Relatedness Team chemistry is crucial in maintaining firefighters’ motivation. It can protect them from the detrimental effects of work underload while at the same time making even the most boring activities enjoyable. However, team chemistry is mostly built by fighting fires together, by experiencing traumatic events as a team. There are very few opportunities for traumatic events when the alarm rarely or even never rings. Moreover, low-volume stations were typically filled with young, inexperienced recruits (who were assigned to the station because of their lack of seniority) and older, near-retirement firefighters (who chose that station because of their seniority). This generational gap was an additional barrier to building team cohesion, as the station’s teams had very different expectations concerning their level of activity during their shifts. Such teams were typified by more conflicts and higher levels of fatigue. Feeling alone at stations was the most frequently expressed source of decreased motivation and workplace boredom, far ahead of the actual low call volume.

PROMOTING EXTRINSIC MOTIVATION – ENHANCING FUNDAMENTAL NEEDS IN MEANINGFUL WAYS To reduce boredom and promote motivation, imposing tasks during firefighters’ waiting periods was not enough. If training and tasks did not make sense in practice, they did not serve a motivational purpose. Putting firefighters in hard training exercises that they were meant to fail was one creative approach we documented. An officer used such an approach in amotivated teams where everything else had failed. He freed the team from incoming alarms and put them in a hard training exercise in which failure would mean serious harm in real-life settings. This scenario was explained and perceived as a likely event that could happen in the future and raised firefighters’ awareness of their own weaknesses and lack of self-efficacy. This exercise was followed with several practice sessions over a certain period, during which firefighters were able to master the technique. While failing induced feelings of shame and pressure to save face, the training exercise had a positive effect on firefighters’ need for specific skills, and the act of failing and then practicing together helped build team chemistry. While this exercise was exceptional in increasing performance and motivation, it could not be applied continuously in the same team. If training exercises were not reviewed either in terms of content or pedagogy, they became meaningless. Firefighters stated that doing the same training in the same way year after year was very boring, as they did not have the feeling that they were learning anything new. While techniques in themselves may not change, officers who taught their teams in innovative ways promoted higher levels of motivation towards mastering the skills in question. Moreover, officers who combined skills training with team bonding seemed to achieve the best results: firefighters needed things to be fun and to do

Managing boredom and motivation: the unusual case of stress in firefighting  81 tasks as a group. Officers who tapped into these fundamental needs had an easier time convincing their teams to engage in training and other less fulfilling tasks.

DISCUSSION Workplace boredom is becoming an issue in firefighting, not only because there are fewer fires than there used to be. In fact, firefighters can have many ‘clean work’ tasks that increase their workload. However, this study showed that these tasks do not necessarily decrease firefighters’ perceived boredom, and they do not increase their motivation at work. Simply put, filling downtime with maintenance, routine, and training is not enough for firefighters to feel motivated. There must also be a conscious effort to align these clean work tasks with firefighters’ fundamental needs. This study has shown that firefighters were not only bored because they had few opportunities to meet their fundamental needs. Although many showed considerably high levels of autonomy, they needed guidance in the ways they chose to spend their time. Officers had to help them invest their time in activities that were meaningful and reflected their public service values. These findings are consistent with the management research trend that shows the links between the behaviors of managers and the well-being of their employees (Biron et al., 2018; Hildenbrand, Sacramento, & Binnewies, 2018; Skakon et al., 2010). Also, while fire safety services offered many training opportunities to fill waiting periods, there was very little effort to show the usefulness and relevance of these workshops and ensure that their content or pedagogy were in line with firefighters’ preferences and values. Most of all, while there is general recognition that low-volume teams are usually less cohesive, fire safety services seem to struggle to find ways to build team cohesion outside traditional fire and emergency interventions. Although many firefighter teams displayed high workplace boredom and amotivation, there were a few instances in which teams were still engaged and motivated at work. The officers’ conscious efforts to nurture team cohesion, promote self-efficacy in mastering new techniques, and clearly show that firefighters should never take their skills for granted were the common thread of the actions put in place in these teams. The aim was to get firefighters out of their complacency and inertia and put them in a situation of failure, while at the same time teaching them how to correct the situation. Firefighters can never assume to know the outcome of any emergency situation, and they have to be reminded of the dangers of neglecting their skills, including their own physical fitness. This study suggests that the current firefighting context often fails to fulfill the expectations of firefighters towards their profession. According to Vroom’s expectancy theory (Vroom, 1964) individuals behave in a certain way because they are motivated to select a specific behavior because of what they expect the result of the said behavior to be. As a result, firefighters have experienced higher amotivation and workplace boredom because they were trained to expect constant emergency activities, and these expectations were not met in their working lives. Once hired,

82  Handbook of research on stress and well-being in the public sector firefighters were put in a work context in which, regardless of how they behaved, they could not generate a volume of emergencies that corresponded to what they were prepared for. Amotivated and bored firefighters displayed higher levels of stress, fatigue, and team conflict than motivated and engaged firefighters. Their work climates were heavier, they were passive in developing or maintaining their skills, and their physical fitness was generally lower. Workplace boredom became a self-fulfilling prophecy, in which the less people did to motivate themselves, the less they wanted to do anything at all. Work simply became a matter of passing the time until the next rotation. While this study did not specifically investigate how amotivation and workplace boredom affected accident rates, performance levels, or psychological distress, the discourse of firefighters on these matters clearly showed that urgent action was needed. Working on firefighters’ self-determination could decrease workplace boredom perceptions, and also the negative health and performance impacts of this phenomenon. Our study also shed light on the effects of certain key principles of the new public management approach on firefighters’ motivation to work. Pressure to increase the relative cost-effectiveness of fire safety services encourages these departments to further fill firefighters’ time with various ‘clean’ jobs and various training programs. Although this may technically make shifts busier, the real impact of these programs and tasks on the acquisition and maintenance of critical skills should be further investigated. The results of our study indicate that several motivational criteria were needed to ensure maximum impact on competence and motivation. This paradoxical effect, whereby efforts to fill firefighters’ spare time with tasks that make no sense to them could decrease their performance instead of improving it, should be further examined. This study contributes to the self-determination literature. Self-determination generally argues that the more autonomy the better (Deci & Ryan, 1985; Deci & Vansteenkiste, 2004; Ryan & Deci, 2000). In firefighting, autonomy must be framed for individuals to experience higher levels of motivation. In this context, it seems that the fit between expectations of autonomy and reality is more important than the actual amount of autonomy. Also, relatedness is often considered a less important, optional feature of self-determination, in contrast to autonomy and competence, which are seen as crucial (Deci & Vansteenkiste, 2004). In firefighting, however, relatedness is perceived as ‘everything’: it precedes all other motivational needs. It is the first factor expressed by firefighters for what motivates them, and also the top risk factor in low cohesion teams. Self-determination theory would benefit from being applied further in emergency professions such as firefighting, where fundamental needs seem to be manifested differently than in the general population. This study also contributes to the firefighting literature. Most research on firefighters’ mental health focuses on their emergency interventions and post-traumatic stress disorder (Heinrichs et al., 2014; McGurk et al., 2014; Wagner et al., 1998). While some studies have focused on the organizational aspects of firefighting (Patterson, 1999; Regehr & Bober, 2005; Regehr et al., 2003) and a few have considered

Managing boredom and motivation: the unusual case of stress in firefighting  83 firefighters’ workload levels (Apud & Meyer, 2011; Bouzigon et al., 2015; Watt, 2002), only one has thus far explicitly focused on firefighters’ self-determination, and only with regard to their motivation to exercise (Long, Readdy, & Raabe, 2014). Self-determination, especially in light of the changes in the nature and context of firefighting, could represent an innovative way to promote firefighters’ health, safety, and performance.

HOW CAN FIRE DEPARTMENTS IMPROVE FIREFIGHTERS’ MOTIVATION AND REDUCE THEIR WORKPLACE BOREDOM PERCEPTIONS? It is impossible, or at least unethical, to artificially create disasters to which firefighters could respond. However, it is possible to promote better workload management and extrinsic motivation that resembles the intrinsic motivation experienced during fieldwork. For instance, the extrinsic motivation of firefighters during their time in barracks can be promoted to improve job satisfaction and avoid the negative repercussions of boredom on health and performance. The study identifies some promising lines of action that can be implemented to gradually change inert workplaces into more motivational and proactive workplaces. Stimulating Decision-making Autonomy Autonomy is about giving employees room to maneuver so they can decide for themselves how their work should be done. Having influence over the course of their own work is a marker of employee autonomy, which is in turn a sign of respect for their skills. For firefighters, autonomy could be promoted with clearly defined autonomy ‘zones’ in the field and at the station, by listening to the ideas of firefighters and officers, by following up on their comments and suggestions, or by conveying the meaning of the mandates and tasks, especially if they are routine and of little intrinsic interest. All personnel should explore opportunities to fulfill their public service values. Skills Development To encourage extrinsic motivation that is close to intrinsic motivation, ‘clean’ work must promote workers’ autonomy and sense of competence at work as much as possible. Certain actions could be implemented to this end: ●● Set time aside for dedicated training sessions, during which firefighters must intervene in critical situations that call for the implementation of complex techniques with major temporal or physical constraints. ●● Raise awareness on the risks of skill deterioration for firefighters’ health, that of their colleagues, and those of the citizens they would have to rescue.

84  Handbook of research on stress and well-being in the public sector ●● Ensure that knowledge transfer, especially in intergenerational teams, promotes the sharing of field knowledge of more experienced firefighters and the technical knowledge of recruits. ●● Use practice drills to reinforce skills and team cohesion, and to master new techniques or new technologies. Promoting Physical Fitness In some cases, however, implementing such strategies requires some firefighters to rebuild their physical fitness, which has fallen prey to daily inertia. A recent stream of studies using the PHLAME (Promoting Healthy Lifestyles: Alternative Models’ Effects) method (Elliot et al., 2004, 2007; Ranby et al., 2011) demonstrates a cascade of positive consequences following the implementation of a structured approach promoting healthy living habits among firefighters, not only in terms of physical health, but also in terms of the work climate. Different actions could thus include: ●● encouraging the physical training of firefighters as a team during their working time; ●● promoting healthy eating during workplace meals; ●● promoting healthy living habits (non-smoking, limiting alcohol, exercise, relaxation) in professional and private lives; ●● signing firefighters up for a race (marathon, obstacle course race, etc.) to raise money for a cause that reflects their values of public service.

LIMITATIONS AND FUTURE RESEARCH This study is exploratory in nature. While ethnography enables a deep understanding of work perceptions and practices, it presents some limitations concerning the generalization of the findings to all firefighters or emergency services. Also, at most fire stations, the researcher was not allowed in the truck during interventions, which made it impossible to observe dialogue and practices during these periods. However, given that these periods account for a minority of their time in the barracks and a debriefing session was held when the trucks returned, the loss of data was reduced to a minimum. As the study was not longitudinal, effects over time could not be observed; however, breaking down the observation periods over the course of a year made it possible to understand monthly and seasonal variations. We also recognize that using a questionnaire in the future to measure current organizational and mental health issues such as boredom proneness, stress, satisfaction, motivation, and intention to quit may help to better understand the consequences of workplace boredom. The scientific community has not adequately examined the motivational aspect of firefighting, especially its intrinsic and extrinsic components. Investigating this issue using current validated tools as well as qualitative methods is crucial in gaining a proper understanding of how work motivation manifests itself in firefighting, and of the factors that influence its presence. Leadership skills and practices specific to

Managing boredom and motivation: the unusual case of stress in firefighting  85 promoting self-determination in emergency services could also be the focus of future research, as many officers have argued that current models of leadership and human resource management are inadequate in their organizational context. Future research could also concentrate on paramedics, Special Weapons and Tactics (SWAT) teams and military services, who are also subjected to the same ‘hurry up and wait’ situations as firefighters. A self-determination scale applied to emergency services that accounts for workload fluctuations can be derived from these studies and may allow for further generalization of this theoretical construct in these professions.

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Managing boredom and motivation: the unusual case of stress in firefighting  87 Ranby, K.W., MacKinnon, D.P., Fairchild, A.J., Elliot, D.L., Kuehl, K.S., & Goldberg, L. (2011), ‘The PHLAME (Promoting Healthy Lifestyles: Alternative Models’ Effects) firefighter study: testing mediating mechanisms’, Journal of Occupational Health Psychology, 16(4), 501–513. Regehr, C., & Bober, T. (2005), In the line of fire. New York: Oxford University Press. Regehr, C., Hill, J., Knott, T., & Sault, B. (2003), ‘Social support, self-efficacy and trauma in new recruits and experienced firefighters’, Stress and Health, 19(4), 189–193. Ryan, R.M., & Deci, E.L. (2000), ‘Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being’, American Psychologist, 55(1), 68–78. Saijo, Y., Ueno, T., & Hashimoto, Y. (2008), ‘Twenty-four-hour shift work, depressive symptoms, and job dissatisfaction among Japanese firefighters’, American Journal of Industrial Medicine, 51(5), 380–391. Saijo, Y., Ueno, T., & Hashimoto, Y. (2012), ‘Post-traumatic stress disorder and job stress among firefighters of urban Japan’, Prehospital and Disaster Medicine, 27(01), 59–63. Salters-Pedneault, K., Ruef, A.M., & Orr, S.P. (2010), ‘Personality and psychophysiological profiles of police officer and firefighter recruit’, Personality and Individual Differences, 49, 210–215. Skakon, J., Nielsen, K., Borg, V., & Guzman, J. (2010), ‘Are leaders’ well-being, behaviours and style associated with the affective well-being of their employees? A systematic review of three decades of research’, Work & Stress, 24(2), 107–139. Skowronski, M. (2012), ‘When the bored behave badly (or exceptionally)’, Personnel Review, 41(2), 143–159. Theureau, J., & Jeffroy, F. (1994), Ergonomie des situations informatisées [Ergonomics of computerized situations]. Toulouse: Octarès. Van Hooff, M.L., & Van Hooft, E.A. (2014), ‘Boredom at work: proximal and distal consequences of affective work-related boredom’, Journal of Occupational Health Psychology, 19(3), 348–359. Van Tilburg, W.A., & Igou, E.R. (2012), ‘On boredom: lack of challenge and meaning as distinct boredom experiences’, Motivation and Emotion, 36(2), 181–194. Verbeeten, F.H., & Speklé, R.F. (2015), ‘Management control, results-oriented culture and public sector performance: empirical evidence on new public management’, Organization Studies, 36(7), 953–978. Villeneuve, M. (2018), ‘Au delà des incendies: la fluctuation de la charge de travail des pompiers québécois’ [Beyond fires: the fluctuating workload of Quebec firefighters]. Doctoral thesis, Université Laval, Quebec, Canada. Vroom, V.H. (1964), Work and motivation. New York: Wiley. Wagner, D., Heinrichs, M., & Ehlert, U. (1998), ‘Prevalence of symptoms of posttraumatic stress disorder in German professional firefighters’, American Journal of Psychiatry, 155(12), 1727–1732. Watt, J.D. (2002), ‘Fighting more than fires: boredom proneness, workload stress and underemployment among urban firefighters’. Doctoral thesis, Kansas State University, Manhattan, Kansas.

7. Nurses’ experiences of workplace mistreatment Zhiqing E. Zhou, Xin Xuan Che and Wiston A. Rodriguez

Workplace mistreatment refers to a wide range of negative behavior that employees may experience in the workplace, including incivility, bullying, verbal aggression, physical violence, and sexual harassment. While all employees who interact with other people at work are likely to become victims of workplace mistreatment, nurses are at a much higher risk due to the nature of their work. The perpetrators of workplace mistreatment can be from multiple sources, including patients, patients’ visitors (family members, friends), co-workers, physicians, and supervisors. Further, exposure to workplace mistreatment has various negative effects on nurses’ health and well-being, emotions and attitudes, and behavior. Given the importance of this phenomenon, the goal of this chapter is to provide an overview of research findings on nurses’ experiences of workplace mistreatment in terms of its frequency, sources, consequences, coping strategies, risk factors, and potential intervention strategies.

WORKPLACE MISTREATMENT TYPES IN NURSING The literature in nursing has examined several different types of workplace mistreatment (Spector, Zhou, & Che, 2014). The broad term of workplace violence has been used to include all of them. For example, the National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as ‘violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty’ (NIOSH, 1996). In addition, the Joint Programme on Workplace Violence in the Health Sector from the International Labour Office (ILO)/International Council of Nurses (ICN)/World Health Organization (WHO)/Public Services International (PSI) defines workplace violence as ‘incidents where staff are abused, threatened or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being or health’ (ILO/ICN/WHO/PSI, 2002, p. 3). The aforementioned definitions of workplace violence are similar to the umbrella term ‘workplace mistreatment’ because they all include a wide range of harmful acts. Yet, researchers have examined several specific types of workplace mistreatment based on a few distinctive characteristics. For example, workplace violence usually refers to physical acts that might cause physical harm, while workplace aggression may include non-physical (i.e., verbal) acts and psychological abuse. In addition, 88

Nurses’ experiences of workplace mistreatment  89 workplace bullying emphasizes the repeated behavior over time that can be physical or psychological. Sexual harassment involves undesirable physical or verbal attention, while workplace incivility refers to low-intensity behavior with ambiguous intent to harm that violates the norms for mutual respect. Horizontal/lateral violence, which might include bullying and incivility, refers to physical and/or psychological aggression conducted by other nurses. Studies in the nursing literature at times tend to focus on one or a few of these constructs, but also use them interchangeably due to the theoretical differences that exist among them.

FREQUENCY OF WORKPLACE MISTREATMENT IN NURSING Aquino and Thau (2009) suggest that employees are more likely to become victims of workplace mistreatment when they need to interact with others frequently at work. Since nurses have frequent interactions with patients, patients’ visitors (family members and friends), other nurses, physicians, and supervisors at work, it is no surprise that nurses experience much higher rates of workplace mistreatment compared to the general workforce. These rates also vary across the different types of workplace mistreatment. Workplace Violence and Aggression Schat, Frone and Kelloway (2006) conducted a national study and estimated that 6 percent and 41 percent of US employees reported experiencing workplace violence and workplace aggression at work, respectively. In comparison, Spector et al. (2014) conducted a quantitative review based on 151 347 nurses from 160 independent samples. They found that 36.4 percent of nurses had experienced workplace violence and 66.9 percent of nurses had experienced workplace aggression. These numbers clearly demonstrate that nurses are at a much higher risk of being victims of workplace mistreatment in comparison to the general workforce. Since Spector et al.’s (2014) review, a few large-scale studies have provided more recent estimates of nurses’ exposure to these types of workplace mistreatment. For example, in Europe, Pekurinen et al. (2017) found that out of 5228 nurses in Finland, 37 percent had experienced workplace aggression, while 25 percent had experienced workplace violence in the previous 12 months. In Turkey, Bilgin et al. (2016) reported that out of 1539 nurses, 38.6 percent had experienced workplace aggression, 5.8 percent had experienced workplace violence, and 15 percent had experienced sexual harassment. With a sample of 4891 Australian nurses, Shea et al. (2017) found that 67 percent had experienced workplace violence/aggression in the previous 12 months, with 44 percent of them experiencing it a few times in a year. Silva et al. (2015) used a sample of 2940 nurses in Brazil and found that 44.9 percent had experienced workplace aggression and 2.3 percent had experienced workplace violence.

90  Handbook of research on stress and well-being in the public sector In Canada, Andrews et al. (2012) found that, out of 3933 nurses, 22 percent had experienced workplace aggression and 16 percent had experienced workplace violence. In Asia, with 3004 nurses from China, Zhang et al. (2017) reported that 25.8 percent had experienced workplace violence, 63.7 percent had experienced workplace aggression, and 2.8 percent had experienced sexual harassment; Wei et al. (2016) found that out of 26 976 nurses, 19.1 percent had experienced workplace violence and 46.3 percent had experienced workplace aggression. With a sample of 1835 nurses in Japan, Sato, Yumoto and Fukahori (2016) reported that 32.8 percent had experienced workplace violence and 48.7 percent had experienced workplace aggression. Workplace Bullying Workplace bullying also happens frequently in the nursing industry. Spector et al. (2014) estimated, based on ten studies, that 37.1 percent of sampled nurses had experienced workplace bullying, and recent studies reported similar exposure rates. For example, An and Kang (2016) found that 15.8 percent of their Korean nurse participants had experienced bullying on a weekly basis in the previous six months. Birks et al. (2017) found that Australian nurses (50.1 percent) had experienced a higher rate of bullying than UK nurses (35.5 percent). Yokoyama et al. (2016) reported that 18.5 percent of their Japanese nursing participants had experienced workplace bullying. Ganz et al. (2015) reported that the exposure rate to bullying was 29 percent in a nurse sample from Israel. Sexual Harassment The estimated exposure rate of sexual harassment from Spector et al. (2014) based on 33 samples was 27.9 percent, ranging from 0.7 percent (Kamchuchat et al., 2008) to 68 percent (Nijman et al., 2005). Some recent studies reported relatively lower rates of sexual harassment, ranging from 10 percent (Sisawo et al., 2017), 18.6 percent (Zeng et al., 2013), 19.7 percent (Park, Cho, & Hong, 2015), to 22.4 percent (Chang & Cho, 2016). Workplace Incivility Workplace incivility occurs often in the workplace, including the nursing industry. It is estimated that 98 percent of employees had reported being victims of workplace incivility and about 50 percent had experienced it on a weekly basis (Porath and Pearson, 2013). Information regarding the prevalence rates of workplace incivility in nursing is limited because a majority of the studies used Likert scales to measure the frequency (ranging from ‘not at all’ to ‘frequently’) of workplace incivility as a way to establish relationships with its antecedents and outcomes. One exception (Lewis & Malecha, 2011), however, reported that 85 percent of 659 nurses they surveyed had experienced workplace incivility in the last 12 months.

Nurses’ experiences of workplace mistreatment  91 Summary While the quantitative review by Spector et al. (2014) provides overall estimates of nurses’ exposure to workplace violence, aggression, bullying, and sexual harassment, the actual rates varied across different studies. However, what is clear is that nurses are at an extremely high risk of being the victims of workplace mistreatment, which can range from rude comments to physical attacks. As recent studies mentioned above show, there is no indication that nurses’ experiences of workplace mistreatment are declining. This unfortunate fact urges researchers, practitioners, and policymakers to continue paying attention to this phenomenon.

SOURCES OF WORKPLACE MISTREATMENT AGAINST NURSES Nurses usually have frequent interactions with multiple parties at work. While patients and visitors are the most commonly studied perpetrators, the sources of perpetrators of workplace mistreatment against nurses actually vary across different types of mistreatment (Spector et al., 2014). Workplace Violence For workplace violence, patients and their visitors (i.e., family members and friends) are the main sources. For example, Roche et al. (2010) found that out of 2487 nurses from Australia, 14.4 percent had experienced workplace violence in the past week; among them, 93.8 percent reported to have experienced workplace violence from patients, 6.8 percent from patients’ families, and only 1.7 percent had experienced workplace violence from other nurses. With a sample of 2166 nurses from the US, Campbell et al. (2011) reported that 19.4 percent had experienced workplace violence in the last year; among them, 90.2 percent reported that the workplace violence involved patients, 27 percent of them involved patients’ relatives, and only 7.6 percent involved other nurses. Adib et al. (2002) surveyed a sample of 5876 nurses from Kuwait and found that 7.2 percent of them reported to have experienced workplace violence in the past six months, and they identified patients (51.5 percent) and patients’ family members or friends (32.2 percent) as the main source of the workplace violence. Overall, Spector et al. (2014) estimated that about two-thirds of workplace violence was perpetrated by patients, about a third were from patients’ family members and friends, and about 10 percent from co-workers (other nurses, physicians, staff). Workplace Aggression In addition to patients and their visitors serving as main perpetrators of workplace aggression, nurses’ co-workers (i.e., other nurses, physicians, and other staff) rep-

92  Handbook of research on stress and well-being in the public sector resent another main source of workplace aggression. For example, Campbell et al. (2011) found that 54 percent of a sample of 2166 nurses from the US reported that the workplace aggression involved patients, 32.8 percent of them involved patients’ relatives, 35.5 percent involved other nurses, 22.8 percent involved physicians, and 11.3 percent involved nurses’ supervisors. With a sample of 2407 nurses from Australia, Farrell, Bobrowski and Bobrowski (2006) found that up to 82.1 percent of them had experienced workplace aggression; among them, 74.3 percent had experienced workplace aggression from patients, 35.3 percent from patients’ visitors, 28.7 percent from nurses’ colleagues, 27.1 percent from physicians, and 15.8 percent from nurses’ managers. Spector et al. (2014) estimated that nurses reported frequent exposure to workplace aggression from all sources, including patients (53.9 percent), patients’ family members and friends (47.3 percent), other nurses (21.8 percent), physicians (28.5 percent), and staff (39.2 percent). Workplace Bullying Studies on nurses’ exposure to workplace bullying suggest that other healthcare professionals are the main perpetrators of bullying. For example, Birks et al. (2017) reported that 53 percent of their Australian nurse participants identified their fellow nurses as the source of workplace bullying, while 68 percent of their UK nurse participants identified their fellow nurses as the source of workplace bullying. Vessey et al. (2009) found that the perpetrators of workplace bullying included senior nurses (24 percent), charge nurses (17 percent), nurse managers (14 percent), and physicians (8 percent). Johnson and Rea (2009) found that 27 percent of their participants had experienced workplace bullying over the past six months, with most of them indicating that their managers/directors or charge nurses were the bullies. For new nurses, however, more experienced nursing colleagues have been identified as the main source of workplace bullying (Vogelpohl et al., 2013). Nursing students are also victims of workplace bullying from co-workers. Clarke et al. (2012) reported that 88.7 percent of nursing students were victims of workplace bullying, with clinical instructors (30.2 percent) being the main source of bullying followed by staff nurses (25.5 percent). Sexual Harassment and Workplace Incivility The main sources of nurses’ exposure to sexual harassment are patients, their family members and friends, and other staff. For example, Pai and Lee (2011) reported that sexual harassment from those sources were 44.8 percent, 11.9 percent, and 43.3 percent, respectively. In contrast, the majority of studies on workplace incivility focused on rude behavior from insiders such as physicians, co-workers, and supervisors (Laschinger et al., 2016; Leiter, Price, & Laschinger, 2010; Smith, Andrusyszyn, & Laschinger, 2010), while patients and family members are also potential sources of workplace incivility (Campana & Hammoud, 2015).

Nurses’ experiences of workplace mistreatment  93 Summary While the main source of perpetrators of different types of workplace mistreatment might vary, patients and visitors (family members and friends) are constantly shown to engage in harmful behavior towards nurses. While this might be considered normal by some nurses, especially in certain units (psychiatric units or mental health institutions), they pose detrimental threats to nurses. Meanwhile, it is unfortunate that insiders (co-workers, supervisors, and physicians) also tend to engage in workplace mistreatment towards nurses when in fact they should be sources of support and help. Thus, hospitals should prioritize building a safe and civil environment in addition to training nurses to handle patients and visitors effectively.

CONSEQUENCES OF NURSES’ EXPOSURE TO WORKPLACE MISTREATMENT Bowling and Beehr (2006) and Aquino and Thau (2009) summarized the main consequences of being victims of workplace mistreatment. Specifically, exposure to workplace mistreatment can be linked to impaired health and well-being (increased strain, anxiety, depression, burnout), decreased perceptions of organizational justice, increased counterproductive work behavior, and increased turnover intentions. Similar results have been found with nurses’ experiences and are summarized below. Health and Well-being Exposure to workplace mistreatment can directly affect nurses’ health and well-being. For example, Spector et al. (2014) estimated that 32.7 percent of nurses reported experiencing physical injuries as a result of workplace mistreatment. Nurses can also experience other physical indicators of health impairment, such as musculoskeletal disorders (Miranda et al., 2014; Thinkhamrop & Laohasiriwong, 2015) and wounds and bruises (Åström et al., 2004). Nurses also experience a variety of psychological symptoms as a consequence of exposure to workplace mistreatment. Among them, burnout is perhaps the most studied indicator of psychological well-being of exposure to physical violence, psychological aggression, bullying, harassment, and workplace incivility (recent studies include Chang & Cho, 2016; Galián-Muñoz et al., 2016; Goussinsky & Livne, 2016; Vander Elst et al., 2016; Yang et al., 2018). Other indicators of psychological well-being include mental health (Cheung & Yip, 2017; Fida, Laschinger, & Leiter, 2018; Lam, 2002), major depression and depressive symptoms (da Silva et al., 2015; Gong et al., 2014), stress (Demir & Rodwell, 2012; Stone et al., 2011), PTSD (Opie et al., 2010), and fatigue (Zampieron et al., 2010).

94  Handbook of research on stress and well-being in the public sector Emotions and Attitudes Nurses also tend to develop various negative emotions and feelings towards their job after experiencing workplace mistreatment. The common experiences of emotional reactions include not feeling safe (Bilgin & Buzlu, 2006), increased feelings of astonishment and powerlessness (Åström et al., 2004), anger (Truman et al., 2013), and grievances (Jafree, 2017). Nurses also develop negative attitudes towards their jobs after experiencing workplace mistreatment. Among them, the most common attitude is higher levels of turnover intent (Fida et al., 2018; Leiter et al., 2010; Roh & Yoo, 2012), which may contribute to the actual turnover of nurses and result in nurse shortages. For example, Jeong and Kim (2018) found that 61 percent of the nurses who experienced workplace mistreatment (workplace violence and workplace aggression) considered leaving the hospital. Meanwhile, victims of workplace mistreatment reported lower levels of job satisfaction (Purpora & Blegen, 2015) and lower organizational commitment (Demir & Rodwell, 2012). These negative job attitudes can potentially further affect nurses’ performance at work. Behavior Exposure to workplace mistreatment can also potentially change nurses’ behavior. For example, it is reported that 1.4 percent of victims of workplace violence took one more day of sick leave (Hahn et al., 2010), while 5 percent called in sick following workplace aggression (Rowe & Sherlock, 2005). Nurses are also likely to make more errors (Bowers et al., 2006) and have lower productivity as a consequence (Berry et al., 2012; Bowers et al., 2006). For example, lost productivity as a result of workplace incivility was calculated at $11 581 per nurse per year (Lewis & Malecha, 2011). The effects of exposure to workplace mistreatment can also spill over to nurses’ lives after work. For example, Miranda et al. (2014) found that exposure to workplace mistreatment can be related to interference with sleep. Summary Being exposed to workplace mistreatment goes beyond the possibility of being physically hurt. Nurses tend to experience various negative emotions and feelings, develop negative attitudes towards work, suffer from health implications, and even change their behavioral patterns. All these findings strengthen the notion that workplace mistreatment is detrimental to nurses, the organizations they work in, and eventually patient care.

Nurses’ experiences of workplace mistreatment  95

NURSES’ COPING STRATEGIES FOR WORKPLACE MISTREATMENT EXPERIENCES Given the detrimental effects of exposure to workplace mistreatment, nurses are likely to engage in different coping strategies. Aquino and Thau (2009) suggest that both problem-focused coping (trying to address the causes for the occurrence of workplace mistreatment) and emotion-focused coping (trying to manage emotional responses of exposure to workplace mistreatment) are used by victims of workplace mistreatment. They conclude that problem-focused coping strategies, such as avoiding the perpetrators and trying to get out of situations that are likely to further aggressive interactions, are the most effective in reducing employees’ exposure to workplace mistreatment. On the other hand, they conclude that (effective) emotion-focused coping involves using humor, alcohol consumption, and forgiveness. Nurses use a variety of strategies to cope with experiences of workplace mistreatment. While problem-/emotion-focused coping strategies were found to be effective in reducing nurses’ intention to leave (Jeong & Kim, 2018), studies have also shown that many nurses decided to do nothing and remain silent about experiences of workplace mistreatment (Jafree, 2017). Meanwhile, some nurses decided to avoid patients as a way of coping with experiences of workplace mistreatment (Chapman et al., 2009; Trahan & Bishop, 2016). One reason nurses do nothing or engage in avoidance coping is because they tend to consider experiences of workplace mistreatment as part of their jobs (Chapman et al., 2009) and sometimes it is because of the lack of support from hospital administration (Gacki-Smith et al., 2009). These reasons also drive nurses not to report their mistreatment experiences because they do not believe any helpful responses would be provided (Bilgin & Buzlu, 2006). Transferring to another unit or leaving the nursing industry is a strategy that is also used by some nurses as a last resort (Mahoney, 1991). On the positive side, nurses also supported those who are victims of workplace mistreatment by talking to each other, filling in for each other, and warning each other and protecting each other (Vandecasteele et al., 2017). Some engaged in informal discussion with colleagues and formal discussion with the working team (Åström et al., 2004). Summary While studies have found that exposure to workplace mistreatment has detrimental effects, how nurses can effectively cope with such experiences remains less examined. As mentioned above, nurses tend to engage in various reactive coping strategies to avoid future encounters of workplace mistreatment, and more research should focus on how nurses can proactively engage in certain behavior/strategies to protect them from becoming victims of workplace mistreatment.

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RISK FACTORS FOR NURSES’ EXPOSURE TO WORKPLACE MISTREATMENT The research on workplace mistreatment in the general workforce has explored various factors that may put employees at risk for exposure to workplace mistreatment, including both individual differences (gender, age, personality traits), workplace stressors (i.e., role conflict), and the roles of leaders and organizations (i.e., leadership, climate). For example, Bowling and Beehr (2006) found that those with a higher level of negative affectivity are more likely to be victims of workplace mistreatment, while age, gender, and tenure were not significantly related to exposure to workplace mistreatment; meanwhile, those working in a working environment with higher levels of role conflict, role ambiguity, role overload, and organizational constraints report having experienced more workplace mistreatment. Aquino and Thau (2009) drew similar conclusions to the findings of Bowling and Beehr (2006) on the relationship of negative affectivity, age, gender, tenure, and workplace stressors on exposure to workplace mistreatment. In addition, they suggest that those experiencing certain leadership or managerial styles (e.g., laissez-faire leadership; Skogstad et al., 2007) are more likely to become victims of workplace mistreatment. A recent meta-analysis (McCord et al., 2017) found that women reported experiencing more gender-based mistreatment than men but similar levels of other types of mistreatment; similarly, racial minorities reported experiencing more race-based mistreatment than whites but similar levels of other types of mistreatment. There are both similarities and differences in risk factors in the nursing industry compared to those in the general workforce. Individual Differences In terms of demographic variables, Al-Omari (2015) reported that female nurses experienced less workplace violence but more workplace aggression than male nurses. Campbell et al. (2011) also found that males were more likely to experience workplace violence, while the difference was not significant for workplace aggression; in addition, minority nurses (Black/African American, Asian/Pacific Islander) were less likely to experience workplace violence or workplace aggression than white nurses. Further, Estryn-Behar et al. (2008) found that male nurses and younger nurses were more likely to experience workplace mistreatment than female nurses and older nurses. To consolidate findings across different studies, Edward et al. (2016) conducted a meta-analysis to compare male and female nurses’ exposure to workplace aggression and workplace violence separately. While there were some variations across studies, they found that a higher proportion of females than male nurses reported to be victims of workplace aggression, while a significant higher proportion of male nurses than female nurses reported to be victims of workplace violence. Nurses with certain personality traits or characteristics were also more likely to become victims of workplace mistreatment. For example, Zhang et al. (2017) found

Nurses’ experiences of workplace mistreatment  97 that nurses with low empathy levels were more likely to be victims of workplace mistreatment, and Zhou, Yang and Spector (2015) found that nurses with higher levels of interpersonal influence and apparent sincerity (two dimensions of political skill) were exposed to less workplace violence. Samir et al. (2012) found that carelessness and malpractice by nurses were usual causes of workplace mistreatment by patients’ relatives, and Zeller et al. (2012) found that confidence in managing physical aggression positively predicted the odds of exposure to workplace violence. Work-related Factors Many work-related factors may increase the risk of nurses’ exposure to workplace mistreatment. Perhaps the most important factor is the setting in which nurses work. Spector et al. (2014) compared the exposure rates of five different settings, and found that workplace violence was more prevalent in psychiatric (55 percent) units, followed by emergency departments (49.5 percent) and geriatric units (45.9 percent); workplace aggression was most prevalent in emergency departments (81.3 percent), followed by psychiatric units (72.8 percent). Edward et al.’s (2016) meta-analysis found that mental health nurses had a higher risk of being victims of workplace mistreatment than nurses in general hospital units. Other risk factors concern the specific features of nurses’ interactions with people at work. For example, Tang et al. (2007) found that long waiting time was the most common reason for nurses to be victims of workplace violence and aggression; in addition, nurses who were less informed and qualified (i.e., basic level) were more likely to be victims of workplace violence and aggression. Estryn-Behar et al. (2008) found that low quality of teamwork and uncertainty regarding treatment were also risk factors for more exposure to workplace mistreatment. A few specific work-related features for the nursing profession were also found to relate to nurses’ exposure to workplace mistreatment. Camerino et al. (2008) found that uncertainty of patients’ treatment, role conflicts and ambiguity, and time pressure all positively predicted nurses’ exposure to mistreatment from supervisors, co-workers, and patients/relatives. Positive interpersonal interactions with others at work, on the other hand, negatively predicted nurses’ exposure to mistreatment from supervisors, co-workers, and patients/relatives. Last, they found that the frequency of having lifting and bending postures positively predicted nurses’ exposure to mistreatment from supervisors and patients/relatives, but not from co-workers. Guidroz et al. (2010) found that lack of social support and high workload related to nurses’ experience of incivility from co-workers, supervisors, physicians, and patients/visitors, while uncertainty with treatment was associated with incivility from physicians. Smith, Morin and Lake (2018) found that various features of positive work environments negatively related to nurses’ reports of co-worker incivility. These features included nurse managers’ ability, leadership, and support; staffing and resource adequacy; nurses’ participation in hospital affairs; nursing foundations for quality of care; and collegial nurse–physician relationships.

98  Handbook of research on stress and well-being in the public sector Organizational cultures/climate are also important factors affecting nurses’ exposure to mistreatment. For example, Spector, Yang and Zhou (2015) found that nurses experiencing a higher level of violence prevention climate were less likely to be victims of workplace violence and workplace aggression. Blackstock, Salami and Cummings (2018) conducted an integrative review on exposure to horizontal violence (violence from co-workers) among nurses. They found that 19 organizational antecedents could be further categorized into the four themes of: influential working conditions (e.g., job control); relational aspects of teams and leadership (e.g., collegial work teams); organizational culture/climate; and the role of structural process (e.g., hierarchy of decision-making). Summary Consistent with findings from the workforce literature, nurses with certain characteristics, who worked in unique settings, or experienced certain work-related factors are at a higher risk of being victims of workplace mistreatment. These findings suggest that hospitals and leaders in the nursing profession should recognize these risk factors and devote resources to training nurses (e.g., increasing political skill or empathy) and improving conditions in the workplace (e.g., increasing social support and organizational climate) to reduce nurses’ exposure to workplace mistreatment.

WORKPLACE MISTREATMENT PREVENTION AND INTERVENTIONS Despite the wide acknowledgment that workplace mistreatment is an important issue in the nursing industry and that appropriate training programs and interventions are needed, such trainings and interventions are not prevalent (Beech & Leather, 2006). Further, such training programs and interventions are not always effective. Heckemann et al. (2014) conducted a narrative review of studies on the effectiveness of aggression management training programs for nurses and nursing students working in acute hospital settings. They found that while training improved participants’ confidence, attitudes, skills, and knowledge about risk factors, it did not reduce the actual exposure to patient aggression. On the positive side, some training/interventions were effective in reducing the occurrence of workplace mistreatment. For example, Lanza, Kazis and Lee (2003) developed a protocol for the Violence Prevention Community Meeting (VPCM) involving all staff and patients in psychiatric wards or institutions, which has been found to be effective in reducing the occurrence of aggression from patients (Lanza et al., 2009). Fitzwater and Gates (2002) examined the effectiveness of a four-hour assault prevention education intervention to reduce residents’ assaults towards certified nursing assistants (CNAs) in nursing homes. It was found that those in the intervention group reported fewer physical assaults and increased levels of knowl-

Nurses’ experiences of workplace mistreatment  99 edge and confidence in their ability to manage aggressive behavior than those in the control group. In some cases, interventions were only partially effective. For example, Gates, Fitzwater and Succop (2005) evaluated the effectiveness of an intervention that involved nine one-hour group sessions that were developed based on social cognitive theory (SCT). While the intervention seemed to improve nurses’ knowledge, self-efficacy and violence prevention skills, it did not show a significant effect in reducing the occurrence of assaults. Laschinger and Grau (2012) examined the impact of a workplace intervention named Civility, Respect, and Engagement in the Workplace (CREW) on nurse empowerment and experiences of incivility from supervisors and co-workers. The six-month intervention involved promoting respectful interactions among staff in the unit through weekly meetings, by developing skills in conflict management, team building within the unit, sharing successes within and outside the units, and eliminating negative communication associated with poor resources. The intervention was found to be effective in promoting nurses’ empowerment and reducing supervisor incivility but not in reducing co-worker incivility. Some research findings were contradictory to expectations. For example, Bowers et al. (2006) examined the effectiveness of a five-day course covering topics on prediction, anticipation, and prevention of workplace violence. A retrospective analysis of 312 nursing course attendees over 2.5 years found that there was no decline in incident rates but, rather, a small increase. Summary While there is consensus among researchers that workplace mistreatment is detrimental and effective training/interventions are needed to prevent them, there is less consistency on the availability and/or effectiveness of such training/interventions for nurses. Thus, it is important for researchers to continue developing, evaluating, and implementing workplace mistreatment prevention training and interventions for nurses.

CONCLUSION In this chapter, we reviewed nurses’ exposure to workplace mistreatment in terms of their prevalence rates, potential antecedents and consequences, nurses’ coping strategies, and findings on training/intervention strategies. A few main themes emerged from the findings of reviewed empirical studies. First, nurses are at a high risk of experiencing various forms of workplace mistreatment, including workplace incivility, workplace bullying, sexual harassment, workplace aggression, and workplace violence. Second, patients, patients’ visitors, physicians, co-workers, and supervisors can all be potential perpetrators of workplace mistreatment against nurses. This puts nurses at an even higher risk of becoming victims of workplace mistreatment. Third, experiences of workplace mistreatment have detrimental effects on nurses’ health

100  Handbook of research on stress and well-being in the public sector and well-being, emotions and attitudes, as well as their behavior at work and after work. Fourth, while nurses may be more likely to become victims of workplace mistreatment because of their individual characteristics, they are more likely to experience workplace mistreatment due to work-related factors. Fifth, training programs and interventions designed to prevent the occurrence of workplace mistreatment have inconsistent findings. Thus, it is important to focus on changing work-related risk factors.

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Nurses’ experiences of workplace mistreatment  101 Camerino, D., Estryn-Behar, M., Conway, P.M., Van der Heijden, B.I.J., & Hasselhorn, H. (2008), ‘Work-related factors and violence among nursing staff in the European NEXT study: a longitudinal cohort study’, International Journal of Nursing Studies, 45(1), 35–50. Campana, K.L., & Hammoud, S. (2015), ‘Incivility from patients and their families: can organisational justice protect nurses from burnout?’, Journal of Nursing Management, 23(6), 716–725. Campbell, J.C., Messing, J.T., Kub, J., Agnew, J., Fitzgerald, S., Fowler, B.,. . .Bolyard, R. (2011), ‘Workplace violence: prevalence and risk factors in the safe at work study’, Journal of Occupational and Environmental Medicine, 53(1), 82–89. Chang, H.E., & Cho, S.H. (2016), ‘Workplace violence and job outcomes of newly licensed nurses’, Asian Nursing Research, 10(4), 271–276. Chapman, R., Perry, L., Styles, I., & Combs, S. (2009), ‘Consequences of workplace violence directed at nurses’, British Journal of Nursing, 18(20), 1256–1261. Cheung, T., & Yip, P.S.F. (2017), ‘Workplace violence towards nurses in Hong Kong: prevalence and correlates’, BMC Public Health, 17(1), 196. Clarke, C.M., Kane, D.J., Rajacich, D.L., & Lafreniere, K.D. (2012), ‘Bullying in undergraduate clinical nursing education’, The Journal of Nursing Education, 51(5), 269–276. da Silva, A.T.C., Peres, M.F.T., de Souza Lopes, C., Schraiber, L.B., Susser, E., & Menezes, P.R. (2015), ‘Violence at work and depressive symptoms in primary health care teams: a cross-sectional study in Brazil’, Social Psychiatry and Psychiatric Epidemiology, 50(9), 1347–1355. Demir, D., & Rodwell, J. (2012), ‘Psychosocial antecedents and consequences of workplace aggression for hospital nurses’, Journal of Nursing Scholarship, 44(4), 376–384. Edward, K.L., Stephenson, J., Ousey, K., Lui, S., Warelow, P., & Giandinoto, J.A. (2016), ‘A systematic review and meta-analysis of factors that relate to aggression perpetrated against nurses by patients/relatives or staff’, Journal of Clinical Nursing, 3(25), 289–299. Estryn-Behar, M., Van der Heijden, B., Camerino, D., Fry, C., Le Nezet, O., Conway, P.M., & Hasselhorn, H.M. (2008), ‘Violence risks in nursing – results from the European “NEXT” study’, Occupational Medicine, 58(2), 107–114. Farrell, G.A., Bobrowski, C., & Bobrowski, P. (2006), ‘Scoping workplace aggression in nursing: findings from an Australian study’, Journal of Advanced Nursing, 55(6), 778–787. Fida, R., Laschinger, H.K.S., & Leiter, M.P. (2018), ‘The protective role of self-efficacy against workplace incivility and burnout in nursing: a time-lagged study’, Health Care Management Review, 43(1), 21–29. Fitzwater, E.L., & Gates, D.M. (2002), ‘Testing an intervention to reduce assaults on nursing assistants in nursing homes: a pilot study’, Geriatric Nursing, 23(1), 18–23. Gacki-Smith, J., Juarez, A.M., Boyett, L., Homeyer, C., Robinson, L., & MacLean, S.L. (2009), ‘Violence against nurses working in US emergency departments’, The Journal of Nursing Administration, 39(7–8), 340–349. Galián-Muñoz, I., Ruiz-Hernández, J.A., Llor-Esteban, B., & López-García, C. (2016), ‘User violence and nursing staff burnout: the modulating role of job satisfaction’, Journal of Interpersonal Violence, 31(2), 302–315. Ganz, F.D., Levy, H., Khalaila, R., Arad, D., Bennaroch, K., Kolpak, O.,. . .Raanan, O. (2015), ‘Bullying and its prevention among intensive care nurses’, Journal of Nursing Scholarship, 47(6), 505–511. Gates, D., Fitzwater, E., & Succop, P. (2005), ‘Reducing assaults against nursing home caregivers’, Nursing Research, 54(2), 119–127. Gong, Y., Han, T., Yin, X., Yang, G., Zhuang, R., Chen, Y., & Lu, Z. (2014), ‘Prevalence of depressive symptoms and work-related risk factors among nurses in public hospitals in southern China: a cross-sectional study’, Scientific Reports, 4, 7109.

102  Handbook of research on stress and well-being in the public sector Goussinsky, R., & Livne, Y. (2016), ‘Coping with interpersonal mistreatment: the role of emotion regulation strategies and supervisor support’, Journal of Nursing Management, 24(8), 1109–1118. Guidroz, A.M., Burnfield-Geimer, J.L., Clark, O., Schwetschenau, H.M., & Jex, S.M. (2010), ‘The nursing incivility scale: development and validation of an occupation-specific measure’, Journal of Nursing Measurement, 18(3), 176–200. Hahn, S., Müller, M., Needham, I., Dassen, T., Kok, G., & Halfens, R.J.G. (2010), ‘Factors associated with patient and visitor violence experienced by nurses in general hospitals in Switzerland: a cross-sectional survey’, Journal of Clinical Nursing, 19(23–24), 3535–3546. Heckemann, B., Zeller, A., Hahn, S., Dassen, T., Schols, J., & Halfens, R. (2014), ‘The effect of aggression management training programmes for nursing staff and students working in an acute hospital setting. A narrative review of current literature’, Nurse Education Today, 35(1), 212–219. ILO/ICN/WHO/PSI (2002), Framework guidelines for addressing workplace violence in the health sector. Geneva: International Labour Organization/International Council of Nurses/ World Health Organization/Public Services International. Jafree, S.R. (2017), ‘Workplace violence against women nurses working in two public sector hospitals of Lahore, Pakistan’, Nursing Outlook, 65(4), 420–427. Jeong, I.Y., & Kim, J.S. (2018), ‘The relationship between intention to leave the hospital and coping methods of emergency nurses after workplace violence’, Journal of Clinical Nursing, 27(7–8), 1692–1701. Johnson, S.L., & Rea, R.E. (2009), ‘Workplace bullying: concerns for nurse leaders’, The Journal of Nursing Administration, 39(2), 84–90. Kamchuchat, C., Chongsuvivatwong, V., Oncheunjit, S., Yip, T.W., & Sangthong, R. (2008), ‘Workplace violence directed at nursing staff at a general hospital in southern Thailand’, Journal of Occupational Health, 50(2), 201–207. Lam, L.T. (2002), ‘Aggression exposure and mental health among nurses’, AeJAMH (Australian e-Journal for the Advancement of Mental Health), 1(2), 1–12. Lanza, M.L., Kazis, L., & Lee, A. (2003), ‘Using the Violence Prevention Community Meeting protocol’, Journal of the American Psychiatric Nurses Association, 9(3), 86–89. Lanza, M.L., Rierdan, J., Forester, L., & Zeiss, R.A. (2009), ‘Reducing violence against nurses: the Violence Prevention Community Meeting’, Issues in Mental Health Nursing, 30(12), 745–750. Laschinger, H.K.S., Cummings, G., Leiter, M., Wong, C., MacPhee, M., Ritchie, J.,. . .Read, E. (2016), ‘Starting out: a time-lagged study of new graduate nurses’ transition to practice’, International Journal of Nursing Studies, 57, 82–95. Laschinger, H.K.S., & Grau, A.L. (2012), ‘The influence of personal dispositional factors and organizational resources on workplace violence, burnout, and health outcomes in new graduate nurses: a cross-sectional study’, International Journal of Nursing Studies, 49(3), 282–291. Leiter, M.P., Price, S.L., & Laschinger, H.K.S. (2010), ‘Generational differences in distress, attitudes and incivility among nurses’, Journal of Nursing Management, 18(8), 970–980. Lewis, P.S., & Malecha, A. (2011), ‘The impact of workplace incivility on the work environment, manager skill, and productivity’, The Journal of Nursing Administration, 41(1), 41–47. Mahoney, B.S. (1991), ‘The extent, nature, and response to victimization of emergency nurses in Pennsylvania’, Journal of Emergency Nursing: JEN, 17(5), 282–291. McCord, M.A., Joseph, D.L., Dhanani, L.Y., & Beus, J.M. (2017), ‘A meta-analysis of sex and race differences in perceived workplace mistreatment’, Journal of Applied Psychology, 103(2), 137–163.

Nurses’ experiences of workplace mistreatment  103 Miranda, H., Punnett, L., & Gore, R.J. (2014), ‘Musculoskeletal pain and reported workplace assault: a prospective study of clinical staff in nursing homes’, Human Factors, 56(1), 215–227. Nijman, H., Bowers, L., Oud, N., & Jansen, G. (2005), ‘Psychiatric nurses’ experiences with inpatient aggression’, Aggressive Behavior, 31(3), 217–227. NIOSH (1996), ‘Violence in the workplace’. DHHS (NIOSH) Publication Number 96–100. Accessed November 2018 at https://​www​.cdc​.gov/​niosh/​docs/​96​-100/​introduction​.html. Opie, T., Lenthall, S., Dollard, M., Wakerman, J., MacLeod, M., Knight, S.,. . .Rickard, G. (2010), ‘Trends in workplace violence in the remote area nursing workforce’, Australian Journal of Advanced Nursing, 27(4), 18–23. Pai, H.C., & Lee, S. (2011), ‘Risk factors for workplace violence in clinical registered nurses in Taiwan’, Journal of Clinical Nursing, 20(9–10), 1405–1412. Park, M., Cho, S.H., & Hong, H.J. (2015), ‘Prevalence and perpetrators of workplace violence by nursing unit and the relationship between violence and the perceived work environment’, Journal of Nursing Scholarship, 47(1), 87–95. Pekurinen, V., Willman, L., Virtanen, M., Kivimäki, M., Vahtera, J., & Välimäki, M. (2017), ‘Patient aggression and the wellbeing of nurses: a cross-sectional survey study in psychiatric and non-psychiatric settings’, International Journal of Environmental Research and Public Health, 14(10), 1245. Porath, C., & Pearson, C. (2013), ‘The price of incivility’, Harvard Business Review, 91(1–2), 114–121. Purpora, C., & Blegen, M.A. (2015), ‘Job satisfaction and horizontal violence in hospital staff registered nurses: the mediating role of peer relationships’, Journal of Clinical Nursing, 24(15–16), 2286–2294. Roche, M., Diers, D., Duffield, C., & Catling-Paull, C. (2010), ‘Violence toward nurses, the work environment, and patient outcomes’, Journal of Nursing Scholarship, 42(1), 13–22. Roh, Y.H., & Yoo, Y.S. (2012), ‘Workplace violence, stress, and turnover intention among perioperative nurses’, Korean Journal of Adult Nursing, 24(5), 489–498. Rowe, M.M., & Sherlock, H. (2005), ‘Stress and verbal abuse in nursing: do burned out nurses eat their young?’, Journal of Nursing Management, 13(3), 242–248. Samir, N., Mohamed, R., Moustafa, E., & Abou Saif, H. (2012), ‘Nurses’ attitudes and reactions to workplace violence in obstetrics and gynaecology departments in Cairo hospitals’, Eastern Mediterranean Health Journal, 18(3), 198–204. Sato, K., Yumoto, Y., & Fukahori, H. (2016), ‘How nurse managers in Japanese hospital wards manage patient violence toward their staff’, Journal of Nursing Management, 24(2), 164–173. Schat, A.C.H., Frone, M.R., & Kelloway, E.K. (2006), ‘Prevalence of workplace aggression in the US workforce: findings from a national study’. In E.K. Kelloway, J. Barling, & J.J. Burrell (Eds.), Handbook of workplace violence. Thousand Oaks, CA: Sage, pp. 47–89. Shea, T., Sheehan, C., Donohue, R., Cooper, B., & De Cieri, H. (2017), ‘Occupational violence and aggression experienced by nursing and caring professionals’, Journal of Nursing Scholarship, 49(2), 236–243. Silva, A., Peres, M., Lopes, C., Schraiber, L., Susser, E., Menezes, P.,. . .Menezes, P.R. (2015), ‘Violence at work and depressive symptoms in primary health care teams: a cross-sectional study in Brazil’, Social Psychiatry & Psychiatric Epidemiology, 50(9), 1347–1355. Sisawo, E.J., Arsène Ouédraogo, S.Y.Y., & Huang, S.-L. (2017), ‘Workplace violence against nurses in the Gambia: mixed methods design’, BMC Health Services Research, 17, 1–11. Skogstad, A., Einarsen, S., Torsheim, T., Aasland, M.S., & Hetland, H. (2007), ‘The destructiveness of laissez-faire leadership behavior’, Journal of Occupational Health Psychology, 12(1), 80–92. Smith, J.G., Morin, K.H., & Lake, E.T. (2018), ‘Association of the nurse work environment with nurse incivility in hospitals’, Journal of Nursing Management, 26(2), 219–226.

104  Handbook of research on stress and well-being in the public sector Smith, L.M., Andrusyszyn, M.A., & Laschinger, H.K.S. (2010), ‘Effects of workplace incivility and empowerment on newly-graduated nurses’ organizational commitment’, Journal of Nursing Management, 18(8), 1004–1015. Spector, P.E., Yang, L.Q., & Zhou, Z.E. (2015), ‘A longitudinal investigation of the role of violence prevention climate in exposure to workplace physical violence and verbal abuse’, Work & Stress, 29(4), 325–340. Spector, P.E., Zhou, Z.E., & Che, X.X. (2014), ‘Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: a quantitative review’, International Journal of Nursing Studies, 1(51), 72–84. Stone, T., McMillan, M., Hazelton, M., & Clayton, E.H. (2011), ‘Wounding words: swearing and verbal aggression in an inpatient setting’, Perspectives in Psychiatric Care, 47(4), 194–203. Tang, J.S., Chen, C.L., Zhang, Z.R., & Wang, L. (2007), ‘Incidence and related factors of violence in emergency departments – a study of nurses in southern Taiwan’, Journal of the Formosan Medical Association, 106(9), 748–758. Thinkhamrop, W., & Laohasiriwong, W. (2015), ‘Factors associated with musculoskeletal disorders among registered nurses: evidence from the Thai nurse cohort study’, Kathmandu University Medical Journal (KUMJ), 13(51), 238–243. Trahan, R.L., & Bishop, S.L. (2016), ‘Coping strategies of neurology nurses experiencing abuse from patients and families’, The Journal of Neuroscience Nursing, 48(3), 118–123. Truman, A., Goldman, M., Lehna, C., Berger, J., & Topp, R. (2013), ‘Verbal abuse of pediatric nurses by patients and families’, Kentucky Nurse, 61(1), 6–8. Vandecasteele, T., Van Hecke, A., Duprez, V., Beeckman, D., Debyser, B., Grypdonck, M., & Verhaeghe, S. (2017), ‘The influence of team members on nurses’ perceptions of transgressive behaviour in care relationships: a qualitative study’, Journal of Advanced Nursing, 73(10), 2373–2384. Vander Elst, T., Cavents, C., Daneels, K., Johannik, K., Baillien, E., Van den Broeck, A., & Godderis, L. (2016), ‘Job demands–resources predicting burnout and work engagement among Belgian home health care nurses: a cross-sectional study’, Nursing Outlook, 64(6), 542–556. Vessey, J.A., Demarco, R.F., Gaffney, D.A., & Budin, W.C. (2009), ‘Bullying of staff registered nurses in the workplace: a preliminary study for developing personal and organizational strategies for the transformation of hostile to healthy workplace environments’, Journal of Professional Nursing, 25(5), 299–306. Vogelpohl, D.A., Rice, S.K., Edwards, M.E., & Bork, C.E. (2013), ‘New graduate nurses’ perception of the workplace: have they experienced bullying?’, Journal of Professional Nursing, 29(6), 414–422. Wei, C.Y., Chiou, S.T., Chien, L.Y., & Huang, N. (2016), ‘Workplace violence against nurses – prevalence and association with hospital organizational characteristics and health-promotion efforts: cross-sectional study’, International Journal of Nursing Studies, 56, 63–70. Yang, B.X., Stone, T.E., Petrini, M.A., & Morris, D.L. (2018), ‘Incidence, type, related factors, and effect of workplace violence on mental health nurses: a cross-sectional survey’, Archives of Psychiatric Nursing, 32(1), 31–38. Yokoyama, M., Suzuki, M., Takai, Y., Igarashi, A., Noguchi-Watanabe, M., & Yamamoto-Mitani, N. (2016), ‘Workplace bullying among nurses and their related factors in Japan: a cross-sectional survey’, Journal of Clinical Nursing, 25(17–18), 2478–2488. Zampieron, A., Galeazzo, M., Turra, S., & Buja, A. (2010), ‘Perceived aggression towards nurses: study in two Italian health institutions’, Journal of Clinical Nursing, 19(15–16), 2329–2341.

Nurses’ experiences of workplace mistreatment  105 Zeller, A., Dassen, T., Kok, G., Needham, I., & Halfens, R.J.G. (2012), ‘Factors associated with resident aggression toward caregivers in nursing homes’, Journal of Nursing Scholarship, 44(3), 249–257. Zeng, J.Y., An, F.R., Xiang, Y.T., Qi, Y.K., Ungvari, G.S., Newhouse, R.,. . .Chiu, H.F.K. (2013), ‘Frequency and risk factors of workplace violence on psychiatric nurses and its impact on their quality of life in China’, Psychiatry Research, 210(2), 510–514. Zhang, L., Wang, A., Xie, X., Zhou, Y., Li, J., Yang, L., & Zhang, J. (2017), ‘Workplace violence against nurses: a cross-sectional study’, International Journal of Nursing Studies, 72, 8–14. Zhou, Z.E., Yang, L.Q., & Spector, P.E. (2015), ‘Political skill: a proactive inhibitor of workplace aggression exposure and an active buffer of the aggression–strain relationship’, Journal of Occupational Health Psychology, 20(4), 405–419.

8. Emotions in nursing Gillian Lewis and Neal M. Ashkanasy

EMOTIONS IN NURSING In this chapter, we analyze the role of emotions in nursing. Our analysis is based on Ashkanasy’s ‘five level model of emotion in organizations’ (Ashkanasy, 2003, p. 9; see also Ashkanasy & Dorris, 2017), where emotions play a role at five levels of analysis ranging from within-person temporal variations in emotion through to emotion effects of the organization as a whole. We address health care organizations in particular, which face barriers to quality care because of financial constraints (Zietlow et al., 2018), increases in acuity, chronic disease, and changes to consumer expectations (Ginter, Duncan, & Swayne, 2018). These factors place stress on the ability of the health care workforce to provide a necessary level of care and can result in poor workforce outcomes and decreased retention. As such, it seems that nurses need a high level of interpersonal skill to manage the demands of emotional engagement during compassionate care (Jack & Wibberley, 2014; Shirey, 2007). We use the term ‘compassion’ to describe feelings of connectedness to another and a desire to alleviate suffering. In this regard, Cassell (2002) points out that compassion relates to but is not the same as empathy or sympathy. Unfortunately, evidence suggests that by engaging in compassionate care, nurses may be at risk of emotional distress and burnout. This presents as a risk to quality in patient care, highlighted in the ‘Francis Report’ (Francis, 2013) linking poor standards of care to a lack of compassion and emotional engagement by nurses with their patients. Subsequent to this, Francis recommended that nurses needed to practice their profession with compassion. In effect, he recommended that nurses must engage emotionally with patients to improve quality care. Similarly, there has been an international trend to incorporate compassion and empathy as performance indicators for nursing professional practice, competence, and ethics (e.g., see International Council of Nurses, 2018; Nursing and Midwifery Board of Australia, 2016). These prescriptive requirements present a challenge for nurses insofar as they must accommodate the adverse effects of emotional distress (Arieli, 2013; Curtis, 2014). Indeed, the contentious nature of emotions in nursing practice has seen ongoing discussion for decades. It is also a defining feature of the culture of health care organizations. We thus begin with a look at the historical background for this debate.

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ORGANIZATIONAL CULTURE IN HEALTH CARE Nursing scholars argue that emotional engagement is an essential but invisible component of nursing practice. As long as 60 years ago, Menzies (1960) identified that, to buffer the risk of emotional distress, nurses must adopt a task-based approach to patient care, thereby avoiding emotional involvement with their patients. Decades later, scholars writing in the nursing literature still struggle with the issues that Menzies raised. More recently, scholars (e.g., see Delgado et al., 2017; Karimi et al., 2014; Pisaniello, Winefield, & Delfabbro, 2012) argue that the particular value emotional engagement brings to nursing practice and quality care can be represented within the literature on emotional labor. The term ‘emotional labor’ describes the use of display rules in paid employment and in general focuses on the expression or suppression of emotions (Grandey, 2000; Hochschild, 1983). Emotional labor also describes the tacit way that human service employees (such as nurses) manage their own emotions at work (Humphrey, 2006). Another misguided view that remains in health care is that emotion in the workplace is potentially disruptive and thus increases the risk of workplace inefficiency (Mark, 2005). By way of explanation, Humphrey, Pollack and Hawver (2008) argue that organizationally mandated rationality tends to overshadow the emotional side of management in health care, which is traditionally associated with conflict management. To set the scene for this view, we discuss the historical origins of emotion in Western philosophy to explain the subordinate role of emotion in health care. Ashforth and Humphrey (1995) point out that, in the traditional view, Western managers see emotions as unintellectual and usually associated with negative human traits, vices, and sins. Plato’s description of souls considers that emotions and feelings are less intellectual than the spiritual and rational souls. In this point of view, the rational soul is deemed to consist of reason, justification, and truth. In this regard, Oatley (2004) points out that although Aristotle believed that certain emotions, including virtue, were essential to a morally good life, the basic emotions were kept in line by higher-order intellect and reasoning. More recently, however, other philosophers (who class emotions as virtues and as important to well-being as reason and logic) strongly contest this idea (e.g., Oatley). The dichotomy between emotion and intelligence is thus clear in the writings of ancient Greek philosophers who viewed emotion, passion, and reason as conflicting elements in human behavior (Lazarus, 1999). In the Middle Ages, people considered emotions such as greed, pride, lust, and envy as sins, and other emotions such as love, hope, and faith as virtues (Dalgleish & Power, 1999). With the changes that occurred during the Reformation, seventeenth-century philosophers Descartes (1595–1650) and Spinoza (1632–77) introduced scientific explanations for emotion. This led to the theory that emotion is a ‘passion’ and, as such, firmly rooted in the human soul, governed by reasoning and logical thought (Lyons, 1980). This theory provides us with the basis for the present analytical and rationalist view of intelligence (Dalgleish & Power, 1999). In short,

108  Handbook of research on stress and well-being in the public sector the prevailing argument is that people guided by logic and reason prospered, while those driven by emotion are somehow ‘mentally ill’. Early in the twentieth century, however, William James and Carl Lange finally established a scientific basis for emotional control. Modern philosophers and scientists now accept that there are neurobiological foundations for emotion (Chrousos & Gold, 1992; Salovey et al., 2000). Erickson and Grove (2008) point out that the existing biomedical model of health care has neglected the emotional engagement aspect of compassionate care (because of the longstanding focus on rationality). Huynh, Alderson and Thompson (2008) note further that codes of professional nursing practice require nurses to demonstrate the skills of compassion and engagement but do not elaborate on how the nurses acquire these skills. Furthermore, the evidence tells us that health care administrators tend to manage emotional distress poorly, and that this also follows through to health care educational settings (Curtis, 2014; Evans & Kelly, 2004; Parry, 2011). Proponents of the clinical decision-making models (CDMs; see Banning, 2008), adopted in health care are based on a medically orientated framework. For example, the information processing model focuses on logic and rationality rather than emotion. Clearly, there is a tension here; nursing practice is inherently emotional, and it is within this environment that CDM models promote a focus on factual evidence by excluding emotion, thereby reducing the potential for bias. In this regard, emotional labor would seem to play a strong role and intuitively one would imagine that to regulate emotions within an emotionally charged environment requires some level of emotional intelligence (EI; Mayer & Salovey, 1993, 1997). This leaves us with a challenge: how do we overcome the lack of understanding about the role of emotion in nursing practice? In fact, a broad literature relating to the effects of emotional labor in nursing practice already exists (e.g., see Delgado et al., 2017; Pisaniello et al., 2012). To explain the complexity surrounding health care, Watson (2009) argues that organizational demands, financial efficiency, and technological advances all effectively contribute to emotional conflict. Nonetheless, a paradox between emotional engagement and a need to maintain an organizationally prescribed professional persona with limited emotional displays remains. Indeed, emotional labor scholars Diefendorff et al. (2011) show that adherence to organizational display rules improves patient satisfaction, teamwork, and overall productivity. Thus, debate continues about emotional engagement. This is most likely because the relationships between emotion, compassion, and caring are poorly understood (Curtis, 2014). More recently, Ledoux (2015) posits that the emotional value of compassion remains an important issue needing investigation. In particular, health care administrators probably need to place a financial cost on compassion and caring before they come to recognize emotional labor as a tangible organizational asset.

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THE FIVE-LEVEL FRAMEWORK We now turn to a discussion of emotions in nursing practice and use Ashkanasy’s (2003) five-level model of emotion in organizations as our guiding framework. The five levels are (1) within-person temporal variations in emotion; (2) between-persons individual differences in perceiving and managing emotions; (3) interpersonal emotional perception and expression (e.g., emotional labor); (4) emotions in groups and teams; and (5) emotions in the organization as a whole (culture and climate). Level 1: Within-person Temporal Variations Within-person emotions are transitory and result from the daily ‘uplifts and hassles’ that occur at work (Ashkanasy, 2003). Consistent with this idea, we describe emotions in nursing by adopting affective events theory (AET; Weiss & Cropanzano, 1996). AET originated as a research framework for workplace emotion by focusing on the structure, causes, and consequences of affective experiences at work. Weiss and Cropanzano specifically regard situational affective events within the context of existing affect states, emotion responses, and the ability to make judgments. In the past, much of the work around emotions in the workplace has focused on the importance of cognitive judgment, thus separating the affect component relating to job satisfaction. Moreover, scholars who study dispositional models of personality consider that satisfaction goes with personality (Weiss & Cropanzano, 1996). For example, positive people have greater role satisfaction, while those with negative disposition are more likely to become distressed and therefore less satisfied with their role. In AET, Weiss and Cropanzano consider emotions to be affective states and the within-person evaluation of the sensed emotion leads to a response or outcome, which directly influences performance. This is an important issue for nurses, whose administrators expect to manage emotions daily, often in stressful situations. Researchers who adopt AET as an organizing framework (e.g., see Ashton-James & Ashkanasy, 2008; Cropanzano & Dasborough, 2015; Dasborough, 2006; Ohly & Schmitt, 2015; Weiss & Beal, 2005) mainly conducted their studies in the area of organizational behavior, work performance, and employee satisfaction and reported generally confirming results. Weiss and Cropanzano (1996) note in this regard that individual management of emotions changes on a day-to-day basis in line with positive or negative moods. For example, personal grief unrelated to practice may have an impact on how nurses cope during emotional engagement with patients. Moreover, and as Diefendorff, Richard and Yang (2008) found, a residual emotional burden can affect individuals’ ability to manage their emotions. Ashkanasy, Ashton-James and Jordan (2004) support this and argue that, because of ‘transitory emotional states’, individuals may perceive affective events differently depending on their mood state at the time (p. 2). There is, however, little evidence of focused research within the nursing literature on the identification of the kinds of affective events that employees or patients see as adverse. In this regard, Riley and Weiss (2016) found in a recent review that multiple

110  Handbook of research on stress and well-being in the public sector factors come into play within health care organizations, including working conditions, professional and organizational expectations, and sociocultural influences that impede the recognition of emotional labor. As such, understanding the factors that contribute to nurses’ transitory emotion states may be extremely complex. Nonetheless, we know that nurses experience discrete emotions such as transitory fear, anger, sadness, helplessness, joy, and happiness in response to emotional stimuli at work (Stordeur, D’Hoore, & Vandenberghe, 2001). Caring for patients who are suffering or dying and exposure to death (e.g., see Melvin, 2012) are areas that have the potential to result in significant emotional distress in nurses. Other researchers (e.g., see Aradilla-Herrero, Tomás-Sábado, & Gómez-Benito, 2012; Curtis, 2014) report that direct or indirect exposure to emergencies and workplace conflict tend to invoke arousal of emotions and result in emotional distress. While research has shown that mild to moderate stress may be a motivator or challenge and lead to better performance (Hargrove, Becker, & Hargrove, 2015), excessive stress can result in negativity, lower performance, burnout, and increased attrition (Maslach, Schaufeli, & Leiter, 2001). In addition to the risks of poor performance and attrition it needs to be noted also that there is evidence that emotional distress has a negative effect on empathy and compassion and quality of care (Morse et al., 2006; Por et al., 2011). In this regard, if nurses are overwhelmed by their emotions, they may lack the ability to think critically and to provide care. This brings us to emotional well-being. How do nurses gain job satisfaction at work? What are the positive aspects of nursing practice and how may these be further developed? We discuss these further at Level 2: between persons. Level 2: Between-persons Individual Differences Based on Ashkanasy’s (2003) model, emotional well-being is the first dimension of individual differences at Level 2, followed by (dispositional) trait affect, and then emotional intelligence (EI). Emotional well-being is an important consideration given the aforementioned risk of emotional distress. The experience of stress is well documented within the nursing literature (Aiken et al., 2010; Garrosa et al., 2010; Rafferty et al., 2007). Scholars (see Karimi et al., 2014; McQueen, 2004; Vitello-Cicciu, 2003) contend that the construct of EI provides a framework in which to understand and manage responses to emotional demands. We use the Mayer and Salovey (1997) definition of emotional intelligence, where the construct involves four ‘branches’: (1) perceiving emotions; (2) using emotions to facilitate thought; (3) understanding emotions; and (4) managing emotions in self and others. The idea that EI plays a role in employees’ responses to emotional stimuli in the workplace has received some support, with meta-analytic evidence that EI (particularly in the emotion management branch of EI) predicts job performance in high emotional labor roles (Joseph & Newman, 2010). In the context of health care, McQueen (2004) argues that nurses need to use the EI skills of perception, facilitation, understanding, and management of own and others’ emotions to provide holistic care to the patient. Increasing interest in the

Emotions in nursing  111 value of EI to nursing has resulted in a growing literature in the undergraduate and postgraduate domains as well as professional practice. Emotional intelligence has been related to cognitive intelligence and developed through experience (Mayer, Salovey, & Caruso, 2004). Also, researchers consider that EI is a form of intelligence vital for perception and management of emotional information, which assists in problem solving (Mayer, Salovey, & Caruso, 2008). Additionally, studies have shown that EI was associated with the ability to cope in adverse situations primarily through adaptive stress management (Begley & Glacken, 2004; Birks, McKendree, & Watt, 2009; Ciarrochi, Chan, & Caputi, 2000). A more recent rendition of the definition describes EI as ‘the ability to carry out accurate reasoning about emotions and the ability to use emotions and emotional knowledge to enhance thought’ (Mayer, Roberts, & Barsade, 2008, p. 511). During the last 20 years, interest in the concept of EI has proliferated in the areas of psychology, social science, education, health care, and organizational development (e.g., see Bar-On, 2000; Ciarrochi et al., 2000; Goleman, 1995; Jordan, Murray, & Lawrence, 2009; Mayer & Salovey, 1993; Petrides & Furnham, 2003; Schutte et al., 1998). Similarly, there is a growing literature about the importance of nurses’ EI to improve both clinical performance and patient care (e.g., see Beauvais et al., 2011; Kooker, Shoultz, & Codier, 2007; McQueen, 2004; Por et al., 2011; Rankin, 2013). Other research has supported the proposition that higher levels of EI contribute to a reduction in the risk of emotional distress (Augusto-Landa et al., 2008; Austin, Dore, & O’Donovan, 2008). Also, Adams and Iseler (2014) found in a preliminary study that EI does have an impact on quality of care (although work in this area is still in its infancy). Notwithstanding this, there is much uncertainty about the influence of EI on the perception and management of the demands of emotional engagement during nursing practice. Level 3: Interpersonal Interactions Interest in the emotional labor that nurses undertake during patient care has stemmed from research surrounding burnout and attrition in the nursing workforce. Hochschild (1983) defined emotional labor as the expression or suppression of emotions as a part of display rules (for example, maintaining a smiling face to keep customers happy) that are required in paid employment and usually dictated by organizational policies. In this regard, there is an extensive body of nursing literature surrounding the need for emotional labor during nursing care (Curtis, 2014; Gray, 2009; Smith, 1991; Theodosius, 2006). Furthermore, Brunton (2005) and Diefendorff et al. (2011) suggest that the psychological effect on nurses (through engaging in emotional labor) is more marked when compared to other service professions. We discuss emotional labor in this section to link nursing practice with the health care multidisciplinary workforce. As Grandey (2000) notes, managers and administrators consider the emotion display rules of nursing (expressing positive emotion and suppressing negative emotion) as a professional and organizational requirement. The presence of covert

112  Handbook of research on stress and well-being in the public sector rules of nursing practice also remains – for example, advice to avoid becoming emotionally involved with patients (Maben, Latter, & Clark, 2006; Menzies, 1960). A further issue is that Hochschild (1983) argued that display rules are latent and an expected norm, as opposed to a job competency (which is usually clearly stated in a role description). In a review of emotions in health care, Theodosius (2006) claimed that, while Hochschild (1983) made clearer the societal expectations and use of emotion, the subconscious management of emotional interaction, within an organizational and educational context, nonetheless remained unseen. Thirty years ago, James (1989) argued that the practice of emotional labor in nursing remained unaccounted for and undefined. She noted that this resulted from the association of caring with women’s domestic functions. More recently, Maben (2008) furthered this idea by suggesting that the caring aspect of nursing was not measurable in terms of units of quantity. Consequently, emotional labor remains invisible still today, especially when compared to activities normally documented on a care plan. The challenge to recognition of the performance of emotional labor lies in its subjectivity, making it difficult to measure and codify as part of a health care goods exchange (Gray & Smith, 2009; Huynh et al., 2008). Nonetheless, Diefendorff and his associates (2011) argue that adherence to organizational display rules improves patient satisfaction, teamwork, and overall productivity. Gabriel, Diefendorff, & Erickson (2011) also found that a positive relationship between nurses and physicians moderated the negative effects of indirect task completion. For example, failure to complete documentation in a timely manner is less likely to result in negative emotions if the relationship between nurses and physicians was supportive. This provides us with further evidence that nurses see a value in caring and compassion and so, in this regard, emotional labor may be a positive rather than a negative component of the nursing role. Although researchers have yet to examine specifically the relationships between emotion, task completion, and levels of EI, it nonetheless seems reasonable to expect the effects of emotional labor to be influenced by emotion perception and ability to regulate emotion. This brings us back to the notion that the value of care and compassion sit at the within-person and between-persons levels of analysis. The key role played by emotional labor in nursing is emphasized in the work of Meier (2006), who contends that emotional labor facilitates personal interactions, which allow more effective workplace performance and improved outcomes. Recently, Peart, Roan and Ashkanasy (2012) pointed out that emotional labor continues to be an expected part of nursing work. Nonetheless, while employee emotional labor may lead to positive outcomes for the organization, Mann and her colleagues (Mann, 2004; Mann & Cowburn, 2005) report that the pressure to conform to display rules and professional norms is associated with adverse effects. This was identified as a risk, particularly in resource-poor organizations such as health care (Bennett & Lowe, 2008; Fairchild, 2010; Gilbert, Laschinger, & Leiter, 2010; Maben, 2008). Within the nursing literature, Boucher (2016) found that female nurse managers are more likely to engage in emotional labor by surface acting as a conscious effort to avoid conflict and the unequal power

Emotions in nursing  113 distance between health care administration or professional groups. The relevance of this lies in the longer-term effect of emotional labor on the risk of burnout and attrition. Therefore, groups and teams working in health care clearly need to adopt a collaborative and collegial approach to ensure a proactive approach to the provision of quality health care. The management of emotions within groups and teams often follows an organizational directive, based in values and administrative requirements. We discuss this level next. Level 4: Groups and Teams As we highlighted earlier, nursing is a high emotional labor role. In this case, providing high-quality compassionate care requires a collaborative effort between multidisciplinary groups and stakeholders. Well-performing teams/groups have been identified in the nursing literature as being significantly related to quality care outcomes and workforce satisfaction. Nonetheless, emotional labor in health care organizations remains linked to ‘women’s work’ and is not just limited to caring for patients (Badolamenti et al., 2017; Riley & Weiss, 2016). The increasing complexity, reliance of delegation of task to unskilled workers, and continuing dominance of the medical profession overshadows and thus devalues emotional labor and caring (Gray, 2009). Nurses describe conforming to display rules by performing emotional labor, specifically surface acting with members of the multidisciplinary team that they work with to meet organizational demands (Badolamenti et al., 2017; Riley & Weiss, 2016). In this regard, Boucher (2016) identified that female managers in particular are more likely to adopt a surface acting approach when dealing with inappropriate displays of emotion from superiors or senior members of the multidisciplinary team. Subsequently, female managers are more likely to suffer the negative effects of emotional labor. Boundary-spanning or collaborative working across organizations has seen particular attention in recent years (Needham, Mastracci, & Mangan, 2017; M. Williams, 2007; P. Williams, 2012). The concept of boundary-spanning recognizes the emotional labor undertaken by employees working between networks of employees and independent health care practitioners. In this regard, health care organizations comprise a wide range of professionals reporting to both the health care management, to government licensing bodies, and also to their own professional agencies. Thus, health care leadership is more complex than other organizations insofar as significant emotional labor is imparted within and between the leadership and professions in regard to the delivery of quality care and efficient use of resources (Brandao de Souza, 2009). Here we adopt the theory of boundary-spanning between nursing, leadership, and interdisciplinary professions as a vehicle to recognize and value emotional labor as an integral part of health care. We argue that nurses need to engage in emotional labor and emotion regulation not only during patient interaction but also with the many collaborations with other professions and stakeholders in the health care environment.

114  Handbook of research on stress and well-being in the public sector Level 5: The Organization The nature of emotions at Level 5 in health care organizations is complex, with competing demands from an expectant public, increased acuity and presence of chronic disease, and drives for financial and operating system efficiencies. At this upper level of the hierarchy, administrators and managers seek to inculcate motion management via a prescriptive set of behaviors, including that of the mission and values of the organization (Bolton & Boyd, 2003). Leavitt (2007) argues that large organizations are ‘unhealthy’ insofar as they tend to inculcate anonymity and authority. In this respect, administrators and those driving financial efficiency lack the understanding of nursing care and the associated emotional labor. As Bolton (2000) argued nearly 20 years ago, emotional labor is used by health care organizations as a business resource. In this regard, nurses may choose to whom they ‘gift’ their emotional labor. For example, a nurse may perceive the emotional laborious nature of advocating for a patient (to avoid an adverse event) as emotionally fulfilling. The potential of emotional labor to have positive outcomes resides in both the Level 2 (interperson) and Level 3 (within-team) dimension, of the multilevel model. Again, this multilevel nature of emotional labor forms the social identity of the nurse and with it, the protective mechanisms to manage emotional labor. Administrative, clinical, and financial leadership have seen shifts in roles and responsibilities over the last two decades. Newman and Lawler (2009) argue that nurses and nurse managers have moved from predominantly clinical leadership to a combination of clinical and financial administration. These new accountabilities of managing health reform objectives and financial efficiency require careful leadership to manage the competing demands between care delivery and available resources (e.g., see Daly et al., 2014; MacPhee et al., 2013). Thus, there is a tension between the care that the public expect and the care that nurses are actually able to provide. It is also apparent that health care organizations are environments embedded with emotion. With this in mind, it would seem to be vital that nurse leaders have the EI skills to manage their own and co-workers’ emotions but also those of a multiprofession group, each of whom are competing for resources. In the health literature there is discussion of barriers to emotion by power gradients, hierarchical control of funding, and gender bias towards a predominantly female nursing workforce (Chattopadhyay, Finn, & Ashkanasy, 2010). Nurse leaders thus need also to use emotional labor to collaborate with the differing professions. In other words, a health care organization is not just one system but is a collection of professions and employees, each tasked with providing patient-centered care. The boundary-spanning theory we discussed earlier would therefore seem to be a requirement for collaboration and team function. Again though, this is heavily influenced by government policy, funding models, profit or not for profit, population socio-demographics, and the power of health care providers. Ultimately, although emotional labor and the value of EI may be recognized at the interpersonal and team level, the picture is quite different at the broader organizational level. Here we introduce the concept of transformational leadership (Bass,

Emotions in nursing  115 1999) to our discussion as a vehicle to move emotions and emotional labor from the invisible to a visible and valued part of caring. For successful organizations, health care leaders need to role model proactive behaviors when managing organizational challenges. In this regard, transformational leadership with a focus on succession planning, which necessarily requires EI as well as involvement between coaches/ mentors and staff, is a means to embed emotions as a vital aspect to organizational life (Barling, Slater, & Kelloway, 2000). With regard to team/group activity, recent nursing literature around emotions is highlighting the relative importance and value of transformational leadership (see Cummings et al., 2010 for a review). Scholars (e.g., see Cummings et al., 2010; Fischer, 2016; Jambawo, 2018) have consistently shown that transformational leadership promotes team functioning, job satisfaction, and retention. Notably, this leadership style appears to act as a means to ameliorate the tension between rising health consumer expectations and resource constraints. In this case, nurse leaders need to be able to find innovative ways to engender trust in both consumers and fellow staff. There are multitudes of leadership styles that may serve as ways to enact positive leadership (as opposed to a more traditional administrative management style). In this regard, Wong, Spence Laschinger and Cummings (2010) found that a transformational leadership style, especially in the form of authentic leadership, with its embedded ethical behavior foundation in which the nurse manager adopts a facilitative and common goal-orientated approach, is essential to managing in the current health care environment.

CONCLUSION The literature around organizational life has grown rapidly over the last two decades – in particular, research on the impact of emotions in work–life and the links with job satisfaction. Moreover, researchers have shown that the relationship between emotions and retention are key indicators of workplace performance (e.g., see Salanova, Agut, & Peiró, 2005). This is contrary to previous beliefs about the relevance of emotions in organizations. Health care is a latecomer to the discussion, even though nursing is a process requiring emotion as process as well as content (Mark, 2005). At the within-person level, enculturation, social and role identity and the dichotomy between these and emotional engagement are all governed by emotional labor. By adopting the multilevel perspective of emotions in nursing, we sought in this chapter to elaborate on the range of emotional interaction from the within-person level up to and including the organization level. Boundary-spanning across the levels between nursing and the multidisciplinary team may act as a bridge for the recognition and value of emotional labor by nurses, insofar as emotional labor and emotion regulation are needed not only during patient interaction but also with the many collaborations with other professions and stakeholders in the health care environment. We further add the potential for a new ‘Level 6’ covering the socioeconomic, political, and professional regulatory factors that influence health care delivery as a business across health care organizations.

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REFERENCES Adams, K.L., & Iseler, J.I. (2014), ‘The relationship of bedside nurses’ emotional intelligence with quality of care’, Journal of Nursing Care Quality, 29, 174–181. Aiken, L., Sloane, D.M., Cimiotti, J.P., Clarke, S., Flynn, L., Seago, J.A.,. . .Smith, H.L. (2010), ‘Implications of the California nurse staffing mandate for other states’, Health Services Research, 45, 904–921. Aradilla-Herrero, A., Tomás-Sábado, J., & Gómez-Benito, J. (2012), ‘Death attitudes and emotional intelligence in nursing students’, Omega: Journal of Death & Dying, 66, 39–55. Arieli, D.P. (2013), ‘Emotional work and diversity in clinical placements of nursing students’, Journal of Nursing Scholarship, 45, 192–201. Ashforth, B.E., & Humphrey, R.H. (1995), ‘Emotion in the workplace: a reappraisal’, Human Relations, 48, 97–125. Ashkanasy, N.M. (2003), ‘Emotions in organizations: a multilevel perspective’. In F. Dansereau, and F.J. Yammarino (Eds.), Research in multi-level issues: vol. 2. Bingley, UK: Emerald Group Publishing, pp. 9–54. Ashkanasy, N.M., Ashton-James, C.E., & Jordan, P.J. (2004), ‘Performance impacts of appraisal and coping with stress in workplace settings: the role of affect and emotional intelligence’. In P. Perrewé, & D. Ganster (Eds.), Research in occupational stress and well-being: vol. 3. Bingley, UK: Emerald Group Publishing, pp. 1–43. Ashkanasy, N.M., & Dorris, A.D. (2017), ‘Emotion in the workplace’, Annual Review of Organizational Psychology and Organizational Behavior, 4, 67–90. Ashton-James, C.E., & Ashkanasy, N.M. (2008), ‘Affective events theory: a strategic perspective’. In W.J. Zerbe, C.E.J. Härtel, & N.M. Ashkanasy (Eds.), Research on emotion in organizations: vol. 4. Bingley, UK: Emerald Group Publishing, pp. 1–34. Augusto-Landa, J.M., López-Zafra, E., Berrios Martos, M.P., & Aguilar-Luzón, M.C. (2008), ‘The relationship between emotional intelligence, occupational stress and health in nurses: a questionnaire survey’, International Journal of Nursing Studies, 45, 888–901. Austin, E.J., Dore, T.C.P., & O’Donovan, K.M. (2008), ‘Associations of personality and emotional intelligence with display rule perceptions and emotional labor’, Personality and Individual Differences, 44, 679–688. Badolamenti, S., Sili, A., Caruso, R., & FidaFida, R. (2017), ‘What do we know about emotional labor in nursing? A narrative review’, British Journal of Nursing, 26, 48–55. Banning, M. (2008), ‘A review of clinical decision making: models and current research’, Journal of Clinical Nursing, 17, 187–195. Barling, J., Slater, F., & Kelloway, E.K. (2000), ‘Transformational leadership and emotional intelligence: an exploratory study’, Leadership & Organization Development Journal, 21, 157–161. Bar-On, R. (Ed.) (2000), Emotional and social intelligence: insights from the Emotional Quotient Inventory. San Francisco, CA: Jossey-Bass. Bass, B.M. (1999), ‘Two decades of research and development in transformational leadership’, European Journal of Work and Organizational Psychology, 8, 9–32. Beauvais, A.M., Brady, N., O’Shea, E.R., & Griffin, M.T.Q. (2011), ‘Emotional intelligence and nursing performance among nursing students’, Nurse Education Today, 31, 396–401. Begley, C.M., & Glacken, M. (2004), ‘Irish nursing students’ changing levels of assertiveness during their pre-registration programme’, Nurse Education Today, 24, 501–510. Bennett, P., & Lowe, R. (2008), ‘Emotions and their cognitive precursors: responses to spontaneously identified stressful events among hospital nurses’, Journal of Health Psychology, 13, 537–546. Birks, Y., McKendree, J., & Watt, I. (2009), ‘Emotional intelligence and perceived stress in health care students: a multi-institutional, multi-professional survey’, BMC Medical Education, Article No. 9, 61.

Emotions in nursing  117 Bolton, S.C. (2000), ‘Who cares? Offering emotion work as a “gift” in the nursing labor process’, Journal of Advanced Nursing, 32, 580–586. Bolton, S.C., & Boyd, C. (2003), ‘Trolley dolly or skilled emotion manager? Moving on from Hochschild’s managed heart’, Work, Employment and Society, 17, 289–308. Boucher, C. (2016), ‘A qualitative study of the impact of emotional labor on health managers’, The Qualitative Report, 21, 2148–2160. Brandao de Souza, L. (2009), ‘Trends and approaches in lean health care’, Leadership in Health Services, 22, 121–139. Brunton, M. (2005), ‘Emotion in health care: the cost of caring’, Journal of Health Organization and Management, 19, 340–354. Cassell, E.J. (2002), Compassion. New York: Oxford University Press. Chattopadhyay, P., Finn, C.P., & Ashkanasy, N.M. (2010), ‘Affective responses to professional dissimilarity: a matter of status’, Academy of Management Journal, 53, 808–826. Chrousos, G.P., & Gold, P.W. (1992), ‘The concepts of stress and stress system disorders’, Jama, 267(9), 1244–1252. Ciarrochi, J.V., Chan, A.Y.C., & Caputi, P. (2000), ‘A critical evaluation of the emotional intelligence construct’, Personality and Individual Differences, 28, 539–561. Cropanzano, R., & Dasborough, M.T. (2015), ‘Dynamic models of well-being: implications of affective events theory for expanding current views on personality and climate’, European Journal of Work and Organizational Psychology, 24, 844–847. Cummings, G.G., MacGregor, T., Davey, M., Lee, H., Wong, C.A., Lo, E.,. . .Stafford, E. (2010), ‘Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review’, International Journal of Nursing Studies, 47, 363–385. Curtis, K. (2014), ‘Learning the requirements for compassionate practice: student vulnerability and courage’, Nursing Ethics, 21, 210–223. Dalgleish, T., & Power, M.J. (Eds.) (1999), Handbook of cognition and emotion. Chichester: Wiley. Daly, J., Jackson, D., Mannix, J., Davidson, P., & Hutchinson, M. (2014), ‘The importance of clinical leadership in the hospital setting’, Journal of Healthcare Leadership, 6, 75–83. Dasborough, M.T. (2006), ‘Cognitive asymmetry in employee emotional reactions to leadership behaviors’, The Leadership Quarterly, 17, 163–178. Delgado, C., Upton, D., Ranse, K., Furness, T., & Foster, K. (2017), ‘Nurses’ resilience and the emotional labor of nursing work: an integrative review of empirical literature’, International Journal of Nursing Studies, 70, 71–88. Diefendorff, J.M., Erickson, R.J., Grandey, A.A., & Dahling, J.J. (2011), ‘Emotional display rules as work unit norms: a multilevel analysis of emotional labor among nurses’, Journal of Occupational Health Psychology, 16, 170–186. Diefendorff, J.M., Richard, E.M., & Yang, J. (2008), ‘Linking emotion regulation strategies to affective events and negative emotions at work’, Journal of Vocational Behavior, 73, 498–508. Erickson, R.J., & Grove, W.J.C. (2008), ‘Emotional labor and health care’, Sociology Compass, 2, 704–733. Evans, W., & Kelly, B. (2004), ‘Pre-registration diploma student nurse stress and coping measures’, Nurse Education Today, 24, 473–482. Fairchild, R.M. (2010), ‘Practical ethical theory for nurses responding to complexity in care’, Nursing Ethics, 17, 353–362. Fischer, S.A. (2016), ‘Transformational leadership in nursing: a concept analysis’, Journal of Advanced Nursing, 72, 2644–2653. Francis, R. (2013), Report of the Mid Staffordshire NHS Foundation Trust public inquiry: executive summary. London: The Stationery Office.

118  Handbook of research on stress and well-being in the public sector Gabriel, A.S., Diefendorff, J.M., & Erickson, R.J. (2011), ‘The relations of daily task accomplishment satisfaction with changes in affect: a multilevel study in nurses’, Journal of Applied Psychology, 96, 1095–1104. Garrosa, E., Rainho, C., Moreno-Jiménez, B., & Monteiro, M.J. (2010), ‘The relationship between job stressors, hardy personality, coping resources and burnout in a sample of nurses: a correlational study at two time points’, International Journal of Nursing Studies, 47, 205–215. Gilbert, S., Laschinger, H.K.S., & Leiter, M. (2010), ‘The mediating effect of burnout on the relationship between structural empowerment and organizational citizenship behaviors’, Journal of Nursing Management, 18, 339–348. Ginter, P.M., Duncan, W.J., & Swayne, L.E. (2018), The strategic management of health care organizations. Chichester, UK: Wiley. Goleman, D. (1995), Emotional intelligence: why it can matter more than IQ. London: Bloomsbury. Grandey, A.A. (2000), ‘Emotion regulation in the workplace: a new way to conceptualize emotional labor’, Journal of Occupational Health Psychology, 5, 95–110. Gray, B. (2009), ‘The emotional labor of nursing – defining and managing emotions in nursing work’, Nurse Education Today, 29, 168–175. Gray, B., & Smith, P. (2009), ‘Emotional labor and the clinical settings of nursing care: the perspectives of nurses in East London’, Nurse Education in Practice, 9, 253–261. Hargrove, M.B., Becker, W.S., & Hargrove, D.F. (2015), ‘The HRD eustress model: generating positive stress with challenging work’, Human Resource Development Review, 14, 279–298. Hochschild, A.R. (1983), The managed heart: commercialization of human feeling. Berkeley, CA: University of California Press. Humphrey, R. (2006), ‘Promising research opportunities in emotions and coping with conflict’, Journal of Management and Organization, 12, 179–186. Humphrey, R., Pollack, J., & Hawver, T. (2008), ‘Leading with emotional labor’, Journal of Managerial Psychology, 23, 151–168. Huynh, T., Alderson, M., & Thompson, M. (2008), ‘Emotional labor underlying caring: an evolutionary concept analysis’, Journal of Advanced Nursing, 64, 195–208. International Council of Nurses (2018), The ICN code of ethics for nurses. Accessed 8 August 2018 at https://​www​.nursingmidwiferyboard​.gov​.au/​Codes​-Guidelines​-Statements/​ Professional​-standards​.aspx. Jack, K., & Wibberley, C. (2014), ‘The meaning of emotion work to student nurses: a Heideggerian analysis’, International Journal of Nursing Studies, 51, 900–907. Jambawo, S. (2018), ‘Transformational leadership and ethical leadership: their significance in the mental health care system’, British Journal of Nursing, 27, 998–1001. James, N. (1989), ‘Emotional labor – skill and work in the social regulation of feelings’, Sociological Review, 37, 15–42. Jordan, P.J., Murray, J.P., & Lawrence, S.A. (2009), ‘The application of emotional intelligence in industrial and organizational psychology’. In C. Stough, D.H. Saklofske, & J.D.A. Parker (Eds.), Assessing emotional intelligence. New York: Springer, pp. 171–190. Joseph, D.I., & Newman, D.A. (2010), ‘Emotional intelligence: an integrative meta-analysis and cascading model’, Journal of Applied Psychology, 95, 54–78. Karimi, L., Leggat, S.G., Donohue, L., Farrell, G., & Couper, G.E. (2014), ‘Emotional rescue: the role of emotional intelligence and emotional labor on well-being and job stress among community nurses’, Journal of Advanced Nursing, 70, 176–186. Kooker, B., Shoultz, J., & Codier, E.E. (2007), ‘Identifying emotional intelligence in professional nursing practice’, Journal of Professional Nursing, 23, 30–36. Lazarus, R.S. (1999), Stress and emotion: a new synthesis. New York: Springer.

Emotions in nursing  119 Leavitt, H.J. (2007), ‘Big organizations are unhealthy environments for human beings’, Academy of Management Learning & Education, 6, 253–263. Ledoux, K. (2015), ‘Understanding compassion fatigue: understanding compassion’, Journal of Advanced Nursing, 71, 2041–2050. Lyons, W.E. (1980), Emotion. New York: Cambridge University Press. Maben, J. (2008), ‘The art of caring: invisible and subordinated? A response to Juliet Corbin: “Is caring a lost art in nursing”’, International Journal of Nursing Studies, 45, 335–338. Maben, J., Latter, S., & Clark, J.M. (2006), ‘The theory–practice gap: impact of professional-bureaucratic work conflict on newly qualified nurses’, Journal of Advanced Nursing, 55, 465–477. MacPhee, M., Chang, L., Lee, D., & Spiri, W. (2013), ‘Global health care leadership development: trends to consider’, Journal of Healthcare Leadership, 5, 21–29. Mann, S. (2004), ‘“People-work”: emotion management, stress and coping’, British Journal of Guidance & Counselling, 32, 205–221. Mann, S., & Cowburn, J. (2005), ‘Emotional labour and stress within mental health nursing’, Journal of Psychiatric and Mental Health Nursing, 12, 154–162. Mark, A. (2005), ‘Organizing emotions in health care’, Journal of Health Organization and Management, 19, 277–289. Maslach, C., Schaufeli, W.B., & Leiter, M.P. (2001), ‘Job burnout’, Annual Review of Psychology, 52, 397–422. Mayer, J.D., Roberts, R.D., & Barsade, S.G. (2008), ‘Human abilities: emotional intelligence’, Annual Review of Psychology, 59, 507–536. Mayer, J.D., & Salovey, P. (1993), ‘The intelligence of emotional intelligence’, Intelligence, 17, 433–442. Mayer, J.D., & Salovey, P. (1997), ‘What is emotional intelligence?’ In P. Salovey, & D. Sluyter (Eds.), Emotional development and emotional intelligence: implications for educators. New York: Basic Books, pp. 3–31. Mayer, J.D., Salovey, P., & Caruso, D.R. (2004), ‘Emotional intelligence: theory, findings, and implications’, Psychological Inquiry, 15, 197–215. Mayer, J.D., Salovey, P., & Caruso, D.R. (2008), ‘Emotional intelligence: new ability or eclectic traits?’, American Psychologist, 63, 503–517. McQueen, A.C.H. (2004), ‘Emotional intelligence in nursing work’, Journal of Advanced Nursing, 47, 101–108. Meier, K.J. (2006), ‘Gender and emotional labor in public organizations: an empirical examination of the link to performance’, Public Administration Review, 66, 899–909. Melvin, C.S. (2012), ‘Professional compassion fatigue: what is the true cost of nurses caring for the dying?’, International Journal of Palliative Nursing, 18, 606–611. Menzies, I.E. (1960), ‘A case study in the functioning of social systems as a defense against anxiety: a report on a study of the nursing service of a general hospital’, Human Relations, 13, 95–121. Morse, J.M., Botorff, J., Anderson, G., O’Brien, B., & Solberg, S. (2006), ‘Beyond empathy: expanding expressions of caring’, Journal of Advanced Nursing, 53, 75–87. Needham, C., Mastracci, S., & Mangan, C. (2017), ‘The emotional labor of boundary spanning’, Journal of Integrated Care, 25, 288–300. Newman, S., & Lawler, J. (2009), ‘Managing health care under new public management: a Sisyphean challenge for nursing’, Journal of Sociology, 45, 419–432. Nursing and Midwifery Board of Australia (2016), Registered nurse standards for practice. Accessed 8 August 2018 at https://​www​.nursingmidwiferyboard​.gov​.au/​Codes​-Guidelines​ -Statements/​Professional​-standards/​registered​-nurse​-standards​-for​-practice​.aspx. Oatley, K.O. (2004), Emotions: a brief history. Oxford: Blackwell.

120  Handbook of research on stress and well-being in the public sector Ohly, S., & Schmitt, A. (2015), ‘What makes us enthusiastic, angry, feeling at rest or worried? Development and validation of an affective work events taxonomy using concept mapping methodology’, Journal of Business and Psychology, 30, 15–35. Parry, M. (2011), ‘Student nurses’ experience of their first death in clinical practice’, International Journal of Palliative Nursing, 17, 448–453. Peart, F.M., Roan, A., & Ashkanasy, N.M. (2012), ‘Trading in emotions: a closer examination of emotional labor’. In N.M. Ashkanasy, C.E.J. Härtel, & W.J. Zerbe (Eds.), Research on emotion in organizations: vol. 8. Bingley, UK: Emerald Group Publishing, pp. 279–304. Petrides, K.V., & Furnham, A. (2003), ‘Trait emotional intelligence: behavioral validation in two studies of emotion recognition and reactivity to mood induction’, European Journal of Personality, 17, 39–57. Pisaniello, S.L., Winefield, H.R., & Delfabbro, P.H. (2012), ‘The influence of emotional labor and emotional work on the occupational health and well-being of South Australian hospital nurses’, Journal of Vocational Behavior, 80, 579–591. Por, J., Barriball, L., Fitzpatrick, J., & Roberts, J. (2011), ‘Emotional intelligence: its relationship to stress, coping, well-being and professional performance in nursing students’, Nurse Education Today, 31, 855–860. Rafferty, A.M., Clarke, S.P., Coles, J., Ball, J., James, P., McKee, M., & Aiken, L.H. (2007), ‘Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records’, International Journal of Nursing Studies, 44, 175–182. Rankin, B. (2013), ‘Emotional intelligence: enhancing values-based practice and compassionate care in nursing’, Journal of Advanced Nursing, 69, 2717–2725. Riley, R., & Weiss, M.C. (2016), ‘A qualitative thematic review: emotional labour in health care settings’, Journal of Advanced Nursing, 72, 6–17. Salanova, M., Agut, S., & Peiró, J.M. (2005), ‘Linking organizational resources and work engagement to employee performance and customer loyalty: the mediation of service climate’, Journal of Applied Psychology, 90, 1217–1227. Salovey, P., Rothman, A.J., Detweiler, J.B., & Steward, W.T. (2000), ‘Emotional states and physical health’, The American Psychologist, 55, 110–121. Schutte, N.S., Malouff, J.M., Hall, L.E., Haggerty, D.J., Cooper, J.T., Golden, C.J., & Dornheim, L. (1998), ‘Development and validation of a measure of emotional intelligence’, Personality and Individual Differences, 25, 167–177. Shirey, M.R. (2007), ‘An evidence-based solution for minimizing stress and anger in nursing students’, Journal of Nursing Education, 46, 568–571. Smith, P. (1991), ‘The nursing process: raising the profile of emotional care in nurse training’, Journal of Advanced Nursing, 16, 74–81. Stordeur, S., D’Hoore, W., & Vandenberghe, C. (2001), ‘Leadership, organizational stress, and emotional exhaustion among hospital nursing staff’, Journal of Advanced Nursing, 35, 533–542. Theodosius, C. (2006), ‘Recovering emotion from emotion management’, Sociology, 40, 893–910. Vitello-Cicciu, J.M. (2003), ‘Innovative leadership through emotional intelligence’, Nursing Management, 34, 28–32. Watson, J. (2009), ‘Caring science and human caring theory: transforming personal and professional practices of nursing and health care’, Journal of Health and Human Services Administration, 31, 466–482. Weiss, H.M., & Beal, D.J. (2005), ‘Reflections on affective events theory’. In N.M. Ashkanasy, W.J. Zerbe, & C.E.J. Härtel (Eds.), Research on emotion in organizations: vol. 1. Bingley, UK: Emerald Group Publishing Limited, pp. 1–21. Weiss, H.M., & Cropanzano, R. (1996), ‘Affective events theory: a theoretical discussion of the structure, causes and consequences of affective experiences at work’. In B.M. Staw,

Emotions in nursing  121 & L.L. Cummings (Eds.), Research in organizational behavior: vol. 18. Oxford: Elsevier Science, pp. 1–74. Williams, M. (2007), ‘Building genuine trust through interpersonal emotion management: a threat regulation model of trust and collaboration across boundaries’, Academy of Management Review, 32, 595–621. Williams, P. (2012), Collaboration in public policy and practice perspectives on boundary spanners. Bristol: Policy Press. Wong, C.A., Spence Laschinger, H.K., & Cummings, G.G. (2010), ‘Authentic leadership and nurses’ voice behavior and perceptions of care quality’, Journal of Nursing Management, 18, 889–900. Zietlow, J., Hankin, J.A., Seidner, A., & O’Brien, T. (2018), Financial management for nonprofit organizations: policies and practices. Chichester, UK: Wiley.

9. The impact of emotional intelligence on daily work life Keri A. Pekaar, Arnold B. Bakker, Dimitri van der Linden and Marise Ph. Born

INTRODUCTION It is Monday morning. You wake up, rush yourself through your daily morning routine, and get in your car to drive to work. You are in a hurry because you have an early meeting scheduled with important clients that you still need to prepare for. When you try to start your car, nothing happens. You try again and again but the car fails to start. All of a sudden you feel stressed and annoyed. You take the city bus that is full of students and arrive at work late, sweaty, and ill-prepared. During the meeting, you cannot sell your ideas as enthusiastically as you were planning to, and you have a hard time focusing because you keep ruminating about your broken-down car. To make matters worse, the clients turn down the business deal and somewhat stressed and dissatisfied with your performance you get back to your desk. When your colleague starts to tell an enthusiastic story about a new project you react in an uninterested and irritated manner. Then you realize that you must calm yourself down to prevent your current emotional state from ruining the rest of your working day. You excuse yourself and decide to take a short walk through the park nearby. The situation above illustrates that emotions may heavily impact our daily (working) lives. Emotions influence what we experience, what we think and decide, and how we behave (Frijda, 1986). Whereas positive emotions such as joy or happiness may help us to cope better with frustrations or setbacks (Cohn et al., 2009), negative emotions such as fear or anger may make daily hassles even worse. Our partner’s, friends’, and colleagues’ emotions may also influence our feelings, thoughts, and actions (Hareli & Rafaeli, 2008). For example, when others around us feel bad, our emotional state may also worsen, and we often start to invest time and energy to cheer others up. It is no exaggeration to say that emotions are an inseparable and important part of our everyday experiences; in our private lives but also at work. Moreover, emotions are a central aspect of many jobs, which can be quite demanding (Ashforth & Humphrey, 1995) and may partly explain the high prevalence of stress and job burnout in our society. Hence, the ways individuals deal with emotions have a great influence on their lives. An important personal resource that may help to deal with emotions is emotional intelligence (EI), which can generally be described as the knowledge and/or abilities to perceive, understand, and manage emotions of the self and others (Mayer & Salovey, 1997; Petrides, 2011; Zeidner, Roberts, & Matthews, 122

The impact of emotional intelligence on daily work life  123 2008). Research has shown that EI contributes to better physical and mental health (Martins, Ramalho, & Morin, 2010), to satisfying social relationships (Schutte et al., 2001), and to good job performance (Joseph & Newman, 2010; O’Boyle et al., 2011). The goal of the current chapter is to provide a concise overview of the role emotions play at work and how EI affects this role. We will first elaborate on the different ways in which emotions may impact employees’ work life by discussing work-related well-being, emotional demands, and emotional labor. Then we will conceptualize EI and introduce a new approach and instrument to examine the construct. Subsequently, we will explain how EI is related to emotions at work and we will discuss potential downsides of EI for employees and/or organizations. The contributions of the current chapter are as follows: (1) we position EI in the emotion and emotional labor literature; (2) we discuss a new approach to EI; and (3) we propose a new EI instrument.

DIFFERENT FLAVORS OF EMOTIONS Emotions come in different flavors and are accompanied with unique facial expressions, physical sensations, action tendencies, and motivations (Frijda, 1986). These unique features are meant to better adapt to our environment and, ultimately, help us to survive (Frijda, 1988). For example, fear signals threat and motivates us to run away to protect us from potential danger. Envy signals that someone else is better off and motivates us to restore this inequality in order to enhance our social status. Six basic emotions can be distinguished that are experienced and expressed in any culture, namely: anger, disgust, fear, happiness, sadness, and surprise (Ekman, 1993). More recent research, however, found evidence for up to 27 different emotions. This taxonomy also includes more nuanced types of emotions such as nostalgia and embarrassment (Cowen & Keltner, 2017). A useful framework to organize emotions is the circumplex model of affect (Russell, 1980). According to this framework, emotions can be described by the two dimensions of pleasure and activation. To illustrate, content is a low-activated positive emotion, whereas excitement is a high-activated positive emotion. The circumplex model of affect has proven to be helpful in better understanding how emotions influence people’s daily lives – for example, with regard to their functioning at work (Bakker & Oerlemans, 2011).

EMOTIONS AT WORK Work-related Well-being When studying the role of emotions at work, a logical and important question is, what types of emotions do employees experience when they are working? One way to look at this question is to examine employees’ work-related well-being, which involves both their evaluation of their job and the number of positive emotions

124  Handbook of research on stress and well-being in the public sector that they experience at work (Diener, Sandvik, & Pavot, 1991). The circumplex model of affect has been used to distinguish between positive and negative forms of work-related well-being (Bakker & Oerlemans, 2011). Work engagement, which refers to ‘a positive, fulfilling, work-related state of mind’ (Schaufeli et al., 2002, p. 74), has been positioned in the circumplex model as a state characterized by high activation and high pleasure. Indeed, engaged employees are highly energetic, optimistic, and enthusiastic, which often helps them to perform better (Bakker, 2009). Job satisfaction is also a positive form of work-related well-being but differs from work engagement by low(er) levels of activation. Satisfied employees are happy with their jobs, but do not always feel energetic or inclined to strive for aspirations (Grebner, Semmer, & Elfering, 2005). Therefore, they may not always achieve high performance levels (Bakker & Oerlemans, 2011). Employees may also feel negative at work. Workaholism, or a strong inner drive to work excessively hard (Oates, 1971), is a negative affective state characterized by high levels of activation. Research showed that the consequences of workaholism can be severe. For example, workaholics may have lower-quality relationships with their friends and partner because they devote almost all their time and energy to their work (Bakker, Demerouti, & Burke, 2009). Even though workaholics tend to work extremely hard, their work performance is not always better (Gorgievski et al., 2010). Reasons for this may be that workaholics suffer from energy depletion, perfectionism, and an inefficient work style. Another negative form of work-related well-being is burnout. Burnout has been positioned in the circumplex model as a state characterized by low activation and low pleasure; hence in many respects it is the opposite of work engagement (Bakker & Oerlemans, 2011). Burnt out employees are emotionally exhausted and cynical about their jobs (Leiter, 1993). They have usually lost the motivation and ability to spend energy in their work, which often results in poor job performance. Not surprisingly, the experience of burnout is accompanied with ill-health and reduced employee well-being (Bakker, Demerouti, & Sanz-Vergel, 2014). So, the most beneficial emotions that employees can experience at work seem to be emotions that are high in activation and pleasure, including excitement, enthusiasm, and happiness. These emotions may lead to a work-engaged state of mind, and, in turn, not only increase employees’ work-related well-being but also their work performance. Emotional Demands One important source of work-related emotions stems from emotional demands. Emotional demands refer to the emotionally laden interactions employees encounter at work – for example, with their co-workers, supervisor, or customers (Heuven et al., 2006). In general, emotional demands can have negative consequences for employee well-being and job performance because they require a lot of attention, effort, and energy. To illustrate, research showed that emotional demands lead to emotional exhaustion, reduced work engagement, burnout symptoms, and impaired

The impact of emotional intelligence on daily work life  125 performance (Bakker & Heuven, 2006; Heuven et al., 2006). However, the picture is not as simple as it seems. Specifically, emotional demands may also create opportunities to take control over an emotional situation, or to actively search for solutions. If employees are good at this (e.g., when employees have high levels of emotional intelligence or self-efficacy), emotional demands can be motivating instead (Bakker & Sanz-Vergel, 2013). A longitudinal study by Xanthopoulou, Bakker and Fischbach (2013) showed that emotional demands led to higher work engagement, but only for employees with high(er) levels of self-efficacy. This suggests that being able to cope with emotional demands can also have a positive and fulfilling effect on work-related well-being. Emotional Labor Jobs in which working with emotions is the core of the business are so-called emotional labor jobs (Hochschild, 1983). For example, salespersons or nurses are expected to express certain types of emotions to potential customers or patients (i.e., display rules) even though they may not truly experience these emotions. The emotions that are desired by emotional labor jobs are part of the service or product, and hence, are expected to enhance profits or patient satisfaction (Ashforth & Humphrey, 1995). Employees can adhere to the display rules of their job in different ways. Surface acting is a way to express the organizationally desired emotions by only adjusting one’s facial expression. In this case, the emotions that employees truly feel are masked by the emotions they express (i.e., faking). Therefore, surface acting may lead to emotional dissonance – a discrepancy between feelings and expressions (Zapf et al., 1999). Another way to express organizationally desired emotions is deep acting. When employees deep act they try to change their inner feelings in order to match the emotions they need to express. This strategy aligns inner feelings and emotional expressions and often results in more genuine and authentic expressions (Hochschild, 1983). Research has shown that surface acting and deep acting have differential effects on employee well-being and job performance. Surface acting is generally seen as a ‘bad’ strategy that leads to emotional exhaustion, strain, and impaired performance. Moreover, it appears that employees who use surface acting have a greater need to recover from their work (Xanthopoulou et al., 2018). Deep acting, on the other hand, is generally seen as a better strategy that is less costly for employees and results in better service (Hülsheger & Schewe, 2011). A recent review of the literature, however, concluded that this good–bad dichotomy is overly simple because there appear to be circumstances under which surface acting is beneficial and deep acting is harmful. Factors that may influence the outcomes of surface and deep acting include personality traits and external rewards (Grandey & Melloy, 2017).

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EMOTIONAL INTELLIGENCE After having discussed the role of emotions at work, we turn to our next and main topic – namely, the way people respond to emotions. For this purpose, we will focus on EI, which describes how effective people are in dealing with their own and others’ emotions (Mayer & Salovey, 1997; Petrides, 2011; Zeidner et al., 2008). EI is a relatively new construct because it was only in the 1990s that scholars started to publish about it (see Mayer & Salovey, 1997). In this same period, there appeared a ground-breaking book on emotional quotient (EQ), the popular equivalent of EI, which also made EI well known among the general public (Goleman, 1995). This is not to say that EI did not exist before the 1990s. In fact, one could say that EI is as old as humanity. The Greek philosopher Aristotle (384–322 BC) already hinted at EI when he wrote ‘Anybody can become angry – that is easy, but to be angry with the right person, to the right degree, at the right time, for the right purpose, and in the right way – that is not within everybody’s power, and is not easy’ (Aristotle, Nicomachean Ethics). We would now say that people who can use their emotions in such a ‘right way’ are emotionally intelligent. Different approaches exist to conceptualize and measure EI. The two main approaches are the ability and the trait approach (Siegling, Saklofske, & Petrides, 2015), on which we will elaborate in the next sections. Subsequently we will introduce a new approach that may be useful when studying the role of EI in daily (working) life: the enacted approach to EI (Pekaar et al., 2017, 2018b). Emotional Intelligence as an Ability Ability EI is defined as a range of interrelated emotional abilities and is assumed to be somewhat similar to cognitive abilities, yet applied to a different domain – namely, emotions. The most influential ability EI model is the four-branch model of EI (Mayer & Salovey, 1997), in which emotional abilities are ordered from basic to complex emotional abilities. These branches are: (1) emotion perception and expression; (2) emotional facilitation of thinking; (3) emotion understanding; and (4) emotion regulation. Ability EI is most often measured using performance-based tests, which is comparable to the way cognitive abilities are measured. The most widely used ability EI test is the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT: Mayer, Salovey, & Caruso, 2002) in which participants are asked to solve emotion-related problems. However, there are other alternatives available, including situational judgment tests or the recently developed Geneva Emotional Competence Test (GECo; Schlegel & Mortillaro, 2018). A strength of the GECo is that the test is adapted to measure EI in the workplace, and that it involves dynamic emotion-related video clips instead of static pictures or written scenarios. A difficult aspect of such performance-based EI tests, however, is to determine which answers are correct. That is, the subjective and often culturally dependent nature of emotional reactions make it hard to objectively evaluate them. As a solution, scholars have used expert

The impact of emotional intelligence on daily work life  127 or consensus scores to determine which emotional responses are most appropriate in a given context (Mayer et al., 2002). Emotional Intelligence as a Trait Trait EI is defined as a set of emotion-related traits or tendencies that can best be measured using self-reported questionnaires, which is more comparable to the personality research tradition (Petrides, Pérez-González, & Furnham, 2007; Siegling et al., 2015). In other words, trait EI refers to the way people perceive their own emotional effectiveness, which is expected to (partially) reflect their true emotional effectiveness. A widely used trait EI measure is the Trait Emotional Intelligence Questionnaire (TEIQue), consisting of the facets of emotionality, sociability, well-being, and self-control (Petrides et al., 2007). A strength of the trait EI approach is that it does justice to the subjective nature of emotional experiences. A downside, however, is that the reliance on people’s own judgment of their EI gives room to socially desirable answers. Specifically, as people generally want to be effective in dealing with emotions, they may overestimate their EI, or they may intentionally provide higher ratings of their EI in order to appear more competent (Côté, 2014). The relationship between ability EI and trait EI measures is typically low (Brannick et al., 2009; Petrides, 2011), which may be the result of methodological differences, conceptual differences, or both. As a result, some scholars argue that ability EI and trait EI are two different constructs, whereas others argue that ability EI and trait EI capture different aspects of one underlying general phenomenon (Brannick et al., 2009). The fact is that the trait EI and ability EI tradition have developed rather independently and are still trapped in a heavy debate. However, as both approaches have their pros and cons, scholars have suggested to pick the approach that is best applicable to one’s research question (O’Boyle et al., 2011). The Enacted Approach to Emotional Intelligence Both ability and trait EI research are usually based on cross-sectional research designs that examine individual differences in EI. This method allows for understanding how stable individual differences in EI are associated with broad outcomes such as health and job performance. However, this method cannot grasp the actual enactment of EI within a given situation, which may be important to reveal the underlying processes and immediate consequences of displaying EI. That is, in order to understand why and how EI affects everyday life, researchers may wish to take a different perspective. One option is to examine whether individuals actually display EI in a given situation, to which we refer to as ‘the enactment of EI’ (Pekaar et al., 2017, 2018b). The enacted approach examines EI much closer to the actual (work) situation than previous EI research has done. Hence, there is a need to use different research methods such as event sampling or day reconstruction methods (Kahneman et al., 2004; Reis & Gable, 2000).

128  Handbook of research on stress and well-being in the public sector One asset of this new approach is that it follows the dynamic experience of emotions. Emotions arise, merge, and fade over time (Beal et al., 2005; Frijda, 1986; Weiss & Cropanzano, 1996). This ebb and flow of emotional experiences is assumed to be reflected in the fluctuating enactment of EI because people are most likely to use EI when they are actually exposed to emotions. To illustrate, an event sampling study showed that the enactment of EI fluctuates from one sales interaction to a following sales interaction (Pekaar et al., 2017). The latter study also showed that sales interactions in which employees enacted more of their EI resulted in more (objective) sales success. In addition, a weekly diary study among health care trainees showed that the enactment of EI also fluctuates from week to week and that the weekly enactment of EI had immediate benefits for the trainees. Specifically, in weeks that the trainees displayed more EI, they had more energy and were better evaluated by their supervisors (Pekaar et al., 2018b). Hence, the enacted approach helps to study the role of EI ‘in vivo’. Another strength of the enactment of EI is that it is more behavioral than people’s general potential for displaying EI. The behavioral nature may be examined to determine under which circumstances the enactment of EI is triggered, how it intervenes with other processes, and what direct consequences it has. For example, it is feasible that volatile factors such as one’s current mood, level of energy, or motive influence the enactment of EI. Research has shown that the experience of positive emotions facilitates effective emotion regulation (Tugade & Fredrickson, 2004), suggesting that positive emotions may also contribute to increased enactments of EI. In addition, individuals with low energy are less able to effectively regulate their emotions (Van Gelderen, Konijn, & Bakker, 2017), suggesting that high energy is another factor contributing to the enactment of EI. The enacted approach of EI could be a fruitful way to explore how these and other circumstances influence how people respond to emotions in their daily work life. Self- and Other-focused Emotional Intelligence Another recent development in EI theory is to distinguish how effective people are in dealing with their own emotions from how effective they are in dealing with the emotions of others (Brasseur et al., 2013; Pekaar et al., 2018a). The reason for this idea is that people’s own emotions have a different impact on them than the emotions of others. Specifically, one’s own emotions directly influence one’s thoughts, physical sensations, and behaviors (Frijda, 1988), whereas others’ emotions have a more indirect influence on a person through the social contact the person has with others (Hareli & Rafaeli, 2008). Research showed that self-focused EI leads to different outcomes than other-focused EI: the former is particularly associated with better health and well-being, whereas the latter is particularly associated with better (social) performance outcomes (Brasseur et al., 2013; Mikolajczak et al., 2015; Pekaar et al., 2018a, 2018b). To illustrate, it was found that self-focused EI related negatively to objective medical consumption such as the number of visits to a psychiatrist (Mikolajczak et al., 2015). Further, research showed that other-focused EI was positively associated

The impact of emotional intelligence on daily work life  129 with supervisor-rated performance outcomes – for example, in an interview setting (Pekaar et al., 2018a) or during a traineeship in the health care sector (Pekaar et al., 2018b). Given this pattern, it has been assumed that the psychological processes that play a role in self-focused EI are different from the psychological processes that play a role in other-focused EI (Brasseur et al., 2013; Pekaar et al., 2019). A recent study indeed showed that the appraisal of one’s own emotions led to different behaviors (e.g., the regulation of one’s own emotions, crafting social job resources) than the appraisal of others’ emotions (Pekaar et al., 2018b). Hence, the distinction in selfversus other-focused EI seems relevant for a more nuanced overview of the benefits and behavioral processes underlying EI. The Rotterdam Emotional Intelligence Scale (REIS) In order to study the unique role of self- and other-focused EI, scholars need EI measures that explicitly distinguish between these foci. As most existing EI measures either merge the abilities or traits that refer to a person’s own and others’ emotions or mainly focus on one of them, we recently developed a new scale: the Rotterdam Emotional Intelligence Scale (REIS; Pekaar et al., 2018a). The 28-item REIS consists of the following four facets: self-focused emotion appraisal, self-focused emotion regulation, other-focused emotion appraisal, and other-focused emotion regulation. Using eight samples, we showed that the REIS reliably measures and distinguishes these four facets. In addition, these studies showed that the REIS had strong correlations with other self-reported EI measures and weak to moderate correlations with the Big Five personality factors and cognitive abilities (Pekaar et al., 2018a). Furthermore, self-focused EI was negatively related to stress, whereas other-focused EI was positively related to a transformational leadership style, interview performance, and work engagement. As such, the REIS appears a promising instrument to measure self- and other-focused EI.

HOW DOES EMOTIONAL INTELLIGENCE AFFECT WORK LIFE? Emotional Intelligence and Emotional Labor EI comes into play when employees are confronted with emotions. This may occur in many occupations, but especially in emotional labor jobs like those of police officers, salespersons, or doctors. Emotional labor theory has suggested that EI may help employees to perform well in such jobs because it allows them to effectively regulate emotions during social interactions and to cope better with emotional demands (Grandey, 2000). Indeed, a meta-analysis showed that the positive relationship between EI and job performance was stronger in high emotional labor jobs than in low emotional labor jobs (Joseph & Newman, 2010). A relevant question is: how do high-EI employees manage to be effective in expressing the organizationally desired emotions that are demanded in emotional labor jobs? Unfortunately, research

130  Handbook of research on stress and well-being in the public sector linking EI to emotional labor strategies is scarce and somewhat inconsistent. One study showed that high-EI employees are more inclined to use deep acting rather than surface acting (Mesmer-Magnus, DeChurch, & Wax, 2012). However, other research showed that EI related positively to both surface acting and deep acting (Grant, 2013). This mixed evidence suggests that high-EI employees seem to understand that both surface acting and deep acting can be ‘good strategies’ under certain circumstances (cf. Grandey & Melloy, 2017), and that EI helps to pick the strategy that fits a situation best. Moreover, the finding that high-EI employees sometimes choose to engage in surface acting is consistent with the finding that they are better equipped to deal with the negative consequences of surface acting (Pugh, Groth, & Hennig-Thurau, 2011). Emotional Intelligence and Employee Well-being The benefits of EI for employee well-being have been widely studied and the message is clear: emotionally intelligent employees are happy and healthy. Research shows that EI reduces the experience of job stress and burnout symptoms (Weng et al., 2011; Zeidner, Matthews, & Roberts, 2009) and it contributes to job satisfaction and work engagement (Extremera et al., 2018; Kafetsios & Zampetakis, 2008). The reasons why high-EI employees feel better at work are that they are better able to repair negative moods and that they profit from richer social networks (Kafetsios & Zampetakis, 2008). Another contributing factor is that high-EI employees tend to have higher energy and are more dedicated to their jobs, which, in turn, contributes to their work-related well-being (Extremera et al., 2018). Despite this well-documented and positive pattern, recent studies suggest that the use of EI at work may also involve some immediate physiological costs. To illustrate, among a sample of secretaries who were asked to respond professionally to emotionally laden phone calls, it was found that EI was positively associated with increased skin conductance, a biological marker of mental stress (Pekaar et al., 2019). Another study showed that high-EI individuals (vs low-EI individuals) who had to give a speech in public had higher levels of stress hormones right after their performance (Bechtoldt & Schneider, 2016). These findings could either be explained by a heightened sensitivity for (negative) emotional cues during these emotionally demanding tasks (Fiori & Ortony, 2016), or the increased stress response could simply signal the effort that high-EI employees tend to put in emotionally demanding tasks (Bechtoldt & Schneider, 2016; Pekaar et al., 2019). Either way, the physiological costs of EI may be somewhat at odds with the previously mentioned positive link between EI and employee well-being. However, more general research has shown that the immediate physical and energetic costs that are associated with emotion regulation are replenished when this regulation is successful (Wong, Tschan, & Semmer, 2017), which would probably occur among high-EI individuals.

The impact of emotional intelligence on daily work life  131 Emotional Intelligence and Job Performance One of the reasons EI has become a popular topic among scholars and practitioners is that it was put forward as the ‘X factor’ that may help employees to perform better at work (Goleman, 1995). High-EI employees would perform better because of their ability to induce emotions that are beneficial for their work (Joseph & Newman, 2010). After three decades of research, several meta-analyses have confirmed that EI indeed contributes positively to job performance (Joseph & Newman, 2010; O’Boyle et al., 2011), although the link is not as strong as expected. In fact, there appear to be important boundary conditions that determine whether EI leads to better job performance. One important boundary condition is the job type. We already mentioned that EI is particularly important when a job involves emotional labor (Joseph & Newman, 2010). For example, a study among waiters showed that EI contributed to better job performance, as rated by the restaurant manager (Sy, Tram, & O’Hara, 2006). Another important boundary condition is the other abilities that employees possess (e.g., cognitive intelligence). To illustrate, research showed that EI is only important for employees with low cognitive intelligence (Côté & Miners, 2006). The idea is that these employees generally have a lower job performance because they lack important knowledge (i.e., facts, rules, procedures) that is relevant to the core aspects of their job (however, see Verbeke et al., 2008). Hence, less intelligent employees may benefit most from EI because they have much room to improve. Consequently, these employees may reach equally high performance levels by relying more on their emotional skills than on their cognitive skills. In other words, EI can be a strength at work. In order to better understand its contribution, however, one should also consider the organizational context and other dispositions of the employee (Côté, 2014). The Downsides of Emotional Intelligence at Work So far, we have focused on the benefits of EI for employees and organizations. Yet, there are several reasons why EI can also be harmful. First, research has shown that high-EI employees tend to be ‘hypersensitive’ to emotional cues (Fiori & Ortony, 2016). This sensitivity may be an advantage in many occupations. However, scholars have argued that when part of the job is to make life-changing decisions for others, it can be a vulnerability. As an example, leaders who are overly sensitive to the emotions of their followers may have more difficulty in making strict decisions (Antonakis, Ashkanasy, & Dasborough, 2009). The question is, however, whether this can be considered a real downside of EI, because high-EI leaders would generally be able to regulate the emotions they catch from their followers. Another context in which EI can be disadvantageous is in low emotional labor jobs. In these jobs employees are not explicitly expected to ‘work’ with emotions. However, if employees in low emotional labor jobs do focus on emotions during their work this may drain energy and attention from their focal work tasks. In support of this notion, meta-analytic research showed a negative link between EI and job performance in low emotional labor jobs (Joseph & Newman, 2010). The final downside

132  Handbook of research on stress and well-being in the public sector of EI for organizations is that it may not always be used for the greater good. In fact, the ability and knowledge to effectively deal with emotions may also foster antisocial or manipulative behaviors. A study by Côté and colleagues (2011) showed that employees’ Machiavellian values only resulted in deviant behavior at work when EI was high. Hence, one should be careful to consider EI as a definite strength at work, because it may turn into a vulnerability or even a threat.

CONCLUSION In this chapter, we discussed how emotions influence work life and focused on the role of EI. Our review suggests that EI may be an important resource for employees to deal with the emotional aspects of their jobs. Therefore, high-EI employees are generally happy and productive at work. In order to understand how a happy and productive day at work unfolds, we introduced a new approach that focuses on the actual display of EI within a situation: the enactment of EI. In addition, we explained that a distinction between self- and other-focused EI may be vital to further unravel the behavioral mechanisms underlying EI and proposed a new instrument to measure (self- and other-focused) EI. It is our hope that our conceptualization and these methodologies will be used to answer questions like ‘How do emotionally intelligent individuals make sure that their daily frustrations (e.g., an argument with a co-worker or a broken-down car) do not ruin their workday?’ Increased insights into such basic emotional processes may make a significant contribution to the EI literature and to people’s daily (work) lives.

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134  Handbook of research on stress and well-being in the public sector Heuven, E., Bakker, A.B., Schaufeli, W.B., & Huisman, N. (2006), ‘The role of self-efficacy in performing emotion work’, Journal of Vocational Behavior, 69, 222–235. Hochschild, A.R. (1983), The managed heart: commercialization of human feeling. Berkeley, CA: University of California Press. Hülsheger, U.R., & Schewe, A.F. (2011), ‘On the costs and benefits of emotional labor: a meta-analysis of three decades of research’, Journal of Occupational Health Psychology, 16, 361–389. Joseph, D.L., & Newman, D.A. (2010), ‘Emotional intelligence: an integrative meta-analysis and cascading model’, Journal of Applied Psychology, 95, 54–78. Kafetsios, K., & Zampetakis, L.A. (2008), ‘Emotional intelligence and job satisfaction: testing the mediatory role of positive and negative affect at work’, Personality and Individual Differences, 44, 712–722. Kahneman, D., Krueger, A.B., Schkade, D.A., Schwarz, N., & Stone, A.A. (2004), ‘A survey method for characterizing daily life experience: the day reconstruction method’, Science, 3, 1776–1780. Leiter, M.P. (1993), ‘Burnout as a developmental process: consideration of models’. In W.B. Schaufeli, C. Maslach, & T. Marek (Eds.), Professional burnout: recent developments in theory and research. Washington, DC: Taylor & Francis, pp. 237–250. Martins, A., Ramalho, N., & Morin, E. (2010), ‘A comprehensive meta-analysis of the relationship between emotional intelligence and health’, Personality and Individual Differences, 49, 554–564. Mayer, J.D., & Salovey, P. (1997), ‘What is emotional intelligence?’. In P. Salovey, & D. Sluyter (Eds.), Emotional development and emotional intelligence: educational implications. New York: Basic Books, pp. 3–31. Mayer, J.D., Salovey, P., & Caruso, D.R. (2002), Mayer-Salovey-Caruso emotional intelligence test (MSCEIT). [Booklet]. Toronto: MHS Publishers. Mesmer-Magnus, J.R., DeChurch, L.A., & Wax, A. (2012), ‘Moving emotional labor beyond surface and deep acting: a discordance-congruence perspective’, Organizational Psychology Review, 2, 6–53. Mikolajczak, M., Avalosse, H., Vancorenland, S., Verniest, R., Callens, M., van Broeck, N.,. . .Mierop, A. (2015), ‘A nationally representative study of emotional competence and health’, Emotion, 15, 653–667. Oates, W. (1971), Confessions of a workaholic: the facts about work addiction. New York: World Publishing Co. O’Boyle, Jr., E.H., Humphrey, R.H., Pollack, J.M., Hawver, T.H., & Story, P.A. (2011), ‘The relation between emotional intelligence and job performance: a meta-analysis’, Journal of Organizational Behavior, 31, 788–818. Pekaar, K.A., Bakker, A.B., Born, M.Ph., & Van der Linden, D. (2019), ‘The consequences of self- and other-focused emotional intelligence: not all sunshine and roses’, Journal of Occupational Health Psychology, 24(4), 450–466. Pekaar, K.A., Bakker, A.B., Van der Linden, D., & Born, M.Ph. (2018a), ‘Self- and other-focused emotional intelligence: development and validation of the Rotterdam Emotional Intelligence Scale (REIS)’, Personality and Individual Differences,  120, 222–233. Pekaar, K.A., Bakker, A.B., Van der Linden, D., Born, M.Ph., & Sirén, H.J. (2018b), ‘Managing own and others’ emotions: a weekly diary study on the enactment of emotional intelligence’, Journal of Vocational Behavior, 109, 137–151. Pekaar, K.A., Van der Linden, D., Bakker, A.B., & Born, M.Ph. (2017), ‘Emotional intelligence and job performance: the role of enactment and focus on others’ emotions’, Human Performance, 30, 135–153.

The impact of emotional intelligence on daily work life  135 Petrides, K.V. (2011), ‘Ability and trait emotional intelligence’. In T. Chamorro-Premuzic, A. Furnham, & S. von Stumm (Eds.), The Blackwell-Wiley handbook of individual differences. New York: Wiley, pp. 656–678. Petrides, K.V., Pérez-González, J.C., & Furnham, A. (2007), ‘On the criterion and incremental validity of trait emotional intelligence’, Cognition and Emotion, 21, 26–55. Pugh, S.D., Groth, M., & Hennig-Thurau, T. (2011), ‘Willing and able to fake emotions: a closer examination of the link between emotional dissonance and employee well-being’, Journal of Applied Psychology, 96, 377–390. Reis, H.T., & Gable, S.L. (2000), ‘Event-sampling methods’. In H.T. Reis, and C. Judd (Eds.), Handbook of research methods in social psychology. New York: Cambridge University Press, pp. 190–222. Russell, J.A. (1980), ‘A circumplex model of affect’, Journal of Personality and Social Psychology, 39, 1161–1178. Schaufeli, W.B., Salanova, M., González-Romá, V., & Bakker, A.B. (2002), ‘The measurement of engagement and burnout: a two-sample confirmatory factor analytic approach’, Journal of Happiness Studies, 3, 71–92. Schlegel, K., & Mortillaro, M. (2018), ‘The Geneva Emotional Competence Test (GECo): an ability measure of workplace emotional intelligence’, Journal of Applied Psychology, 104(4), 559–580. Schutte, N.S., Malouff, J.M., Bobik, C., Coston, T.D., Greeson, C., Jedlicka, C., & Wendorf, G. (2001), ‘Emotional intelligence and interpersonal relations’, The Journal of Social Psychology, 141, 523–536. Siegling, A.B., Saklofske, D.H., & Petrides, K.V. (2015), ‘Measures of ability and trait emotional intelligence’. In G.J. Boyle, G. Matthews, & D.H. Saklofske (Eds.), Measures of personality and social psychological constructs. San Diego, CA: Academic Press, pp. 381–414. Sy, T., Tram, S., & O’Hara, L.A. (2006), ‘Relation of employee and manager emotional intelligence to job satisfaction and performance’, Journal of Vocational Behavior, 68, 461–473. Tugade, M.M., & Fredrickson, B.L. (2004), ‘Resilient individuals use positive emotions to bounce back from negative emotional experiences’, Journal of Personality and Social Psychology, 86, 320–333. Van Gelderen, B.R., Konijn, E.A., & Bakker, A.B. (2017), ‘Emotional labor among police officers: a diary study relating strain, emotional labor and service performance’, International Journal of Human Resource Management, 28, 852–879. Verbeke, W.J., Belschak, F.D., Bakker, A.B., & Dietz, B. (2008), ‘When intelligence is (dys) functional for achieving sales performance’, Journal of Marketing, 72, 44–57. Weiss, H.M., & Cropanzano, R. (1996), ‘Affective events theory: a theoretical discussion of the structure, causes and consequences of affective experiences at work’. In B.M. Staw, and L.L. Cummings (Eds.), Research in organizational behavior, vol. 18. Greenwich, CT: JAI Press, pp. 1–74. Weng, H.C., Hung, C.M., Liu, Y.T., Cheng, Y.J., Yen, C.Y., Chang, C.C., & Huang, C.K. (2011), ‘Associations between emotional intelligence and doctor burnout, job satisfaction and patient satisfaction’, Medical Education, 45, 835–842. Wong, E., Tschan, F., & Semmer, N.K. (2017), ‘Effort in emotion work and well-being: the role of goal attainment’, Emotion, 17, 67–77. Xanthopoulou, D., Bakker, A.B., & Fischbach, A. (2013), ‘Work engagement among employees facing emotional demands: the role of personal resources’, Journal of Personnel Psychology, 12, 74–84. Xanthopoulou, D., Bakker, A.B., Oerlemans, W.G., & Koszucka, M. (2018), ‘Need for recovery after emotional labor: differential effects of daily deep and surface acting’, Journal of Organizational Behavior, 39, 481–494.

136  Handbook of research on stress and well-being in the public sector Zapf, D., Vogt, C., Seifert, C., Mertini, H., & Isic, A. (1999), ‘Emotion work as a source of stress: the concept and development of an instrument’, European Journal of Work and Organizational Psychology, 8, 371–400. Zeidner, M., Matthews, G., & Roberts, R.D. (2009), What we know about emotional intelligence: how it affects learning, work, relationships, and our mental health. Cambridge, MA: MIT Press. Zeidner, M., Roberts, R.D., & Matthews, G. (2008), ‘The science of emotional intelligence: current consensus and controversies’, European Psychologist, 13, 64–78.

10. Stress and well-being in prison officers Andrew J. Clements, Gail Kinman and Jacqui Hart

INTRODUCTION Prison officers are at greater risk of work-related stress than most other occupations in the UK (Johnson et al., 2005). The rates of mental health problems and burnout in the profession are also comparatively high (Kinman, Clements, & Hart, 2016; Kunst, 2011). Challenges to the well-being of prison staff include heavy workloads, lack of autonomy and support, low resources, role stressors, and exposure to aggression and violence (Finney et al., 2013). In this chapter we draw on research conducted by ourselves and others that identifies the key stressors experienced by UK prison officers and the implications for their well-being and job performance. Particular focus is placed on our research that has utilized the Health and Safety Executive Management Standards framework to diagnose the psychosocial hazards experienced by prison staff, but other stressors, such as personal experiences of aggression and violence, poor work–life balance, and recovery opportunities and presenteeism, are also considered. We argue that carefully targeted, multilevel interventions are needed to address the challenges faced by the sector and identify priorities for future research.

PRISONS IN CRISIS Prison officers experience particularly high levels of job-related stressors that can threaten their well-being and effectiveness. The work is intrinsically stressful and emotionally demanding, as they are responsible for the safeguarding and rehabilitation of offenders whose behavior may be resistant, unpredictable, or violent. Adequate numbers of well-trained officers are therefore required to ensure the well-being and safety of staff and prisoners. Nonetheless, at the time of writing this chapter, around two-thirds of prisons in the UK are categorized as overcrowded and many are understaffed, with serious implications for the well-being of prisoners and staff (House of Commons Library, 2018; Prison Reform Trust, 2017). The impact on prisoners has been highlighted by the findings of a recent assessment of four key areas of prisoner well-being (safety, respect, purposeful activity and rehabilitation, and planning for release), where 46 percent of institutions in the UK performed poorly (Ministry of Justice, 2018a). A major concern is the amount of time prisoners spend in purposive activity, with one in five being unlocked for less than two hours a day due to short-staffing (HM Chief Inspector of Prisons for England and Wales, 2018). Although recent recruitment efforts have been successful to some extent, the 137

138  Handbook of research on stress and well-being in the public sector annual turnover rate has risen especially among recent recruits (Ministry of Justice, 2018b).

A STRESSFUL OCCUPATION Based on responses from more than 25 000 individuals across 26 occupations, Johnson et al. (2005) found that prison officers reported worse than average scores for psychological well-being, physical health, and job satisfaction. Although new research is needed at a national level to confirm these findings, it is unlikely that well-being in the sector has improved over time. Several more recent studies have indeed found that prison officers have an elevated risk of burnout and post-traumatic stress disorder (PTSD) and a high proportion have been found to experience mental health problems at a level where intervention is recommended (Denhof & Spinaris, 2013; Finney et al., 2013; Kinman et al., 2016). Mental health is discussed later in this chapter. A systematic review conducted by Finney and colleagues (2013) identified a range of work-related stressors experienced by prison officers. Characteristics of inmates are a key source of stress, with officers who work with dangerous prisoners being at greater risk (Misis et al., 2013). One of the most commonly reported hazards is prisoner-on-staff assault, which has risen considerably in recent years (Ministry of Justice, 2018c). Officers experience different types of aggression ranging from verbal abuse to serious attacks requiring hospitalization and ‘potting’ (the throwing of excrement) (Crown Prosecution Service, 2018). Research conducted by Kinman, Clements and Hart (2014) examined the extent to which 1682 officers experienced six types of aggressive behaviors from prisoners. The most common behaviors were verbal abuse and threats, but 30 percent of respondents had been physically assaulted, with more than one in four taking time off work to recover. The support provided by employers to help staff cope with such incidents was generally considered to be poor and those who had been assaulted were at greater risk of mental health problems (Kinman et al., 2014, 2016). The increasing rates of prisoner self-harm, as well as the threat of physical assault, have left staff vulnerable to PTSD (Boudoukha et al., 2013; Wright et al., 2006). Indeed, there is evidence from the US that prison staff are at similar risk of PTSD to that of war veterans (James & Todak, 2018). Officers need to be constantly alert to potential threats that pose a risk to their mental and physical health to their own well-being and that of prisoners (Fritz et al., 2018). The impact of the sustained need for ‘hypervigilance’, particularly in understaffed and overcrowded prisons in the UK, should be further examined. Low staffing levels and overcrowding in prisons have been identified as a major source of work-related stress (Martin et al., 2012). A larger prison population will intensify workload and time pressure among staff, as well as potentially increase the likelihood of adverse incidents. As discussed above, unsafe staffing levels also limit the time for prisoners to spend in purposive activity (HM Chief Inspector of Prisons

Stress and well-being in prison officers  139 for England and Wales, 2018). It has been argued that the increased use of new psychoactive substances (NPS), such as Spice, among prisoners is partly a way of coping with boredom (Ralphs et al., 2017). Drug use is also widely believed to trigger much of the recent increase in prison violence in the UK (HM Chief Inspector of Prisons for England and Wales, 2016). Research conducted by Norton (2016) has highlighted the additional strain on staff caused by prisoners’ unpredictable reactions to the drug and disruption to the prison regime. Prison officers experience other occupationally specific stressors. Negative depictions of prison officers’ work by the media, and the public more generally, can contribute to burnout and job dissatisfaction (Vickovic, Griffin, & Fradella, 2013). Emotional labor, defined as the effort involved in regulating feelings and expressions to fulfill the emotional requirements of a particular job, is an additional hazard for prison officers. Prisons have been described as emotionally charged institutions (Crawley, 2004) and staff are required to manage their own emotions – including responses to people who have performed acts they may find repellent – and the emotional states of prisoners (Nylander, Lindberg, & Bruhn, 2011). Managing the fear engendered by working in unpredictable and often dangerous conditions could be considered a form of emotional labor. Prison officers who report feeling fearful more regularly tend to experience more stress and be more likely to quit (Stichman & Gordon, 2014). Insight into how fear can be reduced under such potentially hazardous working conditions is therefore required. A study of 40 US institutions by Gordon and Baker (2017) found that low staffing levels, poor organization, and a culture of cynicism intensified fear among officers, whereas feelings of belongingness and transformational leadership inhibited it. As well as occupationally specific threats to their well-being, prison officers also experience more ‘generic’ stressors (Finney et al., 2013). Officers work long and antisocial hours, but a meta-analysis conducted by Dowden and Tellier (2004) failed to find a link between shift work and stress. It is likely that working shifts is considered ‘just part of the job’ and less hazardous than other factors that can compromise safety, such as exposure to violence and overcrowding. This analysis was published 15 years ago, however, and drew upon studies that are even older. More research is therefore needed to examine the effects of working hours under current conditions while considering the context and the type of work performed. For example, long hours spent supervising prisoners in an overcrowded high-security prison are likely to be more hazardous to well-being than working overtime in an open prison where risks are typically low. Prison officers also tend to report low control over how their work is organized and their influence over decision-making (Dowden & Tellier, 2004; Steiner & Wooldredge, 2015). Several studies have also highlighted role difficulties as being particularly stressful for prison officers: for example, although role clarity appears to be high they may experience conflict and ambiguity stemming from competing views about the role of prison as punitive or rehabilitative (Finney et al., 2013; Lambert et al., 2011).

140  Handbook of research on stress and well-being in the public sector

HEALTH AND SAFETY EXECUTIVE MANAGEMENT STANDARDS The UK Health and Safety Executive (HSE, 2017) Management Standards framework was designed to help organizations monitor and manage well-being at work. It follows the principle that preventative approaches that assess risk are more effective in reducing work-related stress than relying exclusively on individually focused initiatives (Cousins et al., 2004). In our own research, described below, we adopted this framework to identify priorities for intervention within the UK prison service. The HSE has developed a measure, the Management Standards Indicator Tool (MSIT), which has been validated at the individual (Cousins et al., 2004) and organizational (Edwards et al., 2008) levels. The measure has been used in many organizations and sectors and benchmarks are available to compare organizational performance against specified targets (see Webster & Buckley, 2008). The MSIT measures the following seven hazard categories (with examples): ●● ●● ●● ●● ●● ●● ●●

demands – the quantity and pace of work; control – the extent of worker autonomy; manager support – listening to concerns, providing encouragement; peer support – helping face challenges; relationships – conflict at work; role – role clarity; change – change management and consultation.

Mean scores for each of the hazard categories are compared with benchmarks to identify if: (1) urgent action is needed (scores are below the 20th percentile); (2) clear need for improvement (scores below average, but not the 20th percentile); (3) good, but some need for improvement (better than average, but does not reach the 80th percentile); and (4) doing well (but needs to maintain performance). A previous study by Bevan, Houdmont and Menear (2010) administered the MSIT and a measure of exhaustion to 1038 UK prison service employees. Of the seven categories, six were identified as needing improvement, whereas the seventh – job demands – was of less concern, but still required attention. Participants who perceived their psychosocial working conditions to be poor were at three times the risk of exhaustion than those who viewed them more positively. Reflecting the importance of role difficulties as a source of stress for prison staff, role difficulties had the strongest effects on exhaustion. These were useful findings, as priorities were identified for intervention, but the participants included non-operational staff and the prisons sampled were restricted to the London area. Our own study (Kinman et al., 2014; Kinman, Clements, & Hart, 2017a) gathered responses from 1682 prison officers across the UK, although most (90 percent) worked in prisons in England. As well as the MSIT, a widely used measure of mental health (General Health Questionnaire [GHQ]; Goldberg, 1978) was administered to identify the hazard categories most detrimental to well-being. Our findings (see Table

Stress and well-being in prison officers  141 Table 10.1

Comparison of survey findings with targets Kinman et al. (2016)

HSE Target Group Mean (with Shortfall)

HSE Target

Demands

1.88

3.44 (–1.56)

3.50

Control

2.39

3.32 (–0.93)

3.50

Manager support

2.57

3.77 (–1.20)

3.80

Peer support

3.46

4.03 (–0.57)

4.00

Relationships

2.75

4.13 (–1.38)

4.25

Role

3.58

4.61 (–1.03)

5.00

Change

2.21

3.54 (–1.33)

3.67

Note:

Higher scores indicate more satisfaction with each of the dimensions.

10.1) differed from those of Bevan and colleagues (2010) in that six out of seven hazard categories required urgent attention: demands, control, manager support, relationships, role, and change. Peer support, while not requiring urgent attention, nevertheless needed some improvement. The hazard categories with the strongest effects on mental health were relationships (β = –0.26), demands (β = 0.24), role (β = –0.17), control (β = –0.07) and management of change (β = –0.06). Unexpectedly, support from managers or peers was not a significant predictor of mental health status. Although a wide range of difficulties was highlighted, of particular note was that four out of ten participants reported being bullied at work sometimes, often, or always. The reasons for the marked difference in findings between our study and that of Bevan and colleagues (2010) are unclear. The deteriorating working conditions in the prison sector highlighted above are likely to have contributed to the more negative findings in our study. It should be acknowledged, however, that we sampled trade union members and those who were most unhappy with their working conditions might have been more motivated to participate. Nonetheless, this is the case with all cross-sectional research and it could equally be argued that the healthy worker effect (where officers who were less healthy and/or unable to cope with the pressures of the job will have left) may mean that the findings underestimate the ‘true’ level of hazards in the sector.

MENTAL HEALTH IN THE PRISON SERVICE As mentioned earlier in this chapter, there is evidence that the mental health of prison officers is a cause for concern. They are at particular risk of burnout, a state of physical and/or psychological exhaustion associated with excessive and prolonged experience of stress (Finney et al., 2013; Gould et al., 2013). Burnout has been associated with low job satisfaction and commitment and high absenteeism and turnover among officers (Carlson & Thomas, 2006; Finney et al., 2013; Lambert et al., 2010; Schaufeli & Peeters, 2000) as well as counterproductive attitudes and behaviors. For example, there is evidence that the depersonalization and feelings of ineffectiveness

142  Handbook of research on stress and well-being in the public sector at work characterized by burnout can encourage them to hold more punitive attitudes towards prisoners (Lambert et al., 2010). Studies of prison officers have also examined the incidence of mental health problems. Our study (Kinman et al., 2016) found that 72 percent of the sample met the criteria for ‘caseness’ (or a clinical level of mental health symptoms), indicating that some intervention is appropriate. Levels of anxiety and insomnia, somatic symptoms and social dysfunction were all high. Walker et al. (2015) reported 95 percent caseness in their sample of 57 officers working in an English therapeutic prison. Both studies suggest that the mental health of prison officers is considerably poorer than other occupational groups (see Goodwin et al., 2013). As with burnout, discussed above, mental health problems increase the risk of absenteeism and turnover and impair job performance (Lerner & Henke, 2008). The GHQ has been used in many occupational studies and is considered valid for this purpose (Jackson, 2007). It has been argued, however, that occupationally specific studies can encourage the over-reporting of mental health problems as participants seek to improve their terms and conditions of employment (Goodwin et al., 2013), so some caution may be needed when interpreting our findings. Nonetheless, there is evidence that reporting poor mental health is stigmatized, particularly in ‘macho’ jobs such as within the prison service (Iversen et al., 2011), suggesting that the level found in our study may be underestimated. Indeed, in our survey few participants reported being able to talk to their line managers about problems they were experiencing (Kinman et al., 2014). It seems clear that urgent action is required to address the high level of burnout and mental health problems in prison officers to protect the well-being of staff, optimize staffing levels, and ensure the safety of prisoners. Individual Differences Although there is evidence that the occupational and organizational factors discussed in this chapter can contribute to stress and burnout in prison officers, not everyone will respond in the same way. Demographic and other individual difference factors will influence the extent to which officers will respond to their work environment. The role of job experience is mixed, with some studies finding that officers who have worked longer in the role report better well-being (Dollard & Winefield, 1998; Morgan, Van Haveren, & Pearson, 2002) while others find no significant effects (Lambert et al., 2015). There is also little evidence for gender differences in stress and burnout risk among prison officers (Griffin, 2006) but women may cope with job-related stress differently than men. For example, a study conducted by Hurst and Hurst (1997) found that women officers were more likely to seek social support, whereas men typically coped by problem solving. As discussed above in relation to the healthy worker effect, officers who are less able to cope with the demands of prison work may be more likely to leave, meaning that those remaining are unusually robust. An examination of coping style in predicting well-being can identify useful strategies to help develop officers’ resilience. Problem or task-focused coping has been positively associated with personal accomplishment and negatively with

Stress and well-being in prison officers  143 emotional exhaustion among officers, whereas the role of emotion-focused coping is mixed and inconclusive (Cieslak et al., 2008; Gould et al., 2013). When examining the role of demographic factors in predicting the well-being of prison officers, it should be acknowledged that our sample (like many other studies) comprised mainly white, middle-aged males. As of March 2018, women formed 38 percent of the workforce in public sector prisons and 6 percent of staff were from Black, Asian and Minority Ethnic (BAME) backgrounds (Ministry of Justice, 2018b). A lack of ethnic diversity in the prison service has been identified as contributing to an ‘us and them’ culture (Lammy, 2017), but the role of ethnicity has been little explored. A meta-analysis by Dowden and Tellier (2004) found that BAME prison officers experienced less stress than their white counterparts, which was attributed to there being greater ‘understanding’ between staff and prisoners (many of whom are from BAME backgrounds). Nonetheless, only two of the 191 studies reviewed were conducted outside North America, so research that examines the role of ethnicity under present working conditions is required. Work–Life Balance and Recovery The relationship between work and personal life is crucial in predicting well-being. Considerable attention has been given to work–life conflict, where the cumulative demands of roles within work and personal life are incompatible so that involvement in one role is made more difficult by participation in the other. Greenhaus and Beutell (1985) proposed three forms of work–life conflict: time (i.e., where time spent in one role limits time available to spend in another); strain (i.e., where negative emotional reactions to one role affects an individual’s well-being and functioning in another); and behavior (i.e., where behaviors required in one role are not appropriate for another). Work–life conflict in general has been associated with a range of negative outcomes such as stress, fatigue, and burnout as well as turnover intentions and job dissatisfaction (Amstad et al., 2011). Surprisingly little research has examined work–life conflict in correctional officers, but there is some evidence that they are particularly susceptible, and this can impair well-being and functioning in both domains (Armstrong, Atkin-Plunk, & Wells, 2015; Hogan et al., 2006). Officers are more likely to experience conflict between work and personal life when they experience role stress at work and when they perceive their work to be dangerous (Hogan et al., 2006; Lambert et al., 2015). Our research found that prison officers experienced all three types of work–life conflict, with time-based conflict being particularly frequent (Kinman et al., 2017b). Demands relating to workload, pace of work and working hours and experiences of aggression were strong predictors of work–life conflict that, in turn, was significantly linked with emotional exhaustion. Adequate recovery from work is crucial for well-being, as disengagement (both physical and psychological) allows individuals to reset their functional systems to pre-stressor levels (Sonnentag & Fritz, 2007). There is evidence that recovery experiences moderate the impact of job demands on well-being and the ability to

144  Handbook of research on stress and well-being in the public sector ‘switch off’ from work is an important resource. Utilizing the work–home resources model (Ten Brummelhuis & Bakker, 2012), our research examined the role that rumination (dwelling on negative experiences) and detachment (disengagement from work) played in emotional exhaustion experienced by prison officers (Kinman et al., 2017b). We found that rumination exacerbated the impact of job demands and aggression on emotional exhaustion, whereas the ability to switch off from work concerns was protective. Our findings indicate that attention is needed to reducing work demands and providing effective support after aggressive incidents. There is evidence that prison officers who experience more emotional demands at work and find it more difficult to stop ruminating about work concerns are more likely to use alcohol to cope (Shepherd et al., 2018). Interventions are clearly needed to help prison officers develop more effective physical and psychological barriers between work and personal life to help them detach from work concerns. Presenteeism As discussed above, working in prisons can impair both physical and psychological ill-health; unsurprisingly, sickness absence is comparatively high. Recovery from sickness is crucial, but this may be threatened by presenteeism, which refers to the act of going to work while unwell (Johns, 2010). Presenteeism is thought to be more common in male-dominated working cultures, where ‘giving in’ to illness is a sign of weakness, and in jobs fostering a strong sense of duty and responsibility for the welfare of others (Chambers, Frampton, & Barclay, 2017; Hansen & Andersen, 2008). The type and severity of illness will clearly influence whether people can continue working, but several other factors have been associated with presenteeism (Miraglia & Kinman, 2017). Our research asked prison officers if they ever worked while sick and, if so, why. Eighty-four percent of our sample reported presenteeism at least sometimes, while 53 percent indicated that they always did so (Kinman et al., 2019). Thematic content analysis found six linked themes that underpinned presenteeism in this sector: ●● punitive absence management systems, where taking sick leave was believed to be frowned upon or even stigmatized; ●● pressure from management where many felt that continuing to work was less stressful than taking time off; ●● short-staffing, leading to fears for the safety of colleagues and concerns about burdening those who were already struggling; ●● job insecurity and fear of dismissal, where anxiety about being disciplined for a poor sick record encouraged presenteeism; ●● fear of disbelief and shaming, where illness may not be considered a legitimate reason for absence, or people feared being seen as faking or exaggerating sickness; and ●● duty and professionalism, where people worked while sick due to a strong sense of duty and loyalty to co-workers and inmates.

Stress and well-being in prison officers  145 Our respondents acknowledged the negative impact of sick leave on the safe functioning of prisons and generally agreed that controls were required to ensure that any absence was genuine. Nonetheless, although operational imperatives may override long-term concerns for employees’ well-being, taking time off sick to recover from legitimate and debilitating illness should be considered responsible behavior on the part of employees and encouraged by managers. There is growing evidence for the negative impact of presenteeism on job performance, especially where work is safety critical (Niven & Ciborowska, 2015), so it is vital to raise awareness of the risks of presenteeism for the well-being of staff and the safe functioning of prisons.

INTERVENTIONS Few studies have evaluated stress-reduction interventions in prison officers. McCraty et al. (2009) reported the findings of a successful case-controlled initiative that included several modules such as identifying risk factors for health, refocusing and restructuring emotions, biofeedback, enhancing communication skills, and how to apply the skills learned in the workplace. Three months post-intervention, improvements were found for prison officers on physical markers of health, such as cholesterol, heart rate, and blood pressure, and a reduction in self-reported emotional distress was also observed. Perceptions of support, motivation, goal clarity, and productivity also improved in the intervention group. More recently, Dugan et al. (2016) used participatory action research to compare the effects of two methods of delivering health and safety interventions in US correctional facilities: the first initiative was ‘top down’ (driven by administrators assisted by health professionals); and the second was ‘bottom up’ (developed by frontline officers themselves). Both programs had mixed success, with the authors noting that setting simple and achievable targets and ensuring continuity through regular meetings were particularly important. Management support and the availability of funding were also among the challenges encountered, with managers sometimes discouraging the implementation of interventions due to security concerns and other operational reasons. There is a clear need for more research on interventions within the prison service to inform initiatives that help improve the well-being of officers. Longitudinal research that examines some of the associations highlighted in this chapter could help guide such interventions. We recommend a risk management approach, drawing on approaches such as the HSE Management Standards (HSE, 2017) set out in this chapter that seek to identify and manage work-related stress at its source. A systemic approach to improving well-being in the sector is, however, crucial, as prison officers will understandably be reluctant to engage with interventions that merely seek to improve their resilience and coping skills rather than address the structural causes of their distress. For example, while our findings suggest that strategies to help officers reduce rumination would alleviate emotional exhaustion and aid recovery, such individual-level interventions should not be at the expense of addressing the root causes of stress, such as short-staffing, overcrowding, and increased violence.

146  Handbook of research on stress and well-being in the public sector Although various primary, secondary, and tertiary stress management options are available, programs should be tailored to the unique challenges faced by correctional institutions and the people working within them. Dugan et al. (2016) have highlighted the importance of considering the hierarchical nature of prison work, as interventions incompatible with this are unlikely to succeed. Although some types of intervention are likely to be effective in all types of prisons (for example, ensuring adequate staffing levels and providing training in reducing rumination), officers working in high-security institutions may have different needs to those employed in open prisons. Action is needed at the policy level, such as reducing the use of incarceration to tackle prison overcrowding; at the organizational level, such as ensuring adequate staffing levels; as well as at the individual level, for example, stress management training. Organizational- and individual-level interventions can be complementary (LaMontagne et al., 2007) and there is potential for secondary-level interventions to enhance the responsiveness of employees to organizational initiatives (Bond, Flaxman, & Bunce, 2008). It is important to recognize the systemic nature of organizations as aspects of the job, the working environment, and the individual worker will influence each other. For example, evidence that managers pressure officers to work while sick will be related to operational concerns about short-staffing. Such techniques may be effective in ensuring cover in the short-term but will impact on the health and safety of staff and inmates and incur greater long-term costs than increasing staffing levels. Moreover, prison officer burnout can encourage more punitive attitudes towards prisoners, which will inevitably impact on the psychological climate of prisons and inmate behavior. The first step is for prison leaders to recognize the financial and organizational benefits of well-being programs and identify challenges to their successful implementation and potential solutions. Trounson and Pfeifer (2016) have provided some guidelines for correctional institutions that are developing interventions to enhance staff well-being. Several steps are recommended, with employee participation being fundamental at each stage: 1. Defining well-being as it relates to the organization. 2. Demonstrating the need for improvement by comparing the well-being needs of staff with the initiatives currently available. 3. Ensuring that the program is congruent with the needs of staff and the organization and supported by research evidence. 4. Measuring the impact of interventions using appropriate tools. 5. Piloting the program. 6. Making changes where necessary. 7. Rolling the program out to the wider organization and continually monitoring its effectiveness.

Stress and well-being in prison officers  147

CONCLUSIONS This chapter provides evidence that the prison service in the UK is currently experiencing a crisis that has increased employees’ exposure to psychosocial stressors such as job demands, low control, and a lack of support. New threats to the well-being of prison staff, such as the use of NPS and an increase in overcrowding, self-harm, and violence among the incarcerated population, are likely to compound the risks of job-related stress, burnout, and mental health problems that are already higher than in many other professional groups. At the same time, managers’ attempts to optimize staffing levels may exacerbate the demands on staff by encouraging presenteeism, further increasing the risk of burnout among their staff. As well as contributing to staff turnover, the performance of officers remaining in the job is likely to suffer and the safety of correctional facilities is likely to deteriorate. To address these challenges, a multilevel approach is required with the input of policy-makers, employers, management, and officers themselves. While stress management training should be part of such an approach, individually focused initiatives will not in themselves be sufficient. The need to consider policy (for example, incarceration strategies) suggests that a multidisciplinary approach would be effective, where experts in crime, rehabilitation and policy work together with occupational health psychologists to identify systemic and sustainable solutions to the current crisis.

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Stress and well-being in prison officers  151 Steiner, B., & Wooldredge, J. (2015), ‘Individual and environmental sources of work stress among prison officers’, Criminal Justice and Behavior, 42(8), 800–818. Stichman, A.J., & Gordon, J.A. (2014), ‘A preliminary investigation of the effect of correctional officers’ bases of power on their fear and risk of victimization’, Journal of Crime and Justice, 38(4), 1–16. Ten Brummelhuis, L.L., & Bakker, A.B. (2012), ‘A resource perspective on the work–home interface: the work–home resources model’, American Psychologist, 67, 545–556. Trounson, J.S., & Pfeifer, J.E. (2016), ‘Promoting correctional officer wellbeing: guidelines and suggestions for developing psychological training programs’, Advancing Corrections, 1, 56–64. Vickovic, S.G., Griffin, M.L., & Fradella, H.F. (2013), ‘Depictions of correctional officers in newspaper media: an ethnographic content analysis’, Criminal Justice Studies, 26(4), 455–477. Walker, E.J., Jackson, C.A., Egan, H.H., & Tonkin, M. (2015), ‘Workability and mental wellbeing among therapeutic prison officers’, Occupational Medicine, 65, 549–551. Webster, S., & Buckley, T. (2008), Psychosocial working conditions in Britain in 2008. Sudbury, UK: HSE Books. Wright, L., Borrill, J., Teers, R., & Cassidy, T. (2006), ‘The mental health consequences of dealing with self-inflicted death in custody’, Counselling Psychology Quarterly, 19(2), 165–180.

11. Well-being in academic employees – a benchmarking approach Gail Kinman and Siobhan Wray

WORK-RELATED STRESS IN ACADEMIC EMPLOYEES The university sector worldwide has experienced intense and wide-ranging change and there is evidence that the work has become increasingly stressful. This means that the well-being of university staff has become of considerable interest to all stakeholders. Over the past ten years or so, studies conducted in countries such as Canada (Biron, Brun, & Ivers, 2008); the United States (Reevy & Deason, 2014); Australia (Winefield et al., 2008); South Africa (Barkhuizen & Rothmann, 2008); Malaysia (Idris, O’Driscoll, & Anderson, 2011); China (Zhang et al., 2014); Oman (Shrivastava, Shukla, & Shrivastava, 2015); India (Reddy & Poornima, 2012); the Netherlands (Taris, Schreurs, & Van Iersel-Van Silfhout, 2001); the Czech Republic (Zábrodská et al., 2018); Ireland (Byrne et al., 2013); and the UK (Kinman & Wray, 2014; Tytherleigh et al., 2005) have investigated the stressors and strains experienced by university employees. There is evidence that academic staff (those with teaching and/or research contracts) are particularly vulnerable to work-related stress, burnout, and mental health problems (Guthrie et al., 2017; Kinman & Wray, 2014; Winefield et al., 2008). A systemic review conducted by Watts and Robertson (2011) concluded that academics have a similar risk of burnout (particularly emotional exhaustion) to ‘highly pressured’ employees such as health care workers. Moreover, 27 percent of a large sample of academics working in universities across North America reported experiencing emotional exhaustion either often or very often, which is higher than the proportion found in many other working populations (Padilla & Thompson, 2016). Pressure from teaching, service activities, and applying for research funding were found to be the most powerful predictors of emotional exhaustion. Our own research using the General Health Questionnaire (GHQ-12: Goldberg & Williams, 1988) indicated that academics in the UK are at considerable risk of psychological distress and the prevalence may be increasing. This measure assesses common mental health problems, such as depression and anxiety, as well as associated symptoms such as cognitive disturbance and sleeping difficulties. In 2004, 50 percent of our sample of almost 10 000 academic employees met the threshold criteria for ‘caseness’ (or a clinical level of mental health symptoms) (Kinman, Jones, & Kinman, 2006). Follow-up research conducted ten years later, however, found that the caseness rate among almost 5000 academics had risen to 62 percent (Kinman & Wray, 2014). This is considerably higher than many other occupational samples that have used the same measure (Goodwin et al., 2013; Stride, Wall, & Catley, 2007). 152

Well-being in academic employees – a benchmarking approach  153 A review of the literature highlights the wide range of stressors experienced by academic employees. There is evidence that demands, such as long working hours, work overload, fast working pace, heavy administrative burden, complying with quality assurance procedures and pressure to obtain research funding and to publish, are considered particularly stressful (Barkhuizen & Rothmann, 2008; Coulthard & Keller, 2016; Gillespie et al., 2001; Guthrie et al., 2017; Taris et al., 2001; Torp, Vinje, & Haaheim-Simonsen, 2016). Other studies have also identified a lack of professional resources, such as low autonomy and independence, insufficient support from managers and colleagues, poor leadership and management, limited career development opportunities, communication difficulties, lack of involvement in decision-making and low job security, as particularly problematic (Edwards et al., 2009; Gillespie et al., 2001; Jerejian, Reid, & Rees, 2013; Kinman, 2014; Torp et al., 2016; Tytherleigh et al., 2007; Winefield et al., 2009). The importance of a supportive, collegial culture to the well-being of academic employees has been highlighted, with poor working relationships and conflict identified as key sources of stress (Kinman & Wray, 2014; Narayanan, Menon, & Spector, 1999; Tytherleigh et al., 2007). Lack of reward and recognition for one’s efforts appears to be particularly harmful for academic staff (Gmelch, Lovrich, & Wilke, 1984; Mark & Smith, 2012). A series of studies testing the effort–reward imbalance model (Siegrist, 1996) with staff working in UK universities (Kinman, 2016a; Kinman & Jones, 2008a, 2008b) found that respect and esteem rewards were robust predictors of mental health, job satisfaction, work–life balance, and retention. Evidence was also found that such rewards can offset the negative impact of job-related efforts. Several studies have identified role stressors, such as overload and conflict, as a key hazard for academic staff. Although occupying multiple roles can benefit well-being (Barnett, 2004), meeting the demands and expectations of one role will deplete the resources available to meet the requirements of others. The negative effects of intra-role conflict (incompatible requirements within the same role) and inter-role conflict (pressures stemming from different domains, such as work and personal life) for well-being have been widely demonstrated (Katz & Kahn, 1978). Academic employees appear to be particularly vulnerable to intra-role conflict due to the increasing number of roles they are expected to fulfill (for example, teaching, research, mentoring and pastoral care, external consultancy, and public engagement) (Biron et al., 2008; Gmelch et al., 1984; Kinman & Wray, 2014). In terms of inter-role conflict, there is evidence that academics are at particularly high risk of conflict between their work and personal lives, which is a powerful source of distress (Barkhuizen & Rothmann, 2008; Kinman & Jones, 2008c; Kinman & Wray, 2014). A combination of work-related, individual difference, and behavioral factors has been found to contribute to work–life conflict among academic staff. Work overload coupled with a deep involvement in the job means that the boundary between work and personal life is often flexible and permeable, increasing the risk of conflict and poor well-being (Kinman & Jones, 2008c). Although the degree of work–life integration considered acceptable by academic staff varies, sufficient opportunities

154  Handbook of research on stress and well-being in the public sector for recovery are essential to protect health and job performance (Kinman, 2016a; Kinman & Jones, 2008c).

A BENCHMARKING APPROACH The accurate diagnosis of psychosocial hazards is essential in developing interventions to reduce work-related stress at source. Approaches that allow researchers to compare their findings with benchmarks from appropriate samples can be particularly useful in interpreting findings, setting priorities, and targeting change initiatives. A benchmarking approach has been used previously in universities in Australia and the UK. Langford (2010) compared responses from over 26 000 staff working in 17 Australian universities with benchmarks from public sector organizations across a range of work practices and outcomes previously linked to high performance. Overall, universities scored more poorly than target groups in areas such as cross-unit cooperation, organizational processes and facilities, wellness and work–life balance, but they reported more role clarity and work engagement, a stronger belief in mission and values, and more positive relationships with colleagues than other sectors. Tytherleigh et al. (2005) used the ASSET screening tool to identify the key sources of stress perceived by staff in 14 universities in the UK. The normative dataset for the ASSET currently has around 100 000 responses from organizations across the public and private sectors (Robertson Cooper, 2019). Findings revealed higher levels of stress among university staff compared to other sectors in areas such as work relationships, control, resources and communication, and the quality of commitment from and to their organization, whereas their well-being relating to workload, work– life balance and physical health status was assessed at lower risk. Both these studies have yielded useful findings but, as data were obtained from a homogeneous group of university staff, no firm conclusions can be reached about academic employees. Moreover, some of the findings differ markedly from other studies of the sector reviewed earlier in this chapter – for example, many studies have identified workload and work–life balance as powerful sources of stress for academic staff. Our research used a well-validated, risk-assessment process to monitor the well-being of UK academic employees rather than a mixed group of university staff. The first wave of data collection in 2008 allowed us to track the well-being profile of academics over time at a sector level and compare our findings with benchmarks from the UK working population. The next section describes the approach taken, presents the three waves of data collection, and discusses any changes emerging over time.

THE MANAGEMENT STANDARD APPROACH The Health and Safety Executive (HSE: the body responsible for policy and operational issues concerning occupational health and safety in the UK) has developed a comprehensive process to help manage the work-related well-being of staff.

Well-being in academic employees – a benchmarking approach  155 A risk-assessment approach is utilized, where stress is considered a major health and safety concern and stressors are measured and managed like any other potential workplace threat. This approach was developed, in part, in response to a growing awareness of the costs of ill-health resulting from workplace stress (MacKay et al., 2004). The HSE framework is based on a set of standards of good management practice (known as benchmarks) that identify the extent to which employers comply with their duty of care to protect the well-being of their staff by preventing stress from occurring at source (Mackay et al., 2004). This approach reflects extensive evidence that primary, or organizational-led, interventions are more effective than secondary initiatives that aim to enhance the stress management skills of individual employees (Nielsen & Noblet, 2018). Following consultation with stakeholders and an extensive review of the literature, several elements of work activity (known as psychosocial hazards) were chosen that (1) are considered relevant to most workers; and (2) have strong evidence as the most critical predictors of employee well-being and organizational performance (Mackay et al., 2004). The hazards are: ●● ●● ●● ●● ●●

demands: for example, workload, pace of work and working hours; control: for example, autonomy over working methods, pacing, and timing; peer support: for example, assistance and respect from colleagues; management support: for example, the availability of feedback and encouragement; relationships: for example, interpersonal conflict, including bullying and harassment; ●● role: for example, role clarity and how work done fits into the aims of the department and the organization; ●● change: for example, how organizational changes are managed and communicated. A self-report questionnaire has been developed to measure the seven hazard categories (the Management Standards Indicator Tool: MSIT; MacKay et al., 2004). The 35 items in the measure are scored using scales indicating the extent of agreement or frequency, with higher scores representing more well-being in each domain. There is growing evidence for the validity and reliability of the tool (Brookes et al., 2013; Edwards & Webster, 2012) and it is strongly correlated with scores on validated measures of job-related mental health and satisfaction (Kerr, McHugh, & McCrory, 2009). Alongside the development of the MSIT, specific ‘states to be achieved’ (or benchmarks) were identified, reflecting the strength of evidence linking exposure to each hazard to mental and physical health problems (Mackay et al., 2004). A large body of normative data from organizations within the public and private sector was used to develop the benchmarks. This approach has been used in a variety of occupational groups, such as police, prison officers and health care staff, to identify priority areas and target interventions (see Houdmont, Kerr, & Randall, 2012; Kerr et al., 2009; Kinman, Clements, & Hart, 2016). The framework has also been incorporated into occupational health guidelines for several professional associations, including

156  Handbook of research on stress and well-being in the public sector Table 11.1

Sample characteristics 2008–14 2008

2012

2014

Sample size

7 196

12 635

5 192

% Female

52

55

53

% Full-time

82

84

83

% Permanent

85

88

85

police and teaching, and in large public sector organizations such as the National Health Service.

OUR FINDINGS We used the MSIT and other measures to obtain data from academic employees working in UK universities in 2008 (n = 7196), 2012 (n = 12 635) and 2014 (n = 5192). The sample characteristics for each wave of data collection are shown in Table 11.1. When using a benchmarking approach, it is crucial to identify the extent to which the sample represents the target population. Comparison with employment statistics for UK universities (for example, HESA, 2014) indicates that the samples generally reflected sector norms in terms of age, but women were slightly over-represented and staff on temporary contracts were under-represented at each wave of data collection. Figure 11.1 shows the findings for each hazard dimension for the three waves, along with the recommended standards, or benchmarks. As mentioned above, higher scores represent greater satisfaction with each category. Apart from job control,

Figure 11.1

Mean scores for work-related hazards 2008–14 with HSE benchmarks

Well-being in academic employees – a benchmarking approach  157 which exceeded the recommended level, none of the benchmarks were met at any of the three data collection points. Scores for demand, relationships, and change were particularly low compared to the reference group from other sectors in all waves. Analysis of variance identified significant reductions in mean scores for five out of the seven dimensions between 2008 and 2012 (demands, control, relationships, role, and change; all p < 0.001), indicating deteriorating well-being in these areas. Between 2012 and 2014, well-being relating to control, relationships, and role reduced further (all p < 0.001), suggesting a continuing decline. Well-being relating to support from managers and peers also deteriorated between 2012 and 2014 (both p < 0.001). Mean scores for control also reduced but continued to meet the recommended standards. Although well-being relating to change deteriorated between 2008 and 2012, there was a slight improvement between 2012 and 2014 but this was non-significant.

IMPLICATIONS OF FINDINGS A fourth wave of data collection is planned (this is not yet in progress). The results of our multiwave research have clear potential to help develop interventions to protect and enhance the well-being of academic staff. A fourth wave of data collection using the MSIT is in progress that will identify any further deterioration or improvements over time. Below, we interpret the findings in light of the rapid, wide-ranging changes to the nature of academic work occurring during the study period. We also highlight the value of extending the benchmarking approach to incorporate hazards that are more job specific (Cox et al., 2009) and contemporary threats to well-being that might compound the negative effects of existing stressors. The degree of satisfaction reported by academics with the level of demand they experience failed to meet recommended standards in 2008 and deteriorated further over the study period. Insight into employees’ perceptions of demand relating to their workload, working hours, and pace of work can undoubtedly help target broad-based interventions. The factors that might have contributed to the increased demand should also be considered, such as rapid expansion of student numbers with a more ‘consumer-driven’ approach to their studies, enhanced scrutiny of teaching and research, more pressure to undertake and publish research, an increased focus on commercial activity, and a general need to ‘do more with less’ (Biron et al., 2008; Kinman, 2014; Nixon, Scullion, & Hearn, 2018; Tytherleigh et al., 2005). In terms of contemporary hazards to well-being, there is growing evidence that email has become a significant source of stress for university staff. Pignata et al. (2015) found that perceptions of overload were commonplace and underpinned by overuse of email by staff and students and expectations for a rapid response. The ability to access emails outside ‘standard’ working hours can also compound the negative impact of work overload among academics, especially where job involvement is high and boundaries between work and personal life are flexible and permeable (Kinman, 2016b). The potential drawbacks of technology for the well-being of academic staff were also highlighted in a study of Icelandic academics (Heijstra &

158  Handbook of research on stress and well-being in the public sector Rafnsdottir, 2010). Although participants believed that technology facilitated flexible working, they tended to work longer hours to comply with expectations of extended availability. The implications for academics’ work–life balance and well-being via lack of recovery opportunities were highlighted in both studies. The increasing role stress that we observed in the sector also poses a considerable risk to the well-being of academic staff. The growing number of roles involved in academic work means that further insight into how they perceive their work tasks is crucial. There is increasing evidence that stressors linked to one’s professional identity are particularly harmful (Semmer et al., 2007). If an individual believes their identity has been devalued, or that their work tasks are not well aligned with what they consider appropriate to their role, the risk of strain increases. Illegitimate tasks (those considered either unnecessary or inappropriate) are particularly damaging and have been associated with a range of negative outcomes such as burnout, job dissatisfaction, and feelings of resentment towards the employer (Kottwitz et al., 2013; Semmer et al., 2015). Our own research has found that academics believe they perform illegitimate tasks at work on a regular basis and this has increased the potential for intra-role stress (Kinman & Wray, 2014). Another recent study has provided some insight into the tasks that academics find legitimate or unreasonable and how this might influence their well-being. Research conducted with 2127 Danish university staff found that long hours spent doing tasks considered intrinsic to the job (such as research) had weaker relationships with well-being than those considered illegitimate (such as administration) (Opstrup & Pihl-Thingvad, 2016). Nonetheless, as respondents were all researchers, their expectations of what constitutes a legitimate task may have been narrower than those on a ‘standard’ academic contract that encompasses many other types of role. Reflecting the effort–reward imbalance model discussed above, the Danish study also observed that a lack of congruence between participants’ expectations of academic freedom, peer recognition, job security, and their actual working conditions increased the risk of stress. Further insight is needed into the tasks that academic employees consider congruent and incongruent with their professional role and how this influences their well-being, engagement, and job performance. It is possible that junior academics are less inclined to see work tasks as illegitimate than their colleagues with longer tenure, who may be more likely to perceive role ‘creep’ and experience associated distress. There is strong evidence that academic employees expect a high degree of autonomy over their working lives and lack of control can be a powerful source of strain (McClenahan, Giles, & Mallett, 2007). Although our research found that the overall level of control reported by participants exceeded the HSE minimum standards at all stages, it reduced significantly over time. It has been previously argued that a shift from a culture of consensual decision-making, cooperation, and shared values towards a non-participative management style has eroded academics’ sense of autonomy (see Fanghanel, 2012; Musselin, 2018). More generally, the importance of ‘employee voice’, defined as one’s actual and perceived involvement in one’s workplace, to their well-being has been highlighted (Wood, 2008). How to increase

Well-being in academic employees – a benchmarking approach  159 feelings of autonomy and involvement by academic staff should be a priority in the sector and this is considered further below. A supportive and open organizational culture is crucial in promoting well-being, engagement, and job performance. Like job control, positive working relationships and mutual support can facilitate employee well-being by reducing strain at source and mitigating or moderating the impact of stressors such as high demand (Viswesvaran, Sanchez, & Fisher, 1999). Our research found that perceptions of support had reduced over time in UK universities and the quality of working relationships had deteriorated. The erosion of academic collegiality documented in the sector that was discussed above will inevitably affect the quality of working relationships. The increase in demand and role stress we observed over time is also likely to have constrained opportunities for academics to gain and offer support due to lack of time and energy. More seriously, several studies have documented an increase in bullying in universities, which has been linked to growing workload pressures, role ambiguity, competitiveness, and threats to professional status (Clark et al., 2013; McKay et al., 2008; Zábrodská et al., 2011). There is also evidence that bullying is likely to thrive under conditions of change and uncertainty (Weinberg et al., 2010), further highlighting the role of current working conditions in reducing satisfaction with working relationships. Fundamental changes to the nature and organization of academic work have been discussed throughout this chapter and linked to employees’ increasingly negative perceptions of their working conditions. Although change is essential for progress, it can be a potent stressor and impair health, job performance, and retention (Weinberg et al., 2010). Changes introduced without adequate staff involvement can also threaten autonomy and professional identity and intensify role stress (Karp & Helgø, 2008). Although it is essential to anticipate and manage change effectively, we found that academics’ satisfaction with the communication and management of change in their institutions was considerably lower than recommended levels in 2008 and deteriorated further over the study period. Most change management initiatives fail; this can be exacerbated by mistrust of the changes that have been imposed, feelings of uncertainty about their impact, and the belief that too many changes have occurred. Change fatigue refers to a sense of passive resignation or apathy towards organizational changes (Bernerth, Walker, & Harris, 2011). We found a high level of change fatigue among our sample of over 5 000 academics; for example, more than half (57 percent) agreed or strongly agreed that too many change initiatives had been introduced in their institution and nearly seven out of ten (68 percent) found the pace of change to be overwhelming (Kinman & Wray, 2014). A considerable majority (76 percent) agreed at least ‘somewhat’ that a period of stability was required, with 41 percent expressing strong agreement. Change fatigue has been associated with burnout, low job satisfaction, and engagement and can also encourage withdrawal behaviors (Bernerth et al., 2011). How to increase employee voice in informing future change should be a key consideration and the potential impact on their well-being considered as part of a risk assessment.

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INTERVENTIONS Given the evidence that academic employees are at high risk of work-related stress, burnout and mental health problems it is crucial to consider how to improve their well-being. The value of a systemic approach to managing stress at work has been highlighted, with interventions required at primary, secondary, and tertiary levels. The business case for improving staff well-being, in terms of reduced sickness absence and turnover and improved productivity, is well established but awareness of the financial benefits of introducing initiatives remains low in UK universities and provision is inconsistent and of varying quality. A report commissioned by research funding bodies in the UK (Shutler-Jones, 2011) identified some areas of good practice in universities, with interventions mainly targeted at management (for example, executive coaching, peer support and leading change) and secondary interventions for staff in general. Little information was available on the effectiveness of these initiatives, but benefits were claimed in several areas such as better scores on employee well-being surveys, reduced sickness absence, and improvements in self-reported flexibility, support, and productivity. An evaluation of a multilevel stress management intervention introduced in an Australian university (Pignata & Winefield, 2015) considered the effectiveness of organization-focused strategies (such as stress awareness, improving communication and the management of change, and increasing trust) and staff-focused interventions (such as the introduction of bullying/harassment policies, recognition of excellence, and lifestyle management). Although post-intervention interviews highlighted some benefits for autonomy and acknowledgment of good work, staff continued to see their work as stressful and many were unaware that any initiatives had been implemented. This suggests that strategies to improve staff well-being need to be recognized as such and they should be well publicized, and staff encouraged to participate. Another study conducted by the same team (Pignata et al., 2016) with staff in 13 Australian universities suggested that the introduction of stress management interventions was unlikely to improve well-being if perceptions of organizational justice and trustworthiness of senior management in the institution were low. Although multilevel interventions are required, initiatives that aim to reduce the risk of work-related stress at source are more effective than those seeking to improve the stress management skills of individuals (Nielsen & Noblet, 2018). Our research outlined above has confirmed the value of using a validated, risk-assessment approach to diagnose the key psychosocial hazards in a particular occupational group, rather than a more ‘ad hoc’ approach that does not permit comparison between sectors or allow a body of knowledge to be developed. The findings have strong potential to address the root causes of stress and ensure that individual universities, and the sector in general, are better placed to respond to the challenges faced by staff now and in the future. The costs of ignoring the deteriorating well-being in the university sector could be significant in terms of lost talent, low engagement, high absenteeism, and reduced job performance, as well as the personal costs for individuals and their families.

Well-being in academic employees – a benchmarking approach  161 Our findings suggest that priority should be given to reducing demand, improving working relationships, and managing change more effectively. Nonetheless, a systemic approach is required, as each of the seven areas of work activity we assessed should not be considered in isolation. As discussed above, poorly managed change is likely to exacerbate demands and role stress, impair working relationships, and reduce support from managers and colleagues. Moreover, although satisfaction with job control met the minimum standards, the gradual erosion of autonomy perceived by UK academics will be linked to their lack of voice in influencing the change process. It is likely, therefore, that input into decision-making and setting goals and priorities will improve well-being and encourage individuals to embrace change rather than resist it. Line managers have a powerful influence on the well-being of their staff, so interventions that improve their competencies can be particularly effective. Based on extensive research in different sectors, Donaldson-Feilder, Yarker and Lewis (2011) have identified the line manager behaviors that can prevent and reduce stress in employees. The four core skills are: (1) managing with respect (managing emotions in self and others effectively, having integrity, being considerate, and taking responsibility); (2) managing existing and future workload (proactive work management, effective problem-solving, and empowering others); (3) managing individuals (being accessible, sociable, and empathic); and (4) managing relationships (dealing with conflict and taking responsibility for resolving issues). This framework has strong potential to inform policy and procedure for the selection, training, and development of managers who will help reduce psychosocial hazards and improve resilience. Work–life conflict is a powerful source of distress among academic employees. Another framework that could help improve their well-being has identified the line management behaviors that can enable employees to improve their work–life balance. Hammer et al. (2006) have emphasized the importance of: (1) emotional support (learning about people’s work–life balance needs and listening to problems); (2) instrumental support (helping employees avoid conflict between work and personal life); (3) role modeling (demonstrating effective work–life balance behaviors personally); and (4) creative work–life balance management (generating novel strategies to reduce conflict between life domains and highlighting the benefits of work–life balance for well-being and job performance). These two frameworks could be supplemented with more job-specific factors within the core skill areas. For example, the high risk of email stress in the university sector discussed above suggests that managers, as well as staff members, should identify and role model the healthy management of technology. Although managers have a key role to play in reducing stress in their staff, it is clearly important that these responsibilities do not compromise their own well-being.

162  Handbook of research on stress and well-being in the public sector

CONCLUSION The importance of autonomy, respect, and professional identity to the well-being of academic staff highlighted in this chapter suggests that participatory approaches will be particularly helpful in identifying ways to reduce the work-related stress they experience. Employees themselves are also ideally placed to suggest opportunities to increase their job satisfaction. Action research techniques could draw upon key frameworks of work stress, such as the effort–reward imbalance model (Siegrist, 1996) discussed above and the job demands–resources model (Bakker & Demerouti, 2017), to help shape practical, low-cost interventions to reduce workloads, enhance perceptions of control, reduce any imbalance between efforts and rewards, and help academics maintain a healthy work–life balance. Longitudinal research conducted by Boyd et al. (2011) suggests that procedural fairness as well as job autonomy are particularly important resources for mitigating the negative effects of job demands in academic staff. Conservation of resources theory (Hobfoll & Shirom, 2000) would also be useful in helping employees identify the resources that could mitigate current and future resource loss and, accordingly, reduce stress and burnout and improve satisfaction and engagement. Moreover, participatory techniques could be used to identify the tasks that academic staff find unnecessary and unreasonable and how they might be better managed to enhance control and foster professional identity and self-efficacy. In conclusion, although we have identified some priority areas for interventions to improve the well-being of academic staff, little is yet known about employees on fixed-term and hourly paid contracts. Such contracts are widespread in UK universities, with one-third of all academic staff and two-thirds of research-only staff employed on a fixed-term basis in 2016/17 (HESA, 2018). In 2013, it was estimated that half of the overall teaching in Australian universities was done by academics on ‘contingent’ contracts (fixed-term and casual/sessional) (Ryan et al., 2013). Recent statistics show the proportion of academics in insecure employment has risen further, with only just over one in three (35.6%) employed securely (National Tertiary Education Union, 2018). A high proportion of academic staff in Australia are also on ‘contingent’ contracts (fixed-term and casual/sessional), accounting for half of the overall teaching in its universities (Ryan et al., 2013). Job insecurity is a long-standing challenge in the higher education sector, particularly for early-career researchers who are often employed on successive short-term contracts. By the nature of their work, they are often harder to access than academics on permanent contracts, but future research should examine their experiences and the support they require to attenuate the pressures they face.

REFERENCES Bakker, A.B., & Demerouti, E. (2017), ‘Job demands–resources theory: taking stock and looking forward’, Journal of Occupational Health Psychology, 22(3), 273–285.

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12. Stress, well-being and aging in the Italian banking sector: evidence and future perspectives Gabriele Giorgi, Giulio Arcangeli, Jose M. Leon-Perez, Massimo Fioriti, Eleonora Tommasi and Nicola Mucci

OCCUPATIONAL STRESS: EPIDEMIOLOGY, TOOLS AND EVIDENCE The international financial crisis of 2007 and the recent policy of alliances and mergers of banking groups have changed the Italian banking sector (Dom et al., 2016; Giorgi, Arcangeli et al., 2015, 2019; Giorgi et al., 2017; Giorgi, Ariza-Montes et al., 2019; Mucci, Giorgi, Roncaioli et al., 2016; Pohl & Tortella, 2017). A bank employee’s work has become more stressful due to this reorganization. The Italian National Institute for Insurance against Accidents at Work and Occupational Diseases (INAIL) carried out a survey of 2100 bank employees regarding their health conditions. Over two-thirds of participants reported mental fatigue due to work-related stress (Macciocu et al., 2008). There are many factors that make the banking environment stressful. The International Labour Organization (ILO) reported examples such as: ergonomic problems, conflicting roles, overwork, difficult relationships with customers, and an increase in stress and cases of violence (Giga & Hoel, 2003). Furthermore, the European Observatory of Working Life identified the following risk factors: heavy workload, long working hours, lack of control and autonomy at work, poor relationships with colleagues, poor support at work, and the impact of organizational changes (Broughton, 2010). The literature also shows that high job demands and low job control, as well as role ambiguity, may play a crucial role in work-related stress (Karasek, 1979; Michailidis & Georgiou, 2005). The National Institute for Occupational Safety and Health (NIOSH, 1999) found lack of job control a common feature in the most stressful jobs. Giorgi and colleagues (2017) recently reviewed the incidence, related factors, and the consequences of work-related stress in the banking sector. Most of their studies showed an increase in health problems related to mental stress. Bankers offer a wide variety of products and services to customers, collaborating with them to achieve the bank’s objectives in areas such as the sale of investment funds, bonds, and insurance policies. The bank employee, due to excessive workload or conflicting relationships, often develops cognitive anxiety or depressive symptoms that evolve into maladaptive behaviors and can lead to burnout syndrome (Giorgi et al., 2017). 167

168  Handbook of research on stress and well-being in the public sector This chapter examines the characteristics of occupational stress in the Italian banking sector, and the new emerging risk factors of robberies and aging. The chapter details the latest research in the area and provides strategies to prevent stress and reduce its adverse effects, which will assist in the development of healthier workplaces in the sector.

OCCUPATIONAL STRESS: DEFINITION AND CHARACTERISTICS Occupational stress is defined as ‘the product of the dynamic interaction between the person and the socio-organizational context in which he or she works, constituting the result of a (not equal) relationship between the stressors related to the task/role and the operator’s ability to cope with these’ (Giorgi, Arcangeli et al., 2019, p. 256). The intent of this chapter is to analyze work-related stress in the banking sector. Bank employees often present with this problem because of social and organizational factors. The direct contact with the user, the aging of employees, and the risk of robberies are fundamental social elements for the development of stress. Organizational factors, on the other hand, relate to the profound changes that the banks have undergone in the last decade that have led to increasingly tight working rhythms and an increase in technology. The main areas of research about work-related stress are burnout syndrome, social support, demographics, and work characteristics. Burnout Syndrome Burnout syndrome affects the worker who is subjected to excessive contact with the user (helping professions) and is characterized by three phases: emotional exhaustion, depersonalization, and reduction of personal satisfaction (Freudenberger, 1974; Maslach & Jackson, 1981; Mucci, Giorgi, Ceratti et al., 2016). There is a direct correlation between the onset of burnout syndrome and the workplace. In general, the employee working in the branch, rather than the central office, has a greater risk of developing this syndrome because they have more contact with users and their problems. Social Support Social support is considered the best-known anti-occupational situational variable, necessary to mitigate the negative effect of stressors and to reduce the volume of stress reactions. If the lack of social support has statistical correlations with negative health outcomes, such as minor psychiatric disorders (Valente et al., 2015), its presence can be considered a protective factor, especially support from friends and family (Snorradóttir et al., 2013). It is likely that work stress could be the effect of organizational changes that disrupt social bonds when new social bonds have not had time to form (Shah, 2000). Occupational stress can be mitigated with ‘psychological

Stress, well-being and aging in the Italian banking sector  169 capital’, or PsyCap, an approach based on positive psychological states, including hope, optimism, and resilience (Luthans et al., 2005, p. 250), all of which can be measured, developed, and managed with various results. If banking employers could reduce burnout, they would increase PsyCap. Demographic Characteristics Individual aspects, such as age and gender, can influence the worker’s reaction to stress. Older employees develop more work-related stress than their young colleagues because they have less technological skills and enthusiasm, which are essential for the profession (Alarcon, 2011; Amigo et al., 2014; Lee et al., 2011). There are conflicting results on gender differences. Some studies report that women may be more exposed to stress because they have both work and domestic issues (Fernandes et al., 2012). Even the level of education has no definitive evidence, but some studies suggest that a higher cultural level corresponds to a greater risk of developing stress-related health problems (Kan & Yu, 2016; Karasek et al., 1998; Michailidis & Georgiou, 2005). Work Characteristics The Karasek model states that high job demands or low job control, or a combination of them, is related to stress in the working environment (Karasek, 1979). The banking sector conforms to this model due to the following work characteristics: ●● employment instability, risk of downsizing, strict deadlines, and lack of job security (Giga & Hoel, 2003); ●● risk of unpredictable violence, higher responsibility, and related burnout syndrome (Harrison & Kinner, 1998); ●● ergonomic issues such as visual discomfort in computer users (Mocci, 2001); ●● repetitiveness of work and lack of training courses (Cavanaugh et al., 2000; Selye, 1976).

THE ITALIAN CONTEXT In Milan, the PSAL (the Service for Prevention and Safety in the Workplace) conducted a pilot study on a prevention plan for work stress in banks. The first step of the study was to submit a questionnaire on stress to employees (see Lombardy Region, ATS Metropolitan City of Milan, 2018). The results were then analyzed by the PSAL and discussed during an audit with the consultants of each company. Eighteen banks took part in the survey. The critical issues and potentials of each bank emerged from the evaluation of the meta-analysis obtained. Based on the results, the banks were divided into the categories of ‘insufficient’ (6/18) and ‘sufficient-good’ (12/18).

170  Handbook of research on stress and well-being in the public sector During the audit, the negative and positive aspects of the evaluation process were analyzed and evaluated. The six ‘insufficient’ companies had the following characteristics: ●● work-related stress not included in the risk assessment document; ●● a lack of intervention plans in the case of risk situations; ●● lack of guidelines on stress management. The 12 ‘sufficient’ or ‘good’ banks showed the following characteristics: ●● active participation of workers’ representatives; ●● provision of training courses for employees with dedicated projects, e-learning platforms; ●● Web TV programs and teaching materials on the local network; ●● information to employees via intranets, newsletters, and company publications; ●● consideration of gender, age, and cultural origin; ●● held focus groups with work-related stress experts; ●● treated problems such as mental fatigue, monotony, and repetitiveness (UNI EN ISO10075-1 and 10075-3: Ergonomic principles related to mental workload); ●● strong interest of senior management and managers in the areas of stress, health, and safety of workers; ●● use of surveys about the organization; ●● activities to promote the welfare and health of employees in the workplace; ●● promotion of a policy of voluntary reduction of working time for all employees who are permitted to be absent. The companies that obtained the highest scores were those in which managers have paid attention to work-related stress through initiatives such as creation of the Commission for Equal Opportunities, offered part-time facilities and flexible hours, and established support for stressed employees by working with qualified personnel. Survey results show that there are fewer women among senior management regardless of company size (one woman to nine men). To guarantee women’s access to managerial positions, the company must facilitate the relationship between the home and work environment, and the care of children and the elderly. The presence of training courses on the management of health problems that may arise in the workplace (for example, work-related stress) was very important (Lombardy Region, ATS Metropolitan City of Milan, 2018).

Stress, well-being and aging in the Italian banking sector  171

ROBBERIES: INCIDENCE, RISK FACTORS, AND CONSEQUENCES Epidemiology In Italy, robberies reported to the police present a fluctuating trend with a three-year periodicity. Robberies between 2005 and 2007 reported a constantly increasing trend. In 2007 in particular, the highest peak was 87.6 robberies per 100 000 inhabitants. Thereafter, the number of robberies decreased (minimum value 56.9 in 2010) and then progressively climbed up (72.6 robberies per 100 000 inhabitants in 2013). The latest data (over the three-year period 2014–16) showed a further decline in the incidence. In 2016, Italy recorded a minimum number of 54.3 robberies per 100 000 inhabitants, the lowest level in the last 14 years. In 2016, the Italian area most affected by robberies was the south (67.2 robberies per 100 000 inhabitants). The region with the most robberies was Campania (135.4 robberies per 100 000 inhabitants), followed by Lazio (62.0), Lombardy (59.3), Piedmont (55.4), Sicily (54.0), and Puglia (51.5 per 100 000 inhabitants), which showed values above the national average. The lowest levels were in Basilicata (11.7) and Valle d’Aosta (14.9) (Research Centre for Anti-Crime Security, 2013). In Europe, police reported that the number of robberies fell by 24 percent between 2012 and 2016, to around 396 000 in 2016. There was relatively little change between 2009 and 2011. The European definition of ‘robbery’ also contains cases of theft. Italian figures adjusted to the European definition in 2016 was 81.8 (54.3 robberies and 27.5 bag snatchings) and it is widely below the European maximum values (Eurostat, 2018). In Italy, bank robberies grew between 1985 and 1998 (from 1.5 to 5.7 robberies per 100 000 inhabitants), then gradually decreased (particularly in 2010–13), with a period of substantial stability in subsequent years (Italian National Institute of Statistics, 2018a). Recently, Italy recorded a further reduction in the number of robberies from 1.3 for 100 000 inhabitants in 2015 to 0.9 in 2016. The Italian Banking Association (2018) published a report in the first nine months of 2017 stating that bank robberies decreased by 36.9 percent compared to the same period in the previous year. The risk index – the number of robberies per 100 branches – also fell from 1.2 to 0.9. Risk Management Risk management in robberies has gradually become one of the main health and safety problems at work. The risk assessment must be in accordance with the principles and rules established by the legislation for prevention. Legislative Decree No. 81/2008 aims to eliminate or minimize the risks to which employees are exposed after a criminal event. The company is responsible for protecting the employee from the risk of robbery because it is a risk related to the work environment. INAIL believes that the ‘risk of robbery’ should be included as an occupational risk in Legislative Decree No. 81/2008 (Mucci et al., 2015).

172  Handbook of research on stress and well-being in the public sector Psychological Consequences Robbery represents a traumatic event with possible consequences for both the physical and psychological health and well-being of the worker involved. Usually the employee’s psychological mental status is the most affected with post-traumatic reactions (Giorgi, Leon-Perez, Montani et al., 2015). The reactions of victims of a robbery can be varied. The trauma of the person involved can resolve spontaneously, especially if the conditions of the subject are positive. When spontaneous resolution is absent, the victim’s reaction can evolve into more complex situations. The scenarios that can occur if the trauma does not resolve spontaneously are acute stress disorder (ASD) or post-traumatic stress disorder (PTSD). ASD is the preliminary category of PTSD. It usually appears within four weeks of violence and lasts from a minimum of two days to a maximum of four weeks. This anxiety disorder, according to the American Psychological Association (APA, 2014) Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis of PTSD, is defined by specific criteria: exposure to a traumatic event such as sexual assault, warfare, traffic collisions, or other threats on a person’s life; presence of specific symptoms like intrusion (intrusive and disturbing thoughts, nightmares related to the events, intrusive feelings and imagery, and re-experiencing thoughts, mental or physical distress to trauma-related cues); avoidance (numbing of responsiveness, avoidance of feelings, situations, and ideas); and hyperarousal (increase in the fight-or-flight response, such as anger, irritability, hypervigilance, difficulty concentrating, and heightened alarm), resulting in clinically significant distress or impairment in social, occupational, or otherwise important areas (APA, 2014, pp. 271–280). PTSD following a robbery has a prevalence of 13 percent (Hansen & Elklit, 2011). PTSD occurs when psychophysical disorders last more than a month, and can be divided into different stages. Depending on the duration of the disorder, we can define PTSD as: ●● acute PTSD, if symptoms last less than three months; ●● chronic PTSD, if symptoms last longer than three months; ●● delayed-onset PTSD, if symptoms occur at least six months after the event. Factors that Influence the Response to Trauma Elements that influence an individual’s response to a traumatic event can be divided into three macro-categories: pre-traumatic, peri-traumatic, and post-traumatic variables. Pre-traumatic risk factors refer to professional skills and individual characteristics (age, gender, level of education, socio-economic status). Although conflicting data emerge from the scientific literature (Brewin & Holmes, 2003; Ozer et al., 2003), some studies noticed that being female, aged less than 25 years, having a low level of education, the presence of pre-existing psychopathological disorders, and having experienced traumatic events in the past are correlated with the onset of

Stress, well-being and aging in the Italian banking sector  173 PTSD (Belleville et al., 2012; Hansen & Elklit, 2011). The presence of pre-existing pathologies (especially anxiety and depression) and a history of violence are the most important risk factors. A recent survey found that a greater number of robberies in the workplace corresponded to a lower reporting of adverse events. This could result from a greater ‘awareness’ of the victim, who has learned to manage the psychological, physical, and emotional consequences related to the trauma as a result of repeated robberies (Converso & Viotti, 2014). Peri-traumatic risk factors are the characteristics of the traumatic event such as duration, intensity, and nature. These factors are objective and correlate with health outcomes. Direct contact with the thief, the use of weapons, and a large number of robbers are associated with post-traumatic symptomatology (Miller-Burke, Attridge, & Fass, 1999; Mucci et al., 2015). However, the presence of colleagues is a protective factor, and sharing the traumatic event can reduce fear during and after the robbery (Converso & Viotti, 2014). Post-traumatic risk factors consist of immediate physical or psychological reactions following trauma (Hansen et al., 2014). Longitudinal studies suggest that post-traumatic symptomatology reaches its maximum within 24 hours of the event and resolves within three to four weeks (Fichera et al., 2014; Kamphuis & Emmelkamp, 1998; Leymann, 1985). A recent survey (Giorgi, Leon-Perez, Montani et al., 2015) analyzed the effects of exposure to a robbery, focusing on psychological distress and job dissatisfaction. This study was part of a research project on psychological risks in Italian banks. The project provided the Italian version of the 12-item General Health Questionnaire (GHQ-12) to bank employees who were victims of a robbery (Giorgi et al., 2014). This tool can have a total score between 0 and 36; a high score corresponds to a more serious mental disorder of the worker. The interesting part of the study was that the GHQ-12 was first given to the victim of a robbery between 48 hours and one week after the traumatic event (Time 1). Therefore, employees participating in Time 1 were invited to complete the same questionnaire two months later (Time 2). The timing of the delivery of the questionnaires was decided based on the current literature. The study found that an increase in the incidence of mental health problems after a robbery can lead, immediately or after two months, to job dissatisfaction. This study for the first time examines the consequences of physical violence on job satisfaction in the banking sector. Studies on the psychological consequences of bank robberies are difficult to compare because the few studies have discordant results but the data show that bank robberies have important repercussions on the psychological, physical, and working performance of the employee (Skogstad et al., 2013). The most common symptoms affecting employees are sleep disorders, difficulty in concentrating, headaches, anger, stress, worsening of physical health, greater suspicion towards clients, insecurity, a decrease in the desire to work for the current employer, increased depression, increased absenteeism, and an increased use of medical services (Belleville et al., 2012; Miller-Burke et al., 1999).

174  Handbook of research on stress and well-being in the public sector The Impact of Event Scale The Impact of Event Scale (IES) is considered a valid screening tool for victims with PTSD. Although it does not strictly follow the DSM-V diagnostic criteria, it is effective for evaluating epidemiology and intervention proposals. IES was created to identify the connection between traumatic events and the development of psychological aspects. When the DSM-IV introduced the PTSD diagnosis, the scale was revised (IES-R) to introduce the appearance of hyperarousal (which is fundamental for the diagnosis of PTSD). The new IES-R (22 item) scale contained seven other articles to improve the diagnosis of PTSD. In Italy, initially a scale of 15 questions was proposed but the European Community requested a further reduction to a total of six items. The Italian version of the IES (IES-R-6) could provide professionals with a valid tool for diagnosing PTSD in individuals with significant symptoms of traumatic stress. This questionnaire is a shorter and updated version of IES. Giorgi, Fiz-Perez, Dantonio et al. (2015) compared the IES-6 with the original version of 22 elements (IES-R), the Italian version of 15 elements and the GHQ-12. Furthermore, they studied IES-6 associations with peri-trauma variables. The questionnaires were sent to 350 Italian employees shortly after a robbery (from one to a maximum of seven days later) because most of the victims of armed robbery have clinically evident symptoms immediately after the acute event. This study highlights how the IES-6 is a valid and statistically significant tool for measuring PTSD. Furthermore, the positive correlation between IES-6 and GHQ-12 shows that the more people are traumatized, the more they are inclined to develop mental problems (Giorgi, Fiz-Perez, Dantonio et al., 2015).

A NEW PROBLEM IN THE SECTOR: AGING Aging in Italy and Europe The aging workforce and work-related stress are two of the most current and challenging topics regarding health and safety management in the workplace. The problem of aging is also recognized in the banking environment. However, there are no protocols and shared guidelines to address it. More studies are needed, especially in Italy where the average age of the population increases each year. On 1 January 2017, Italy recorded an average age of 44.9 years, about two-and-a-half months more than the same time in 2016 and exactly two years more than in 2007. This increase in the average age is due to the continuous decline in births (3.3 percent reduction compared to 2014) and to the increase in the elderly population (65 years and over), which in 2017 was 22 percent (over one percentage point more than in 2011) (Italian National Institute of Statistics, 2018b). The improvement in the quality of life, the reduction of risk factors for chronic diseases (smoking cessation and diet-behavioral policies), and the progress of medical-hospital treatments have led to a progressive lowering of the risks of death, promoting the aging of the population.

Stress, well-being and aging in the Italian banking sector  175 The Italian demographic balance follows the European demographic. In Europe, almost one-fifth of the population is over 65 years of age. Based on this data, the international community is increasingly interested in the aging of the population. The European Commission (2018) published The 2018 Ageing Report: Economic & Budgetary Projections for the 28 EU Member States (2016–2070), which predicts an increase in the old age dependency ratio (percentage of people aged 65 or over compared to those aged 15–64) from 27.8 percent to 50.1 percent in the period 2013–2060. If the prediction is correct, the number of people of working age will switch from four to two for each person over the age of 65. This scenario will be problematic for the sustainability of current welfare systems and consequently will put pressure on national governments to reduce social spending and/or increase the tax burden in order to finance pensions and health care. Companies, especially those in the banking sector, must find new strategies to keep older employees active at work, thus avoiding early retirement or absenteeism. Strategies to Solve the Problem of Aging in the Workplace In the banking sector, one of the biggest problems for the elderly worker may be a lack of knowledge of new technologies. Banks are equipped with increasingly up-to-date operating systems and this can demotivate the older worker who may be unable to use them. The support of colleagues and the employer are very important to avoid the lack of satisfaction of the elderly worker evolving into the psychological frameworks that are typical of work-related stress (anxiety, depression, burnout syndrome) (Valente et al., 2015). Collaboration with younger colleagues is essential and can generate an ‘intergenerational relay’ in which the oldest employee shares his or her work experience and strategic thinking, while the younger employee teaches the former how to use new technologies (Arcangeli & Mucci, 2009). Amigo et al. (2014) demonstrated the importance of a greater knowledge of technological skills in the workplace. In particular, bank employees under the age of 35 and with a seniority of less than ten years showed greater results in terms of professional efficiency than their older colleagues. This is likely to not just depend on the greater enthusiasm typical of young people but, above all, their greater technical skills. The role of social support is essential also to avoid the negative perception of organizational policies by the older worker and maintain a collaborative climate. A workplace characterized by lack of organizational support and discrimination may strongly influence relational stress (Marco et al., 2016, 2018). Social support enhances the relationship between organizational policies and job demands and job control. Conflicts between colleagues can greatly increase work-related stress. Petarli et al. (2015) recorded a perception of disqualification of the elderly employee with consequent difficulties regarding the organization of work when the banks introduced new technologies without organizing courses to teach them. This circumstance made older employees more susceptible to stress. Mannocci et al. (2018) published an observational pilot study involving ten banks in the Tuscany region (Italy) with a sample of 384 employees. The survey concerned the relationship between occupa-

176  Handbook of research on stress and well-being in the public sector tional stress and working factors in Italy. The results showed that the most stressed workers were the elderly working in a commercial role. A sense of inadequacy has been reported by older workers at work, and their negativity translated into a lower capacity for adaptation.

FUTURE PROSPECTS FOR STRESS MANAGEMENT The work-related stress of bank employees is a problem that requires increased attention from society and the scientific community. Several strategies currently exist to reduce the impact of stress on bank employees but more initiatives are needed. The transparency of organizational processes for employees, by making company objectives public, is a proposed strategy. A good relationship with superiors and a shared decision-making process can also increase awareness of an employee’s position, and consequently their satisfaction levels. Self-confidence is important for breaking down stress levels. The introduction of a reward system to achieve goals can further incentivize the employee to become an active part of the business organization. It is also important to encourage a continuous training process by organizing refresher courses. In particular, these initiatives can help older employees who find it more difficult to keep up to date or learn the latest technological operating systems by themselves. Courses and meetings can also be used to increase social cohesion between employees of different sectors and generations who may have few opportunities to interact in the workplace. In this way, the conditions for the ‘intergenerational relay’ can be created with the exchange of notions between old and young employees. The level of stress in the banking sector can also influence the work environment in terms of space and the microclimate. Excellent solutions include more open spaces, ergonomic chairs, height-adjustable desks and an adequate lighting system. The intention is to make the employee as comfortable as possible at work. The risk of robbery remains the main risk factor for the development of work stress for banks and their employees. Banks must pay particular attention to this problem and do everything possible to protect their employees. Anti-intrusion systems, video surveillance, and access control are examples of how banks’ levels of security can be increased. Courses that teach employees how to behave in the case of a robbery should be offered to all employees. If a robbery occurs, the victim should have access to a service path with specialized personnel. Emotional support should be offered on a daily basis to build relationships with employees, not just in the case of a robbery. Therefore, banks have potential strategies to reduce stress related to the work of their employees. It is important that employers become aware of these problems. A stress-free work environment increases the productivity of the company and the quality of life of individual employees. By improving the working conditions of employees, we also improve the well-being of the total community.

Stress, well-being and aging in the Italian banking sector  177

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PART III CASE STUDIES OF EFFORTS TO BRING ABOUT ORGANIZATIONAL CHANGE

13. Applications of psychological capital in the public sector Carolyn M. Youssef-Morgan, Barbara L. Ahrens, Kristi Bockorny, Lanell Craig and Matthew Peters

Over the last two decades, the field of organizational psychology has taken a positive turn toward understanding positive individual and organizational strengths and resources that can promote excellence, well-being, and optimal functioning (Cameron & Spreitzer, 2012). Specifically, psychological capital (PsyCap) is a multidimensional psychological resource that has emerged in the organizational literature and received notable attention due to its solid theoretical foundation, valid and reliable measures, impact on work-related outcomes, and evidence of malleability and developmental potential (Luthans, 2002a, 2002b; Luthans & Youssef, 2004, 2007). It integrates the positive psychological resources of hope, efficacy, resilience, and optimism (HERO), which are viewed to work synergistically and yield higher outcomes in combination (Luthans et al., 2007). The acronym (HERO) and the expression ‘the HERO within’ have been used to describe PsyCap (Luthans & Youssef-Morgan, 2017). Other psychological resources such as gratitude, courage, authenticity, flow, mindfulness, and others, have also been considered. PsyCap has been examined in numerous work settings, and has been shown to relate to numerous attitudinal, behavioral, and performance outcomes in the workplace (Avey et al., 2011). However, to date, positivity in general, and more specifically PsyCap applications, in the public sector remain scarce in the literature. As explained in other chapters of this volume, public and private sector organizations vary in meaningful and important ways, creating boundary conditions and discontinuities that should be examined carefully and systematically before generalizing research findings across sectors. Moreover, the unique characteristics of the public sector warrant attention in their own right to better understand how to foster positivity to achieve excellence and optimal functioning in these work environments. For example, unlike the private sector, bottom-line performance measures may receive less emphasis in the public sector. Additionally, pay may not be the primary incentive for public sector employees. Other motivations such as desire to serve the public and make a difference in others’ lives are more common. Public sector employees also face unique challenges, such as negative public perceptions and difficulties in navigating extensive structural roadblocks (Lavigna, 2014). Thus, it is likely that positivity and its impact take on unique meanings and applications in the context of the public sector. The purpose of this chapter is to explore some of these unique applications. 182

Applications of psychological capital in the public sector  183 This chapter begins with a general overview of PsyCap, including its definition, constituent resources, underlying mechanisms, and development processes. PsyCap is then applied to four specific public sector contexts in the United States: fire departments, the Air Force, K-12 education, and higher education. The four case studies showcase specific practices and dynamics that can foster positivity and PsyCap, as well as challenges that can hinder PsyCap development.

WHAT IS PSYCAP? PsyCap is defined as ‘an individual’s positive psychological state of development that is characterized by: (1) having confidence (efficacy) to take on and put in the necessary effort to succeed at challenging tasks; (2) making a positive attribution (optimism) about succeeding now and in the future; (3) persevering toward goals and when necessary, redirecting paths to goals (hope) in order to succeed; and (4) when beset by problems and adversity, sustaining and bouncing back and even beyond (resilience) to attain success’ (Luthans, Youssef-Morgan, & Avolio, 2015, p. 2). As indicated in this definition, PsyCap has four constituent positive psychological resources: hope, efficacy, resilience, and optimism. Hope is ‘a positive motivational state based on an interactively derived sense of successful (a) agency (goal-directed energy) and (b) pathways (planning to meet goals)’ (Snyder, Irving, & Anderson, 1991, p. 287). In other words, hope integrates the willpower or determination to achieve one’s goals (agency), as well as the ‘waypower’ or ability to generate alternative paths to achieve those goals (pathways). Agency and pathways work together to help sustain motivation and effort toward goal pursuit, especially when faced with obstacles and roadblocks that make one’s initial goals or plans appear unattainable (Snyder, 2000). As long as an individual can muster the agency and continue to generate new pathways, hope can be sustained. Efficacy is one’s ‘conviction or confidence about his or her abilities to mobilize the motivation, cognitive resources or courses of action needed to successfully execute a specific task within a given context’ (Stajkovic & Luthans, 1998, p. 66). Confident people not only believe in their abilities, but as a result of this belief also choose to pursue more challenging goals than their less confident counterparts and are more effective in deploying their resources and actions to achieve those goals. They are more motivated and persistent in their goal pursuit, which increases their chances of success (Bandura, 1997). Resilience is ‘the capacity to rebound or bounce back from adversity, conflict, failure or even positive events, progress and increased responsibility’ (Luthans, 2002a, p. 702). Resilience is a positive reaction to challenges, setbacks, or adversities. Instead of being crushed under pressure, resilient people are able to bounce back. Importantly, they not only go back to their ‘normal’ level of functioning (a zero-sum game), but also they often learn from and grow through these experiences, and use them as a springboard to achieve new heights in their psychological stamina. It is also important to note that resilience is not only needed in negative situations. Positive but

184  Handbook of research on stress and well-being in the public sector overwhelming experiences can be just as challenging and may also require resilience to overcome. Optimism is a generalized positive outlook. In general, optimists often expect the best. Other things being equal, optimists tend to expect good things to happen (Carver et al., 2009). More specifically, optimists also adopt a positive explanatory style. This style attributes positive events to personal, permanent, and pervasive causes, and negative events to external, temporary, and situation-specific ones (Seligman, 1998). As a result, they are able to move on after negative events, make the most out of bad situations, and continue to expect the best in the future. Pessimists, on the other hand, internalize negative situations, often blaming themselves for them and expecting them to have permanent and pervasive effects on their lives. As a result, they have a hard time moving on and expecting better future outcomes. Importantly, PsyCap can occur in individuals as well as in groups and organizations. For example, one team member may not necessarily be confident about his or her ability to complete all components of a challenging task or activity but collectively the team members may be confident about their combined abilities. This is often referred to as ‘collective efficacy’, which can be defined as ‘a group’s shared belief in its conjoint capabilities to organize and execute the courses of action required to produce given levels of attainments’ (Bandura, 1997, p. 477). Similarly, comparable to resilient individuals bouncing back from setbacks, organizations can also become resilient by building structures, cultures, and processes that can help them respond effectively to change and uncertainty (Hamel & Välikangas, 2003; Horne & Orr, 1998). How Does PsyCap Work? Although each of PsyCap’s resources is important, unique, and effective in its own right, they also tend to work synergistically and reinforce each other. PsyCap operates through several underlying mechanisms, and its resources are linked through common themes or processes (see Luthans & Youssef-Morgan, 2017 for a comprehensive review). The first set of these mechanisms or processes are the conative processes that promote agency, intentionality, and an internal sense of control. In other words, hope, efficacy, resilience, and optimism all share an internalized belief that one is in charge of his or her actions and in control of his or her destiny. In line with social cognitive theory (Bandura, 1997), we are both products and producers of our environment. In the same way that our circumstances exert influence on who we are, we are also capable of shaping and changing our environment through our own intentional actions. Second, PsyCap and its constituent resources are deeply rooted in positive cognitive appraisals. Luthans and colleagues (2007) describe this mechanism as ‘positive appraisal of circumstances and probability for success based on motivated effort and perseverance’ (p. 550). In other words, hope, efficacy, resilience, and optimism promote favorable evaluations of one’s motivation, resources, chances of success,

Applications of psychological capital in the public sector  185 and situation in general. Those with high PsyCap are more likely to select challenging goals and pursue them more persistently because they expect to succeed. Third, PsyCap resources such as hope, confidence, resilience, and optimism trigger positive emotions. Positive emotions, and positivity in general, have a broadening and building effect (Fredrickson, 2001, 2009). In terms of broadening, positive emotions expand one’s thought–action repertoires, leading to a wider range of options. In terms of building, positive emotions nurture and replenish physical, social, and psychological resources, which can be drawn upon in times of challenge or negativity. The fourth underlying mechanism for PsyCap is a social mechanism. Hope, efficacy, resilience, and optimism draw from social resources and processes. For example, meaningful and constructive relationships can help build resilience (Masten, 2001). Role modeling can enhance efficacy (Bandura, 1997). Networking can provide additional hope pathways. Together, these social processes highlight the importance of others in building one’s psychological resources beyond what can be accomplished through personal efforts. Developing PsyCap Important to the definition of PsyCap is that it is open to change and development. Unlike many personality traits, which tend to be genetically determined or hard-wired at an early age, PsyCap is malleable. There are recognized techniques to develop each of PsyCap’s constituent resources, as well as PsyCap as a composite resource. For example, hope, agency, and pathways are often developed through training and coaching on effective goal-setting (for example, SMART goals – specific, measurable, achievable, realistic, and timely), contingency planning to overcome obstacles, mental rehearsals of difficult or challenging tasks, and regular evaluation and adjustment of goals to avoid false hope (Lopez, 2013; Snyder, 2000; Snyder & Rand, 2003). Efficacy can be developed through mastery and success experiences, role modeling, social persuasion, and physical and psychological arousal, health, and well-being in general (Bandura, 1997). Resilience development can be asset focused, risk focused, and process focused. Asset-focused processes emphasize increasing one’s assets, such as knowledge and skills. Risk-focused processes emphasize mitigating risks, such as negative environmental influences, toxic relationships, or excessive stress. Process-focused processes emphasize the effective utilization of one’s assets to deal with risk factors. A good example is the development of effective coping strategies or stress management techniques (Masten et al., 2009). Optimism can be developed by learning to regularly engage in more positive internal dialogues when interpreting past events. Optimistic ‘self-talk’ is lenient toward the past (for example, giving oneself credit for successes and avoiding excessive self-blame for failures), appreciative of the present (for example, seeing the ‘silver lining’), and opportunity seeking for the future (maintaining a positive outlook and expecting things to get better) (Schneider, 2001). Recent research also shows that PsyCap can be developed as an integrated set of resources (see Youssef-Morgan & Petersen, 2019 for a comprehensive review). In

186  Handbook of research on stress and well-being in the public sector general, developmental approaches and interventions that aim to develop multiple psychological resources simultaneously (such as a ‘shotgun’ approach) tend to work favorably (Sin & Lyubomirsky, 2009). This approach is consistent with most PsyCap development approaches. For example, in a typical PsyCap development intervention, participants are trained to set goals effectively, assess risks, anticipate obstacles and setbacks, plan ways to overcome them using their assets and strengths, and work with others to gain additional perspectives, motivation, and encouragement. As a result, participants typically come out of these interventions with a higher sense of agency and control; a more positive outlook and constructive internal dialogue; more specific, measurable, and achievable goals and milestones; and a more realistic view of what they can and cannot control. With this background as a point of departure, we now present four case studies that apply PsyCap and its development to unique public sector contexts: fire departments, the United States Air Force, K-12 education, and higher education. Although these case studies are drawn from the US, many of their characteristics are readily applicable to similar contexts across the world, and to the public sector in general.

FIRE DEPARTMENTS: WHERE HEROS ARE MADE Contributed by Matthew Peters, Fairfax County Government A fire department is a public organization that provides emergency and non-emergency services. Firefighters protect lives, property, and the environment in their communities, which can include fire suppression, emergency medical, technical rescue, hazardous materials, water rescue, life safety education, fire prevention, and arson investigation services. Firefighting is a physically and emotionally challenging profession. Firefighters deal with tremendous trauma, tragedy, injury, death, and heartbreak on a daily basis, which requires remarkable resilience in order to bounce back, recover, and do it all over again day after day. Moreover, despite this challenging environment, firefighters need to approach their work with positivity. Every day brings on its own challenges. They need to stay hopeful and optimistic so that they can muster the motivation and energy necessary to give their all in each situation, despite past failures and present uncertainties, to save lives and property. They need to exhibit exceptional confidence in their individual and collective abilities to be successful in their missions, each of which can literally be ‘a matter of life or death’. Thus, positivity and PsyCap are integral to firefighters’ performance, as well as their well-being and ability to handle the stresses involved in their daily work. Fire departments are well aware of the challenges involved, as well as the need for positivity to be successful as a firefighter. Firefighters’ abilities and job characteristics are closely aligned to produce a tireless, dedicated career workforce that is also hopeful, confident, resilient, and optimistic. This does not occur by accident. The fire and rescue community has developed powerful socialization, training, and development processes, as well as cultural values and norms, to help firefighters

Applications of psychological capital in the public sector  187 perform their jobs effectively and deal successfully with the emotional challenges involved. Orientation and initial training carefully build recruit efficacy and resilience. Rigorous physical training increases the recruits’ stamina and instills lifelong habits that improve health and well-being. Training regimens, honed by decades of practice and lessons learned, help new firefighters develop confidence in their abilities to perform their job responsibilities in various high-risk environments. The training scenarios start as simple, singular tasks and tools, and gradually increase in complexity as recruits demonstrate and master more advanced individual and team activities, eventually culminating in exercises with live fire, burning buildings, and loaned structures scheduled for demolition. Real-world challenges are simulated with blackout masks to mimic blindness, piped-in noise to increase confusion, and unforeseen physical obstacles to add an element of surprise. Recruits are allowed to fail and are provided constant feedback and assessments to improve their performance. This incremental training improves the recruit’s capacity to absorb and bounce back from high levels of stress and uncertainty, while still maintaining a positive outlook about making the best out of the worst of situations. PsyCap conditioning continues as the recruits arrive at their first fire station. Continuous training, at both the individual and team levels, ensures standardization and proficiency in everything from opening locked doors, to entering ablaze buildings, to manning firehose teams. Recruit self-efficacy is nurtured and developed during exercises run by top-ranked firefighters who serve as instructors and role models, and fire station teams rotate back through training academies on a regular basis for live fire scenarios and instruction on new equipment and techniques. Recruits must show determination in these challenging scenarios and adapt to deal with unexpected circumstances as the scenarios evolve. They are trained to recognize risks, rely on their teammates, and persevere until the simulated emergency is stabilized. Ultimately, firefighters must know and trust what their teammates will do in any situation, have consummate knowledge of all team roles and pieces of equipment, and be prepared for more dangerous environments. This impressive fire station team proficiency transcends county and state boundaries. A fire station typically has one firetruck and one emergency medical services vehicle. Since most fires require multiple firetrucks, assets are dispatched from contiguous zones to merge seamlessly to engage the emergency. Large fires can draw resources from across the region, encompassing volunteer and full-time firefighters from neighboring cities, counties, states, and, if adjacent to a large military facility, even military firefighters, who rapidly and seamlessly integrate to fight the fire. Specialized firefighting assets stationed throughout the region, such as Heavy Rescue Squads, which carry tools and extraction equipment to rescue people trapped in cars, collapsed building or hazardous materials situations, and Brush Trucks, which are equipped with pumps, water and tools to extinguish brush fires, also converge seamlessly. The collective efficacy of these specialized teams allows them to integrate their skills synergistically while responding to large emergencies. While technical skills and practical experience are clearly important, the firefighter’s emotional and psychological stamina are even more important. The chasm

188  Handbook of research on stress and well-being in the public sector between tenured firefighters and the new recruits is most readily apparent in this emotional and psychological realm. Firefighters provide expert assistance to citizens in distress, and strive to safely control fires to save lives and property, but they should also recognize that there are limits to their capabilities and chances of success. Their teams take calculated risks, but only when absolutely necessary. Seasoned firefighters develop coping mechanisms that help them accept the sad realities they cannot control, while attributing negative events to external factors beyond their control. They shelter their protégés as they gain experience and capacity to deal with trauma and tragedies. In that sense, firefighting teams develop a collective capacity to absorb high levels of stress and strain, while still remaining positive. This collective resilience provides stability during difficult times, and promotes a hopeful and optimistic outlook toward the future. It is important to note that not all daily operations in a fire department are high-risk situations that are full of uncertainty. A firefighter’s socialization beyond initial orientation and training occurs in two diametrically opposed environments. At one end of the spectrum is the fast-paced, dangerous, operational arena. At the other end of the spectrum is communal life in the fire station. Each environment builds PsyCap in different ways. The majority of the firefighter’s time is spent in the fire station, which becomes a home away from home where firefighters live together for extended periods of time (24-hour shifts) in bunk rooms and other common areas, while partaking in meals and other routine family-like tasks of buying and preparing food and cleaning the facility. Akin to a military boot camp, new firefighters must ‘earn their stripes’. They wear different uniform symbols that separate them from their peers, and are assigned repetitive and undesirable tasks, all the while under the close and constant observation and supervision of more seasoned firefighters. Some recruits may have never mastered basic life skills such as cooking a meal, cleaning a bathroom, or changing a tire, yet are now embedded in a highly social clan. The fire and rescue culture is highly ritualistic. New recruits must quickly recognize and accept the powerful unwritten rules that govern the behavioral expectations of this culture or risk rejection. Artifacts, symbols, stories, and norms convey powerful symbolism. Uniforms and equipment branding, including departmental patches, logos, and certification patches reinforce branding and acculturation. Even firefighter helmets brand their owners with their allegiance and professional standing. Recruits who meet expectations in this grueling but sheltered environment under the watchful eyes of their more seasoned teammates develop exceptional confidence and resilience. The social support and family-like solidarity of fire departments are key factors in helping firefighters maintain hope and optimism in an otherwise highly negative and crisis-driven profession that can otherwise take its physical and emotional toll on its incumbents. In other words, PsyCap is an integral component of the social fabric of fire departments that unites firefighters and protects them from the physical and psychological challenges of an otherwise highly stressful profession.

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THE US AIR FORCE: PEOPLE FIRST, MISSION ALWAYS Contributed by Lanell Craig, United States Air Force In the US Air Force, the increasing pace of global change calls for the ability to adapt and respond faster than adversaries, which requires a strategically agile workforce. To meet these demands, the US Air Force has shifted its strategic focus to human capital management by incorporating a human capital annex in the master strategic plan and adopting the mantra ‘people first, mission always’. This focus recognizes that humans are a valued asset, and that their contribution, performance, and well-being are essential for meeting the primary goal: the mission. This strategy focuses on unlocking the potential in each and every Airman to turn a possible vulnerability into an enduring advantage. However, members of the Air Force, and many Armed Forces, are faced with unique challenges daily in order to achieve exceptional global excellence and mission execution. Specifically, members may face extreme stress and adversity associated with combat operations, deployments, lengthy training and exercises, and regular moves, which may be compounded by stressors from other life roles, such as family and relationships (Bowles & Bates, 2010). Stress, though a natural physiological reaction to handle challenges, can be detrimental to a person who experiences it for a long period of time or is overextended beyond his or her ability to cope. Military careers come with serious responsibilities that can have life-impacting ramifications and consequences if performed improperly. Therefore, it is essential to find ways to mitigate prolonged stress to ensure mission accomplishment, readiness, performance, and well-being. The need for Airmen who can cope with stress has driven a strategic emphasis on developing positive psychological resources, particularly resilience. Resilience is in focus because the Air Force recognizes it as a personal resource that mitigates stress and promotes well-being through facilitating the psychological processes necessary for overcoming hardship. Individuals with resilience have the skills to endure, flex, adapt, rebound, and grow from adversity and setbacks. That is why resilience training has become an essential component of Airman readiness in the Air Force. A prominent example of the emphasis of the Air Force, and the US Military in general, on building psychological resources such as resilience, is the Comprehensive Soldier and Family Fitness training program, which was established by the US Army in 2008. The purpose of the program is to build resilience in soldiers and their families as a protective and preventative approach, to proactively prepare them to effectively cope with stress and adversity, rather than relying on reactive approaches and treatment programs after the fact (Seligman & Matthews, 2011). The US Military and Air Force made large investments into this program. Empirical evidence supports the effectiveness of this program in building resilience and positivity in general, as well as buffering stress and promoting well-being (Krasikova, Lester, & Harms, 2015; Schaubroeck et al., 2011).

190  Handbook of research on stress and well-being in the public sector Deployment and Training In the Air Force, deployments, as well as extended training or exercises, are commonplace. Deployments vary in location and length, from fortified to austere bases and ranging from days to over a year. The mission also varies significantly depending on the categorization: combat, humanitarian, or peacekeeping. Air Force members may also be tasked with exercises and training that vary in location, duration, and mission. Exercises and training missions may cause members to be away for extended periods of time. Frequently being away from one’s family can strain and degrade relationships. In that respect, Airmen make significant sacrifices in their personal lives by being away from family and friends. For example, it is common to miss important events such as births, birthdays, weddings, vacations, graduations, milestones, anniversaries, and funerals. In addition, combat has the potential to expose Airmen to danger, death, isolation, fatigue, uncertainty, and other negative events. This type of exposure may lead to mental and behavioral health challenges, as well as emotional trauma. The Air Force recognizes the importance of positivity for Airmen’s performance and well-being. PsyCap can be a valuable resource for members of the Air Force. It can enhance their ability to cope with the challenges of deployment experiences. For example, beyond the importance of resilience discussed earlier, an Airman can apply hope’s agency and goal-directed energy to muster the determination to meet goals, as well as hope pathways to overcome obstacles. He or she can also mobilize the confidence to deploy the necessary skills and resources to execute the mission, and optimism to maintain a positive outlook. Thus, PsyCap can buffer potentially negative deployment experiences, enables effective coping, and promotes overall well-being. Beyond recovery from adversity and challenges, positivity can also promote learning and growth, which are particularly important in extended training situations. For example, instead of dwelling on the negativity of loneliness, separation from family and friends, and grueling job demands, a positive Airman can focus on learning from these experiences and growing closer to his or her fellow Airmen. In other words, facing challenges can have benefits, but these benefits can be more readily seen and capitalized upon by Airmen with a positive mindset. For example, the benefits of challenges can be manifested in the form of self-concept changes, enhanced relationships, life outlook shifts, and ultimately well-being. This implies that positive Air Force members may experience positive rather than negative outcomes from exposure to challenges as they deal with adversity in effective ways that open them up to personal and professional growth and development. Permanent Change of Station The military is structured such that Airmen are regularly ordered to move to a new base, known in the military as a permanent change of station (PCS), which may include overseas locations and foreign countries. When an Air Force member is

Applications of psychological capital in the public sector  191 notified to move, there is a specified location and timeline for the move. The member may or may not have input or control over the location or the timeline. Air Force members may also be assigned to locations that are unaccompanied, which means that their families are not authorized to move with them. The challenges associated with PCS can be significant. In addition to moving, when the Airmen arrive at the new location they are required to start a new job. The job is often associated with their primary skillset, but the unit, position, duty title, job description, and position responsibilities vary. This requires Airmen to learn and build confidence again in their abilities to perform in the new position. Additionally, establishing new homes, social circles, support systems, routines, transportation, as well as potential financial burdens and loneliness can be overwhelming. Positive psychological resources can be critical in overcoming these challenges. Airmen with high PsyCap are more likely to deal with these professional, social, and emotional challenges optimistically and resiliently, especially as the excitement wanes and the realities of the new situation set in. Instead of giving in to negative thoughts of rumination and regrets of what they missed, they can choose to maintain a positive outlook about the future, which can help them look forward to the new experiences awaiting them. They can also choose to believe in themselves and their abilities to find paths to overcome the challenges. Professionally, Airmen with high PsyCap are likely to integrate into their new unit with more ease and to demonstrate hope to achieve their goals, confidence in their abilities and skills, and resilience to rebound and move forward. This is because positivity enables adaptation, developing a new normal, and optimal functioning. To summarize, each of the PsyCap resources is critical for Airmen to have the mental fortitude and positive outlook to accomplish challenging and even life-threatening missions. Positive levels of, and training in, PsyCap can help to mitigate stress and increase well-being, which in turn can lead to increased performance and enhanced mission execution. The future adversary is unknown, and to execute challenging missions with dominance the Air Force must recruit, retain, and grow Airmen who have high levels of PsyCap. Airmen with high levels of PsyCap can apply their positive psychological resources to achieve positive adaptation, problem-solving, growth, and development during periods of risk or adversity.

POSITIVITY IN K-12 EDUCATION: THE ‘GIVE LOVE’ INITIATIVE Contributed by Barbara L. Ahrens, Waukee Community School District Many times individuals choose public sector professions, such as health care, military, police, and public education, due to a desire to make a difference in the lives of others and for a greater cause beyond themselves. This case study applies PsyCap to K-12 education, that is, education from kindergarten to 12th grade, in the US, at

192  Handbook of research on stress and well-being in the public sector a Midwest public school district. There are approximately 10 000 students and 750 teachers in the district. The case study focuses on teachers. In the educational arena, the recognized center of attention and primary focus is on ‘what is best for the learner’. However, recognizing the role of the educator in the classroom and supporting teachers’ needs can also assist in meeting learners’ needs. Teachers are role models, counselors, the voice of learning, facilitators, and many times, serve as a pseudo parent. Therefore, expectations for educators can be mentally and physically exhausting. During these challenging times, teachers’ physical and psychological resources and well-being are extremely important. PsyCap, and positivity in general, can be a wonderful tool for developing a strong psyche, personally and professionally. As suggested by Avey et al. (2010) positivity and PsyCap plays an instrumental role in developing resources necessary to ‘weather the storm’ in a dynamic organizational environment or a challenging personal environment. So, if educators can increase their repertoire of positive psychological resources, these resources can enhance their daily performance and long-term well-being. Research has shown that positive, happy people are more successful and have better physical and psychological health (Lyubomirsky, King, & Diener, 2005). Recently, a ‘Give Love’ theme was launched in the Midwest school district. The theme’s purpose was to focus on teachers’ psychological resources and their overall well-being. Specific initiatives entailed further development of staff relationships, enhancing a teacher’s feeling of value within the organization, appreciation of staff, improving emotional and physical well-being, and improving overall positivity in the workplace. Opportunities to increase well-being were accomplished through professional development, teacher in-service days, and activities during and beyond the workday. Gratitude was a significant component of the ‘Give Love’ theme, but other PsyCap resources were evident as well. Although most PsyCap research focuses on the HERO resources, recent research supports gratitude as a potential PsyCap resource (Ahrens, 2016; Luthans et al., 2015). Following is an overview of the ‘Give Love’ theme and how it was used to build teachers’ reservoir of psychological resources. At the beginning of the academic year, the school district launched a professional development program that focuses on gratitude. Gratitude activities were front loaded for each professional development session. For example, to begin each professional development session, teachers were asked to ‘count their blessings’ by listing three items they were grateful for personally and professionally. This activity lasted the duration of the academic year. As a result, teachers also began to count their blessings at home, too. In fact, regularly counting one’s blessings has been shown to be one of the most effective approaches for developing positivity (Seligman et al., 2005), and in this case teachers were no exception. When teachers got into the habit of identifying and finding goodness in their work life such as counting blessings, a visible shift became apparent in the workplace. Educators were calmer and seemed to be happier. Furthermore, by focusing on the positives, teachers’ motivation shifted from maintaining the status quo to identifying other methods to create an even more

Applications of psychological capital in the public sector  193 meaningful work life. Slowly, other choices were offered to teachers throughout the year to increase well-being such as a gratitude wall, yoga, fitness classes, and stress management classes. Other PsyCap resources are also evident in the culture and practices of this school district. For example, the school district provides numerous opportunities for teachers to strengthen their efficacy. Mentoring programs are in place for new teachers to the profession and new teachers to the district. Teachers have numerous opportunities to visit, observe, and consult with more seasoned colleagues across the district on best teaching practices. For example, many novice teachers struggle with classroom management. Through observation of master teachers and then master teachers observing a novice teacher’s classroom, along with mentoring, novice teachers are afforded the opportunity of modeling and eventually mastery of classroom management. Another PsyCap resource that is evident in the educational environment is resilience. For example, if an employee has surgery, a long-term illness, or some other catastrophic life event, the first words spoken by colleagues are, ‘How can I help?’ Teachers’ generosity is extended via meals, clothing, time, and money for colleagues in need. Additionally, teachers are able to donate a personal day to a colleague in time of need. Taking care of each other builds both individual and collective resilience across the organization. The generosity and appreciation by both the recipient and giver create a healthy working climate of reciprocity and strengthens a person’s resilience to help overcome professional and personal adversity. Bouncing back from adversity can be difficult, but with others’ support, a person can persevere and cope effectively, which can promote long-term well-being and organizational resilience. Gradually, the ‘Give Love’ theme expanded to other initiatives to further promote positivity. For example, teachers are encouraged to take care of themselves physically and psychologically with several offerings from the school district such as a well-being education blog with ideas for reducing stress, healthy weight competitions, social events, friendly teacher competitions, massage therapy discounts, fitness center discounts, fitness equipment discounts, flu shots, health screenings, and even financial fitness initiatives. All these opportunities provided teachers with the necessary pathways to ‘take charge’ of their well-being and increase their positivity over time and across life domains. To conclude, when the school district implemented the ‘Give Love’ theme, it changed the vision and priorities of the organization. By expressing gratitude and love to teachers and promoting their positivity and well-being, the focus shifted from only ‘what is best for the learner’ to ‘what is best for the learner and the teacher’, because teachers’ well-being is important for their performance as well. Thus, when organizations have the mindset of doing what is right for their employees by enhancing their psychological resources and promoting their well-being, exceptional and sustainable performance will follow.

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PSYCAP IN HIGHER EDUCATION: DOCTOR, HEAL THYSELF Contributed by Kristi Bockorny, Northern State University Dr. Amanda Greenfield is a recent graduate of a top-rated business PhD program. She has thoroughly enjoyed her program, and believes she is fully equipped with the most up-to-date knowledge. She has researched and written papers, successfully defended her dissertation, and even published a couple of articles with her advisor. She felt ready to share her knowledge with others. Dr. Greenfield was hired as an assistant professor in a tenure-track position at a small, liberal arts public university. This university is considered a teaching school, which means that professors spend most of their time planning for classes, teaching, and evaluating student performance. In her first semester, Dr. Greenfield would be teaching four courses, two of which were the same, which meant she had three preparations. One of the courses was for freshmen, the second course had two sections and was taken by sophomores and juniors, and the third class was an upper-level course taken by seniors. She would be teaching freshmen through to seniors, which all varied in level of responsibility and dedication. Also there are no graduate assistants or teaching assistants at this university. Dr. Greenfield had a small amount of teaching experience during her doctoral program. She was a teaching assistant for a management professor and had the opportunity to teach three sections of ‘Introduction to Management’ classes over a one-year time period. She followed the lecture outlines provided by her supervising professor. She was essentially told how to teach the course, what assignments to give, and what test questions to ask. Dr. Greenfield never took a class on teaching; she was not required to do so in her PhD program. Therefore, she had no experience at designing courses, establishing course objectives, writing lesson plans, or developing an exam. However, she enjoyed her limited teaching experiences, especially observing students learn, gain confidence, and move on to subsequent classes. She felt that she was making a difference in students’ lives and career prospects. At first, Dr. Greenfield was very excited about the opportunity to develop, prepare, and teach her own classes. She no longer had to follow the directions given to her by another professor as to how to teach a course. However, it was not too long into the semester that Dr. Greenfield started to feel stressed. She was starting to doubt her teaching abilities. Students were not understanding the material as quickly as she had hoped. They did not seem to be engaged in her lectures. She was starting to question whether her teaching methods were working. She knew there were other teaching methods, but she did not know how to utilize them. When it seemed like things could not get any worse, today the technology did not work in the classroom. Dr. Greenfield was very flustered and had no back-up plan because she was depending on PowerPoint for her lecture. Dr. Greenfield was very upset with herself because she was unable to ‘wing it’ in class when her first option did not work. Here she was, trying to help her students learn and become confident in their knowledge and skills,

Applications of psychological capital in the public sector  195 when she herself was doubting her teaching abilities. How would she ever be able to walk into that class again? Would her class see her as a credible professor after her obvious failure? Dr. Greenfield decided she would speak to her department chair, Dr. Williams, about her teaching. As Dr. Greenfield began to tell Dr. Williams about her struggles in the classroom, he quickly reassured her that all professors feel that way from time to time, and to keep working on her techniques. Dr. Williams then said to Dr. Greenfield, ‘While you are in my office, we should talk about how your research is coming along. Are you currently working on any new projects?’ Dr. Greenfield was not sure how to answer. Since she was hired, she has been spending the majority of her time planning for her four classes. She used to love researching and writing, but she did not seem to have the time she used to have. She reluctantly told Dr. Williams that she was working on some ideas. As Dr. Greenfield was ready to leave Dr. Williams’ office, he said, ‘Dr. Greenfield, one more thing. The Dean wanted me to ask you if you would be willing to serve on the department’s curriculum committee. We are thinking about adding a new emphasis to our management major, and with your research interests she thinks you would be a great person to lead this. What do you say?’ Dr. Greenfield was in shock that the Dean would want her to lead the research process on the new emphasis. She also did not know if she could actually deny the request since the Dean was essentially entrusting her with this role and expecting her to accept, so she agreed. Dr. Greenfield felt worse now than she did before she talked with her department chair. Prior to the conversation, she was doubting her teaching abilities, but now she was starting to doubt her abilities in research and service as well. On her way back to her office, she started to feel really overwhelmed. She had been so focused on her teaching that she had forgotten that research and service were also part of her responsibilities. How could she manage her time to be a great teacher, conduct research, and serve her profession? Does she have what it takes to be a college professor? She started to think that there must have only been a few applicants to apply for this teaching job; how else would she have gotten the position? Did she make the wrong career choice? How would she ever get promoted and tenured if she could not make it through the first semester? Dr. Greenfield felt discouraged, stressed, overwhelmed, and unsure that she made the right career choice. At this point, she was lacking the positive psychological resources of hope, self-efficacy, resilience, and optimism, collectively referred to as PsyCap. Instead of being confident and determined, and bouncing back from a difficult day, she was down-spiraling, doubting her abilities, feeling helpless, and unable to come up with solutions to overcome the setbacks she was encountering. The next morning, Dr. Greenfield ran into Dr. Lee, a long-time faculty member from her department. As the two professors spoke, Dr. Greenfield noticed that Dr. Lee seemed very relaxed and confident. Dr. Lee always seemed to be very positive, enjoying her job, and looking forward to another day of teaching, research, and service. She did not seem stressed or overwhelmed, although she had even more

196  Handbook of research on stress and well-being in the public sector demanding responsibilities. Dr. Lee shared with Dr. Greenfield some pointers on how she can develop her PsyCap and become more positive. For example: ●● Visualize yourself in the classroom delivering a successful lecture and group activity. ●● Break down each class presentation into smaller segments with clear goals for each segment. ●● Observe other professors who excel at teaching. This will allow you to see other teaching techniques that can be used in the classroom. ●● Set goals for each area of teaching, research, and service, and establish realistic timelines, pathways, and contingency plans to achieve each goal. ●● Reward yourself when you accomplish important milestones. ●● Remember to be lenient with yourself for past mistakes, especially things that you cannot control or change. Learn from mistakes and move on. ●● Appreciate your present circumstances and good fortunes. Know your strengths and resources and capitalize on them as strategically as possible. ●● Always seek opportunities for the future. Be proactive in finding opportunities, not just reactive to what comes your way. ●● Realize that your teaching, research, and service are all ongoing works in progress that continually need to be refined. Avoid perfectionism and being excessively hard on yourself or competitive with others. Instead, develop a learning orientation where your goal is to learn, grow, and reach your full potential. ●● Develop relationships with other faculty and share your successes and failures with them. These relationships will help you get the support you need. You do not have to do this alone. Dr. Greenfield was so happy she ran into Dr. Lee that morning. Later on in the week, Dr. Greenfield met with her department chair, Dr. Williams, to share her new findings. It was at that time that Dr. Williams decided he could do more as a department chair to better support the new faculty. He asked Dr. Greenfield what she needed from him, and together, Dr. Williams and Dr. Greenfield developed some strategies for new faculty, such as: ●● Establishing a mentorship program where new faculty are assigned a senior faculty member as a mentor. This relationship allows for plenty of sharing regarding teaching techniques, research ideas, and overall concerns. ●● Setting goals for each semester regarding teaching, research, and service. It is also important to establish contingency plans in case something unexpected occurs. ●● Establishing teaching training sessions with the teaching laboratory to increase confidence in teaching abilities and techniques. ●● Encouraging new faculty to attend teaching-focused conferences and providing resources for them to attend such conferences. ●● Attending other professors’ classes to learn various teaching methods.

Applications of psychological capital in the public sector  197 ●● Becoming more strategic in service and committee assignments for new faculty, aligning such assignments with new professors’ interests and developmental needs. As Dr. Greenfield left Dr. Williams’ office, she was already feeling that she had more options to think about, and more possibilities to pursue. She knew she could succeed, with hard work, determination, and a positive attitude. In other words, with guidance and role modeling from Dr. Lee, as well as support and resources from Dr. Williams, Dr. Greenfield was able to change her perspective and outlook to become more hopeful, confident, resilient, and optimistic. Although only time will tell what Dr. Greenfield will accomplish, and she still needs to work hard and muster all the motivation and persistence she can, she is much more likely to be successful as a professor, effective as a teacher, and happy with her life and career if she maintains and nurtures her newfound positivity.

CONCLUSION Positive psychological resources can be beneficial in many work and life contexts. They are critical for mitigating stress and promoting well-being. Many public sector jobs involve a lot of stress, must be performed with limited resources, and lack the traditional rewards, sources of motivation, and stress mitigation processes available in the private sector. Instead of only reactively dealing with the aftermath of these conditions in the form of treatment, public sector employees can also learn to proactively and intentionally exercise internalized psychological processes to prevent stress and maintain well-being while also performing their jobs effectively. PsyCap and positivity provide conative, cognitive, affective, and social mechanisms that can be developed and managed to facilitate optimal psychological functioning.

REFERENCES Ahrens, B. (2016), ‘Gratitude, psychological capital, and work stress’. PhD thesis, Bellevue University, Nebraska. Avey, J.B., Luthans, F., Smith, R.M., & Palmer, N.F. (2010), ‘Impact of positive psychological capital on employee well-being over time’, Journal of Occupational Health Psychology, 15, 17–28. Avey, J.B., Reichard, R.J., Luthans, F., & Mhatre, K.H. (2011), ‘Meta-analysis of the impact of positive psychological capital on employee attitudes, behaviors, and performance’, Human Resource Development Quarterly, 22, 127–152. Bandura, A. (1997), Self-efficacy: the exercise of control. New York: Freeman. Bowles, S.V., & Bates, M.J. (2010), ‘Military organizations and programs contributing to resilience building’, Military Medicine, 175, 382–386. Cameron, K., & Spreitzer, G.M. (Eds.) (2012), Oxford handbook of positive organizational scholarship. New York: Oxford University Press.

198  Handbook of research on stress and well-being in the public sector Carver, C., Scheier, M., Miller, C., & Fulford, D. (2009), ‘Optimism’. In S. Lopez, & C.R. Snyder (Eds.), Oxford handbook of positive psychology (2nd ed.). New York: Oxford University Press, pp. 303–312. Fredrickson, B.L. (2001), ‘The role of positive emotions in positive psychology: the broaden-and-build theory of positive emotions’, American Psychologist, 56, 218–226. Fredrickson, B.L. (2009), Positivity. New York: Crown. Hamel, G., & Välikangas, L. (2003), ‘The quest for resilience’, Harvard Business Review, 81(9), 52–63. Horne III, J., & Orr, J. (1998), ‘Assessing behaviors that create resilient organizations’, Employment Relations Today, 24(4), 29–39. Krasikova, D.V., Lester, P.B., & Harms, P.D. (2015), ‘Effects of psychological capital on mental health and substance abuse’, Journal of Leadership & Organizational Studies, 22, 280–291. Lavigna, R. (2014), ‘Why government workers are harder to motivate’, Harvard Business Review, 28 November. Accessed 19 November 2019 at https://​ hbr​ .org/​ 2014/​ 11/​ why​ -government​-workers​-are​-harder​-to​-motivate. Lopez, S. (2013), Making hope happen: create the future you want for yourself and others. New York: Atria. Luthans, F. (2002a), ‘The need for and meaning of positive organizational behavior’, Journal of Organizational Behavior, 23, 695–706. Luthans, F. (2002b), ‘Positive organizational behavior: developing and managing psychological strengths’, Academy of Management Executive, 1(1), 57–72. Luthans, F., Avolio, B.J., Avey, J.B., & Norman, S.M. (2007), ‘Positive psychological capital: measurement and relationship with performance and satisfaction’, Personnel Psychology, 60, 541–572. Luthans, F., & Youssef, C.M. (2004), ‘Human, social, and now positive psychological capital management: investing in people for competitive advantage’, Organizational Dynamics, 33(2), 143–160. Luthans, F., & Youssef, C.M. (2007), ‘Emerging positive organizational behavior’, Journal of Management, 33, 321–349. Luthans, F., & Youssef-Morgan, C.M. (2017), ‘Psychological capital: an evidence-based positive approach’, Annual Review of Organizational Psychology and Organizational Behavior, 4, 339–366. Luthans, F., Youssef-Morgan, C.M., & Avolio, B. (2015), Psychological capital and beyond. New York: Oxford University Press. Lyubomirsky, S., King, L., & Diener, E. (2005), ‘The benefits of frequent positive affect: does happiness lead to success?’, Psychological Bulletin, 131, 803–855. Masten, A.S. (2001), ‘Ordinary magic: resilience processes in development’, American Psychologist, 56, 227–239. Masten, A.S., Cutuli, J.J., Herbers, J.E., & Reed, M.G.J. (2009), ‘Resilience in development’. In S.J. Lopez, & C.R. Snyder (Eds.), Oxford handbook of positive psychology (2nd ed.). New York: Oxford University Press, pp. 117–131. Schaubroeck, J.M., Riolli, L., Peng, A.C., & Spain, E. (2011), ‘Positive psychological traits, appraisal and well-being among soldiers deployed in combat: individual resilience to different levels of traumatic exposure’, Journal of Occupational Health Psychology, 16, 18–37. Schneider, S.L. (2001), ‘In search of realistic optimism’, American Psychologist, 56, 250–263. Seligman, M.E.P. (1998), Learned optimism. New York: Pocket Books. Seligman, M.E.P., & Matthews, M.D. (2011), ‘Special issue: comprehensive soldier fitness’, American Psychologist, 66, 1–86. Seligman, M.E.P., Steen, T.A., Park, N., & Peterson, C. (2005), ‘Positive psychology progress: empirical validation of interventions’, American Psychologist, 60, 410–421.

Applications of psychological capital in the public sector  199 Sin, N.L., & Lyubomirsky, S. (2009), ‘Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis’, Journal of Clinical Psychology, 65, 467–487. Snyder, C.R. (2000), Handbook of hope. San Diego, CA: Academic Press. Snyder, C.R., Irving, L., & Anderson, J. (1991), ‘Hope and health: measuring the will and the ways’. In C.R. Snyder, & D.R. Forsyth (Eds.), Handbook of social and clinical psychology. Elmsford, NY: Pergamon, pp. 285–305. Snyder, C.R., & Rand, L.L. (2003), ‘The case against false hope’, American Psychologist, 58, 820–822. Stajkovic, A.D., & Luthans, F. (1998), ‘Social cognitive theory and self-efficacy: going beyond traditional motivational and behavioral approaches’, Organizational Dynamics, 26, 62–74. Youssef-Morgan, C.M., & Petersen, K. (2019), ‘The benefits of developing psychological capital in the workplace’. In R. Burke, & A. Richardsen (Eds.), Creating psychologically healthy workplaces. Cheltenham, UK and Northampton, MA, USA: Edward Elgar Publishing, pp. 113–132.

14. The benefits of individual proactive and adaptive performance: an organizational learning perspective Mindy Shoss, Clair Kueny and Dustin K. Jundt1

The Greek philosopher Heraclitus is credited with the observation that all things are constantly in flux (Sedley, 2003). This remains applicable today as political, economic, and technological changes create demands for organizations to innovate and adapt. In particular, public sector organizations (for example, governments, hospitals, schools) are under increased scrutiny (1) to innovate change in order to be more efficient and better serve the public; and (2) at the same time to adeptly respond to changes such as those that occur at environmental, political, economic, and societal levels (Choi & Chandler, 2015). For employees, this leads to a demand for proactive and adaptive performance. Surprisingly, however, the literatures on individual-level proactive and adaptive performance have developed independently and without a discussion of how such individual-level behaviors link to organizational-level change efforts. This chapter aims to address these gaps and offer an integrated model of proactive and adaptive performance for public sector organizations. To do this, we (1) define proactive and adaptive performance; (2) utilize organizational learning theory (Crossan, Lane, & White, 1999) to link proactive and adaptive performance and describe their critical role in enabling organizational learning and strategic renewal; (3) discuss factors that influence the effectiveness of adaptive and proactive performance in change settings; (4) identify strategies organizations can pursue to influence employee proactive and adaptive performance; and (5) consider how unique factors facing public sector organizations can influence proactive and adaptive performance.

DEFINING PROACTIVE AND ADAPTIVE PERFORMANCE Proactive Performance Proactive performance is defined as employee behaviors that are future focused, self-starting, and change oriented (Parker & Bindl, 2017). These behaviors are targeted at challenging the status quo, where employees strive to change their role, the team, and/or the organization (Griffin, Neal, & Parker, 2007). Inherent in the definition of proactive performance is the concept of bringing about organizational change. In particular, proactive performance includes behaviors such as issue selling and 200

Individual proactive and adaptive performance  201 strategic scanning – both of which focus on better aligning the organization’s strategy with its environment (Parker & Collins, 2010). Typically, proactive performance has been considered desirable, as research suggests that these behaviors are related to beneficial individual (e.g., performance, career progression), team (e.g., team effectiveness), and organizational (e.g., performance) outcomes (see Bindl & Parker, 2011 for a review). However, research also suggests that there is a potential ‘dark side’ to proactive performance, as these behaviors are risky (Bolino, Turnley, & Anderson, 2017) and may bring about undesirable change (see Chan, 2006; Erdogen & Bauer, 2005). Thus, it is important to recognize the organizational contexts and influences that can shape proactive performance (Parker & Bindl, 2017) as we discuss below. Adaptive Performance Adaptive performance occurs in conjunction with externally induced changes in job/ role assignments, requisite tools and technologies, organizational structures, and so forth related to one’s work (Chan, 2000; Jundt, Shoss, & Huang, 2015). In contrast to proactive performance, adaptive performance focuses on coping with, responding to, and supporting changes, as opposed to initiating them (Griffin et al., 2007). Jundt et al. (2015) define adaptive performance as ‘task-performance-directed behaviors individuals enact in response to or anticipation of changes relevant to job-related tasks’ (pp. S54–S55). This definition explicitly recognizes that adaptive performance is behavior that is separate from, but related to, the outcomes of that behavior (cf., Campbell et al., 1993) and antecedent conditions that influence it. Likewise, it acknowledges that adaptive performance can be either anticipatory (changing behavior, strategies, etc. in anticipation of an upcoming change) or reactive (changing behavior, strategies, etc. in reaction to a recent change). Like proactive performance, adaptive performance is generally thought to be beneficial to individuals, groups, and organizations (Baard, Rench, & Kozlowski, 2014). However, there is some evidence that individuals (and organizations) can adapt too little or too much, or adapt in the wrong way (e.g., focusing on the less consequential changes, adapting too early or too late; Shoss, Witt, & Vera, 2012). Thus, like proactive performance, we discuss in detail below the antecedents of adaptive performance that may help contribute to more effective adaptive behaviors.

USING ORGANIZATIONAL LEARNING THEORY TO LINK PROACTIVE AND ADAPTIVE PERFORMANCE From a change perspective and based on the definitions we present, in general it is appropriate to consider proactive and adaptive performance as individual-level behaviors that respectively seek to challenge the status quo and adjust to a changing status quo. We believe that organizational learning theory, particularly the 4I framework by Crossan and colleagues (1999) (see below), provides helpful insight into how proactive performance and adaptive performance relate, and how they

202  Handbook of research on stress and well-being in the public sector can benefit organizational change. Organizational learning is defined as the capacity or ability of an organization to acquire, develop, disseminate, and utilize new knowledge for the purposes of organizational and process improvement and change (Cummings & Worley, 2015; Shaw & Perkins, 1992). Crossan and colleagues (1999) describe organizational learning as a dynamic process inherently linked to individual behavior. In particular (p. 532): ‘through feedforward processes, new ideas and actions flow from the individual to the group to the organization levels. At the same time, what has already been learned feeds back from the organization to group and individual levels, affecting how people act and think’. In other words, organizational learning requires (1) ideas for change and new insights that start with the individual to ultimately transmit to group- and organizational-level changes; and (2) at the same time, new directions and objectives at the organization or workgroup level to ultimately shape individual thoughts and actions.

Source:

Adapted from Crossan et al. (1999).

Figure 14.1

Feedforward and feedback loops in public sector organizations

Figure 14.1 depicts these feedforward and feedback loops, their connection with individual proactive and adaptive performance, and environmental factors that may

Individual proactive and adaptive performance  203 influence these processes in public sector organizations (which we discuss later). We suggest that proactive performance may be one starting point for the feedforward process, as Crossan and colleagues (1999) suggest it begins with individual efforts to create change that will presumably be institutionalized at higher levels (e.g., workgroup or organization). There are a number of dimensions in the proactive performance literature that reflect this feedforward process, including voice, taking charge, issue selling, and strategic scanning (Morrison & Phelps, 1999; Ong & Ashford, 2017; Parker & Collins, 2010; Van Dyne & LePine, 1998). Each of these reflect individual efforts to bring attention to and make the case for opportunities for change and improvement (Ong & Ashford, 2017). For example, the proactive public sector employee may initiate a discussion on ways to improve the organization’s public image, or may independently search for and then bring attention to opportunities to align the organization with efforts of other policy-makers in the field. The end point for the feedback process parallels adaptive performance in that employees must adapt to changes implemented at higher levels of the organization. Continuing with the previous examples, if a public sector organization decides to initiate a new policy direction that better aligns with other policy decision-makers in the field, the public sector employee needs to adapt to the new directions the policy initiative mandates. Alternatively, if the organization decides to change its public image strategy, the public sector employee needs to be ready and willing to communicate and support the new image. Crossan et al. (1999) suggest that the feedforward and feedback processes allow organizations to achieve ‘strategic renewal’ by simultaneously (1) exploring new ideas and ways of operating; and (2) exploiting existing knowledge.2 A provocative idea then is that organizational strategic renewal relies on proactive performance and adaptive performance on the part of individual employees. But, how does this occur? And what can organizations do to foster it? In this regard, Crossan et al. (1999) propose ‘4Is’. Specifically, for the feedforward process to occur, employees need to (1) intuit opportunities and knowledge in their environment; and (2) interpret these insights for others in their workgroups. Through shared understandings, insights are then (3) integrated into the group’s activities. Finally, these insights are (4) institutionalized into organizational routines and practices. Organizational change is cemented through the feedback process where (1) institutionalized rules and procedures are (2) integrated into group-level systems through mutual adjustments, ultimately leading individuals to (3) interpret and (4) intuit the meaning of these changes and adjust their behaviors accordingly.

ACHIEVING EFFECTIVE PROACTIVE AND ADAPTIVE PERFORMANCE The ‘4Is’ have practical and theoretical relevance for influencing individual-level proactive and adaptive performance.3 These steps suggest, for example, that organizations should focus not only on whether employees engage in proactive behavior

204  Handbook of research on stress and well-being in the public sector but also on whether they do so in a manner that will create shared understandings with other members of the workgroup and organization, and thus inform change effectively. Furthermore, adaptive performance will be best facilitated when changes are made in ways that allow employees to understand their nature, meaning, and implications and when individuals have the necessary knowledge, skills, and resources to adjust their behavior. Thus, we discuss a number of factors that may influence the effectiveness of adaptive and proactive performance within a change setting. We organize this discussion around four main questions: (1) Can we select employees who engage in more effective adaptive/proactive performance? (2) Can we train employees to engage in more effective adaptive/proactive performance? (3) What contextual factors influence the likelihood of effective adaptive/proactive performance? (4) And, given that change can be stressful, how do employee stress/ well-being factors relate to adaptive/proactive performance (in)effectiveness? Selecting for Effective Adaptive and Proactive Performance There are a number of individual differences related to proactive behavior. Meta-analytic evidence suggests that conscientiousness and extraversion are consistently relevant Big Five personality trait predictors of proactive performance, specifically those related to organizational change efforts (i.e., voice behaviors; Tornau & Frese, 2013). Notably, however, there are other individual differences more relevant to predicting proactive performance. Proactive personality (i.e., one’s predisposition to be motivated to bring about change), role-breadth self-efficacy (i.e., belief that one is capable of engaging in organization-focused activities outside of one’s prescribed role), felt responsibility for change (i.e., belief that one is personally obligated to bring about change in an organization), and future orientation (i.e., consideration of distant versus immediate consequences of one’s behavior) are all consistently moderate-strong predictors of proactive performance (Parker & Collins, 2010; Wu & Li, 2017). Thus, organizations may consider selecting for employees who display high levels of these individual differences. Numerous cognitive and non-cognitive individual differences have been found to predict adaptive performance as well. General cognitive ability has been frequently examined and findings generally support a positive relationship between cognitive ability and adaptive performance (Allworth & Hesketh, 1999; Bell & Kozlowski, 2002, 2008; Blickle et al., 2011; Kozlowski et al., 2001; LePine, Colquitt, & Erez, 2000; Pulakos et al., 2002; Stokes et al., 2010). Regarding non-cognitive individual differences, Big Five personality traits have been most frequently studied. These studies suggest mixed results, primarily regarding openness to experience, conscientiousness, and emotional stability (e.g., Allworth & Hesketh, 1999; Blickle et al., 2011; Griffin & Hesketh, 2003; Neal et al., 2012; Pulakos et al., 2002; Shoss et al., 2012). Recent meta-analytic evidence (Huang et al., 2014), however, suggests that both conscientiousness and emotional stability are positively related to adaptive performance, while agreeableness, extraversion, and openness to experience are not significantly related. Narrower aspects of Big Five traits (i.e., facets) have also been

Individual proactive and adaptive performance  205 examined, with results suggesting that the ambition aspect of extraversion (Huang et al., 2014), the achievement orientation (Pulakos et al., 2002) and dependability (LePine et al., 2000) facets of conscientiousness, and the intellect facet of openness (Griffin & Hesketh, 2004) may provide incremental prediction over broad personality traits. Beyond the Big Five, trait goal orientations have also been frequently examined, with results generally demonstrating that trait mastery orientation (tendency to pursue goals aimed at increasing competence) is positively related to adaptive performance, while performance orientation (tendency to pursue goals aimed at demonstrating competence to others) effects are mixed (e.g., Bell & Kozlowski, 2002, 2008; Chai, Zhao, & Babin, 2012; Ford et al., 1998; Heimbeck et al., 2003; Kozlowski et al., 2001). Training for Effective Adaptive and Proactive Performance While it is ideal to select for the best employees initially, there are only so many selection criteria an organization can use to make hiring decisions. Thus, it is of critical importance to understand whether employees can be trained to engage in proactive (and adaptive) behaviors that will inform successful feedforward (and feedback) organizational learning efforts. Notably, there is little research available on the effectiveness of proactive performance training. However, one foundational approach to proactive performance considers it a goal-driven motivation process where employees’ self-efficacy influences their proactive goal generation and proactive goal-striving efforts (Parker, Bindl, & Strauss, 2010). As research suggests that self-efficacy and goal-setting are manipulable and trainable (Locke & Latham, 2002), this would suggest that employees can be trained to have greater self-efficacy to generate and strive for proactive goals. Notably, Mensmann and Frese (2017) recently proposed a model targeted at training employees to engage in effective proactive behaviors. This model focuses on action-regulation theory, and following the proactive goal-conceptualization presented by Parker and colleagues (2010), starts with efforts focused on training employees to generate appropriately directed, proactive goals, followed by information collection, planning, and feedback-seeking efforts (Mensmann & Frese, 2017). While their training model has yet to be tested, the evidence they use to inform it suggests that proactive performance is trainable among employees (see Tables 16.1 and 16.3 in Mensmann & Frese, 2017 for more detail). As such, organizations interested in improving their organizational change efforts through well-placed feedforward processes (which will then inform better feedback/adaptive performance efforts) may consider efforts to train employees on how to set and follow through with constructive proactive behavior goals. Substantially more work in the training domain has focused on adaptive performance. Error-based training (cf. Frese & Altmann, 1989) techniques, which provide some manner of instructions and/or support aimed at having people intentionally make errors during training in order to learn from and positively cope with them, have been most emphasized and have demonstrated consistent positive effects on adaptive performance (Dormann & Frese, 1994; Heimbeck et al., 2003; Ivancic &

206  Handbook of research on stress and well-being in the public sector Hesketh, 2000; Keith & Frese, 2005). Similarly, Joung, Hesketh and Neal (2006) found positive effects of highlighting errors on adaptive performance via diagnosing problems and developing alternative strategies, as compared to more traditional training. Additionally, Kozlowski et al. (2001) examined goal framing (mastery vs performance framing) and found positive effects of mastery framing on self-efficacy and knowledge development, which in turn positively influence adaptive transfer. Notably, Bell and Kozlowski (2008) examined active learning elements (i.e., error-framing instructions, adaptive guidance, exploratory learning, and mastery goals) in a more comprehensive and inclusive manner. They found a multitude of positive effects on adaptive transfer through efficacy, knowledge development, and intrinsic motivation, among others. Beyond training techniques themselves, this research has revealed a number of positive effects of cognitive and motivational factors that can emerge during training. Declarative knowledge (i.e., knowledge of facts, information, rules, etc. relevant to task performance) has been found to positively predict adaptive performance (Chen, Thomas, & Wallace, 2005; Ford et al., 1998; Gwinner et al., 2005; Kozlowski et al., 2001), as has knowledge structure coherence (i.e., knowledge of relationships among task-relevant concepts and elements; Kozlowski et al., 2001). Metacognitive activities, which involve self-directed planning, monitoring, and revising goal-directed activity, also have positive effects (Bell & Kozlowski, 2008; Ford et al., 1998; Keith & Frese, 2005). Likewise, self-efficacy beliefs have frequently been shown to lead to increased adaptive performance (Bell & Kozlowski, 2008; Chen et al., 2005; Ford et al., 1998; Griffin, Parker, & Mason, 2010; Kozlowski et al., 2001; Stokes et al., 2010). As seen here, this work generally focuses on training situation-specific skills, experience, and beliefs. To our knowledge, no research has focused explicitly on training generic or task-general adaptive skills. Contextual Influences of Adaptive and Proactive Performance Notably, just like most organizational phenomena, context matters in whether employees’ proactive and adaptive performance efforts are likely to be effective. Specifically, research and theory suggest that if employees’ organization change-focused proactive behaviors are going to be successful, they need to be enacted within contexts that support these behaviors. Research has shown that proactive efforts are rated more positively by supervisors when the employees who enact them have good person–organization fit (Erdogen & Bauer, 2005), or when supervisors attribute an employee’s proactive efforts to genuine, prosocial motives (Grant, Parker, & Collins, 2009). Supervisors who are more supportive of proactive performance will be more likely to encourage employees’ proactive/feedforward processes. Additionally, it is important that the organizational culture supports feedforward efforts and provides a psychologically safe environment for employees to communicate errors or failures if their proactive efforts are not successful (Ong & Ashford, 2017). In other words, if an organization claims encouragement of feedforward processes in an effort to make the organization more efficient, but then punishes or

Individual proactive and adaptive performance  207 otherwise discourages employees if their proactive efforts fail, the organization sends a message that proactive performance is only welcome to the extent that successful outcomes are guaranteed. However, that guarantee is an unreasonable expectation to place on feedforward, proactive efforts – thus, employees will not want to take the risk and the organization will never see a benefit from employee organizational learning efforts (Cummings & Worley, 2015). Similar to proactive performance, research on contextual influences on adaptive performance has generally focused on leadership and climate. Leaders may facilitate adaptive performance by providing increased job autonomy (Griffin & Hesketh, 2003; especially when followers perceive they are overqualified; see Wu et al., 2016); providing support; and clearly articulating a vision for change (Griffin & Hesketh, 2003; Griffin et al., 2010; O’Connell, McNeely, & Hall, 2008). The effects of clearly articulating a change vision may be especially impactful when individuals are high in openness to role change (Griffin et al., 2010), or work in groups with a strong innovation climate (Charbonnier-Voirin, El Akremi, & Vandenberghe, 2010). In addition, clarifying what is valued and supported (i.e., reducing perceived politics) helps individuals effectively translate adaptive performance activities into outcomes (Shoss et al., 2012). Furthermore, research suggests that positive leader–member exchange relationships and perceived organizational support both positively influence and can interact to influence adaptive performance (Kraimer, Wayne, & Jaworski, 2001; Sweet, Witt, & Shoss, 2015). Finally, Hui and Sue-Chan (2018) found that guidance coaching (delivering clear expectations and directly modeling desired behaviors) had negative effects on adaptive performance, while facilitation-based coaching (encouraging employees to explore and discover solutions on their own) had positive effects. Stress/Well-being Factors Related to Effective Adaptive and Proactive Performance Organizational change is a stressful process. Thus, it is important to consider relevant employee well-being relationships as they relate to proactive and adaptive performance. Generally speaking, research has found positive relationships between positive well-being status and proactive performance (i.e., positive relationships between employee positive affect and positive self-perceptions, and proactive behavior; Wu & Li, 2017). Additionally, employees are more apt to engage in proactive performance on a given day if they have had a chance for rest and recovery from the day before (Sonnentag, 2003). However, research in the proactive literature also presents a potentially dark side of proactive performance and employee well-being. More specifically, Fay and Sonnentag (2002) found that employees are more likely to be proactive if they are experiencing stressors at work – presumably to change the stressful status quo. Additionally, employees may experience increased stress as a result of their proactive organizational change/feedforward efforts if their efforts are perceived by others as deviant or threatening, the organizational threats they are trying to address are beyond their abilities, and/or simply because engaging in these behaviors is resource consuming (Bolino et al., 2017; Reynolds, Shoss, & Jundt,

208  Handbook of research on stress and well-being in the public sector 2015). Finally, proactive employees may increase others’ stress levels if their proactive efforts do not align with the team/organization’s efforts, if they are constantly calling attention to what is wrong with the organization (e.g., engaging in too much scanning of threats for the organization), or if they are calling attention to or trying to sell leadership on the wrong change-focused issues (Bolino et al., 2017). Thus, ensuring effective proactive performance is critical to ensuring that these feedforward efforts minimize rather than maximize stress as the organization moves through the feedforward/feedback change process. Comparatively less research has focused on the influences of stress-related phenomena on adaptive performance, although the extant studies suggest that a number of different factors may be of interest. Niessen and Jimmieson (2016) found that the threat of resource loss (which is a common feeling during organizational change processes; Cummings & Worley, 2015) negatively impacted post-change performance, especially for those with low emotion control. Emotion control has been investigated in other studies as well, with Keith and Frese (2005) finding that it positively influences adaptive performance (and mediates the aforementioned positive effect of error-management training) and Schraub, Stegmaier and Sonntag (2011) finding that it helped mitigate the negative effect of perceived change severity on experienced strain and, subsequently, adaptive performance. Relatedly, Hui and Sue-Chan (2018) found that job-related anxiety negatively related to adaptive performance. Parker, Jimmieson and Amiot (2017) investigated work demand and control levels on adaptive performance. In addition to a positive main effect of control on adaptive performance, they found that at high levels of control there was a significant positive indirect effect of demand on adaptive performance, while at low levels of control there was a negative indirect effect. Finally, Demerouti et al. (2017) found that employee efforts to reduce demands were positively related to adaptive performance when employees assessed changes as positive, but negatively related when they assessed changes as negative. Thus, effective adaptive performance as part of the feedback process is possible; however, it is important to ensure employees see the change as positive and manageable for it to be effective.

UNIQUE DEMANDS OF ORGANIZATIONAL CHANGE IN THE PUBLIC SECTOR Public sector organizations, like organizations in the private sector, need to meet established productivity goals. In the case of the public sector organization, however, these goals are focused on addressing public needs and providing public services (Patchett & Brown, 2015). Thus, we would expect the adaptive or proactive public sector employee to engage in or initiate the most effective processes to meet these goals. However, open-systems theory reminds us that public sector organizations are influenced by external environmental forces, and the external environment is reciprocally influenced by the organization’s outputs (Shafritz & Hyde, 2007; for a detailed discussion see Freedman, 2013). As a result, researchers and practitioners need to

Individual proactive and adaptive performance  209 consider organizational change dynamics unique to the issues and environments within which public sector organizations function. Specifically, these organizations face constant political and social scrutiny, have to manage unique economic and resource limitations (e.g., government budget regulations), and often function within inflexible structures that have been in place for decades (Patchett & Brown, 2015; Shafritz & Hyde, 2007). One of the largest challenges public sector organizations face is managing the public access and scrutiny inherent to their purpose and structure (i.e., as organizations voted into existence for the purpose of serving the public). For example, most Americans express dissatisfaction and distrust with their government structures (Jones et al., 2017). Additionally, the leadership of these organizations changes frequently and potentially drastically, as new political leaders are elected into positions every two to eight years (depending on the position), and the administrative leadership that attempts to provide continuity to the organization must still answer to these political changes. This creates a pervasive tug-of-war in organizational ideals and direction that makes it difficult to find stability and focus (Gilson, Dunleavy, & Tinkler, 2009). Furthermore, organizational leadership has to answer to multiple decision-makers, including public citizens, lawmakers, corporations, not-for-profits, interest groups, legislative policy, and other public agencies whose own efforts are intricately connected with the focal public sector organization (Golembiewski, 1969). Any of these decision-makers have the opportunity to influence the policy-making process (i.e., the goal process) of a public sector organization, making it difficult to know what direction the public sector organization should take, or even legally can take, in its organizational change efforts (Patchett & Brown, 2015). Finally, public administration organizations’ budgets are often mandated by law, making it difficult to allocate the necessary resources to organizational change efforts or to have a flexible budget available to deal with the uncertainties and challenges public sector organizations may face (Caiden, 1981 [2007]). As depicted in Figure 14.1, these factors reflect environmental constraints, opportunities, and shocks that impact the feedforward and feedback processes. For example, budgetary limits, inflexible organizational structures, public sentiments, and various decision-makers impose constraints on the new ideas, procedures, and strategies that can be implemented. At the same time, new leaders offer opportunities that can facilitate proactive performance. New leaders also implement new objectives that require adaptation. Additionally, public sector organizations may be particularly vulnerable to environmental shocks (e.g., an emergency event, financial crisis) that impact both the feedforward and feedback processes. Such shocks may be anticipated, such that proactive performance and subsequent adaptive performance may help organizations to better situate themselves when a new environment emerges (e.g., Vergne & Depeyre, 2016). For example, election polling can shed light on likely political party administration changes, and time between elections and actual administration change allows public sector organizations a chance to take proactive and adaptive action as necessary. Further, to the extent to which such

210  Handbook of research on stress and well-being in the public sector shocks stimulate the organization to engage in meaningful change or to better exploit its capabilities, organizational learning and performance may benefit. However, when shocks serve to tighten constraints and sidetrack proactive performance from resulting in positive group and organizational change or sidetrack individuals’ abilities to adapt, organizational learning and performance are likely to suffer. For example, as Choi and Chandler (2015) describe, public sectors may try to respond to shocks (e.g., recession) through rapid cycles of change that leave stakeholders and ultimately the organization unable to adapt. Thus, when thinking about how the adaptive and/or proactive employee helps address organizational change within a public sector organization, it is important to keep in mind the greater complexities and challenges these employees likely face in attempting to bring about organizational change efforts. While these unique challenges may make it seem that feedforward and feedback organizational learning processes would be difficult to achieve in a public sector organization, research and practice do suggest that organizational learning processes are possible. For example, research suggests that government agencies are more inclined to trust and follow knowledge and information generated internally within the organization (Gilson et al., 2009). Arguably then, considering the ‘4I’ model (Crossan et al., 1999), public sector organizations should be more inclined to accept innovative recommendations from their own employees (i.e., proactive employees initiating a feedforward process). However, if public sector organizations are going to rely heavily on internally generated information, it is important that leadership encourages employees to study innovative processes outside of their single organization – for example, by looking to public sector organizations in other local governments, other countries, and even studying private sector processes where applicable (Gilson et al., 2009). One way innovation can be shared across public sector organizations, and emphasis placed within public sector organizations to focus employees on effective feedforward and feedback processes, is through local and national recognition of the value of organizational learning (Cummings & Worley, 2015; Gilson et al., 2009). For example, in the United States, the Malcolm Baldrige National Quality Award recognizes non-profit, health care, education, and other public sector organizations for exceptional efforts in quality improvement achieved specifically through feedforward and feedback organizational learning strategies such as emphasizing strategies that empower the workforce to be innovative and generate improved processes (feedforward) while also ensuring strategies to internalize and stabilize critical knowledge (feedback) to support the key processes that are working successfully (NIST, 2017). The practices implemented by the public sector organizations that win this award are made publicly available, allowing other organizations the opportunity to learn from award-winning organizational learning best practices (NIST, 2017). In summary, proactive and adaptive performance on the part of employees has the potential to help organizations innovate, exploit existing capabilities, and respond to environmental changes. This chapter reviewed a variety of strategies that organizations can employ to promote effective proactive performance and adaptive perfor-

Individual proactive and adaptive performance  211 mance, as well as potential opportunities, constraints, and shocks unique to public sector organizations that may impact these processes.

NOTES 1. Mindy Shoss and Clair Kueny contributed equally to this chapter and thus share first authorship. 2. It is important to note that at the organization level, exploration may be done either in a proactive or adaptive manner. In other words, organization-level exploration may be done to create a change in the environment (change is endogenous to organizational exploration), or in response to a change where the goal is to develop new activities that help the firm to best situate themselves in a changed environment (change is exogenous to organizational exploration) (Choi & Chandler, 2015; Vergne & Depeyre, 2016). 3. They also have relevance for thinking about group- and organization-level practices and changes. Given the chapter’s focus on individual-level proactive and adaptive performance, we limit our discussion to these constructs.

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Individual proactive and adaptive performance  213 Griffin, M., Neal, A., & Parker, S. (2007), ‘A new model of work role performance: positive behavior in uncertain and interdependent contexts’, Academy of Management Journal, 50, 327–347. Griffin, M., Parker, S., & Mason, C. (2010), ‘Leader vision and the development of adaptive and proactive performance: a longitudinal study’, Journal of Applied Psychology, 95, 174–182. Gwinner, K.P., Bitner, M.J., Brown, S.W., & Kumar, A. (2005), ‘Service customization through employee adaptiveness’, Journal of Service Research, 8, 131–148. Heimbeck, D., Frese, M., Sonnentag, S., & Keith, N. (2003), ‘Integrating errors into the training process: the function of error management instructions and the role of goal orientation’, Personnel Psychology, 56, 333–361. Huang, J.L., Ryan, A.M., Zabel, K.L., & Palmer, A. (2014), ‘Personality and adaptive performance at work: a meta-analytic investigation’, Journal of Applied Psychology, 99, 162–179. Hui, R.T.Y., & Sue-Chan, C. (2018), ‘Variations in coaching style and their impact on subordinates’ work outcomes’, Journal of Organizational Behavior, 39, 663–679. Ivancic, K., & Hesketh, B. (2000), ‘Learning from errors in a driving simulation: effects on driving skill and self-confidence’, Ergonomics, 43, 1966–1984. Jones, J.M., Newport, F., & Saad, L. (2017), ‘How Americans perceive government in 2017’, Gallup News, 1 November. Accessed 2 November 2018 at https://​news​.gallup​.com/​opinion/​ polling​-matters/​221171/​americans​-perceive​-government​-2017​.aspx. Joung, W., Hesketh, B., & Neal, A. (2006), ‘Using “war stories” to train for adaptive performance: is it better to learn from error or success?’, Applied Psychology, 55, 282–302. Jundt, D.K., Shoss, M.K., & Huang, J.L. (2015), ‘Individual adaptive performance in organizations: a review’, Journal of Organizational Behavior, 36, S53–S71. Keith, N., & Frese, M. (2005), ‘Self-regulation in error management training: emotion control and metacognition as mediators of performance effects’, Journal of Applied Psychology, 90, 677–691. Kozlowski, S.W.J., Gully, S.M., Brown, K.G., Salas, E., Smith, E.A., & Nason, E.R. (2001), ‘Effects of training goals and goal orientation traits on multi-dimensional training outcomes and performance adaptability’, Organizational Behavior and Human Decision Processes, 85, 1–31. Kraimer, M.L., Wayne, S.J., & Jaworski, R.A.A. (2001), ‘Sources of support and expatriate performance: the mediating role of expatriate adjustment’, Personnel Psychology, 54, 71–99. LePine, J., Colquitt, J., & Erez, A. (2000), ‘Adaptability to changing task contexts: effects of general cognitive ability, conscientiousness, and openness to experience’, Personnel Psychology, 53, 563–593. Locke, E., & Latham, G. (2002), ‘Building a practically useful theory of goal setting and task motivation: a 35-year odyssey’, American Psychologist, 57, 705–717. Mensmann, M., & Frese, M. (2017), ‘Proactive behavior training: theory, design, and future directions’. In S. Parker, & U. Bindl (Eds.), Proactivity at work: making things happen. New York: Routledge, pp. 434–468. Morrison, E.W., & Phelps, C.C. (1999), ‘Taking charge at work: extrarole efforts to initiate workplace change’, Academy of Management Journal, 42(4), 403–419. National Institute of Standards and Technology (NIST) (2017), ‘Baldrige Performance Excellence Program’. Accessed 3 November 2018 at https://​www​.nist​.gov/​baldrige. Neal, A., Yeo, G., Koy, A., & Xiao, T. (2012), ‘Predicting the form and direction of work role performance from the Big 5 model of personality traits’, Journal of Organizational Behavior, 33, 175–192. Niessen, C., & Jimmieson, C. (2016), ‘Threat of resource loss: the role of self-regulation and adaptive task performance’, Journal of Applied Psychology, 101, 450–462.

214  Handbook of research on stress and well-being in the public sector O’Connell, D.J., McNeely, E., & Hall, D.T. (2008), ‘Unpacking personality adaptability at work’, Journal of Leadership & Organizational Studies, 14, 248–259. Ong, M., & Ashford, S. (2017), ‘Issue-selling: proactive efforts toward organizational change’. In S. Parker, & U. Bindl (Eds.), Proactivity at work: making things happen. New York: Routledge, pp. 138–168. Parker, S., & Bindl, U. (2017), ‘Proactivity at work: a big picture perspective on a construct that matters’. In S. Parker, & U. Bindl (Eds.), Proactivity at work: making things happen. New York: Routledge, pp. 1–20. Parker, S., Bindl, U., & Strauss, K. (2010), ‘Making things happen: a model of proactive motivation’, Journal of Management, 36, 827–856. Parker, S., & Collins, C. (2010), ‘Taking stock: integrating and differentiating multiple proactive behaviors’, Journal of Management, 36, 633–662. Parker, S., Jimmieson, N.L., & Amiot, C.E. (2017), ‘The motivational mechanisms underlying active and high-strain work: consequences for mastery and performance’, Work and Stress, 31, 233–255. Patchett, R.R., & Brown, V. (2015), ‘Organization development in the public sector’. In T.G. Cummings and C.G. Worley (Eds.), Organization development and change. Stamford, CT: Cengage Learning, pp. 703–711. Pulakos, E.D., Schmitt, N., Dorsey, D.W., Arad, S., Hedge, J.W., & Borman, W.C. (2002), ‘Predicting adaptive performance: further tests of a model of adaptability’, Human Performance, 15, 299–323. Reynolds, C., Shoss, M., & Jundt, D. (2015), ‘In the eye of the beholder: a multi-stakeholder perspective of organizational citizenship and counterproductive work behaviors’, Human Resource Management Review, 25, 80–93. Schraub, E.M., Stegmaier, R., & Sonntag, K. (2011), ‘The effect of change on adaptive performance: does expressive suppression moderate the indirect effect of strain?’, Journal of Change Management, 11, 21–44. Sedley, D.N. (2003), Plato’s cratylus. New York: Cambridge University Press. Shafritz, J.M., & Hyde, A.C. (2007), Classics of public administration (6th ed.). Boston, MA: Thomson Wadsworth. Shaw, R., & Perkins, D. (1992), ‘Teaching organizations to learn: the power of productive failures’. In D. Nadler, M. Gerstein, & R. Shaw (Eds.), Organizational architecture. San Francisco, CA: Jossey-Bass, pp. 175–191. Shoss, M.K., Witt, L.A., & Vera, D. (2012), ‘When does adaptive performance lead to higher task performance?’, Journal of Organizational Behavior, 33, 910–924. Sonnentag, S. (2003), ‘Recovery, work engagement, and proactive behavior: a new look at the interface between nonwork and work’, Journal of Applied Psychology, 88, 518–528. Stokes, C.K., Schneider, T.R., & Lyons, J.B. (2010), ‘Adaptive performance: a criterion problem’, Team Performance Management, 16, 212–230. Sweet, K.M., Witt, L.A., & Shoss, M.K. (2015), ‘The interactive effect of leader–member exchange and perceived organizational support on employee adaptive performance’, Journal of Organizational Psychology, 15, 49–62. Tornau, K., & Frese, M. (2013), ‘Construct clean-up in proactivity research: a meta-analysis on the nomological net of work-related proactivity concepts and their incremental validities’, Applied Psychology: An International Review, 62, 44–96. Van Dyne, L., & LePine, J.A. (1998), ‘Helping and voice extra-role behaviors: evidence of construct and predictive validity’, Academy of Management Journal, 41(1), 108–119. Vergne, J.P., & Depeyre, C. (2016), ‘How do firms adapt? A fuzzy-set analysis of the role of cognition and capabilities in U.S. defense firms’ responses to 9/11’, Academy of Management Journal, 59(5), 1653–1680.

Individual proactive and adaptive performance  215 Wu, C.H., & Li, W.D. (2017), ‘Individual differences in proactivity: a developmental perspective’. In S. Parker, & U. Bindl (Eds.), Proactivity at work: making things happen. New York: Routledge, pp. 226–257. Wu, C.H., Tian, A.M., Luksyte, A., & Spitzmueller, C. (2016), ‘On the association between perceived overqualification and adaptive behavior’, Personnel Review, 36, 339–354.

15. Building a health and safety culture: actions, commitment, and perceptions Sybil Geldart and Christine Alksnis

‘The best way to find yourself is to lose yourself in the service of others.’ (Mahatma Gandhi, civil rights activist and leader) ‘To give real service you must add something which cannot be bought or measured with money, and that is sincerity and integrity.’ (Douglas Adams, author, The Hitchhiker’s Guide to the Galaxy) ‘Public service must be more than doing a job efficiently and honestly. It must be a complete dedication to the people and to the nation.’ (Margaret Chase Smith, former US Senator, Maine) ‘I realized if you can change a classroom, you can change a community, and if you change enough communities you can change the world.’ (Erin Gruwell, school teacher, founder of Freedom Writers Foundation, Long Beach, California)

INTRODUCTION We captured some inspirational quotes from speakers in the United States and abroad. The quotations, while eye-catching and touching, were showcased here for two reasons. First, we hope that our readers will read each of the personal statements and reflect upon the fact that for many people – not just the notable individuals we cited above – work is seen as both a purposeful and gratifying aspect of life; indeed, for many employees, work is integral to their personal growth and well-being. It seems to follow then that occupational health scholars and practitioners ought to concern themselves with identifying and promulgating effective practices that are geared not only towards removing workplace dangers, but also towards a proactive goal of promoting employee health.1 Therefore, we would argue that an important mission of occupational health and safety research today is to examine and evaluate organizations in terms of a range of features – safety, physical health, mental health, and wellness. The inclusion of a psychological dimension as part of health and safety takes on heightened importance in light of mounting evidence that stress and mental health issues are major problems in the public and private sector alike, resulting in personal suffering for employees, as well as lower productivity, exit behaviors, and higher costs for employers (for example, Kessler & Frank, 1997; Kessler, Merikangas, & Wang, 2008; Simon, 2003; Stewart et al., 2003). 216

Building a health and safety culture: actions, commitment, and perceptions  217 Second, our goal in selecting these particular quotations was to have readers go back and reread each statement as if someone else had proclaimed them – specifically, the administrators or overseers of public service work as opposed to the ‘doers’ of such work. The topic of this chapter, building a health and safety culture, explicitly deals with shared ideas, perceptions, attitudes, and actions regarding an organization’s commitment to health and safety. Our takeaway message is that in order to build the capacity to safeguard and advance the physical and emotional health and well-being of all of its employees, individuals at the different levels of an organization – from top managers to frontline workers – need to be on the same page regarding the centrality of workplace health and safety. Research on occupational health and safety has a lengthy history, with earlier investigations focused on initiatives at the level of the individual employee and later work shifting to considerations of contextual factors, including the impact of leadership and other organization-wide features (Hale & Hovden, 1998; Hofmann, Burke, & Zohar, 2017). This chapter builds upon the theory of Hale and Hovden that suggests that occupational safety (and health) is predicated on a broad class of organizational factors subsumed under the term ‘management systems’; studies of safety culture or safety climate are specific forms of this approach. Our aim is to move beyond consideration of safety engineering methods for altering the physical environment (for example, providing protective equipment to workers, eliminating physical hazards, and improving hygiene) by examining some of these broader factors that contribute to health and safety culture. In fact, we hope to bring to light that employees’ mental health is at the forefront of an increasingly holistic conceptualization of health and safety culture. We begin our review by providing a general background on occupational health and safety research and the public sector. This will be followed by a description of what ‘safety culture’ entails, including an explication of the related construct ‘safety climate’. Our review then moves on to consider safety culture within one large sub-area of the public sector – that is, health care settings. Our chapter ends with a summary and concluding remarks, including some mention of practical resources available to employers to assist in building an effective health and safety culture.

A BACKGROUND TO HEALTH AND SAFETY RESEARCH AND THE PUBLIC SECTOR The public sector encompasses a wide range of constituents, including federal, state/ provincial and municipal public servants, police and firefighters, postal workers, employees within school boards, universities and colleges, and workers in hospitals and other health care settings. The types of services delivered by the government can vary greatly from country to country, with corresponding differences in the size of the public sector from less than 10 percent of total employment in Asian countries to almost 30 percent in Nordic countries; in Canada, where both authors are employed at the same government-funded university, the proportion is roughly equivalent to

218  Handbook of research on stress and well-being in the public sector the Organisation for Economic Co-operation and Development (OECD) average of 18 percent (OECD, 2017). Even with austerity-related reductions in the size of government workforces since the global financial crisis in 2007–08, employment within the public sector as a percentage of total employment has actually remained relatively stable in most OECD countries between 2007 and 2015 (OECD, 2017). In Canada, there are over 3.6 million employees with positions in the public sector; within the last 15 years, the number of public sector employees has increased by over 22 percent, which is roughly double the increase for employees working in private business (Di Matteo, 2015). This increase in the number of public sector employees is commensurate with the rise in Canada’s population size, and can be traced to an increase in an aging population utilizing health care and a greater demand for services and programs (Almost et al., 2018). The extensive variety in the job descriptions of public sector employees means that there is a wide range of health and safety issues that can arise in different settings. First responders such as law enforcement, the fire department, and emergency response services have higher than normal risks of exposure to physical threat or death in their daily work life, and they often experience distress, trauma, and psychosomatic symptoms (for example, headaches, hypertension, musculoskeletal disorders) as a result (see Duckworth, 1986; Sterud, Ekeberg, & Hem, 2006). Parole officers, case management officers, and support staff in correctional services have been known to experience secondary trauma following exposure to criminal histories and moving victim statements, and consequently, many of these types of workers have developed mental health issues such as depression and addictions (Union of Solicitor General Employees, 2017). In a related vein, burnout, which is associated with somatization, anxiety disorders, substance abuse, and depression (Maslach, Schaufeli, & Leiter, 2001), is prevalent in nurses, educators, and helping professions whose work involves interacting with people with high levels of physical and emotional need (Carod-Artal & Vásquez-Cabrera, 2013; Maslach & Leiter, 2016). Last, recent surveys of Canadian federal government public servants have revealed a steady increase in the number of disability claims that are stress-related, accounting for almost half of all claims (May, 2012); this particular situation was perceived as so dire that senior leadership in the Canadian Psychological Association (CPA) intervened in an effort to ameliorate it (CPA, n.d., para. 1). These troubling trends on the mental health front have led some workplaces to adopt occupational health and safety initiatives that move beyond a circumscribed focus on physical safety.2 For example, to address burnout and chronic stress, counseling services or therapy are generally offered in organizations via an employee assistance program (see Fitzgerald, Hammond, & Harder, 1989; Kirk & Brown, 2003). Mindfulness-based interventions have become popular in the health care sector (see Atanes et al., 2015; Bazarko et al., 2013), and have been shown to reduce stress levels among nurses, physicians and occupational therapists (Burton et al., 2017), mental health professionals (Yang, Meredith, & Khan, 2017), and students of nursing and medicine (see O’Driscoll et al., 2017 for a systematic review).

Building a health and safety culture: actions, commitment, and perceptions  219 Over the last 20 years, the American Psychological Association (APA) has been encouraging North American employers to acknowledge and incorporate mental health as part of an expanded definition of health and safety. Since 1999, APA has partnered with state/provincial/territorial psychological associations to bestow annual Psychologically Healthy Workplace Awards that recognize new programs and company policies towards employee health and well-being (APA Center for Organizational Excellence, n.d.a, para. 1). APA has delineated five recommended practices for creating a psychologically healthy workplace. One important practice pertains to workers’ physical health and it bridges traditional safety programming with health promotion (for example, weight loss, regular exercise) and the delineation of procedures when health is compromised (access to health insurance, health screening, addictions counseling; APA Center for Organizational Excellence, n.d.b, para. 2). The remaining four practices pertain to workers’ mental health and wellness and include (but are not limited to) employee recognition, skills building, employee empowerment, and work–life balance (APA Center for Organizational Excellence, n.d.c, para. 2). These APA-recommended practices are backed by empirical research and supported by theory (Grawitch, Gottschalk, & Munz, 2006; Tetrick & Peiró, 2016). Industries in the private sector have adopted APA-endorsed health promotion practices in an attempt to encourage good habits (for example, blood pressure control; Alderman, Green, & Flynn, 1980), discourage risky behaviors (smoking cessation; Eriksen & Gottlieb, 1998) and boost energy and vitality (Naumanen, 2006). Interventions of this type are beneficial to organizations by maintaining productivity and profitability while simultaneously reducing health care costs. In the private sector, such programs can also help reduce lost-time injuries and the number of disability days from work (Bertera, 1990).3 But are they enough to establish a positive health and safety culture at work? According to Kelloway (2015), individually focused interventions aimed at stress management may not actually be addressing the problematic conditions under which some people work; the mere existence of a set of policies and programs ostensibly designed to address ‘stress’ (or ‘employee empowerment’, ‘work–life balance’, etc.) does not inevitably lead to actual improvements in employees’ lives. This is especially true if workers perceive that said programs simply pay lip service to health and well-being, or if the programs’ aims are incongruent with demands of the job (long hours, job insecurity, etc.). If there is any hope for producing real and measurable benefit in workers’ lives, these programs cannot be superficial ‘add ons’ – rather, there needs to be a shared underlying philosophy and culture in place whereby the creation of a healthy workplace is a core organizational goal (Ballard & Grawitch, 2016; Kelloway, 2015). In the following section, we will explore in more depth how one might define the culture of an organization with regard to health and safety.

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SAFETY CULTURE: WHAT IS IT? Concepts such as organizational culture and safety culture began to take momentum following major catastrophic events around the world that claimed the lives of workers and the general public, beginning with the nuclear accident at Chernobyl in 1986 and including other disasters in aviation and oil platforms (Cox & Flin, 1998; see Cooper, 2000 for a review). Poor safety in high-risk industries led researchers to shift attention from worker issues and human error (see Reason, 1997) to a broader examination of systems and processes. Turning to the health care sector, the landmark Institute of Medicine report, To Err is Human, pointed to systematically flawed practices leading to patient suffering and death, which seemed to be caused by endemic problems in governance, education, and technologies (Kohn, Corrigan, & Donaldson, 1999).4 This report led to a plethora of studies aimed to measure safety culture in health care settings and determine effective interventions. It also led to a somewhat complex distinction between patient safety culture and occupational (or worker) safety culture (Wagner et al., 2018). Despite there being several definitions of safety culture (refer to Cooper, 2000 and Wiegmann et al., 2004 for reviews), the way most academics and practitioners conceptualize it comes from the nuclear power industry: The safety culture of an organization is the product of individual and group values, attitudes, perceptions, competencies and patterns of behaviour that determine the commitment to, and the style and proficiency of, an organisation’s health and safety management. Organisations with a positive safety culture are characterized by communications founded on mutual trust, by shared perceptions of the importance of safety and by confidence in the efficacy of preventive measures. (ACSNI, 1993, p. 23, cited in Flin, 2007, p. 656)

Safety culture and safety climate are two (sometimes confusing) terms that have been used in the literature, and there has been debate as to whether safety climate as a concept is distinct from safety culture (Cox & Flin, 1998; Griffin & Curcuruto, 2016; Guldenmund, 2000; Hale, 2000). Safety climate, as first described by Zohar (1980), considers shared perceptions by employees regarding their employers’ desire to act safely despite demands for productivity. Another way to think about safety climate is to consider shared perceptions at a given moment, one that is subject to change quickly following improvements in the work environment (Wiegmann et al., 2004). Still another way to conceptualize safety climate is to embed it within Guldenmund’s (2000) three layers of safety culture: the core layer comprises basic assumptions about safety, the middle layer consists of espoused values and attitudes, and the outermost layer represents behavioral displays of the underlying culture. Using this metaphor, safety climate may be best understood as perceptions of the middle and outer layers of safety culture – or rather, as reflecting more surface features rather than deeper, pervasive assumptions (Denison, 1996). Climate, then, may be more amenable to change through deliberate organizational actions such as safety training, strategic planning, and participative decision-making (Beus et al., 2010).

Building a health and safety culture: actions, commitment, and perceptions  221 Regardless of the exact wording, the most commonly used tool for measuring safety culture has been the Nordic Safety Climate Questionnaire (see Kines et al., 2011; Zohar, 1980), which is a self-report survey asking different levels of employees to report on beliefs, values, attitudes, and perceptions at their workplace in terms of management commitment to health and safety, worker commitment and empowerment, communication, trust in safety systems, and so forth. Research consistently shows that better safety climate in organizations is associated with lower workplace accident rates (Arezes & Migual, 2008; Smith et al., 2006). Better safety climate is also associated with stronger shared perceptions among managers and employees regarding who is responsible for safety (Prussia et al., 2003). Meta-analyses of over 200 studies on safety climate have shown that workers’ perceptions of management priority to safety are a strong predictor of safety performance – and this is true both across sectors and across countries (Beus et al., 2010; Christian et al., 2009). Returning to the health care domain, workplaces that are perceived as having a strong safety climate or culture – where workers share the belief that their occupational risks are low – appear to engender greater work satisfaction in nurses and physicians (Zarei et al., 2016) and diminished patient-related burnout among nurses (Wagner et al., 2018).

BUILDING SAFETY CULTURE IN THE HEALTH CARE SETTING Hazards for Health Care Workers It is easy to understand why building a culture of safety has extended into health care. Health care in many jurisdictions has become complex as a result of rising costs to operate safe, humane and highest-quality treatment to patients, an increase in demand for health services by patients, particularly in an aging population, and greater complexity in patients’ medical issues and co-morbidity in health problems. In referencing health care research in Canada, Joan Almost and her colleagues (2018) have argued that a greater demand for health services in an aging workforce combined with a recent rise in pandemics and environmental risks continues to pose a threat to the health and safety of health care workers, and thus must be addressed. Some of the restructuring of health care in Canada that occurred over two decades ago involved an increase in health care within the home setting, with that segment of the workforce comprising a larger number of part-time workers, migrant workers, and women (Statistics Canada, 1999); research on home health care workers has revealed a strong relationship between work-related health problems (stress, musculoskeletal disorders) and (lack of) support by supervisors and co-workers (Denton et al., 2002). However, many health professionals in Canada continue to be employed in hospital settings; in one such hospital that underwent significant downsizing, flattened hierarchies, and longer hours of work, health care employees reported high

222  Handbook of research on stress and well-being in the public sector levels of depression, anxiety, emotional exhaustion, and job insecurity (Woodward et al., 1999). More recently, a number of studies have shown that when physicians, nurses, and other hospital staff experience pressures at work, the effect is poor health outcomes for themselves as well as a reduction in the care given to patients (Aiken et al., 2014; Donaldson, 2008; Starc, 2018; Ulrich et al., 2014). Indeed, work-related demands such as job overload, role conflicts, and time pressure that occur in a changing economy have been known to lead to psychological stress (Karasek, 1979); when these job demands cause stress and burnout in nurses and physicians, the effect is that patients report feeling less satisfied with the quality of their care (Crane, 1998; Poghosyan et al., 2010). Fast-paced hospital settings not only contribute to work stress but they can produce lost-time injuries, which, in turn, can cause a shortfall of nursing staff, low retention rates of staff, and more capital dedicated towards workers’ rehabilitation and recovery (James et al., 2018). For nursing staff working in mental health services, being constantly exposed to serious psychopathology and disturbed thought processes, and having to manage emotional dysregulation and violent behaviors in patients, similarly results in compromised health and an increased risk of injury (Chen, Hwu, & Williams, 2005; Christodoulou-Fella et al., 2017; McKinnon & Cross, 2008). Measuring Safety Culture in Hospital Settings In health care, the majority of instruments used to assess safety culture have specifically addressed patient safety (in terms of outcome measures like number of medication errors, patient falls, and injury) (Arrieta, Suárez, & Hakim, 2018; Conner et al., 2018; Sexton et al., 2006; Vogus & Sutcliffe, 2007; Wallis & Dovey, 2011). For the purposes of this chapter, we are partial towards instruments that specifically deal with worker physical health, mental health, and well-being (Wagner et al., 2018; Yassi & Hancock, 2005). As an illustration, in 2009, the American Association of Critical-Care Nurses (AACN) developed a web-based survey for employees, called the ‘Healthy Work Environment Assessment Tool’ (HWEAT, for short; see Conner et al., 2018) as a way to learn from physicians, nurses, and other hospital staff members how healthy their work environment is in terms of a range of benchmarks. The standards used in HWEAT, taken from the National Academy of Medicine’s core competencies for health professionals (AACN, 2005) include: (1) skilled communication; (2) true collaboration (involving staff members in higher-level decision-making); (3) effective decision-making; (4) appropriate staffing; (5) formal recognition of employees’ work; and (6) authentic leadership (involving positive interactions between nurses on the floor and nurse leaders). The instrument was shown to be reliable and valid for use with nurses and physicians in various types of settings, both in the US and beyond (Aboshaiqah, 2015; Huddleston & Gray, 2016). Moreover, it can differentiate viewpoints among different types of professionals; nurses scored lower than physicians on all six dimensions, particularly for the core competency of ‘meaningful recognition and respect’ of staff (making staff feel valued, letting staff

Building a health and safety culture: actions, commitment, and perceptions  223 know when they have done well in their tasks, motivating opportunities for personal growth; Conner et al., 2018). This is an important finding because it tells us that nurses who feel less valued or perhaps disrespected by physicians nevertheless are expected to put feelings aside and work in harmony with professional colleagues in order to deliver competent and compassionate nursing care. There are numerous points of overlap between the HWEAT’s six dimensions for creating healthy work environments in the health care sector and APA’s five recommended practices, which are intended to be applicable more broadly across work settings. Both APA and the HWEAT refer to employee recognition and employee involvement, both are concerned with workers’ physical health and safety, and both emphasize that communication is key. In fact, communication is viewed as the essential element underpinning successful implementation of any of the five recommended practices within the APA framework (Grawitch & Ballard, 2016). They diverge somewhat in that APA highlights employee-specific issues such as work–life balance and employee growth, whereas the HWEAT emphasizes specific managerial behaviors, such as the value of effective decision-making and the importance of authentic leadership. In the next section, we will examine managers’ leadership actions and skills in more detail. What we will see is that transformational leadership (Bass, 1995), when applied to the health care setting, plays a critical role in shaping safety culture. Transforming Health Care via Transformational Leadership Transformational leaders in health care institutions have a vision that the work environment must be positive for all users, workers, and patients alike. They are strong role models because they empower nursing staff to offer support to one another and reinforce the shared goal of upholding patient safety. Not only do such leaders communicate the values and goals of the organization clearly, they are capable of persuading staff members to share these same beliefs and goals. Knowing that individuals can differ in points of view, transformational leaders must know how to elicit change, often by virtue of having certain personality styles such as empathy, good listening skills, coaching (Avolio, Bass, & Jung, 1999), and forward thinking (Saeed et al., 2014). The presence of transformational leadership has been associated with higher incident reporting by nurses (for example, more reporting of medication errors), less burnout in nurses, and fewer intentions to quit (Hillen, Pfaff, & Hammer, 2015; McFadden, Henagan, & Gowen, 2009; Squires et al., 2010; Wong, Cummings, & Ducharme, 2013). So how do transformational leaders achieve the goal of reporting safety issues and lowering occupational risks? Transformational leaders are, of course, trained to instruct subordinates to be cognizant of patient safety. But they also focus on developing nursing staff to become leaders themselves (Bass, 1995) and to feel empowered by work demands (Boamah et al., 2018). Nursing managers who serve in this capacity have a dual role of attending to the needs of their nursing staff while simultaneously supporting upper management in their broader vision of patient care and

224  Handbook of research on stress and well-being in the public sector institutional safety. It has been shown that nurse managers who demonstrate a better understanding of senior managers’ expectations about patient safety (compared to those managers who are less aware of its importance) report a greater number of adverse events or near misses (Ammouri et al., 2015). In a recent qualitative study, nurse managers in a large urban hospital were asked to discuss adverse events that they had experienced in the past. Themes that emerged corresponded well with the characteristics of transformational leaders as mentioned above, including: emphasizing patient safety as a shared goal; initiating novel and effective ways to solve problems; encouraging staff to report incidents in a blame-free culture; and, being non-judgmental when staff members discuss adverse situations (Liukka, Hupli, & Turunen, 2017). It is easy to see how shared values and actions have a positive effect beyond better patient care – that is, nurses who report that their managers use a transformational leadership style compared to other styles of leadership (for example, leaders who prefer supervising, organizing, and receiving compliance towards existing goals) report better job satisfaction, better conflict management, and greater psychological well-being (Boamah et al., 2018; Cummings et al., 2010; Munir et al., 2012). Taken together, the findings suggest that a transformational leadership style has the potential to improve outcomes for the public and for health care workers.

SUMMARY AND CONCLUDING REMARKS This chapter began with definitions of the safety culture construct, and a review of occupational research within the public sector – with an emphasis on safety culture in health care organizations. But safety culture as a point of earnest discussion did not have its beginnings in health care, or the public sector per se. An interest in the topic arose following significant disasters in high-risk industries, which then prompted a cascade of empirical research on safety culture in other work settings. In this chapter, we reviewed how safety culture is assessed via workplace surveys, and we highlighted some core competencies, including the important role of transformational leadership. We contend that in health care institutions and elsewhere, the creation and maintenance of healthy workplaces requires the presence of individuals in leadership positions who can bring people together to work towards this shared goal. Having described ingredients for a health and safety culture, how might an organization go about implementing these practices? The APA Center for Organizational Excellence website is replete with resources that employers can use for guidance, with resources available in the form of peer-reviewed empirical research articles as well as information presented in less formal, non-academic venues (including blog, podcast, newsletters, webinars). In Canada, the National Standard of Canada for Psychological Health and Safety in the Workplace (the Standard for short), was recently developed via a partnership among the Mental Health Commission of Canada (MHCC), the Standards Council of Canada, and the Bureau de Normalisation du Québec (Canadian Standards Association, 2013). The Standard is a voluntary set of guidelines for employers geared towards preventing psychological harm and

Building a health and safety culture: actions, commitment, and perceptions  225 promoting mental health at work, complete with online training modules and a toolkit that is easily accessible and freely available for employers. As with the APA materials, there is flexibility in how specific organizations might choose to engage with the Standard. There are five elements of the Standard that relate to building an effective safety culture, namely: (1) commitment, leadership and participation; (2) planning; (3) implementation; (4) evaluation and corrective action; and (5) management review. The employee surveys conducted under the auspices of the Standard cover 13 different psychosocial risk factors for mental health, many of which overlap with elements in the HWEAT and APA Psychologically Healthy Workplace materials that we described earlier. As discussed in this chapter, APA began formal recognition of organizations that demonstrate exemplary implementation of the practices that contribute to a psychologically healthy workplace (APA Center for Organizational Excellence, n.d.a, para. 1). A look at the list of past annual winners of APA’s Psychologically Healthy Workplace Awards reveals that a good number of recipients happen to be public sector employers. Companies that have received this award of distinction have been found to show statistically better outcomes on numerous dimensions relative to the American average, including having a smaller proportion of employees diagnosed with chronic stress (APA, 2018), lower turnover (APA, 2017), and a higher proportion of workers who report that they are ‘motivated to do my very best for my employer’ (APA, 2017, 2018). That being the case, we realize that senior managers having a desire to implement the set of practices will want to be strategic about which types of programs, and how many initiatives, would work optimally given their unique context (see Ballard & Grawitch, 2016 for a discussion). And, of course, we agree with the experts when they maintain that creating an effective safety culture requires a sustained and ongoing effort on the part of all members of an organization – it is an aspirational goal for which the organization needs to continually strive (Grawitch & Ballard, 2016).

NOTES 1. Burgeoning work in the area of positive psychology has underscored a wide array of benefits that accrue to individuals who engage in healthy living and a positive sense of self (see reviews by Creswell, 2017 and Dimidjian & Segal, 2015). 2. Of course, interventions centered on minimizing physical risks and improving work design (e.g., reducing noise levels, improving air quality, ergonomics) can also have salutary mental health effects by reducing employees’ stress levels (Cox et al., 2000). 3. Note that these types of workplace initiatives are not universally lauded; in one study, workers voiced their concerns that health promotion efforts at their own workplace had interfered with individual rights for privacy and lifestyle choices (Robroek et al., 2012; see also Powroznik, 2017). 4. For reviews and discussions across North America and Europe, see Aiken et al. (2014); de Vries et al. (2008); Makary & Daniel (2016); Waring et al. (2016); WHO-Europe (2008).

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230  Handbook of research on stress and well-being in the public sector Reason, J. (1997), Managing the risks of organizational accidents. Aldershot, UK: Ashgate Publishing Company. Robroek, S.J., Van de Vathorst, S., Hilhorst, M.T., & Burdorf, A. (2012), ‘Moral issues in workplace health promotion’, International Archives of Occupational and Environmental Health, 85, 327–331. Saeed, T., Almas, S., Anis-ul-Haq, M., & Niazi, G.S.K. (2014), ‘Leadership styles: relationship with conflict management styles’, International Journal of Conflict Management, 25, 214–225. Sexton, J.B., Holzmueller, C.G., Pronovost, P.J., Thomas, E.J., McFerran, S., Nunes, J., … Fox, H.E. (2006), ‘Variation in caregiver perceptions of teamwork climate in labor and delivery units’, Journal of Perinatology, 26, 463–470. Simon, G.E. (2003), ‘Social and economic burden of mood disorders’, Biological Psychiatry, 54, 208–215. Smith, G.S., Huang, Y., Ho, M., & Chen, P.Y. (2006), ‘The relationship between safety climate and injury rates across industries: the need to adjust for injury hazards’, Accident Analysis and Prevention, 38, 556–562. Squires, M., Tourangeau, A., Spence Laschinger, H.K., & Doran, D. (2010), ‘The link between leadership and safety outcomes in hospitals’, Journal of Nursing Management, 18, 914–925. Starc, J. (2018), ‘Stress factors among nurses at the primary and secondary level of public sector health care: the case of Slovenia’, Open Access Macedonian Journal of Medical Sciences, 6, 416–422. Statistics Canada (1999), Statistical report on the health of Canadians. Accessed 14 November 2019 at http://​www​.publications​.gc​.ca/​site/​eng/​290912/​publication​.html. Sterud, T., Ekeberg, Ø., & Hem, E. (2006), ‘Health status in the ambulance services: a systematic review’, BMC Health Services Research, 6, 82–92. Stewart, W.F., Ricci, J.A., Chee, E., Hahn, S.R., & Morganstein, D. (2003), ‘Cost of lost productive work time among US workers with depression’, Journal of the American Medical Association, 289(23), 3135–3144. Tetrick, L.E., & Peiró, J.E. (2016), ‘Health and safety: prevention and promotion’. In M.J. Grawitch, & D.W. Ballard (Eds.), The psychologically healthy workplace: building a win–win environment for organizations and employees. Washington, DC: American Psychological Association, pp. 199–229. Ulrich, B.T., Lavendero, R., Woods, D., & Early, S. (2014), ‘Critical care nurse work environments 2013: a status report’, Critical Care Nurse, 34, 64–79. Union of Solicitor General Employees (2017), Moving forward: a report on the invisible toll of psychological trauma on federal public safety workers. Ottawa: Union of Solicitor General Employees. Vogus, T.J., & Sutcliffe, K.M. (2007), ‘The impact of safety organizing, trusted leadership, and care pathways on reported medication errors in hospital nursing units’, Medical Care, 45, 997–1002. Wagner, A., Hammer, A., Manser, T., Martus, P., Sturm, H., & Rieger, M.A. (2018), ‘Do occupational and patient safety culture in hospitals share predictors in the field of psychosocial working conditions? Findings from a cross-sectional study in German university hospitals’, International Journal of Environmental Research and Public Health, 15, 2131–2148. Wallis, K., & Dovey, S. (2011), ‘Assessing patient safety culture in New Zealand primary care: a pilot study using a modified Manchester Patient Safety Framework in Dunedin general practices’, Journal of Primary Health Care, 3, 35–40. Waring, J., Allen, D., Braithwaite, J., & Sandall, J. (2016), ‘Healthcare quality and safety: a review of policy, practice, and research’, Sociology of Health & Illness, 38, 198–215. WHO-Europe (2008), Guidance on developing quality and safety strategies with a health system approach. Copenhagen: World Health Organization Regional Office for Europe. Accessed 23 July 2018 at http://​www​.euro​.who​.int/​en/​health​-topics/​Health​-systems/​patient​

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16. An organizational perspective on well-being in the health sector: a focus on leadership, systems, and culture Peter Spurgeon

INTRODUCTION This chapter focuses on the UK’s public sector and specifically within that the health sector. The focus within the sector is a single professional group – medical doctors both qualified and in training. This in part reflects the initial role of this group in health care delivery systems but also the research base of the author that facilitates access to the core issues to be covered – that of stress experienced by doctors, the changing and emerging role especially with regard to medical leadership, and the overarching concept of medical engagement that is perhaps the underpinning cultural feature in relation to establishing enhanced well-being. The approach of the author, as the title suggests, involves reviewing the workplace from a systems perspective with interdependent processes and often quite distinct cultures. Negative forces that affect individual staff may be located within these organizational characteristics. It is the contention of this chapter that by recognizing this, by managing these elements more effectively and sympathetically, the negative forces may be ameliorated, and enhanced well-being provided for the majority of staff. The approach is inherently efficient, since it would eliminate the need to provide a number of individual support programs to those under strain. The argument is further reinforced by the findings that well-managed organizations benefit both from reduced individual distress but also more effective performance. To set the scene, a few brief comments about the UK health sector follow.

UK HEALTH SECTOR The UK health sector represents just under 20 percent of the total UK public sector expenditure. Like many health systems it is under pressure from common trends such as increasing populations, older populations with more complex morbidities, and the rapid advance of expensive innovations and technologies. It is essentially a general tax-funded service that is free at the point of delivery. There are some co-payment exceptions such as dentist appointments and eye tests, but many are exempt and even then, the percentage does not really alter the free-at-point-of-delivery notion. The spend as a proportion of gross domestic product (GDP) is between 8 and 9 percent 232

An organizational perspective on well-being in the health sector  233 compared to 10 percent in France and 11 percent in Germany. Despite this slightly lower spend, the Commonwealth Fund (2017) has reported the UK health system as best in terms of safe care, affordability, and equipment – although less good in terms of health care outcomes. Although total expenditure has continued to increase in recent years, the rate of growth in spend on the National Health Service (NHS) has slowed markedly since 2010 – an enactment of the ‘austerity’ program by the Conservative/Liberal Democrat government following the financial crash. Sadly, this has coincided with a steady increase in demand. For example, from 2009–10 to 2016–17 the number of emergency attendances has increased by 7.7 percent and electoral elective surgery by 15.7 percent. The funding shortfall is most recognizable in terms of staff shortages, which are severe in some particular organizations. In 2016, the UK had 2.8 physicians per 1000 of the population, compared to 4.1 in Germany and 6.1 in France (NHS Confederation, 2017). The cold numbers suggest a system under strain but there are also increasing demands and expectations from a population that has been led to feel entitled to instant access and whatever service provision they feel appropriate. The primary cost of health services provision is staff, and it is staff, therefore, who bear the brunt of coping with this extremely challenging set of circumstances. Shanafelt and Noseworthy (2017) report that from a similarly pressurized US hospital system, 50 percent of US physicians are experiencing professional burnout. This is especially so for those specialties working in direct frontline care contexts. They also suggest that this level of burnout contributes to disturbing symptoms in individuals affected, such as relationship break-up, alcoholism, and suicide.

THE HISTORIC CONTEXT OF THE MEDICAL PROFESSION The evolution of the medical profession from early recognition to the current day is beyond the scope of this chapter. However, an abstracted version may serve to highlight how some of the stresses and strains and vulnerabilities of this group in part result from their position within the overall health system. As Klein (2006) notes, the initial framework to include doctors within the NHS was one where financial allocation was essentially a central and political domain, with doctors quite separately determining the focus of expenditure by their decisions to allocate different treatments. This initial structure has had long-term consequences. The decision-making about treatment regimes established doctors as the pre-eminent power group in terms of other health care professionals and the financial separation has promoted a sense of lack of involvement or responsibility for what happens in the overall organization. Marnock, McKee and Dinnie (2000) described doctors as occupying a form of no man’s land between the managerial (financial) and other clinical groupings. The dominance of the medical profession and its exercise of clinical autonomy is to a large extent based on the medicalization of health care. It is only doctors who can define medical work, its diagnosis, and treatment. This singular note creates

234  Handbook of research on stress and well-being in the public sector a dependency for health organizations (Ackroyd, 1996) and enables doctors to determine priorities and commit resources. The continuing development of medical treatments and technologies reinforces the expertise and power of the medical profession. As Spurgeon, Clark and Ham (2011) write, the increasing sub-specialization of knowledge creates powerful domains of knowledge for those who have it. However, alongside this knowledge emerge particular patterns of working and an individualistic approach. This is often in contrast to the managerialist focus of organizations who wish to devise patterns of working and flexibility that best serve to meet the wider organizational goals. This tension is, as Mintzberg (1983) suggests, particularly problematic in what he describes as professional bureaucracies where the knowledge and expertise of a particular group are vital to the success of an organization. There is an ongoing tension here where the medical ethos does not always fit happily with more generic organizational processes. The context of health care creates an almost naturally stressful environment. Examples abound – a newly qualified doctor plunged into: (1) coping with an overly crowded Accident & Emergency Department (A&E), with patients arriving with a mix of trivial complaints (who should not be at A&E) or life-threatening conditions, with all treatment cubicles full, the hospital having no spare beds to admit patients, and a managerial system desperate to prevent any patient breaking the four-hour wait target; or (2) imparting news to parents about the just diagnosed terminal condition of their child. Firth-Cozens and Payne (1999) edited an entire text devoted to describing the stressful context of health care and the way in which various staff groups may be affected.

STRESS IN DOCTORS: AN ORGANIZATIONAL APPROACH This first empirically based section is concerned with evidence of stress in the medical workforce and also demonstrating the value of viewing the issue from an organizational perspective. The term ‘stress’ is used rather generally to incorporate physiological and psychological aspects, to incorporate quite short-lived events and longer-term exposure, and also to recognize that individuals may respond quite variably to apparently similar environmental contexts (Herbert, 1999). This chapter is not the place for a full detailed discussion of all aspects of the stress process. The link between the experience of stress and subsequent health consequences is controversial when seen as a rather literal one-to-one relationship. However, Beehr and Newman (1978) usefully describe a range of both psychological (anxiety, depression, boredom, feelings of futility and alienation, low self-esteem, and suppression of feelings) and physical consequences (cardiovascular disease, gastrointestinal disorders, skin disorders, and fatigue). The variability in individual reactions has at times led researchers to pursue the identification of personal factors that may influence this reactive predisposition (Spurgeon, 1999). As a consequence, coping strategies and

An organizational perspective on well-being in the health sector  235 concepts such as ‘hardiness’ (Kobasa, 1989) have attracted attention, possibly to the detriment of investigating causes of stress. Cooper, Davies-Cooper and Faragher (1986) provide a generic overview of factors in the organization that may contribute to stress, and, notably, factors intrinsic to the job such as workload and time pressures; the individual’s role within the organization; career concerns; relationships at work; and organizational structure and climate. Vincent (1999) focused more specifically on doctors – in particular, junior doctors – and their heightened stress about errors and consequences for patients. Spurgeon, Barwell and Maxwell (1995) identified a number of sources of stress in general practitioners – such as balancing work and life demands; challenging patients; work interruptions; and liaison with other staff, hospitals, and external agencies. The impact of such pressures on the individual clinician may, of course, flow through to serious negative impacts on patient care and outcomes. It is, though, clear that burnout is a major concern for the profession in terms of the effect of sustained pressures. Shanafelt and Noseworthy (2017) document this issue, suggesting that burnout in US physicians is increasing at a higher rate than in any other field. They also argue that the distress felt by professionals has a clear repercussion for various aspects of quality of patient care. The problem is exacerbated, according to Brooks and colleagues (Brooks, Chalder, & Gerada, 2011; Brooks, Gerada, & Chalder, 2011, 2016), in that despite doctors having a high level of stress they have great difficulty in admitting to problems, fearing such disclosure will have a negative impact on their future career. A typical organizational response is to focus upon the individual and to provide programs such as stress management workshops, counseling, and training in resilience techniques. Of course, such interventions can be of great value to any particular individual, but, as Shanafelt and Noseworthy (2017, p. 131) comment: ‘Such techniques neglect the organizational factors that are the primary drivers of physician burnout and are correctly viewed with skepticism by physicians as an insincere effort by the organization to address the problem’. This is, of course, in line with the thrust of the argument of the first section of this chapter – that stress experienced by doctors is more effectively tackled as an organizationally based issue. Murphy (1996) reviewed the contribution of work design to reducing sources of stress. He makes the point that the attitudes and social responses of staff tend to relate more to patient satisfaction than the ‘hardware’ elements of health care. Spurgeon, Mazelan and Barwell (2012) describe a specific approach and metric aimed at assessing both individual and organizational sources of stress in the form of the Organizational Stress Measure (OSM). Organizations face increasing legal and moral pressures to take responsibility for stress experienced by their employees.

THE OSM MODEL Through a variety of organizational processes such as inappropriate leadership styles or through the less than optimal strategic and operational decision-making processes

236  Handbook of research on stress and well-being in the public sector of senior managers, some sources of stress may be considered to originate at the cultural level. These may be seen as fundamental or ‘root’ causes of organizational problems since although they arise from the ways in which the organization is structured or from bad leadership or management approaches, the negative consequences of these faults is typically not immediately apparent. In this way, these ‘root’ organizational problems can act as ‘latent’ sources of stress. In other words, they are problems waiting to happen and can surface when the organizational conditions are ripe.

Source: Applied Psychology Ltd. (2003). (Original figures supplied by Applied Research Ltd, 124 Lightwoods Road, Bearwood, West Midlands, B67 5BE, UK, used with permission).

Figure 16.1

The OSM model

The OSM is based upon a simple but powerful model of stress, as shown in Figure 16.1. It is clear that potential sources of stress become increasingly visible as they ‘flow downstream’ to the workplace where they create conditions that may be perceived by staff as organizational pressures. The OSM model, discussed below, shows that perceived organizational pressures (POP) can, under some conditions and for some staff, become transformed into felt individual strains (FIS). These FIS impact upon and influence the organizational situation. These staff reactions to stress can manifest themselves as part of various organizational states or situations. The OSM seeks to help organizations overcome problems associated with stress by initially defining the problems through the views of those directly affected (the staff) and then devising appropriate interventions that the organization can use to tackle the sources. The Primary and Secondary Scales of the OSM The advantage of the OSM technique is that it measures perceived organizational pressures (i.e., the workplace sources of stress) and felt individual strains (i.e., the

An organizational perspective on well-being in the health sector  237 person’s reactions to perceived stress) within the same instrument. The OSM consists of 64 items that provide information for 15 perceived organizational pressure scales (i.e., POP scales) and 15 felt individual strain scales (i.e., FIS scales). This clear separation of external pressures from internal strains is at the heart of the OSM model of stress. For ease of interpretation, the 15 primary POP scales can be summated into four basic types of organizational pressure and, similarly, the aggregation of the 15 primary FIS scales results in four parallel types of individual strain. The summated scales (eight in all) are called secondary scales. It can be seen from the brief definitions included in Figure 16.2 that the four types of organizational pressure identify the four crucial causes of stress in organizations. These typically emanate from problems in one or more of the following four domains: ●● ●● ●● ●●

the cultural domain (value system); the technical domain (job demands); the control domain (resource utilization); the social domain (interpersonal climate).

Each domain has the potential to act as primary causes of staff stress. Similarly, the four types of individual strain identify the four key areas where psychological threats to performance at work can attack an individual’s self-confidence and/or perceived competence and result in feelings of strain. In addition to coping capacity, which is seen as a form of ‘free-floating’ ability to cope with ongoing work issues (with the potential to become attached to any perceived problem), the other three types of individual strain parallel the well-established occupational distinction between task, job, and role. Ongoing perceived task proficiency (empowerment) is distinguished not only from longer-term job success (achievement) but also from role fulfillment (cohesion). In this way an individual has a dual profile that defines his or her unique pattern of perceived work stress. Interpreting the OSM The OSM analysis answers two distinct questions: (1) What is the average level of stress? (2) Are there significant clusters of stressed staff? Figure 16.3 illustrates that the frequency distribution of stressed staff is often skewed and sometimes bimodal. This means that it is important to identify whether there are clusters of stressed staff in an organization as well as identifying the average levels of staff stress. To answer the questions shown above, the OSM is analyzed in two ways. The first type of analysis is called ‘Staff Profile Analysis’ and this provides an indication of where particular staff samples within an organization (e.g., staff groups, departments, divisions, or units) lie in relation to each other as measured on the various scales in the OSM. The average group responses are calculated and plotted on a background scale that has been derived from a normative reference group of other groups of staff

238  Handbook of research on stress and well-being in the public sector

Source: Applied Psychology Ltd. (2003). (Original figures supplied by Applied Research Ltd, 124 Lightwoods Road, Bearwood, West Midlands, B67 5BE, UK, used with permission).

Figure 16.2

The typology of organizational pressures and individual strains

who have previously completed the OSM. This profile provides a useful summary statement of where the ‘average’ group response for a sample of staff lies compared to the wider normative reference group. The second type of analysis is called ‘Outlier Analysis’ and this is used to identify and prioritize targets for managerial interven-

An organizational perspective on well-being in the health sector  239

Source: Applied Psychology Ltd. (2003). (Original figures supplied by Applied Research Ltd, 124 Lightwoods Road, Bearwood, West Midlands, B67 5BE, UK, used with permission).

Figure 16.3

Staff distributions and stressed clusters of staff

tion. Outlier analysis identifies where there are significant clusters of members of staff within any organizational group who are particularly stressed. Based on the patterns of scale scores for these outlying staff clusters, suggestions for targeted organizational interventions are derived. The essential argument presented here is that doctors are vulnerable to various sources of stress and that the provision of individually based support programs is worthy but not sufficient. Where sources of stress can be identified within organizational practices then a more cost-effective approach to tackling stress and enhancing well-being is to focus on eliminating or controlling these sources. The OSM provides an organizationally centered methodology for doing this.

DOCTORS AS LEADERS As the previous section has shown, doctors are potentially susceptible to a range of particular stressors, both individual and organizational. A more recent development has seen changes in the societal context of health care and as a consequence challenges the previous role and status of the medical profession. Traditionally, doctors have been the pre-eminent profession within the health care sector, with expertise,

240  Handbook of research on stress and well-being in the public sector status, and power. Spurgeon (2001, cited in Spurgeon, Clark and Ham, 2011, p. 49) succinctly summarized this situation as follows: The historical precedents that created the medical power base led initially to doctors existing in a closed sub-culture cushioned from scrutiny and challenge from others within the system. The individualistic culture affirmed by doctors’ training serves to support and reinforce this position. The public, too, were keen to endorse such an individual focus, believing that doctors should be concerned primarily with their patients and that health care organisations had some sort of secondary existence for the purpose of facilitating medical activity.

Most advanced health care systems now advocate the increased involvement and participation of doctors in the leadership of their organizations (Loh, Long, & Spurgeon, 2018). However, this position has actually been evolving for quite some time and incorporated within it a diminution of the established power base of doctors and hence a degree of discomfort in adjustment to the new situation. Despite different systems operating in each country there are some common forces that led to both: (1) a change in the status of the medical profession; and (2) a drive for enhanced levels of medical leadership. Mintzberg (1979) captured the traditional model of health care organizations, describing them as professional bureaucracies where the frontline staff (doctors) exercise a considerable degree of control over the nature of their work content as a result of their training and unique specialist knowledge. However, since that book there have been four decades of sustained change contributing to an erosion of this position. A particular force has been the growth of external scrutiny, and a widening set of performance metrics alongside a more informed and demanding public. Although many professionals have experienced the process it is not too surprising that this encroachment on the previous situation has been resented, leaving many disgruntled. Salaries too have failed to preserve status in the face of other sectors (finance in particular). In addition, it is acknowledged that greater complexity of care systems requires more team-based delivery. Bohmer (2010) has argued that while specialist knowledge and excellence is expected of the individual doctor it is insufficient by itself to generate good patient outcomes. The parallel emergence of managerialism has exacerbated this blurring of hierarchies. Complex systems have multiple goals and it has fallen to managers to ensure that financial targets and central targets are met irrespective of how far doctors feel these issues intrude upon their focus on patient care. These different motivations and perspectives have formed the basis of conflict between managers and doctors. Ironically, both groups can claim a degree of conviction to their positions. The doctors’ concern to provide the best quality of care to their individual patients without regard to the costs is, in reality, what most of us (as patients) would want. However, it is equally legitimate for the managerial community to claim on behalf of the government and taxpayer that financial control is in the wider interest. It is inevitable that clashes will occur in such circumstances but extreme conflict can be dysfunctional, with serious consequences for patient care.

An organizational perspective on well-being in the health sector  241 One response of the medical profession to this changed situation might have been to withdraw, to refuse to participate, to obfuscate and resist – and many individuals did adopt such a strategy. This, of course, compounded the divisions described above. A possible consequence was that managerialism would prevail, become the dominant force, and further undermine the previous role of the doctor. The threat implicit in this approach was essentially that if doctors will not accept responsibility for the wider organizational issues then others will have to, with inevitable consequences for the medical power base. Or, as has largely emerged as the preferred alternative, doctors need to accept the requirement and move into medical leadership roles. In terms of well-being then, we have seen that the medical profession has had to cope with diminished status and increasing challenge to their pre-eminent role in the social hierarchy. The advocated solution of becoming medical leaders represented a further challenge. Angood and Shannon (2014) were typical of those proposing greater medical involvement in leadership and suggested that doctors represent a natural interface between medicine and management. They argue that doctors’ medical knowledge and experience of patient care makes them most appropriate to lead and support organizations through the rapid change prompted in health by new technologies and ways of working. However, they also recognize that the medical profession has not historically equipped itself with the necessary leadership skills. It is this that was to prove the next source of tension for doctors on medical leadership. The momentum towards involving doctors in the leadership function was helped in part by the recognition that in more complex organizations there is a degree of consensus that a shared or distributed model of leadership is needed (Pearce & Konger, 2003)..Essentially, this approach suggests that all the skills and expertise needed are unlikely to be found in a single individual. This therefore enables doctors with a range of personal professional skill sets to contribute in different ways as need arises. Alongside this was the greater emphasis being placed upon medical professionalism. The Royal College of Physicians of London in the future-oriented report Doctors in Society: Medical Professionalism in a Changing World (2005) outlined professionalism as a set of values and behaviors, including leadership. In this document there was the crucial recognition that decisions made by doctors have both clinical and organizational implications. A final strand in this changing understanding of the wider role of doctors was contained in the report by Lord Darzi, High Quality Care for All (Department of Health, 2008), which not only recognized the need for more medical leadership but linked it to improved patient care outcomes. This was a significant relationship, and difficult then for doctors to ignore the push towards involvement in the necessary training and development required. A number of approaches to developing leadership skills have emerged in different countries (Spurgeon, Clark and Ham 2011). There was a degree of overlap in the content of the leadership models, especially those incorporating the notion of leadership competence. In the UK, the Medical Leadership Competency Framework (MLCF) was developed from a national project undertaken by the NHS Institute for Innovation and Improvement and the Academy of Medical Royal Colleges (2010,

242  Handbook of research on stress and well-being in the public sector p. 6). A full account of its development is to be found in Spurgeon, Clarke and Ham (2011). The MLCF is based on the concept of shared or distributed leadership, thus incorporating the option for any doctor to contribute to the leadership function in whatever way seemed most appropriate and which utilizes their particular expertise or personal characteristic. The development process involved an extensive review of the literature relating to all existing competency models and a wide consultation with all the medical professional organizations with an interest in medical practice and education. It was, as a consequence, incorporated by the General Medical Council (GMC) into the revised version of Tomorrow’s Doctors (2009), which prescribes the coverage for all medical undergraduate programs in the UK. Subsequent incorporation into postgraduate training and then the process of revalidation saw the model uniquely encompassing the entire medical career trajectory. The aim was to allow the necessary skills of leadership to be developed over time at different stages and in accord with the context and demands of medical practice. The MLCF is probably unique in its comprehensive coverage across all stages of training and development. After a recent internal review in 2018, the model has been reinforced as the most appropriate leadership material for the embedding of leadership skills into the practice of the medical profession. Despite its success, it is fair to point out that the teaching of leadership remains uneven across undergraduate and postgraduate levels primarily because of the limited number of medical tutors who have acquired sufficient expertise to feel confident and comfortable to deliver it. A recent case study (Murphy, Spurgeon, & Flanagan, 2016) has demonstrated that when tutors are appropriately skilled, the acquisition of leadership skills by trainees is rapid and there is a powerful transformation in their understanding of the nature of leadership. Despite the content and mechanism for education and leadership being available, the process of acceptance across the whole profession is quite slow and will almost certainly be generational. More junior doctors and trainees are aware of the contribution they can make through medical leadership. However, they will still encounter more senior doctors who provide rather negative role models, regarding leadership as either a quality that they have naturally, so training and learning is unnecessary, or that leadership is a hostile domain and doctors are better served by keeping a distance from it. Things are changing with increasing acceptance of the necessity for doctors to become part of the leadership process. McGivern et al. (2015) describe the difficulty experienced by talking of hybrid roles and a conflict with professional identity. The challenge to a pure professional (medical) identity is clearly articulated, and, as a consequence, a range of motivations identified in those who take on such roles and indeed reactions from others around them. They suggest that there are signs that medical leadership is slowly gaining acceptance as a medical sub-specialty. However, those directly involved in medical leadership remain a minority and there is undoubtedly continuing tension around how willing doctors should be to take on such roles, especially if there are decisions to be made that may restrict or curtail the clinical autonomy of other medical colleagues.

An organizational perspective on well-being in the health sector  243 However, it is Shanafelt and Noseworthy (2017) who made the case most powerfully, suggesting that effective leadership can play an important role in enhancing professional satisfaction and well-being of the doctor. They talk of harnessing the power of leadership to those goals. So, despite the challenges involved in making medical leadership ‘normal’ there is a growing view that it is essential to complex health care systems and ultimately beneficial to both patients and medical practitioners. Therefore, the expansion of role and expectation that doctors contribute to the leadership of organizations provides a further challenge and potential source of stress. This brings us to the final section of our chapter, that of medical engagement, which may offer a way of reconciling the challenges so far described and of providing a positive culture for both the individual and the organization.

MEDICAL ENGAGEMENT The concept of medical engagement has become one of great focus in many health systems across the world (Ahnfeldt-Mollerup, 2018; King’s Fund, 2012; Spurgeon & Clark, 2018). The essential argument in terms of engagement is that higher levels of engagement generate greater manifestation of positive effect, such as satisfaction and commitment, and this in turn flows through to enhanced work performance. The concept is used in both private and public sectors, with Guthrie (2005) and Paller (2005) reporting that higher levels of clinical engagement are associated with organizational performance. MacLeod and Clarke (2009) provide a useful overview across various sectors. Despite various approaches and measures of engagement they conclude that: (1) engagement is a two-way process, with organizations endeavoring to engage employees and the latter having the option of varying degrees of response; (2) that engagement is measurable, albeit with the use of a variety of tools; and (3) that engagement correlates with performance, again measured in a variety of ways. A number of specific engagement measures exist, with the Medical Engagement Scale (MES) perhaps the most comprehensive and widely used, particularly in the UK. It was developed in 2008 by Spurgeon, Barwell and Mazelan (2008) using a large sample of NHS staff. It was subsequently refined to focus specifically on medical engagement as well as providing an overall index of levels of medical engagement, and offers an assessment of the key cultural underpinnings of engagement via three meta-scales (Working in an Open Culture; Having Purpose and Direction; and Feeling Valued and Empowered). The measure simultaneously assesses both the individual perspective as well as the organizational (or cultural) parameters of the relationship. This is reflected in the operational definition of engagement within the MES instrument: ‘The active and positive contribution of doctors within their normal working roles to maintaining and enhancing the performance of the organization which itself recognizes their commitment in supporting and encouraging high quality care’ (Spurgeon et al., 2008, p. 214). The MES has been used extensively in the UK and overseas, with approximately 120 health care organizations and over 17 000 doctors on the current database. This

244  Handbook of research on stress and well-being in the public sector material has facilitated examination of the links between levels of medical engagement and organizational performance. In a series of case studies, Dickinson et al. (2012) reported that MES scores were the only metric to relate to various aspects of organizational performance at both the overall organizational level as well as at the individual directorates and specialty levels. Medical engagement is therefore an important cultural component of effective organizations. However, in the context of the well-being of individual doctors, a recent study by Spurgeon and Wathes (2015) is of most relevance. The use of MES across many health organizations has revealed considerable variation in the level of engagement of the consultant body. In terms of junior doctors, a smaller sample suggested that engagement levels were generally low. However, there were exceptions, with a small number of organizations having significantly higher levels of engagement in their junior doctor workforce. The authors sought to understand why this might be and whether the organizations had taken specific initiatives that might be used elsewhere. If medical engagement is problematic in senior doctors it may be that a focus on juniors could establish a more positive cultural context and thus avoid problems developing later. Interviews and focus groups were conducted with over 120 junior doctors at six NHS trusts with higher levels of junior doctor engagement. Whilst some initiatives had been taken, the findings relating to the junior doctors themselves were of particular interest. Not only did they report being happier in their role, but also had higher levels of satisfaction and commitment and generally felt more in control of their work and outside life. The results suggest that medical engagement may well be a key element of organizational performance and contribute to the individual practitioner’s mental health as well.

CONCLUSION This chapter has focused upon the organizational context in which doctors work, and sought to see whether the system itself is part of the cause (and solution) to the stress experienced by many in the medical profession. The notion of medical leadership and the linked notion of medical engagement are proposed as ways in which health care organizations can create more supportive cultures that will not only benefit their level of overall performance but also the individuals working within them.

REFERENCES Ackroyd, S. (1996), ‘Organization contra organization: professions & organizational change in the United Kingdom’, Organization Studies, 17(4), 599–621. Ahnfeldt-Mollerup, P. (2018), ‘Medical engagement in general practice’. Research Unit for General Practice, University of Southern Denmark, Odense. Angood, P., & Shannon, D. (2014), ‘Unique benefits of physician leadership – an American perspective: leadership in health services’, 27(4), 272–282.

An organizational perspective on well-being in the health sector  245 Beehr, M., & Newman, A. (1978), ‘Job stress, employee health, and organizational effectiveness: a facet analysis, model, and literature review’, Personnel Psychology, 31, 665–699. Bohmer, R. (2010), ‘Leadership with a small “i”’, BMJ, 340, 265. Brooks, S., Chalder, T., & Gerada, C. (2011), ‘Vulnerable to psychological distress and addictions: treatment from the Practitioner Health Programme’, Journal of Mental Health, 20(2) 157–164. Brooks, S., Gerada, C., & Chalder, T. (2011), ‘Review of the literature on the mental health of doctors: are specialist services needed?’, Journal of Mental Health, 20(2), 146–156. Brooks, S., Gerada, C., & Chalder, T. (2016), ‘The specific needs of doctors with mental health problems: qualitative analysis of doctor-patients’ experiences with the Practitioner Health Programme’, Journal of Mental Health, 26(2), 161–166. Commonwealth Fund (2017), ‘Health care systems performance ranking’. [Table]. Accessed 29 September 2018 at https://​www​.commonwealthfund​.org/​chart/​2017/​health​-care​-system​ -performance​-rankings. Cooper, C.L., Davies-Cooper, R.F., & Faragher, E.B. (1986), ‘A prospective study of the relationship between breast cancer and life events, type A behaviour, social support and coping skills’, Stress Medicine, 2, 271–277. Department of Health (2008), High quality care for all: NHS next stage review final report. London: Stationery Office. Dickinson, H., Ham, C., Snelling, I., & Spurgeon, P. (2012), Are we there yet? Models of medical leadership & their effectiveness: an exploratory study. Southampton, UK: National Institute of Health Service Research. Firth-Cozens, J., & Payne, R. (Eds.) (1999), Stress in health professionals. Chichester, UK: Wiley & Sons. General Medical Council (2009), Tomorrow’s doctors (2009): outcomes and standards for undergraduate medical education. Manchester, UK: GMC. Guthrie, M. (2005), ‘Engaging physicians in performance improvement’, American Journal of Medical Quality, 10(5), 235–238. Herbert, J. (1999), ‘Psychological & physiological aspects of stress’. In J. Firth-Cozens, & R. Payne (Eds.), Stress in health professionals. Chichester, UK: Wiley & Sons, pp. 43–62. King’s Fund (2012), Leadership and engagement for improvement in the NHS: together we can. London: King’s Fund. Klein, R. (Ed.) (2006), The new politics of the NHS (5th ed.). Oxford: Radcliffe Publishing. Kobasa, S. (1989), ‘Stressful life events, personality, and health: an enquiry into hardiness’, Journal of Personality & Social Psychology, 37, 114–128. Loh, E., Long, P., & Spurgeon, P. (Eds.) (2018), Textbook of medical administration and leadership. Singapore: Springer. MacLeod, D., & Clarke, N. (2009), Engaging for success: enhancing performance through employee engagement. Department for Business, Innovation & Skills. Accessed 14 November 2019 at https://​dera​.ioe​.ac​.uk/​1810/​1/​file52215​.pdf. Marnock, G., McKee, L., & Dinnie, N. (2000), ‘Between organisations and institutions: legitimacy and medical managers’, Public Administration, 78, 967–987. McGivern, G., Currie, C., Ferlie, E., Fitzgerald, L., & Waring, J. (2015), ‘Hybrid manager– professionals’ identity work: the maintenance and hybridization of medical professionalism in management contexts’, Public Administration, 93(2), 412–432. Mintzberg, H. (Ed.) (1979), The structuring of organizations. Englewood Cliffs, NJ: Prentice Hall. Mintzberg, H. (Ed.) (1983), Structures in fives: designing effective organizations. Englewood Cliffs, NJ: Prentice Hall. Murphy, C., Spurgeon, P., & Flanagan, H. (2016), ‘Creating a comprehensive integrated leadership development programme: a case study of the School of Psychiatry (West Midlands)’. In P. Spurgeon, and B. Klaber (Eds.), Medical leadership: a practical guide for tutors and trainees (2nd ed.). London: BPP Learning Media, pp. 37–52.

246  Handbook of research on stress and well-being in the public sector Murphy, L.R.C. (1996), ‘Stress management in work settings: a critical review of the research literature’, American Journal of Health Promotion, 11, 112–135. NHS Confederation (2017), ‘NHS statistics, facts & figures’. Accessed 29 September 2018 at https://​www​.nhsconfed​.org/​resources/​key​-statistics​-on​-the​-nhs. NHS Institute for Innovation & Improvement and Academy of Medicine Royal Colleges (2010), Medical leadership competency framework: enhancing engagement in medical leadership, third edition. Coventry, UK: NHS Institute for Innovation & Improvement. Paller, D.A. (2005), ‘What the doctor ordered: the best hospitals create emotional bonds with their physicians’, Gallup Business Journal, 8 December. Accessed 12 September 2018 at https://​news​.gallup​.com/​businessjournal/​18361/​what​-doctor​-ordered​.aspx. Pearce, C., & Konger, J. (2003), ‘All those years ago: the historical underpinnings of shared leadership’. In C. Pearce, & J. Konger (Eds.), Shared leadership: performing the hows and whys of leadership. Thousand Oaks, CA: Sage, pp. 1–18. Royal College of Physicians (2005), Doctors in society: medical professionalism in a changing world. Report of a Working Party of the Royal College of Physicians, December 2005. London: Royal College of Physicians. Shanafelt, T.D., & Noseworthy, J.H. (2017), ‘Executive leadership and physician wellbeing: nine organizational strategies to promote engagement and reduce burnout’, Mayo Clinic Proceedings, 92(1), 129–146. Spurgeon, P. (Ed.) (1999), The new face of the NHS (2nd ed.). London: Royal Society of Medicine. Spurgeon, P. (2001), ‘Involving clinicians in management: a challenge of perspective’. Accessed 16 November 2019 at https://​www​.researchgate​.net/​publication/​283657125​ _Involving​_clinicians​_in​_management​_A​_challenge​_of​_perspective. Spurgeon, P., Barwell, F., & Maxwell, R. (1995), ‘Types of work stress and implications for the role of general practitioners’, Health Services Management Research, 8(3), 186–197. Spurgeon, P., Barwell, F., & Mazelan, P.M. (2008), ‘Developing a Medical Engagement Scale (MES)’, The International Journal of Clinical Leadership, 16, 213–223. Spurgeon, P., & Clark, J. (2018), Medical leadership: the key to medical engagement and effective organisations (2nd ed.). London: Taylor & Francis. Spurgeon, P., Clark, J., & Ham, C. (2011), Medical leadership: from the dark side to centre stage. London: Radcliffe Publishing. Spurgeon, P., Mazelan, P.M., & Barwell, F. (2012), ‘The Organizational Stress Measure: an integrated methodology for assessing job-stress and targeting organizational interventions’, Health Services Management Research, 25(1), 7–15. Spurgeon, P., & Wathes, R. (2015), ‘Junior doctors engagement: investing in the future’. Manchester, UK: Faculty of Medical Leadership and Management. Vincent, C. (1999), ‘Fallibility, uncertainty and the impact of mistakes and litigation’. In J. Firth-Cozens, & R. Payne (Eds.), Stress in health professionals. Chichester, UK: Wiley & Sons, pp. 63–76.

PART IV ORGANIZATIONAL INITIATIVES AND CHANGING WORKPLACE ENVIRONMENTS

17. Developing nurse leaders for well-being and performance Margaret M. Hopkins and Deborah A. O’Neil

Nurse leaders are responsible for providing high-quality care in an environment of rapid change, with a focus on operational efficiencies in health care. Financial limitations, resource constraints, high turnover, and a nursing shortage projected for the next ten years are some of the more pressing issues facing nurse leaders (Haggman-Laitila & Romppanen, 2017). The restructuring of health care necessitates a more interdisciplinary and collaborative approach to health care delivery. The role of the nurse leader has expanded to include multiple unit management responsibilities as well as increased budget, staffing, and regulatory compliance duties. According to Gallup (Ellrich, 2018), it is common for nurse leaders in inpatient units to have spans of control exceeding 40 direct reports. Thus, nurse leaders are dealing with high levels of competing demands and diminishing resources, resulting in their roles becoming more complex. In this chapter, we discuss the concept of well-being as it relates to nurse leaders. We first present the existing literature on nurse leaders’ well-being, as well as its antecedents and outcomes. Next, we describe the results and implications of a survey of nurse leaders’ well-being. Finally, strategies for the development of the well-being of nurse leaders are proposed in line with the extant literature and survey outcomes.

NURSE LEADERS’ WELL-BEING Significant relationships between employee well-being and performance outcomes have been found (for example, Wright & Staw, 1999). The initial approach of studies on well-being focused on job satisfaction (see Harris et al., 2003), and subsequent research identified positive emotions, interpersonal skills, and collaborative relationships as generating well-being (Biggio & Cortese, 2013). Psychological well-being has been defined as harmony between an individual’s abilities and expectations, environmental demands, and opportunities (Levi, 1987). Employee well-being has also been described as a universal concept incorporating life, work, and psychological needs (Page & Vella-Brodrick, 2009; Zheng et al., 2015). Well-being is the result of the interaction between subjective factors and workplace characteristics (Biggio & Cortese, 2013). For example, the American Hospital Association (2018) states that personal resilience, regulatory and cultural factors, and clinical environment and health system characteristics all influence well-being. Ryff (1989) specified six dimensions of well-being – self-acceptance, positive relations with others, autonomy, 248

Developing nurse leaders for well-being and performance  249 environmental mastery, purpose in life, and personal growth – in her model of psychological well-being. Numerous studies have examined the well-being of nurses. Research conducted in several countries has found high levels of nursing dissatisfaction, stress, burnout, and intent to leave the profession (see Vahey et al., 2004). However, fewer studies have analyzed the well-being of nurse leaders. Some investigations have focused on the challenges nurse leaders face in their roles, and the impact of those challenges on their own well-being and the well-being of nurses whom they lead. One recent study discovered that one-sixth of nurse leaders reported high to very high feelings of emotional exhaustion, with pressures on the job, role conflict, and lack of social support as the most significant predictors (Van Bogaert et al., 2014). These challenges to nurse leaders’ job satisfaction and work environments are the result of individual, job role, and organizational factors. In contrast to the challenges faced by nurse leaders, the significant factors that positively impact nurse leaders’ well-being have also been identified in the extant literature. The predominant indicator of nurse leaders’ well-being can be characterized as having a collaborative culture and social support. The Nurses Organization Alliance (2004) has identified a collaborative practice culture as one of nine key elements to support a healthy work environment. The American Association of Critical-Care Nurses names true collaboration as one of their six standards for authentic leadership (Anderson et al., 2010). Successful nurse leaders have collaborative working relationships and provide a supportive culture (Anthony et al., 2005), which in turn influence their job satisfaction (Hudgins, 2016). Nurse leaders who create a positive climate with a cohesive work group experience higher productivity, increased commitment, and overall employee well-being (Ingersoll et al., 2002; McNeese-Smith, 1997). The social support for nurse leaders is provided by a variety of peers, staff, and superiors. For nurse leaders, trust and identification with their own nurse leader is a form of social support, which is positively associated with organizational commitment (McNeese-Smith, 1997). Effective nurse-leader-to-nurse relationships predict well-being, retention, and organizational commitment (Brunetto et al., 2010). Alternatively, working relationships can be a source of nurse leader job dissatisfaction (Lu et al., 2012). A low amount of social support from supervisors results in strain and burnout, while a higher level of social support is positively related to well-being (Pisanti et al., 2011). The amount of control on the job and the ability to have autonomy in their work are two additional influences on the well-being of nurse leaders. Job demands and job control predict well-being and overall job satisfaction (Adriaenssens et al., 2016). Job demands have been found to be related to emotional exhaustion and low job satisfaction (Pisanti et al., 2011). Job control is beneficial to well-being and job satisfaction (Pisanti et al., 2011), while low levels of job control increase the risk of poor psychological well-being (Escriba-Aguir & Perez-Hoyos, 2007). The amount of job control is one of two critical contributors to employee engagement and employee well-being, the other being social support (Pfeffer, 2018). A review of nurse leaders’ well-being reports that their autonomy at work directly effects their well-being and their

250  Handbook of research on stress and well-being in the public sector intentions to stay in their positions (Haggman-Laitila & Romppanen, 2017). Their autonomy is also related to their job satisfaction and overall well-being (Krugman & Smith, 2003). Successful nurse leaders create and sustain an autonomous practice environment (Anthony et al., 2005). A third element that contributes to the well-being of nurse leaders is the personal significance of the role itself, such as role meaningfulness. Role meaningfulness is a catalyst for work engagement and job satisfaction in nurse leaders (Van Bogaert et al., 2014). The importance of their role and the meaning that they attach to their role are usually defined in highly individualized terms. However, a cohesive work group and the delivery of quality patient care are two primary components of the meaning of the role for nurse leaders. The other predominant factors for nurse leaders’ well-being are adequate resources for accomplishing their work, recognition for a job well-done, and opportunities for professional development and career growth. An increase in job resources predicts job satisfaction, work engagement, and occupational well-being in nurse leaders (Adriaenssens et al., 2016). Receiving respect and recognition also impacts their well-being, job satisfaction, and intentions to stay in their roles (Haggman-Laitila & Romppanen, 2017; Krugman & Smith, 2003). In addition, access to professional development opportunities has also been found to contribute to nurse leaders’ well-being (Brown et al., 2013). Summary Hospitals with engaged staff have better patient outcomes, higher productivity, and less turnover (Ellrich, 2018). High-quality nurse leaders are essential to staff nurse satisfaction, retention, and positive patient outcomes (Hudgins, 2016). Nurse leaders who experience well-being are successful advocates for their nurses, provide a supportive culture, and encourage collaborative relationships (Anthony et al., 2005). They also assign significant meaning to their roles as leaders of teams delivering high-quality health care. They have enough autonomy and control over their jobs to positively affect their well-being. Finally, they have the resources that they require, recognition for their work, and opportunities for professional development. Ultimately, their well-being results in their own job satisfaction, work engagement, and commitment to their organization, all of which lead to a higher quality of patient care (Adriaenssens et al., 2016).

SURVEY OF NURSE LEADERS’ WELL-BEING We surveyed 12 individuals in nurse leader roles in hospital settings through a purposive and convenience sample. A 42-item survey developed by Ryff (1989; Ryff & Keyes, 1995) measured the well-being of the nurse leaders. The instrument assesses psychological well-being based on six dimensions: autonomy, environmental mastery, personal growth, positive relations, purpose in life, and self-acceptance.

Developing nurse leaders for well-being and performance  251 High scorers in autonomy are self-determining, independent, and self-evaluate based on personal standards. High scorers in environmental mastery have a sense of mastery and competence in managing their environments. High scorers in personal growth have a sense of continued development and are open to new experiences. High scorers in positive relations have warm and trusting relationships with others and are capable of showing empathy. High scorers in purpose in life are those who have goals and objectives and find life meaningful. Finally, high scorers in self-acceptance are individuals who possess positive attitudes toward themselves and have accurate assessments of their strengths and weaknesses. The nurse leaders who responded to our survey indicated that positive relations was the most important factor in their well-being, followed by the dimensions of personal growth and purpose in life. The three lowest-scoring dimensions were self-acceptance, environmental mastery, and autonomy. The scores on each dimension were the following: positive relations – 411; personal growth – 212; purpose in life – 209; self-acceptance – 201; environmental mastery – 185; and autonomy – 180. The well-being dimension of positive relations was not only the primary factor for the nurse leaders’ well-being, but it was also far and away the predominant consideration, as the scores indicate. In addition to positive relations being an essential aspect of well-being for these nurse leaders, the range of individual scores on this dimension was very close, between 28 and 30. Purpose in life, the third dimension of well-being important to nurse leaders in our survey, also had a very limited range of individual scores (29–30). Thus, there was a high level of agreement among our respondents with two of their top three components of well-being. The primary well-being indicator for the nurse leaders in our sample, positive relations, supports the theme of a collaborative culture and social support from the existing literature discussed above. Personal growth, the second most important well-being factor in our results, seems to be highlighted more so by the nurse leaders in our survey than previous reports. While it is a consideration in prior studies of nurse leaders, it has not been previously noted as a major contributing factor for their well-being. Purpose in life was the third principal well-being dimension for the nurse leaders in the current survey. This is an intriguing and unique finding, since this well-being element is not apparent in prior examinations of nurse leaders. Purpose in life, as defined by Ryff (1989; Ryff & Keyes, 1995), is a holistic measure of having goals for living and holding beliefs that give life purpose. This finding may relate to the importance of nurse leaders defining their jobs as having meaning; yet purpose in life extends beyond work to encompass all life roles.

PRIMARY FACTORS FOR WELL-BEING IN NURSE LEADERS Below we discuss the three primary themes from the results of our survey of nurse leaders and make connections to existing literature. We then propose individual and

252  Handbook of research on stress and well-being in the public sector organizational strategies for the development of nurse leaders as a way to ensure their continued well-being. Nurse leaders engaged in positive work relationships, realizing opportunities for personal growth, and leading purposeful lives will then be able to positively influence the nurses in their charge, resulting in greater overall satisfaction, retention, and most importantly high-quality patient care. Positive Relations As indicated in the well-being survey (Ryff & Keyes, 1995), a high scorer on positive relations ‘has warm, satisfying trusting relationships with others; is concerned about the welfare of others; capable of strong empathy, affection, and intimacy; understands give and take of human relationships’ (p. 727). This is similar to previous findings that a collaborative culture and social support were key indicators of nurse leaders’ well-being (Anderson et al., 2010; Anthony et al., 2005; Nurses Organization Alliance, 2004), and that a nurse leader’s relationship with their own leader was instrumental in how they developed their nurse leader practice (McNeese-Smith, 1997). In order to promote positive relations in a hospital setting, there must be an expectation of collaboration and support among patient care teams. Medicine is a team game, with physicians, nurse leaders, and nurses needing to work together to ensure quality patient care. However, given the complex and critical nature of the work of caring for patients that hospital staff perform, the possibility of conflict in high-pressure situations exists. From an organizational perspective, hospital administrators should foster a climate of teamwork guided by the superordinate goal (Sherif, 1958) of saving lives through high-quality patient care. Hospital leaders ought to involve all employees in developing a common set of work values (Sherman & Pross, 2010). Nurse leaders play a key role in creating these cultures of engagement and shared values. In addition, cultures of collaboration are an essential factor for the well-being of nurse leaders themselves. Evidence suggests that work environments are rated as healthier and staff retention is higher when staff feel supported by their nurse leaders (Kramer et al., 2007; Shirey, 2006). Continuing to promote collaborative, supportive cultures of engagement particularly during times of high stress is a critical component of the role of nurse leaders. Given that the nurse leader’s role is critical in fostering high-quality work environments that promote positive working relationships, the nurse leader must be skilled in relational practice, described by Fletcher (1999) as ‘a way of working that reflects a relational logic of effectiveness and requires a number of relational skills such as empathy, mutuality, reciprocity, and a sensitivity to emotional contexts’ (p. 84). Relational practice comprises four elements: a focus on task, called preserving, ‘shouldering responsibility for the whole’; a focus on other, called mutual empowering, ‘outcomes embedded in others such as increased knowledge or competence’; a focus on self, called self-achieving, using relational skills to enhance one’s ability to achieve goals; and a focus on team, called creating team, ‘creating background conditions in which group life can flourish’ (Fletcher, 1999, p. 85). In ideal terms,

Developing nurse leaders for well-being and performance  253 effective nurse leaders embody the four elements of relational practice. They are responsible and accountable for overseeing the work of the nurses in their care and ensuring that the system runs smoothly. They teach, coach, and mentor the nurses they direct in order to expand the knowledge and expertise of the entire team. They must be self-starters and demonstrate the drive and achievement orientation required to direct their staff efficiently with diminishing resources. And finally, they create conditions of support and collaboration, which empowers their teams to do their best work. In turn, sustaining these positive relationships and a culture of collaboration results in the well-being of nurse leaders themselves. Personal Growth According to the Ryff and Keyes’ (1995) well-being survey, a high scorer on the personal growth scale is described as someone who ‘has a feeling of continued development, sees self as growing and expanding, is open to new experiences, has sense of realizing his or her potential, sees improvement in self and behavior over time, is changing in ways that reflect more self-knowledge and effectiveness’ (p. 727). In order to develop themselves as well as developing positive relations with others, a nurse leader must first be self-aware. In their work on leadership and emotional intelligence (EI), Goleman, Boyatzis and McKee (2002) note that ‘self-awareness facilitates both empathy and self-management, and these two, in combination, allow effective relationship management. EI leadership, then, builds up from a foundation of self-awareness’ (p. 30). Developing self-awareness can allow nurse leaders to recognize and manage their own emotions in high-stress situations, thus potentially defusing conflicts that may occur. Self-awareness also helps in developing empathy (Goleman et al., 2002), a crucial building block for fostering positive relations with others. If a nurse leader is aware of their own feelings, they have a greater chance of understanding the perspectives of other nurses on their team and are thus able to better guide work and relationships in a positive direction. Once a nurse leader has a highly developed sense of self-awareness, they will then be well positioned to develop their social awareness skills of empathy, organizational awareness, and service orientation (Goleman et al., 2002). Self-awareness is also a foundational competency toward understanding one’s strengths and developmental opportunities. Nurse leaders with a heightened sense of self-awareness are better able to identify new experiences for their personal growth. In addition, they are resilient, they remain optimistic in the face of challenges, and they see setbacks as opportunities for learning and development. The building blocks for resilience and growth are relationships, engagement, meaning, positive emotion, and accomplishment (Seligman, 2011), all of which directly relate to the definition of well-being (Ryff, 1989).

254  Handbook of research on stress and well-being in the public sector Purpose in Life A high scorer on the purpose in life scale on the Ryff and Keyes’ (1995) well-being survey is described as someone who ‘has goals in life and a sense of directedness, feels there is meaning to present and past life, holds beliefs that give life purpose, has aims and objectives for living’ (p. 727). Prior research determined that role meaningfulness was a catalyst for work engagement and job satisfaction in nurse leaders (Van Bogaert et al., 2014). Role meaningfulness would seem to be a key component of purpose in life as nurse leaders direct teams that literally make life and death decisions in the daily course of doing their jobs. Finding meaning and life purpose have been positively linked to psychological and physical well-being (Steger, 2012). Meaning in life has also been found to be directly related to psychological maturity, self-actualization, ego strength, and self-control, which may result in a willingness to direct one’s own future (Steger, 2012). Similar to the discussion in the previous section about personal growth, having a sense of one’s purpose in life begins with self-awareness. In particular, self-awareness of the things that one is grateful for and the things that contribute to a feeling of being connected to something larger than oneself are two areas of focus for finding meaning and life purpose (Smith, 2018). The importance of realizing one’s life purpose requires not only self-awareness but also a drive to fulfill that image of a meaningful life.

INDIVIDUAL STRATEGIES FOR DEVELOPING WELL-BEING IN NURSE LEADERS The fundamental influences of the three primary factors for nurse leaders’ well-being – positive relations, personal growth, and purpose in life – are all associated with EI competencies. EI competencies are learned behaviors that contribute to outstanding performance (Goleman et al., 2002). The primary EI competencies discussed in the previous section that impact nurse leaders’ well-being include the following: emotional self-awareness, accurate self-assessment, empathy, optimism, and achievement orientation. The following narrative presents strategies to develop each of these five competencies. Self-awareness is the ability to understand one’s own emotions, why those emotions occur, and the implications of those emotions (Goleman et al., 2002). Self-awareness is critical for nurse leaders since they need to remain steady and grounded in order to direct hospital staff on critical issues regarding patient care. One effective strategy to develop self-awareness is to practice mindfulness. Mindfulness is a method of shifting attention inward to observe thoughts, feelings, and actions without interpretation or judgment (Goleman & Lippincott, 2017). The practice of mindfulness begins with focusing on one’s breath and then noticing when the mind wanders. As concentration increases, a focus on the individual’s inner experience increases as well. Ultimately, mindfulness results in heightened self-awareness.

Developing nurse leaders for well-being and performance  255 A second strategy to enhance self-awareness is to maintain a daily journal of thoughts, feelings, and experiences. In this way, common patterns in feelings and behaviors can be identified. Finally, another method to develop self-awareness is to request feedback from trusted colleagues and friends. Obtaining feedback on the standard responses to situations leads to increased self-awareness, since an individual cannot always identify what they are projecting to others. Accurate self-assessment is the second EI competency that contributes to the well-being of nurse leaders. This competency is the ability to know one’s strengths and limitations. One effective strategy for improving accurate self-assessment is to obtain 360-degree feedback assessments from peers, direct reports, and managers, and then comparing that to a self-assessment. These assessments can be based on a leadership skills model used by the health care system or, if no such model exists, any validated assessment of leadership skills. Another method is to continually maintain a list of strengths and development opportunities, with evidence of how each strength has been effectively demonstrated and a rationale for developing one’s limitations. Similar to developing self-awareness, asking for feedback from trusted individuals is a third strategy for improving accurate self-assessment. The third competency related to the well-being of nurse leaders is empathy. Empathy is the ability to understand others’ thoughts, feelings, and concerns (Goleman et al., 2002). Empathy can be strengthened through the practice of active listening, which is demonstrated through paying attention, withholding judgment, reflecting, clarifying, and restating key themes when engaged in conversations (Hoppe, 2006). A second valuable strategy to develop empathy is to use inquiry and effective questioning to indicate a sincere interest in understanding another person’s perspective. The practice of questioning one’s own assumptions is another method to strengthen the empathy competency. Finally, attending to the use of tone and body language along with verbal cues presented by both parties in a conversation assists in a deeper understanding of the actual messages being transmitted. Optimism is another important EI competency contributing to the well-being of nurse leaders. Optimism is seeing opportunities more than threats and having mainly positive expectations for the future (Goleman et al., 2002). This competency is directly associated with the concept of resilience, which is the capacity to bounce back from adversity. Given the nature of the work in which nurse leaders are engaged, maintaining optimism, hope, and resilience are key to fostering well-being and avoiding a feeling of burnout. Strategies to develop optimism include practicing mindfulness, gratitude, and positive affirmations on a regular basis. An additional way to strengthen optimism is to make a habit of assessing the ‘what ifs’ in a situation, taking into account the various scenarios and the results they may yield. In this way, both the positive outcomes and potential pitfalls can be considered. Positive visualization techniques are further disciplines for maintaining an optimistic outlook. The fifth EI competency we have identified as integral to the well-being of nurse leaders is achievement orientation. Achievement orientation is defined as establishing challenging goals and setting a standard of excellence (Goleman et al., 2002). This competency directly contributes to the two well-being areas of personal

256  Handbook of research on stress and well-being in the public sector Table 17.1

Individual strategies for developing well-being in nurse leaders

Emotional Intelligence Competencies Emotional self-awareness

Well-being Factors

Development Strategies

Positive relations

Practice mindfulness

Personal growth

Maintain daily journal

Purpose in life

Request feedback Obtain 360-degree feedback

Accurate self-assessment

Personal growth

Maintain list of strengths and

Purpose in life

limitations Request feedback Practice active listening

Empathy

Positive relations

Use inquiry and effective questioning

Personal growth

Question assumptions

Purpose in life

Pay attention to tone and body language Practice mindfulness

Optimism

Positive relations

Exercise gratitude and positive

Personal growth

affirmations

Purpose in life

Assess the ‘what ifs’ Perform positive visualizations

Achievement orientation

Personal growth Purpose in life

Create professional and personal goals with measurable outcomes Monitor progress toward each goal

growth and purpose in life for nurse leaders. Nurse leaders must demonstrate the drive and determination required to continually develop themselves and serve as role models and developers of their nursing staff. The primary strategy for developing achievement orientation is to create goals and objectives with measurable outcomes. It is optimal if these goals are in both the personal and the professional domains. A second and related strategy is to regularly monitor the progress toward each of the established goals. The active monitoring of each goal provides motivation as progress is made, as well as adaptation if changes are required in order to achieve the goal. It is important that nurse leaders remain adaptable and open to revising goals, as life events may require rethinking at various points along the way. Achievement orientation does not mean rigid adherence to set-in-stone goals, but rather a flexible approach to determining next steps as goals are either achieved or redirected based on exigent circumstances. A summary of these individual strategies and their relationships with the well-being dimensions of positive relations, personal growth, and purpose in life is shown in Table 17.1. Two additional EI competencies are worth mentioning in this discussion as they are also associated with the well-being of nurse leaders. These competencies are teamwork and collaboration, and conflict management. The collaborative nature of the work performed by nurse leaders calls for a focus on enhancing these two aspects of EI. Teamwork can be assessed through a variety of indicators, some of which include role clarity and the processes necessary for team interdependence. Conflict

Developing nurse leaders for well-being and performance  257 management can be strengthened through the exercise of empathy. One example is having the nurse leader consider the conflict from the perspective of three different stories: one party’s story, the second party’s story, and a third story – someone uninvolved in either story and in the role of observer of the other two stories. Placing themselves outside of the two parties’ stories and contemplating a novel perspective will assist the nurse leader in managing the conflict and helping to invent options for conflict resolution.

ORGANIZATIONAL STRATEGIES FOR DEVELOPING WELL-BEING IN NURSE LEADERS As enumerated in the prior section, there are various methods that individual nurse leaders can adopt in order to enhance their well-being. Health care institutions can also take action in order to support the well-being of nurse leaders. Creating a culture of development as well as a culture of performance is a predominant way to promote nurse leaders’ well-being. A system that includes the annual establishment of development plans that integrate well-being factors along with other skills and abilities is an important first step. Frequent conversations between leaders and their direct reports in support of development plans is another effective strategy. A formalized and transparent career development program with flexible pathways within the institution is a third helpful strategy. A fourth useful practice is the offering of mentorship, sponsorship, and professional coaches. Including a menu of professional development opportunities in departmental and organizational budgets is a further approach to assist in the well-being of nurse leaders, as personal growth was indicated in our survey as being an important contributor to well-being. Often, the focus of professional development is solely on technical skills, and the inclusion of well-being offerings would be a helpful addition. Finally, given the importance of collaboration in the work of nurse leaders, health care organizations might also provide periodic team-building programs or activities to ensure they are fostering an inclusive, supportive climate for nurse leaders and their staff.

CONCLUSION Nurse leaders do jobs of immense importance. Thus, it is critical that they are able to maintain a sense of psychological and physical well-being in order to effectively discharge their responsibilities. Attending to the individual and organizational strategies for nurse leaders’ well-being is a way to ensure that high-quality patient care will be directed by grounded, competent, caring nurse leaders who promote supportive, collaborative environments for the benefit of all patient-care staff.

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REFERENCES Adriaenssens, J., Hamelink, A., & Van Bogaert, P. (2016), ‘Predictors of occupational stress and well-being in first-line nurse managers: a cross-sectional survey study’, International Journal of Nursing Studies, 73, 85–92. American Hospital Association (2018), ‘Be well: cultivating resilience to address health and well-being’. Accessed 18 July 2018 at https://​www​.aha​.org/​system/​files/​2018​-10/​AHA​ _Alliance​_Issue​_Brief​_2018​_Resilience​.pdf. Anderson, B.J., Manno, M., O’Connor, P., & Gallagher, E. (2010), ‘Listening to nurse leaders’, The Journal of Nursing Administration, 40(4), 182–187. Anthony, M.K., Standing, T.S., Glick, J., Duffy, M., Paschall, F., Sauer, M.R., … Dumpe, M.L. (2005), ‘Leadership and nurse retention: the pivotal role of nurse managers’, The Journal of Nursing Administration, 35(3), 146–154. Biggio, G., & Cortese, C.G. (2013), ‘Well-being in the workplace through interaction between individual characteristics and organizational context’, International Journal of Qualitative Studies in Health and Well Being, 8, 1–13. Brown, P., Fraser, K., Wong, C.A., Muise, M., & Cummings, G. (2013), ‘Factors influencing intentions to stay and retention of nurse managers: a systematic review’, Journal of Nursing Management, 21, 459–472. Brunetto, Y., Farr-Wharton, R., & Shacklock, K. (2010), ‘The impact of supervisor– subordinate relationships on public and private sector nurses’ commitment’, Human Resource Management Journal, 20, 206–225. Ellrich, M. (2018), ‘How to reduce spans of control in nursing’, Gallup Workplace, 16 March. Accessed 18 July 2018 at https://​www​.gallup​.com/​workplace/​236024/​reduce​-spans​-control​ -nursing​.aspx. Escriba-Aguir, V., & Perez-Hoyos, S. (2007), ‘Psychological well-being and psychosocial work environment characteristics among emergency medical and nursing staff’, Stress and Health, 23, 153–160. Fletcher, J. (1999), Disappearing acts: gender, power and relational practice at work. Cambridge, MA: MIT Press. Goleman, D., Boyatzis, R., & McKee, A. (2002), Primal leadership: unleashing the power of emotional intelligence. Boston, MA: Harvard Business Review Press. Goleman, D., & Lippincott, M. (2017), ‘Without emotional intelligence, mindfulness doesn’t work’, Harvard Business Review, 8 September. Accessed 15 November 2019 at https://​hbr​ .org/​2017/​09/​sgc​-what​-really​-makes​-mindfulness​-work. Haggman-Laitila, A., & Romppanen, J. (2017), ‘Outcomes of interventions for nurse leaders’ well-being at work: a quantitative systematic review’, Journal of Advanced Nursing, 74, 34–44. Harris, C., Daniels, K., & Briner, R.B. (2003), ‘A daily diary study of goals and affective well-being at work’, Journal of Occupational and Organizational Psychology, 76, 401–410. Hoppe, M. (2006), Active listening: improve your ability to listen and lead. Greensboro, NC: CCL Press. Hudgins, T.A. (2016), ‘Resilience, job satisfaction and anticipated turnover in nurse leaders’, Journal of Nursing Management, 24, E62–E69. Ingersoll, G.L., Olsan, T., Drew-Cates, J., DeVinney, B.C., & Davies, J. (2002), ‘Nurses’ job satisfaction, organizational commitment, and career intent’, The Journal of Nursing Administration, 32(5), 250–263. Kramer, M., Maguire, P., Schmalenberg, C., Brewer, B., Burke, R., Chmielewski, L., … Waldo, M. (2007), ‘Nurse manager support: what is it? Structures and practices that promote it’, Nursing Administration Quarterly, 31(4), 325–340. Krugman, M., & Smith, V. (2003), ‘Charge nurse leadership development and evaluation’, The Journal of Nursing Administration, 33(5), 284–292.

Developing nurse leaders for well-being and performance  259 Levi, L. (1987), ‘Fitting work to human capacities and needs: improvements in the content and organization of work’. In R. Kalimo, M.A. El-Batawi, and C.L. Cooper (Eds.), Psychosocial factors at work and their relation to health. Geneva: World Health Organization, pp. 168–184. Lu, H., Barriball, K.L., Zhang, X., & While, A.E. (2012), ‘Job satisfaction among hospital nurses revisited: a systematic review’, International Journal of Nursing Studies, 49, 1017–1038. McNeese-Smith, D.K. (1997), ‘The influence of manager behavior on nurses’ job satisfaction, productivity and commitment’, The Journal of Nursing Administration, 27(9), 47–55. Nurses Organization Alliance (2004), Principles and elements of a healthful practice/work environment. Accessed 15 November 2019 at https://​nacns​.org/​advocacy​-policy/​position​ -statements/​principles​-elements​-of​-a​-healthful​-practicework​-environment/​. Page, K.M., & Vella-Brodrick, D.A. (2009), ‘The “what”, “why” and “how” of employee well-being: a new model’, Social Indicators Research, 90, 441–458. Pfeffer, J. (2018), ‘The overlooked essentials of employee well-being’, McKinsey Quarterly, 3, 82–89. Pisanti, R., Van der Doef, M., Maes, S., Lazzari, D., & Bertini, M. (2011), ‘Job characteristics, organizational conditions, and distress/well-being among Italian and Dutch nurses: a cross-national comparison’, International Journal of Nursing Studies, 48, 829–837. Ryff, C.D. (1989), ‘Happiness is everything, or is it? Explorations on the meaning of psychological well-being’, Journal of Personality and Social Psychology, 57(6), 1069–1081. Ryff, C.D., & Keyes, L.M. (1995), ‘The structure of psychological well-being revisited’, Journal of Personality and Social Psychology, 69(4), 719–727. Seligman, M.E.P. (2011), ‘Building resilience’, Harvard Business Review, 89(4), 100–106. Sherif, M. (1958), ‘Superordinate goals in the reduction of intergroup conflict’, American Journal of Sociology, 63(4), 349–356. Sherman, R., & Pross, E. (2010), ‘Growing future nurse leaders to build and sustain healthy work environments at the unit level’, Online Journal of Issues in Nursing, 15(1). https://​doi​ .org/​10​.3912/​OJIN​.Vol21No01PPT04 Shirey, M.R. (2006), ‘Stress and coping in nurse managers: two decades of research’, Nursing Economics, 24(4), 193–211. Smith, J.A. (2018), ‘How to find your purpose in life’, Greater Good Magazine, 10 January. Accessed 12 August 2018 at https://​greatergood​.berkeley​.edu/​article/​item/​how​_to​_find​ _your​_purpose​_in​_life. Steger, M.F. (2012), ‘Experiencing meaning in life: optimal functioning at the nexus of spirituality, psychopathology and well-being’. In P.T.P. Wong (Ed.), The human quest for meaning (2nd ed.). New York: Routledge, pp. 165–184. Vahey, D.C., Aiken, L.H., Sloane, D.M., Clarke, S.P., & Vargas, D. (2004), ‘Nurse burnout and patient satisfaction’, Medical Care, 42, 1157–1166. Van Bogaert, P., Adriaenssens, J., Dilles, T., Martens, D., Van Rompaey, B., & Timmermans, O. (2014), ‘Impact of role-, job- and organizational characteristics on nursing unit managers’ work related stress and well-being’, Journal of Advanced Nursing, 70(11), 2622–2633. Wright, T.A., & Staw, B.B. (1999), ‘Affect and favorable work outcomes: two longitudinal tests of the happy-productive worker thesis’, Journal of Organizational Behavior, 20, 1–23. Zheng, X., Zhu, W., Zhao, H., & Zhang, C. (2015), ‘Employee well-being in organizations: theoretical model, scale development, and cross-cultural validation’, Journal of Organizational Behavior, 36, 621–644.

18. Introducing a National Well-being Service for emergency responders in the United Kingdom Ian Hesketh and Cary L. Cooper

INTRODUCTION This chapter details the practical delivery of an evidence-based well-being service for UK emergency service responders. It is broadly based on our research in policing over a number of years (Hesketh & Cooper, 2017a, 2019). We have outlined the program in some detail along with our learning in terms of conceiving through to delivery. To make this chapter useful for those seeking to implement such schemes we have included a number of reflections and highlighted alternative routes that may make life easier. At this point it is important to highlight that delivering programs of work within the public sector sphere is entirely different from private ventures. Further, delivering live services in a functioning working environment is also not without challenge. One of our team likened it to building an aircraft whilst in the air. Emergency services responders (ESRs) in the UK have undergone a period of radical change in the period 2010–19. This has been largely attributable to government-imposed economic cutbacks and the subsequent downsizing that followed. Although this is now seemingly reversing, to meet those challenges many emergency service organizations had to make drastic cutbacks in support functions in an effort to keep frontline emergency responder resources fully staffed. In hindsight, this may have been too hasty a response and we will look at the consequences later in this chapter. In view of the changes that were made, there has been a considerable decrease in overall well-being reported amongst all emergency responder groups within the UK operation. Layer on top of this a working environment in which ESRs have found themselves unprepared, and the case for wholesale intervention becomes apparent. This unpreparedness largely stems from the scale and pace of the required change, together with the speed of technology and social expectations. Nevertheless, it created multiple challenges for a shrinking ESR community in the UK, and we suggest it is a similar picture internationally. This chapter details the conception, creation, and application of a Blue Light Well-being Framework (BLWF) for ESRs in the UK and the subsequent rollout of a National Police Well-being Service. The aim of both initiatives is to stem the aforementioned decline in well-being and to bring about positive change within ESR communities and add value to the public sphere (Hesketh & Hartley, 2016). This has been achieved by applying robust evidence-based practice to frontline ESRs, their 260

National Well-being Service for emergency responders in the UK  261 supervisors, and their organizations. This chapter serves to illustrate how, even with unprecedented cutbacks, a focus on employee well-being can dramatically improve the working life for those employed within the emergency services sphere. The chapter begins by exploring the strategic context in which these initiatives are set, along with the criticality of obtaining strategic buy-in. The next area unpicks the conception of a national platform through which ESR communities can work on well-being proactively, focusing their efforts on what works to improve their working and private lives. This chapter will then go on to describe the Blue Light Well-being Framework, the vehicle by which ESRs can assess their progress and share best-practice examples with other ESRs. Highlighting an ethos of continuous improvement, the areas of psychological risk management, trauma support and contingency, and peer support are described. These elements complement the framework and increase the working knowledge and awareness of these important areas for employees. This chapter includes the much reported and truly awful condition that afflicts so many ESRs – post-traumatic stress disorder (PTSD) and complex PTSD. With a recently revised diagnoses criteria in the UK this is a timely review of the impact and signs. A short section on continuous improvement follows and then the all-important area of leadership capability is discussed in depth. The chapter finishes with a look at how to evaluate workplace interventions and some reflections on lessons learnt and proposals for next steps. The concluding remarks finish off this live service example of how well-being can have a huge impact on the workforce. As can be seen clearly, it is not an easy concept to land in any workforce, and the nuances of ESR work add additional complexity to what could already be a contentious area of workplace psychology.

STRATEGIC CONTEXT One of the primary considerations is to establish whether ESRs are more vulnerable to negative health than the general population. According to Mind (2019), a UK mental health charity, 67 percent of ESRs in the UK experienced mental health problems. These include depression, anxiety, and PTSD. This is more than double that of the general working population. The respondents’ reasons for this were cited as excessive workloads, trauma exposure, pressure from management, long hours, and organizational upheaval. During this chapter, although looking more broadly at ESRs across the board, we will use examples from the foundation of the National Police Well-being Service (NPWS) in the UK. The police force in England and Wales employs approximately 211 400 people. In 2019, this is made up of 122 400 police officers, 62 800 police staff, 10 100 police community support officers, 4400 designated officers and 11 700 special constables. Although extending to other ESRs in most of the work, the NPWS is directed primarily at policing. Based on improvements in mental well-being alone, we estimate potential savings, from introducing well-being interventions, of over £5 million per annum for the

262  Handbook of research on stress and well-being in the public sector police from reduced absence. This will be over time, as it is highly likely that by promoting good mental health and well-being an increased awareness of and reduction in stigma may mean that initially absences may rise. Therefore, this needs to be acknowledged as a positive outcome in the short term, with a long-term positive impact, particularly regarding the opportunities to enhance the prevention part of the NPWS holistic approach. The holistic approach has four elements: promote, prevent, detect and support, and treat and recover (Figure 18.1).

Figure 18.1

The four pillars of the National Police Well-being Service

The service is set up to make mental health and its promotion a key concern for all in policing, thereby reducing the stigma thus far associated with disclosing mental health issues. In an occupation that is high on emotional labor the service aims to look at mitigating, as far as possible, the stressors of life as an ESR. Effectively detecting early signs, largely through our peer support work, supporting and signposting is critical to success. Finally, inevitably, and unfortunately, there will always be cases where we must look at treatment pathways to recovery. We have established a lifecycle of support and treatment, to either treat and recover to full working capacity or to exit with dignity and gratitude from the service. The overall aim is to have mental and physical health options in place for modern day ESR work. We know the physical health challenges normally fall into musculoskeletal problems, which can be addressed through traditional health services provided largely by national health services, with a wraparound of physiotherapy and returning to the workplace care. What is all together more challenging is addressing the mental health needs of the contemporary ESR, which will form the bulk of this chapter.

National Well-being Service for emergency responders in the UK  263

PLANNING A LIVE SERVICE The initial scope of the NPWS, as it is now, was ambitious. Making an application for government funding for greenfield projects requires expertise. One of our earliest reflections would be that this should be one of the primary considerations. In this case, the project had ample high-level support and expertise from the start. The expectations from stakeholders were almost that the service would be up and running overnight and there was limited cognizance of meeting the requirements of public service procurement and onboarding, together with numerous other bureaucratic protocols. The initial project aimed at exploring opportunities to improve operational capability, morale, and staff retention, increase efficiency and effectiveness, and reduce medium- and long-term sickness absence. Further, the service would eventually provide early interventions that would reduce the likelihood of physical and mental ill-health, as well as early interventions to address absenteeism, presenteeism, and leaveism (Hesketh & Cooper, 2014), thereby making direct cost savings. This modeling of benefits realization would become a key area of strategic work and requires expertise in this field. Analyzing productivity, performance, happiness, and satisfaction is not easy in the emergency services realm. We carried out a scoping review with partners from Public Health England (PHE) to examine early interventions and to establish relevant data for use in a meta-ethnography to assess outcomes (Gauntlett et al., 2019). We conducted several small-scale pilot tests to identify interventions that would be effective in the context of policing. There are already many evaluated interventions to improve well-being facets, such as resilience training (Hesketh, Cooper, & Ivy, 2018). The question for us was whether that would be successful in an emergency services setting. Based on these small-scale pilot findings, provisions would then be put in place to mainstream the most successful options as a National Police Well-being live service provision across England and Wales.

FRAMEWORK FOR BLUE LIGHT WELL-BEING The underpinning framework to the service is the BLWF. This contains six key areas with 94 statements that allow organizations to self-assess against, and was developed together with colleagues at Public Health England and is loosely based on the Public Health Responsibility Deal (PHRD) developed in 2011 for organizations to improve the health of their workforces and tackle public health inequalities. Although the PHRD had four areas, the Blue Light Framework has the six areas of leadership, absence management, creating the environment, mental health, protecting the workforce, and personal resilience. The framework asks respondents to consider whether their organization is fully developed in relation to these six elements. If not, to look at whether they are underdeveloped or in development. This information is then used to form a tool they can utilize for gap analysis. This gap analysis allows regional and national capabilities to be formed, helping identify areas for development for

264  Handbook of research on stress and well-being in the public sector the NPWS. It allows the service to obtain an understanding of the existing national picture of well-being within policing and to look for consistent themes and issues. Further, it helps us to identify best practice, opportunities, risks, and threats to police well-being. Finally, it helps us in our work to inform the specification for the NPWS on the opportunities to progress improvements and, over time, improve and revise the BLWF. Great care is being taken to ensure we get this right. Adding to a body of work that is viewed positively is not without risk in the environment in which ESRs operate. In our first round of analysis four broad themes were identified: development; organizational learning, policy and process; staff support; and the working environment. At this early stage it was unsurprising that inconsistencies were found in the policies, procedures, and interventions noted across police forces. Absence management appeared to be the most developed section of the framework across forces, with personal resilience considered to be the most underdeveloped. There were also gaps in policy, procedures, and training provision. There was also inconsistency in the actual use of the framework (e.g., variations in evidence and content provided). This was a learning point for us and should be improved if its benefits are to be realized. Analysis of the framework also highlighted the challenges of evaluating progress. Currently, the framework’s emphasis is based on qualitative information, which generates particular types of methodological challenges. It may be useful in future to discuss how information will be captured over the long term, to assist in monitoring and discussing how evidence is secured to illustrate that change. The framework has proven popular with users, which probably stems from its simplicity and ease of use. This is a good learning point if considering this type of approach. Our planning now looks at updating the BLWF, which would contain additional sections on sleep, fatigue, and driving (with a focus on 24/7 responders doing shift work) and on occupational health standards for ESRs.

PSYCHOLOGICAL RISK MANAGEMENT AND SCREENING ESRs need to be able to deal with a variety of demanding events, often with little or no preparation (Hesketh & Tehrani, 2018a). When attending incidents, they very often do not have the full details of what has happened or who is involved, adding extra pressures en route to incidents. On arrival at a scene or an incident, the ESR can find that the more calculated and deliberate an act, the more distressing it can be. This is particularly relevant if the injured party or victim is a child, innocent, or vulnerable. By way of example, the scene of a murder or unusual accidents can play on the mind and be the source of nightmares or flashbacks for the ESRs. Further, the weight of carrying responsibility for others, be they colleagues or members of the public, can create feelings of guilt or shame if things go wrong. Knowing that the incident or event could happen again also makes it more difficult to tolerate. Most ESRs will mentally prepare for events, but often things happen with no warning, and there is no time to consider what would be the best action to take. A lack of organ-

National Well-being Service for emergency responders in the UK  265 izational support can make everything much worse. This is why psychological risk management is an important addition to preparing ESRs for their challenging roles. Psychological screening, as part of risk management, involves utilizing reliable instruments (usually in the form of questionnaires) to assess the psychological health and well-being of an individual (Hesketh & Tehrani, 2018b). These instruments must have been robustly tested and validated in order to make the process reliable. The instrument must also contain an approach to ascertain if the respondent is answering dishonestly. This too is an important aspect and underpins the necessity to carry out psychological risk management. The most common approach is to have the questionnaires completed quickly, without the respondent giving too much thought about the response – that is, it is their spontaneous answer. The questionnaire is then assessed and scored by a person skilled in their interpretation. The findings are then referred, if necessary, to occupational health services for further action to be taken. This action can be a stepped approach and may include monitoring the individual, having discussions, or referring for therapy. Many ESRs’ activities are known to have a potential for causing psychological harm and therefore can be foreseen. The Health and Safety Executive (in the UK) developed Management Standards, identifying potential hazards that should be monitored and controlled in organizations. The stress-related hazards include: ●● ●● ●● ●●

lack of control and support; exposure to conflictual relationships; poorly defined roles; organizational change.

These hazards can result in workers suffering psychological injuries, including anxiety and depressive disorders. In addition to workplace stress, several ESR roles are exposed to more extreme hazards as part of their work. These officers and staff members are exposed directly or indirectly to death, trauma, and distress where the possibility of psychological injury is known and is therefore foreseeable. There is a significant body of evidence to show that workers directly or indirectly exposed to traumatic events during their work have an increased risk of developing post-traumatic stress disorder, major depression, anxiety, alcohol or drug dependency (Breslau, 1998). These events include: ●● ●● ●● ●● ●● ●● ●● ●●

handling dead bodies; shootings; rape and other sexual assaults; transportation disasters; physical attacks; verbal threats; harassment; accidents.

266  Handbook of research on stress and well-being in the public sector Some of the most psychologically challenging roles in all ESR work stem from dealing with extremes in vulnerability and hardship. Particularly in policing, these include those dealing with child protection, domestic violence, and family liaison. In all ESR roles, some roles will carry with them a higher level of psychological risk. In response to these risks our service has introduced additional psychological support, although there are some ESRs who have not recognized this need. The level of psychological support can range from a simple annual meeting with a welfare officer or counselor, to a comprehensive program of psychological screening and surveillance. In these programs, levels of anxiety, depression, burnout, primary and secondary trauma, as well as their coping skills, resilience, and personality are tested, and those who are found to be experiencing difficulties are referred for further assessment and support. This is all seen as supportive and generally well received. Within the NPWS we have developed a program of psychological screening. At this stage it is confined to policing as the service develops. Psychological screening needs to use valid and reliable questionnaires that have norms created with working populations. We utilize three types of psychological approaches in the NPWS screening: 1. Initial screening questionnaires. The initial screening of police officers and staff needs to identify whether the individual might be harmed by working in a specific role. This means that there should be a measurement of their current psychological well-being in terms of any symptoms of anxiety, depression, primary or secondary trauma. In addition, there should also be measures of personality, coping skills and style, and resilience. Research has also shown that early life exposures to trauma can create additional vulnerability. Adverse childhood experiences, or ACE scores as they are known, are an indication of harmful occurrences experienced during childhood (Felitti et al., 1998). These may be domestic violence, abuse, neglect, or mistreatment. High ACE scores can present increased risk factors in later life. These initial screening questionnaires are also important as they provide a benchmark against which subsequent screening can be measured. 2. Ongoing screening questionnaires. The ongoing screening includes all the clinical measures from the initial screening but adds in questions on sickness absence, exposure to trauma, attitudes to health and experiences of the working environment. This questionnaire also looks at personal stressors such as bereavement, relationship issues, physical ill-health, financial difficulties, and problems at work. 3. Referral screening questionnaires. The referral questionnaire is used for individuals who are struggling at work. It is used where additional occupational, behavioral styles and beliefs can be measured to make it easier for the assessor to identify the most appropriate intervention to help them regain their health. It is important to recognize that even the most robust person can suddenly find themselves having difficulties. This could be due to unrecognized compassion fatigue or burnout, or perhaps a change in personal circumstances. It is essential that

National Well-being Service for emergency responders in the UK  267 referrals can be made in a supportive atmosphere where there is an expectation of recovery. Screening programs are not only useful for individuals, they also provide line managers and strategic managers with the information they need to help them identify how the individual teams are handling their work, and whether clinical interventions, training or other changes have had an impact on these specialist teams. Anonymized management information on the proportion of officers and staff experiencing clinical-level symptoms is essential if the organization is to take a proactive approach to managing well-being. One of the benefits comes from acknowledging the human being and their limitations. As in a physical sense, there are also psychological limits to coping. Specialist ESR roles often carry, by their very nature, increased psychological risks. Research on anxiety, depression, and traumatic stress has shown a wider range of vulnerability. This includes: ●● ●● ●● ●● ●●

gender; personality; education level; pre-existing disorders; early life abuse.

These factors have been shown to increase the impact of an exposure to a hazardous event and need to be considered in recruitment, task design, and providing support. For example, there is a need to identify which individuals may be at more risk, introduce reasonable adjustments, and take account of these vulnerabilities when planning and undertaking a surveillance program (Alexander & Klein, 2003; Breslau, 2009; McFarlane, 2004). Aligning to protocols as described can help reduce the psychological harm, benefiting individuals and, of course, the public.

TRAUMA SUPPORT AND CONTINGENCY ESRs are often nervous about asking for help in dealing with stress and trauma, particularly if this could lead to them being removed from a role they really enjoy and gives them meaning and purpose in their life. However, it is inevitable that stressful situations and traumatic incidents will occur, and it is important to recognize that these may not be viewed, felt, or experienced in the same way by everyone. It is important to have a plan to deal with differences in responses. There is a cultural tendency for ESRs to downplay personal danger and distress and it is essential that this is addressed. Without openness and acceptance of the reality that stress and trauma are the source of much of the sickness absence for ESRs, there will be a continuing trail of psychologically damaged and psychologically injured staff. Supporting ESRs who experience trauma should not be viewed as something new. However, advances in neuropsychology have allowed us to understand more about what is going on in the experience of trauma and post-trauma (Miller, Peart,

268  Handbook of research on stress and well-being in the public sector & Magdalena, 2019). In this section, we will explain the rationale behind screening, particularly employed in mass casualty situations, grading the results, and then applying recovery paths for individuals highlighted as requiring further help. Our approach in the NPWS in the UK has focused, in the initial stages, on identifying and applying best-practice post-incident trauma management interventions. These include the most appropriate screening measures, post-incident support mechanisms, and longer-term therapeutic treatments for more advanced conditions, such as complex post-traumatic stress disorder. The individual responses to trauma are very different from those related to stress. It is important that all ESRs are fully aware of the nature of trauma and the symptoms that show that the ‘trauma fuse’ has blown. Initially, the typical symptoms of trauma, such as becoming hyper-alert, jumpy, not wanting to eat, avoiding people or places, or feeling upset and sad are common responses and diminish in a day or so. However, if they go on for a long time, they may indicate that further support may be required. From a supervisory point of view, it is important to cultivate a climate in which it is perfectly normal to talk about responses to distressing or traumatic events.

PEER SUPPORT One of the most effective measures, peer support, has provided ESRs with their own internal stress management network. Based largely on some great work in the Canadian policing system, the model employed in the UK advocates for greater awareness of colleagues, along with a skills development program. The program is based on awareness of the various things that can happen to ESRs, both physically and mentally. This is really important as it then develops the awareness into a philosophy of looking out for each other and knowing how to address the various day to day things that can creep up on emotionally charged work. There is also the proposition that those who have experience of working in an ESR role have the best knowledge and understanding to appreciate what colleagues may experience and be able to relate to it more closely than those who are not. The NPWS program looks at a number of areas of peer support. These begin with general peer support methodology – that is, to listen, assess, refer, and follow up when colleagues seek support or the peer supporter senses something amiss (for example, following an incident). Following this is a formal post-incident support approach. This sometimes overlaps with the post-trauma procedures we will explore in the next section. Considerations are also given to family members, officers or staff who are being investigated internally, losing a colleague from the workplace, grieving, workplace conflict, and supporting traumatized members of the public. All of these can be high in emotional labor and can cause a great deal of stress (Hesketh & Cooper, 2017b). Finally, the program addresses the personal issues around looking after the peer supporters themselves, addresses rules and protocols around confidentiality and data retention (keeping in mind that they are not clinicians or have any medical expertise), and establishes procedures for referring on or withdrawing from the work

National Well-being Service for emergency responders in the UK  269 with dignity. This withdrawal allows those doing support work time to recharge their batteries, as this work can lead to compassion fatigue (or secondary traumatic stress) – a further issue for peer supporters. This focus on those who actually do the peer support work is immensely important and getting this right will ensure people are willing to engage with peer support and value it, whether that be as a recipient or a peer supporter themselves. In occupations where trauma can be the day-to-day activity it is critical that people working within this realm have an enhanced understanding of how trauma is processed in order to maintain good psychological health.

POST-TRAUMATIC STRESS DISORDER (PTSD) A study (n = 16 857) by Police Care UK, a prominent UK police charity, suggested that as many as one in five police officers and staff in the UK have some form of trauma disorder. Over 90 percent reported trauma exposure in their everyday role. Most importantly, fewer than half said they had the opportunity to try and make sense of their experiences (Miller et al., 2019). It is inevitable that ESRs will be exposed to traumatic events. Most people who experience trauma will not develop PTSD. If they do, it is treatable, and they can make a full recovery. However, if unrecognized and left untreated it can be fatal. It may be useful to look at the criteria for developing PTSD at this point. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5) is generally recognized by international experts as the authority on all aspects of mental health (APA, 2013). PTSD is classified as a trauma- and stress-related disorder. It was previously classified as an anxiety disorder. First, PTSD requires a stressor. This requires that the person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s): ●● ●● ●● ●●

direct exposure; witnessing the trauma; learning that a relative or close friend was exposed to a trauma; indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., ESRs).

An intrusion symptom is required, which may be any one of the below. The traumatic event is persistently re-experienced in the following ways: ●● ●● ●● ●● ●●

intrusive memories; distressing dreams; flashbacks or feeling that the trauma is reoccurring; intense distress when exposed to cues; marked physiological responses to cues.

270  Handbook of research on stress and well-being in the public sector There needs to be evidence of avoidance of trauma-related stimuli after the trauma, in the following ways: ●● avoidance of distressing memories, thoughts, or feelings about trauma; ●● avoidance of reminders (e.g., people, places, objects that cause distress). The criteria for PTSD also require negative thoughts or feelings that began or worsened after the trauma, in at least two of the following ways: ●● ●● ●● ●● ●● ●● ●●

inability to remember parts of trauma; negative beliefs or expectations; distorted thinking, including blaming of self or others; persistent negative affect and lack of positive emotions; lack of interest in future; feelings of detachment; inability to feel positive emotions.

There also needs to be an alteration in trauma-related arousal and reactivity that began or worsened after the trauma, in the following ways: ●● ●● ●● ●● ●● ●●

irritability or aggression; risky or destructive behavior; hypervigilance; heightened startle reaction; difficulty concentrating; difficulty sleeping.

Finally, the symptoms last for more than one month and they are not due to medication, substance use, or other illness. A more recent addition is that of complex post-traumatic stress disorder (complex PTSD). This is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g., torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse). All the diagnostic requirements for PTSD above are met. In addition, complex PTSD is characterized by severe and persistent: ●● problems in affect regulation; ●● beliefs about oneself as diminished, defeated, or worthless, accompanied by feelings of shame, guilt, or failure related to the traumatic event; ●● difficulties in sustaining relationships and in feeling close to others. These symptoms cause significant impairment in personal, family, social, educational, occupational, or other important areas of functioning (WHO, 2019). Within the NPWS, we have integrated educational programs and guidance documents for officers, staff, occupational health and human resource professionals.

National Well-being Service for emergency responders in the UK  271 Further, we have included input on PTSD within leadership programs, peer support education, and dealing with traumatic incidents. The identification of PTSD is crucial, as with help it is a condition from which a person can completely recover. This is why we prioritize the recognition, both in oneself and others around us. Having done this we need to have well-established treatment pathways that people are clear about and aware of how to signpost into services.

CONTINUOUS IMPROVEMENT During the journey of the NPWS we have applied a continuous improvement philosophy. That is, we have continually reviewed activity, the demand of the business (which continually changes) and how work flows through the system. The purpose is to ensure we are adding quality and value to the service that leads to benefits for both the workforce and the public. To do this effectively, of course, requires an agile approach and an ability to adapt services in the context of ESR work. This is not without challenges, especially when lead times for public sector activity are relatively long. Having good program governance is essential for this to be successful and pragmatic project management allows this approach to succeed. Good leadership and an effective engagement strategy are also enablers for continuous improvement, as are robust methodology and rigor. The final enabler is around the correct level of project resourcing. The use of subject matter experts is essential, as well as professionals in procurement, financing, and project management – the business enablers.

BUILDING LEADERSHIP CAPABILITY This is the area that requires most work in almost all organizations. Moving from a leadership model that has been largely transactional to a much more transformational approach (Bass, 1985) offers up many challenges. Emergency service work is no exception; in fact, it may be even more difficult than in other occupations. Particularly during major incidents, a formal command process is followed to the letter. To then layer in a more consultative approach, maybe during the same incident even, can be difficult. The program seeks to champion an operating model based on caring for each other in the workplace, as the acceptable paradigm. An entire leadership program, from first-line management to executive leadership, is included in the NPWS. We know that positive leadership behaviors have a positive impact on employees’ well-being and that negative leadership behaviors have a negative impact (Gilbreath & Benson, 2004). Further, transformational leadership skills can be developed through training, and learning the techniques and qualities required to become a transformational leader (Bass, 1990; Parry & Sinha, 2005). The strategic vision statement for the NPWS is to support policing by developing leadership and building capability that individuals and organizations can access to enhance well-being in the service. It also aims to deliver transformational capabil-

272  Handbook of research on stress and well-being in the public sector ity through a holistic approach to well-being through the elements of promotion, prevention, detection and support, and treatment and recovery, as detailed in Figure 18.1. Having leadership front and center is critical to the success of the NPWS. Transforming leadership is well understood in the police and it is appropriate to facilitate this style of approach.

NEXT STEPS The future work of the NPWS looks very promising. The addition of a performance management structure in the piece of work will be essential, not least to track progress and direction of travel against the key milestones. This ambitious piece of work has been conducted against a backdrop of changing political landscape, including austerity cuts, comprehensive spending review, and ever-constant turbulence of Brexit. However, such has been the popularity and drive to succeed that these challenges have been met head on and largely overcome. The creation of metrics and helpful data to aid the progress of NPWS divides opinion. We have carried out assessments, peer support programs to help make sense of the data, and are looking to introduce a national survey in support of the program. Further, a considerable piece of work is being scoped to align available health service provisions with the policing need. This will be centrally run and aims to address common police ailments, both physical and mental. A piece of work is also planned to research an optimum way forward in respect of sleep and fatigue in ESR work. Although this has been an issue for a long time, there appears to be no consensus on a preferred way forward. So-called tidal shift rotas,1 although purporting to be better for general health and recovery patterns, are generally unpopular with those working them, mainly due to the limited days off the shift system allows. A multinational study with colleagues in the USA and Canada is planned to understand more of the challenges for ESR workers covering round-the-clock response duties.

CONCLUSIONS One of the interesting factors about the work of emergency service responders (we have focused largely on policing in this chapter), is that they are exposed to a full range of emotional challenges almost on a daily basis. Whilst issues like PTSD and stressors more generally may be periodic challenges in some occupations, ESRs are regularly exposed to the potentially life-changing harm experiences like this can bring. However, we propose that early recognition, regular screening, a culture of peer support, and structured post-trauma procedures can mitigate against these harmful effects. This chapter has sought to illustrate the everyday aspects of bringing the recommendations of scholarly research on stress and well-being into practice with emergency service responders. We have drawn on a lifetime of knowledge and experience to exemplify what can be achieved in a relatively short space of time

National Well-being Service for emergency responders in the UK  273 in a difficult working environment. The chapter seeks to highlight that drawing on expertise and the support of key stakeholders is essential to garnering broad support amongst ESRs, including trust that the interventions are credible and the whole system is an effective means by which to improve workplace well-being and reduce stress. These are discussed in academic depth elsewhere in this book, so we have purposely not gone into detailed theoretical mapping. What we hope is useful is the articulation of a full work program that models a number of what are effectively stress and resilience interventions. Well-being is the priority of many organizations, as the realization of having a sustained business strategy is becoming ever more popular. We hope this glimpse into the practical aspects will prove a useful resource to all those doing research in, or indeed implementing, this critical area of business.

NOTE 1. A pattern of shift works that moves forward. Officers would work two early shifts, then two afternoon shifts, followed by two night shifts, have days off, then begin again.

REFERENCES Alexander, D., & Klein, S. (2003), ‘The epidemiology of PTSD and patient vulnerability factors’, Psychiatry, 2(6), 22–26. American Psychiatric Association (APA). (2013), Diagnostic and statistical manual of mental disorders, fifth edition. Washington, DC: APA. Bass, B. (1985), Leadership and performance beyond expectations. New York: Free Press. Bass, B. (1990), ‘From transactional to transformational leadership: learning to share the vision’, Organizational Dynamics, 18(3), 19–31. Breslau, N. (1998), ‘Epidemiology of trauma and post-traumatic stress disorder’. In R. Yehuda (Ed.), Psychological trauma. In J.M. Oldham & M.B. Riba (Eds), Review of Psychiatry, 17, 1–29. Washington, DC: APA. Breslau, N. (2009), ‘The epidemiology of trauma, PTSD, and other post trauma disorders’, Trauma, Violence and Abuse, 10(3), 198–210. Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., … Marks, J.S. (1998), ‘Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults’, American Journal of Preventive Medicine, 14(4), 245–258. Gauntlett, L., Richens, M., Tehrani, N., Hesketh, I., Weston, D., Carter, J., & Amlot, R. (2019), Scoping review: early post-trauma interventions in organizations. British Psychological Society. Accessed 15 November 2019 at https://​www​.bps​.org​.uk/​sites/​bps​.org​.uk/​files/​Member​ %20Networks/​Sections/​Crisis/​CDT​%20Scoping​%20Review​%20Early​%20Post​%20Trauma​ %20Interventions​%20in​%20Organisations​%20Report​_09052019​%20FINAL​.pdf. Gilbreath, B., & Benson, P. (2004), ‘The contribution of supervisor behaviour to employee psychological wellbeing’, Work and Stress, 18, 255–266. Hesketh, I., & Cooper, C. (2014), ‘Leaveism at work’, Occupational Medicine, 64(3), 146–147. Hesketh, I., & Cooper, C. (2017a), ‘Measuring the people fleet: general analysis, interventions and needs’, Strategic HR Review, 16(1), 17–23.

274  Handbook of research on stress and well-being in the public sector Hesketh, I., & Cooper, C. (2017b), Managing health and well-being in the public sector: a guide to best practice. Abingdon, UK: Routledge. Hesketh, I., & Cooper, C. (2019), Wellbeing at work: how to design, implement and evaluate an effective strategy. London: Kogan Page. Hesketh, I., Cooper, C., & Ivy, J. (2018), ‘Asset rich, peelers poor: measuring and efficacy of resilience training in policing’, Australian Journal of Evidence Based Policing, 3(3). Accessed 15 November 2019 at https://​www​.researchgate​.net/​publication/​330412139​ _Asset​_Rich​_Peelers​_Poor​_Measurement​_and​_Efficacy​_of​_Resilience​_Training​_in​ _Policing/​citation/​download. Hesketh, I., & Hartley, J. (2016), ‘Public value: a new means to peel an apple?’, European Police Science and Research Bulletin, 13, 64–69. Hesketh, I., & Tehrani, N. (2018a), ‘Psychological trauma risk management in the UK police service’, Policing, 13(4), 531–535. Hesketh, I., & Tehrani, N. (2018b), ‘The role of psychological screening for emergency service responders’, International Journal of Emergency Services. https://​doi​.org/​10​.1108/​ IJES​-04​-2018​-0021 McFarlane, A. (2004), ‘The contribution of epidemiology to the study of traumatic stress’, Social Psychiatry and Psychometric Epidemiology, 39, 874–882. Miller, J., Peart, A., & Magdalena, S. (2019), ‘Can police be trained in trauma processing to minimise PTSD symptoms? Feasibility and proof of concept with a newly recruited UK police population’, The Police Journal: Theory, Practice and Principles. https://​doi​.org/​10​ .1177​%2F0032258X19864852 Mind (2019), ‘Wellbeing and mental health support in the emergency services: our learning and key recommendations for the sector’. Accessed 15 November 2019 at https://​ www​.mind​.org​.uk/​media/​34555691/​20046​_mind​-blue​-light​-programme​-legacy​-report​-v12​ _online​.pdf. Parry, K., & Sinha, P. (2005), ‘Researching the trainability of transformational organizational leadership’, Human Resource Development International, 8(2), 165–183. World Health Organization (2019), ‘ICD-11 for mortality and morbidity statistics (Version: 04/2019)’. Accessed 15 November 2019 at https://​icd​.who​.int/​browse11/​l​-m/​en​#/​http​%3a​ %2f​%2fid​.who​.int​%2ficd​%2fentity​%2f585833559.

19. Occupational health and safety: in crisis, or in charge? Renae Hayward and John Durkin

INTRODUCTION The concept of psychological well-being amongst first responders in emergency service work has relied upon a medical perspective within a patient- or victim-based framework where psychiatric language informs how mental health is discussed. However, emergency services’ workers encounter a range of physically, cognitively, and emotionally demanding stressors, not as victims, but as members of cooperative teams willing to encounter such stressors. If traumatic incidents form an attractive part of emergency work, the medical view of an unwitting victim in need of expert help is inadequate. By taking an occupational health and safety perspective, a greater explanatory power may be available because pre-incident, operational, and post-incident factors will be considered. In this model, prevention and intervention will take on a greater number of forms, tap into different resilience, recovery, and well-being processes, and predict more positive outcomes than the medical model. Hence a novel, dynamic picture emerges, with well-being and resilience, rather than mental disorder, at the forefront of health and safety planning. The importance of camaraderie, teamwork, and the resultant culture of trust inherent in staying safe during critical incident exposure is imperative to well-being and resilience. In this chapter, the nature of prevention and intervention processes are considered and explored within two contexts: (1) in South Australia, where large areas of the state are protected by volunteers and professional emergency services’ personnel as members of communities confronted by critical incidents; and (2) in London, UK where terrorist incidents and the multiple-fatality Grenfell Tower fire were attended by professional police officers supported by a specialist peer-support team. Two aspects of well-being in emergency services will be highlighted and explored within the differing contexts of South Australia and London. Theoretical processes that underpin individual well-being and team functioning will be considered within an occupational health and safety framework. As such, symptoms of mental disorder will be reinterpreted as reactions to psychological shock and the 28-day ‘watchful waiting’ period required for psychiatric diagnosis seen as a fruitful period within which psychological function can be restored in first responders and their well-being assured.

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CRITICAL, NOT TRAUMATIC A critical incident is any situation faced by emergency service personnel that causes them to experience unusually strong emotional reactions which have the potential to interfere with their ability to function either at the scene or later. (Mitchell, 1983, p. 36)

This defining quote is helpful for a number of reasons, especially when compared to a psychiatric assessment manual (APA, 2013). First, it refers directly to the disabling effects of a reaction, not the presence of symptoms. Second, the situation is self-defined as ‘any’ rather than one found on a psychiatric checklist. Third, the situation is cited as the cause of the reaction, not an individual vulnerability. Fourth, the ability to function is the important criterion, not the symptom formation of a mental disorder. It takes a medical or mental health professional (e.g., psychiatrist) to diagnose acute stress disorder (ASD) within four weeks and await post-traumatic stress disorder (PTSD) beyond that. However, the transition from ASD to PTSD appears unremarkable, given the first 28-day period during which ASD is valid and the post-28-day period when PTSD becomes valid (APA, 2013). Symptoms and treatments are common to both conditions, yet the categorical transition from one disorder is of dubious value if the ability to function is key, as in emergency response. Categorizing the struggle to cope as the mental disorders ASD or PTSD, puts early, natural reactions into a medical framework with the risks of isolation, misdiagnosis, and confusion. The medicalization of early emotional reactions has seen guidance published that encourages exploration of them with a clinician, but not with colleagues – specifically, as debriefing (NICE, 2018). The reason cited is ‘the potential to cause significant harm’ (NICE, 2005, p. 81). With neither estimation of the magnitude of the ‘potential’ nor definition of the ‘harm’ being caused, the recommendation is unlikely to be of use to operational decision-makers. Further, the warning against debriefing is followed by the recommendation to provide ‘general and practical social support’ (NICE, 2005, p. 85), yet critical incident stress debriefing (CISD) is, by design, social support (Mitchell, 1983). The debate over whether CISD is harmful or not might be an artifact of the medical viewpoint that sees symptoms of disorder as harmful, while avoiding consideration of the psychosocial dynamics of a CISD. A ‘symptoms-only’ approach ignores the benefits of safety-conscious teamwork and interpersonal monitoring that first responders rely upon for task completion and personal survival in operational settings. It is our opinion that teamwork and monitoring practiced in the field is re-employed during CISD where support is spontaneous, generous, and directed to those in need. We see the expertise in a CISD as a collective one that draws on the confidence and respect of the debriefing team while first responders recall the personal and operational demands of the incident and their early emotional reactions to it. If the early emotional reactions that CISD was implemented to reduce are not addressed, it seems likely that they later become the presentations of symptoms of PTSD. If the symptoms persist and a PTSD diagnosis is made, then medicalization

Occupational health and safety: in crisis, or in charge?  277 might be justified. However, medicalization in the period of coping and adjustment is premature if an organizational response includes peers delivering crisis intervention, providing social support, and being engaged in a culturally familiar way. Only where function was not restored after exhausting socially supportive options should, in our view, a clinical assessment be considered. Most mental health practitioners who work with individual patients and quantitative researchers who work with statistics may never work with first responders, where clues to their resilience might be observed. This might explain how authors of expert guidelines can recommend social support and simultaneously call for the abandonment of CISD. To place a clinician in front of a first responder after a critical incident not only decontextualizes the experience of the first responder but also denies the unique forms of social support that peers and colleagues provide. The early aftermath of exposure to a critical incident finds one body of PTSD experts recommending ‘watchful waiting as a way of managing the difficulties presented by individual sufferers’ (NICE, 2005, p. 128) during the first four weeks and arguing for ‘active monitoring within the first month after the trauma’ in a later revision of the guidelines (NICE, 2018, p. 31). However, no information on what to ‘watch’, ‘wait for’ or ‘monitor’ is presented. Another expert body promotes psychological first aid (PFA) with the focus on each person’s needs for safety, connectedness, self-efficacy, and where needed, referral (Hobfoll et al., 2007; Phoenix Australia, 2013). However, while PFA is informed by the literature on risk and resilience following trauma (Everly, 2011), its application has yet to be tested in the field to determine the appropriate application (Dieltjens et al., 2014). Similarly, mental health first aid (MHFA; Mental Health First Aid Australia, 2019) has a mandate to ‘raise awareness and encourage referral’ by training members of the general public. If first responders face serious mental health threats moreso than members of the public it is difficult to endorse an approach designed for the general population. First responders are exposed to injury, suicide, and premature ill-health retirement, including within their own ranks, so a standard of training that exceeds that of MHFA is likely to be necessary. Concerns arise because watchful waiting and active monitoring imply covert observation, PFA processes remain speculative, and MHFA claims to raise awareness, while all fail to address the early emotional reactions when they are being experienced. However well intended the overall advice, if expert guidance threatens social connection with the remainder of the team it will contradict the ethos of collective preparedness, rapid response, and collaborative task completion embedded in emergency response work. The medical imperative to focus solely on an individual during treatment seems likely to further separate them psychologically and physically from the team, its purpose, and any collective appraisal of operational achievements. We argue that much can be accomplished in the first 28-day post-incident period by exploiting the purpose and camaraderie familiar to the members of such teams and maintaining the operational ethos of the first responder while providing support to them. The medicalization of reactions by using psychiatric language to describe them seems unnecessary. Everyday terms such as ‘shock’ and ‘disbelief’ will be better

278  Handbook of research on stress and well-being in the public sector understood by first responders than ‘dissociation’, for example. We argue that ‘crisis’ is familiar to the first responder and seen as a changeable state likely to improve with time to reflect and converse. We argue that ‘trauma’ will be less familiar to the first responder and will appear as a ‘stuck’ state that requires expert treatment. If the traumatic state requires the attention of mental health professionals working in a medical framework and the critical state requires the attention of trained peers working in an occupational health and safety (OH&S) framework, a simple choice would appear. Will an organization choose to meet its legal responsibility by investing in its current employees to confront crises as they arise or rely on outside experts to treat ‘trauma’ after four weeks has elapsed?

COULD PTSD SYMPTOMS BE ADAPTIVE? The assumption that PTSD symptoms describe a disorder and are therefore problematic might be open to question. In post-deployment military settings, psychologists have recognized the adaptiveness of trauma-related symptoms in the field: [T]he DSM–IV model assumes that all of the symptoms follow exposure to a traumatic event. This makes sense in the case of a victim-based approach in which the individual is surprised by a traumatic event for which they are not prepared. Within the military deployment context, however, many of the symptoms for PTSD exist prior to the occurrence of a specific traumatic event. For example, hypervigilance is normal in the deployed context because service members are explicitly trained to continuously look for signs of danger and are warned not to become complacent. Difficulty sleeping is another normal response to the deployed context because the field conditions, noise, lack of privacy, and 24/7 routines are likely to disrupt sleep. Restricted range of affect is also a normal response to the military context because of the cultural emphasis on suppressing emotions to maintain military professionalism on combat operations. (Castro & Adler, 2011, p. 221)

An organizational culture that accepts unpleasant post-traumatic reactions as a likely consequence of efforts made in difficult circumstances might regard them as welcome, especially where interventions do facilitate recovery and confidence in peer support is high. An organization that accepts all reactions as valid has the potential to alleviate stigma and lead its people to find opportunities for personal growth. The gratitude that peer-support teams report hearing from colleagues they have helped identifies several positive qualities being attributed to its members. Trust, recovery, and interdependency are attributes that may be missed or ignored by mental health professionals seeking only to identify symptoms.

Occupational health and safety: in crisis, or in charge?  279

DOES PSYCHOLOGICAL TREATMENT WORK FOR FIRST RESPONDERS? Roundtable discussions in Australia have highlighted the inadequacy of current frameworks for first responders regarding prevention, diagnosis, and early intervention (Barratt, Stephens, & Palmer, 2018). One-third of first responders being treated for PTSD recovered, one-third reported benefits and retained symptoms, and one-third reported no benefit. As new and innovative approaches were called for, we saw the opportunity to propose a comprehensive post-incident support system that relied upon the delivery of interventions by specialist peers. Further, we envisage it being delivered according to principles and beliefs, some privately expressed to the authors by first responders, including: ●● ●● ●● ●●

finding meaning and purpose in dangerous work; the drive for novel experience, personal challenge, and self-development; working as part of a team in a meaningful and purposeful way; holding mutual obligation (e.g., mateship, ‘having your back’, ‘looking after our own’); ●● elevated social status; ●● the respect of colleagues, admiration and gratitude from others; ●● simple and practical application of procedures that see tangible outcomes. Beyond describing the qualities of ongoing personal development, our focus is on the provision of optimized support in an organizational setting. We envisage a program designed to be embedded within the emergency services’ work environment to promote recovery, provide tailored support whenever needed, and to create the optimal conditions for personal, team, and organizational development.

STRESSORS ARE WELCOME A welcome physical environment on return to base would include showers, fresh uniforms, the provision of hot, nutritious food and a comfortably furnished soundproofed room (or rooms) large enough to conduct defusings (and later, CISDs). Our combined experience in this field informs us that soiled uniforms, tired bodies, and suppressed appetites are reminders of the incident that can be weakened simply by preparing the physical setting for crews to return to. This helps delineate the incident and its impact ‘back there and past’, from safety and comfort ‘right here and now’. A peer-support team back at the base will offer genuine interest and early social support. The first opportunity for a brief psychological risk assessment will likely arise back at the base where even conversations with peers can reinforce perceptions of being valued. The optimal environment will be one that provides immediate social support, early risk assessment, and the fewest physical reminders of the incident.

280  Handbook of research on stress and well-being in the public sector The cognitive demands of a critical incident can involve challenges to belief systems and assumptive worlds (Janoff-Bulman, 1989). Belief systems range from global (e.g., good things happen to good people) through to incident-specific (e.g., information is correct, equipment will operate, and victims will be grateful). Seeing an innocent driver die after a collision with a drunk driver who is uninjured can challenge assumptions of the world being fair, the existence of a just, intervening God, or render life as a series of random and uncontrollable events. With experience, first responders realize that not every job goes to plan, tools sometimes fail, and those being helped can be surprisingly hostile. Furthermore, certain incidents can have a sinister disabling effect on them. Among the ‘Terrible Ten’ critical incidents listed by Mitchell (2016) are line-of-duty deaths, the deaths of children, and the suicide of a colleague. A CISD, as a form of team support, invites participants to express their thoughts as they choose during the debriefing. Hearing similar or starkly different thoughts from colleagues can both comfort and challenge fixed beliefs and assumptions and sets in train the processes that could derive some positive personal meaning from the experience (Linley & Joseph, 2004). This is in keeping with therapeutic approaches to trauma resolution where key mechanisms to recovery include problem-solving, cognitive reframing, and information processing (Phoenix Australia, 2013). The emotional demands of a critical incident can lead to experiencing a range of negative emotions and unwanted intruding thoughts. Feeling sick at the sight of mutilated bodies can elicit memories of prior similar incidents. Engaging with ‘self-talk’ and focusing on a specific task at hand to cope might then elicit different or less intense emotional responses. For example, the realization that people are dead might be a shock, resulting in an initial inability to move, but when the decision to treat and focus is shifted to the injured, a calm emotional reaction might result as purposeful work begins. The pendulum swings of emotions at critical incidents are familiar and expected in first responders and is often the topic of post-incident rumination, conversation, and debriefing. Again, a process that facilitates information processing and cognitive framing of the experience within the safety of the group in which one belongs and identifies with is in keeping with the protective mechanism of engaging with social supports. In this environment, first responders are more likely to discuss and begin processing their own experiences and support others in the processing of their experiences. However, whatever is remembered of the interpersonal dynamics, changing fortunes, and performance appraisals in the immediate aftermath is surely lost after the passage of 28 days. If the early reactions are seeds that germinate into future symptoms and a ‘disorder-in-the-making’, the earliest intervention would be the most efficient in preventing PTSD and promoting resilience and recovery.

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MENTAL HEALTH OR OCCUPATIONAL HEALTH AND SAFETY? Our model draws on work-related stress and well-being (see Demerouti et al., 2001; Karasek & Theorell, 1990) fields of research framed within health and safety legislation in the UK (HM Government, 1999) and South Australia (South Australian Government, 2012). These regulations carry legislative power such that all employers and employees are bound by law to obey them. Three elements are outlined: (1) risk assessment; (2) targeted intervention; and (3) monitoring. The risk assessment element requires that hazards be identified, interventions be employed to eliminate or minimize the hazard and then monitored to ensure the interventions were successful in addressing the hazard. This legal framework underpins the occupational health approach to promoting health and safety at work, especially with regard to mental health. In keeping with principles familiar in the emergency services context it requires a pre-incident plan to support first responders (e.g., rehearsed procedures, allocation of resources), dynamic operational options (risk assessment, when, where, and how to apply interventions), and a post-incident review to determine lessons learned and to inform future pre-incident plans. By following the principles of physical health risks there should also be little additional burden to addressing mental health. If mental health risks can be assessed, addressed, and monitored in the emergency services’ workplace the role of psychiatry and clinical psychology will be limited. A key distinction between an occupational health approach and a medical (psychiatric) approach is the speed of action. A health and safety approach demands intervention whenever a hazard to mental health (e.g., distress, catastrophic appraisal) is identified. A psychiatric approach generally requires the passage of four weeks before a meaningful assessment (APA, 2013; NICE, 2005, 2018). Any delay is at odds with the call to intervene as soon as a hazard is identified. The immediate aftermath of a critical incident is the first phase of the psychological and emotional unfolding that could, after four weeks, give rise to symptoms of mental disorder recognizable to the psychiatrist. Given the time spent in the work environment, the impact on an employee’s psychological state is likely to be profound (Hochschild, 1997; Ryan & Deci, 1995; Tedeschi & Calhoun, 2004). This may be especially so where a period of inaction and waiting suddenly propels the first responder into a scene that is unpredictable, dangerous, and beyond immediate control. As each responder will be trained to assess risks in the environment, this will require comparisons between the demands of the job and the resources available to meet them. Where demands exceed resources such that planned solutions are not enough, opportunities for generating novel cognitive and emotional alternatives exist. These may then support resilience, psychological well-being, and learning for the operational and psychological debriefings to come. For example, a watch1 that one of the authors (JD) worked on had a firefighter en route to an incident killed in a road traffic collision. It also saw several members of the public killed. The watch members described ‘sticking together’ by refusing compassionate or sick leave and rejecting offers of outside help or support. JD later joined the watch as a junior officer

282  Handbook of research on stress and well-being in the public sector and was immediately struck by two things: (1) the unconditional support of the watch for the driver despite the death of one of its members; and (2) absolution for the driver’s decisions and actions regardless of how a court would later judge him. Annually thereafter the watch commemorated the incident as a restatement of support and sympathy for the driver and to remain cohesive as a team, both on and off duty. No absence from work was attributed to the incident and no blame was apportioned to the driver, even upon conviction. Some years later a firefighter from a neighboring station was killed in a fire. Almost immediately afterwards its members endured acrimony, domestic problems, and within a year one of them committed suicide. If in this case the death of a colleague is an emotional demand that exceeded resources, both (demographically similar) watches experienced it, yet both reacted in quite different ways. In the absence of any external support or expertise, the two groups’ members would only have each other and their families and friends to draw on. While the second watch seemed to follow a chaotic route towards mental disorder, the first did not. The first watch seemed to find sufficient resources within their team in the early aftermath to then generate their own culture of affection, non-judgment, and respect. The environment in which these two watches survived and changed may appear similar, but clearly the salient factors within the work environment that might predict the direction of change were not apparent. Job stress theories offer a framework within which to consider the influence of the work environment, including demands and resources on psychological health. Job demands on the first responder are those that require continued effort (physical, cognitive, and emotional) to meet the requirements of the job (Demerouti et al., 2001). Demands may be acute or chronic. Acute demands are relatively short-lived but could include shocking experiences that arouse strong emotions of fear and helplessness (Shakespeare-Finch, Smith, & Obst, 2002; Van der Ploeg & Kleber, 2003). Chronic demands are more enduring and require sustained efforts that can drain energy and motivational reserves over time (Cooper, Dewe, & O’Driscoll, 2001; Demerouti et al., 2001). Seeing exhaustion as a consequence of critical incidents identifies links between emotional demands and poor mental health outcomes (Bennett et al., 2005; Brotheridge & Lee, 2002; Brough, 2004; Giardini & Frese, 2006; Mikkelsen, Ogaard, & Landsbergis, 2005; Tuckey & Hayward, 2011; Van der Ploeg & Kleber, 2003). Importantly, involvement in a critical incident can stimulate efforts to regulate emotions, including their suppression, for example, in gruesome or threatening situations. While this ability might enable task progress, enforced suppression of negative emotions has been associated with physical and psychological stress symptoms (Watsell, 2002). In anticipation of both the necessity to suppress potentially overwhelming emotions and the negative consequences of doing so, resources should encompass physical, psychological, social, and organizational responses. Beyond the management of the effects of emotional suppression it may also be possible to directly foster motivational and learning processes to achieve positive psychological outcomes (Bakker, Demerouti, & Euwema, 2005; Linley & Joseph, 2004) such as those presented during crisis intervention (e.g., CISDs). If

Occupational health and safety: in crisis, or in charge?  283 attention is directed towards the quest to find symptoms the positive possibilities may be overlooked. Physical Job Demands The work that first responders undertake can be complex, dynamic, and unpredictable. It can involve periods of mundane, repetitive preparation and imaginary scene-setting followed by an indefinite wait. Then probably with little or no warning an alarm can direct the first responder to a scene that makes numerous demands on them while engaged on the scene for an indefinite period. Some incidents can last for hours (e.g., a car fire with fatalities), days (e.g., a missing person search), or weeks (e.g., the 2009 Black Saturday bush fires in Victoria). The subsequent organizational investigations and media intrusion can create an indefinite period of speculation awaiting public judgment, which can prolong the event and act as a secondary trauma, including a ‘betrayal trauma’ with its ‘systemic failure, injustice, (and) blame’ (MacFarlane, 2018, p. 16). The physical demands range from passivity while waiting, to urgent engagement in an incident requiring strength, endurance, and agility. The physical burden and cognitive appraisal will invariably activate an autonomic stress response and, subsequently, high levels of arousal and hypervigilance. Also, first responders are likely to be exposed to intrusive environmental elements embedded within the incident, such as heat, fires, smells and the ‘noise of battle’. Cognitively, first responders can anticipate a variety of choices, priorities, and expectations during preparation and then sudden entry into active problem-solving, decision-making, and risk assessments on scene. When discrepancies between expectations created during planning and reality increase, so too can hypervigilance and sensitivity be expected to increase. Changing elements within the critical environment appear on a continuum of uncertainty and risk-taking for first responders, while simultaneously preserving their own and the team’s safety. In volunteer contexts, first responders can be acutely aware of the dangers to their own property and families while actively engaged on scene, including being moved a great distance from the area they have the most concern for – their own. Emotionally, there might be additive effects from the frustration of waiting to be mobilized, being held back by cautious incident commanders, the fear of entrapment, horror at seeing bodies incinerated and the tragedy of the event for an entire community. Regardless of the perceptions of the first responder and their own appraisals of competence and failure there may also be pride in mastering equipment, braving the elements, and surviving another ‘big one’, with a greater appreciation for family and their team. Given the identification of these demands and their likely consequences, the physical, cognitive, and emotional resources developed should aspire to match the expectations of the type of incident and the different stages of its aftermath. Such matching emphasizes the practical relevance of the risk assessment, intervention, and monitoring requirements of an OH&S safety approach.

284  Handbook of research on stress and well-being in the public sector The demand-control-support model of Karasek and Theorell (1990) suggests that work environments should provide the individual with (1) a degree of control over how to execute their roles; and (2) adequate social support. Where they do not it is likely to lead to strain, a factor linked to poor psychological and physical health outcomes. Likewise, the job demand–resources model (JD–R) suggests that health impairment and burnout can result from highly demanding jobs that lack adequate resources (Demerouti et al., 2001). In contrast, these theories indicate that adequately resourced yet demanding jobs are associated with positive experiences, including engagement and motivated learning (e.g., Demerouti et al., 2001; Dollard, 2003; Llorens et al., 2007; Turner, Barling, & Zacharatos, 2002). Reversing, or at least minimizing, such negative consequences may promote positive cognitive processing. For example, if exposure to traumatic work generated resources, particularly social support from supervisors and co-workers (Bakker et al., 2005; Demerouti et al., 2001; Van der Ploeg & Kleber, 2003) long-term outcomes may be far more positive than a symptom-identification system for mental disorder would permit. From an OH&S perspective, risk assessment, intervention, and monitoring should also incorporate an understanding of the job’s likely demands, the organizational resources provided, and their interactions to promote a safe and healthy work environment regardless of its level of threat. Social Support Often cited in the clinical literature on trauma, but rarely elaborated on, is the importance of social support with its moderating (Cobb, 1976), buffering, and main effects on stress (Cohen & Wills, 1985; Tuckey & Hayward, 2011). Social support exists in perceived and received forms with numerous sources of provision that mitigate against the stress and strain associated with acute and chronic demands. A form of social support tailored to first-responder culture is CISD (Mitchell, 1983). To those experienced in the delivery of CISD2 it is clearly a social support resource that taps into the cognitive elements of a critical incident and then into the emotional reactions of those present in a non-judgmental setting. Few with such experience would argue that a well-run CISD does not normalize reactions, process aberrant cognitions (e.g., blame, guilt) into an acceptable form, and help to reframe the incident in a way that finds common agreement amongst those present. The availability of several forms of social support throughout a CISD will be self-evident to those present and obvious to those who receive it. From an OH&S perspective an incident that threatens to overwhelm the coping abilities of a team can be addressed during the CISD process by: (1) assessment observing reactions rather than interpreting symptoms; (2) bringing group and individual support based on identified needs amongst trusted peers;3 and (3) ongoing monitoring through follow-ups or data collection to determine recovery, and where required, referral. The environment into which a first responder returns is likely to have a significant impact on their reactions and recovery. Specifically, the notion of a betrayal trauma (MacFarlane, 2018) is associated with punitive work environments. Where emphasis

Occupational health and safety: in crisis, or in charge?  285 is placed more on minimizing organizational risk and defending against litigation than on promoting individual recovery, feelings of shock, disgust, and abandonment can arise. These additional stressors can overlay and compound early feelings of fear, threat, and horror experienced during and soon after the critical incident. Facing blame, denial, and adversarial insurance processes may defend the public reputation of the organization but can act as a secondary trauma that isolates the individual from support provision even where resources have been developed. By definition, a betrayal is not foreseeable and so difficult to prepare for. The state of Tasmania has instigated presumptive legislation that bypasses the adversarial process required to justify support and treatment for PTSD through workers’ compensation. As a betrayal trauma can emerge from the actions of people and organizations, including the employer, it can exert a great impact on the capacity to return to the state of trust and psychological equilibrium required to recover (Commonwealth of Australia, 2019). Given that, a supportive environment may help the first responder harness and build their own affective and cognitive resources that may emerge with enhanced team cohesion where team members draw their own compatible conclusions. Where the acceptance of difficulties, failings, and individual fallibilities occurs, a focus on activities to address them may follow, adding to the perceptions of social support and cohesion. The social support literature is replete with the positive effects of supportive networks and even merely perceiving access to resources may have a direct positive influence on well-being arising from the work environment (Ashforth & Mael, 1989; Paton, 2005). With regard to job-related resources, findings from empirical studies that consider the impact of work-related stressors on mental health and well-being make reference to the positive influence of membership in a cohesive team, also under the umbrella of social support (Brotheridge & Lee, 2002; Mikkelsen et al, 2005; Paton, 2005; Park & Helgeson, 2006). For example, a job environment with extreme emotional demands (e.g., confronting death, horror, and human suffering) that finds the support of colleagues and appreciative supervisors will be more likely to see positive psychological and emotional outcomes for employees (De Jonge & Dormann, 2006). Perceptions of trust, a sense of belonging, and willing cooperation as social resources are associated with reduced stress, burnout, and depression (Burke & Mikkelsen, 2006; Cowman, Ferrari, & Liao-Troth, 2004). If such perceptions infuse camaraderie, they are likely to exert a protective effect against stress (Tuckey & Hayward, 2011). Camaraderie represents feelings of belonging, a common identity, and reciprocated trust. The strong bonds and positive relationships that exist within cohesive work groups (Paton, 2005) suggests the work environment can, to some degree, be regulated by team-based norms of identity, mutual support, and understanding. If camaraderie brings both prevention and intervention processes into the first-responder context, it would appear appropriate to harness these team-based resources to target the threats to well-being whenever it arises (see Tuckey & Hayward, 2011). Group-based interventions such as CISD within an overall program of crisis intervention with delivery by peers seem important. Certainly, the empirically based studies and theoretically informed opinions cited above highlight the

286  Handbook of research on stress and well-being in the public sector necessity for generating resources that go beyond early assessment, intervention, and monitoring by further enhancing camaraderie. In this way, dynamic resource-building can occur within the work environment long before the emergence of attitudes and behaviors that signal disorder. Dynamic and Responsive Social Support The first author (RH) has been carrying out risk assessments, group and individual crisis interventions, and ongoing monitoring of emergency services personnel and firefighters (paid and volunteers) throughout South Australia for over a decade. Having worked closely with peer-support teams as the initial resource in risk assessment, the teams have participated in targeted interventions and ongoing monitoring after critical incidents. Peer support has been employed beyond assessment and support to provide training in crisis reactions, mutual support, and confronting possible suicidality in volunteers throughout the state. The teams were supervised by a well-being coordinator and supported by psychologists who partnered with peer-support teams. Group interventions took place for over two decades, usually to meet a direct request from units and brigades. Usually, peer support is the first contact for personnel who choose to discuss personal difficulties, which demonstrates the protectiveness of social support perceived to be offered through early conversations. Whether through the formality of a group intervention where team camaraderie fosters post-incident processing, or the informality of ‘well-being calls’ as assessments, one-to-one ongoing discussions act as support and are used for monitoring peers. It is clear to both authors that the promotion of well-being and resilience is enhanced by the employment of colleagues trained to address reactions rather than clinicians trained to identify symptoms. Where reactions are successfully addressed it is probable that symptom development will be reduced, with the prospect of minimizing a later mental health diagnosis.

PREVENTION, CURE OR BOTH? TERRORIST ATTACKS AND A LARGE-SCALE FIRE IN LONDON, UK One of the authors (JD) led the crisis response at London’s Metropolitan Police Service (MPS) after large-scale multiple-fatality incidents in 2016 and 2017. Drawing on his experience with New York’s police officers after the 9/11 attacks and from techniques already shown to alleviate distress in emergency services personnel, interventions were used with officers involved in four major incidents in London.4 Although the principle ‘it takes one to know one’ might justify a peer-led approach, work with the police over this period was actually undertaken by firefighters.5 Despite the professional and cultural differences, police officers’ emotional reactions were comfortably met by the firefighters. Personal satisfaction, black humor, and confidence addressing whatever emotional reactions emerged would all have been evident to an observer. In total, around 120 police officers were seen by

Occupational health and safety: in crisis, or in charge?  287 the Nottinghamshire Fire and Rescue Service’s peer-support team. Since then, no officer is reported to have taken sick leave and attributed it to those events. No case of PTSD was reported over a year later. Predictions of 20–30 percent PTSD following terrorism have been cited (Rizzo et al., 2015) raising the prospect that a specialist peer-support approach had prevented PTSD in those likely to succumb. The cultural differences between the police involved, and the firefighters supporting, did not appear to diminish the outcomes. This suggests the intervention itself was of greater importance than who provided it. The events in London were all, by definition, critical incidents. They were addressed by firefighter peer-support teams using critical incident stress debriefings (CISD) with groups, and face-to-face interventions with individual police officers under the supervision of the psychologist (JD). All assessments and interventions were completed within 28 days, the period for ‘watchful waiting’ recommended by mental health experts (e.g., NICE). If, as these outcomes would suggest, peer support is capable of going beyond the prevention of post-traumatic stress to promoting positive developmental outcomes such as resilience and psychological well-being, responsibility for first responders’ mental health can be incorporated into an organization’s existing OH&S framework. With confidence in a program run by peers, administered by OH&S managers, and overseen by open-minded mental health professionals an effective and trusted policy might be constructed and implemented.

CONCLUSION Our decision to promote peer support in the early aftermath of a critical incident places joint responsibility for first responders’ mental health on employees and employers, as demanded by an OH&S framework. Emergency service, disaster response, and deployed military personnel face critical incidents of varying frequency and magnitude, including natural disasters, terrorism, and other situations that threaten their physical and psychological integrity. As direct exposure increases the likelihood of diagnosis with acute stress disorder (ASD; APA, 2013) soon afterwards, and post-traumatic stress disorder (PTSD; APA, 2013) some weeks later, medicalized psychiatric terms such as ‘diagnosis’, ‘symptoms’ and ‘treatment’ are likely. So, while the defining features of ASD and PTSD may be evident, we favor discussing reactions, not symptoms, and recommend exhausting sources of social support before a referral for clinical assessment is made. With conflicting evidence for the benefits of post-incident support in the emergency response field we draw attention to the basis upon which recommendations are made. Clinically derived evidence that underpins expert PTSD management guidelines likely lack ecological validity where findings are generalized from individual hospital patients to anyone employing a debriefing (Bisson et al., 1997; Mayou, Ehlers, & Hobbs, 2000) including first responders. Of some concern is the existence of ecologically valid evidence from psychologists who have personal experience as

288  Handbook of research on stress and well-being in the public sector first responders6 and finding it ignored by guideline authors. It is from such psychologists that key objections have been made (see Adler et al., 2008; Hawker, Durkin, & Hawker, 2011; Tuckey, 2007; Tuckey & Scott, 2014). As clinical authority appears to support PFA, MHFA, and calls for debriefing to be abandoned, the lack of real-world experience may undermine the value of the guidance. Not only do mental health experts support conceptual models such as PFA and MHFA, they also call for a clinical approach to treatment. However, the recent call for innovation after finding that most therapeutic approaches were of limited use to first responders (Barratt et al., 2018) may have already challenged the guidance. While critics of debriefing rely on studies that lack ecological validity, ignore studies that demonstrate it, and then recommend treatments that have limited benefit, a review is surely overdue. The approach we advocate is structured within an OH&S framework based on health and safety law. We argue for reaction-focused crisis intervention being prioritized, the behavioral characteristics of first responders being acknowledged, and social support exhausted before referral for a formal mental health assessment. A health and safety approach does not permit a delay of 28 days before acting because it requires an intervention as soon as a hazard is identified, which would include, therefore, being on scene. The characteristics of first responders we draw attention to are those where the negative aspects of the work are counterbalanced, if not overbalanced, by the unique interpersonal and mutual support available within the first response community. With peer support, a variety of social support processes are in place throughout the initial adjustment period, and certainly within the four-week delay presented in expert guidelines. Job stress theories offer explanatory power for developing capacity to resist the burden of emotional demands (see Demerouti et al., 2001; Karasek & Theorell, 1990) and expose the dynamic interactions between demands, resources, and the environment. In this light, responsibility for managing post-incident emotional reactions can meet cultural, practical, and theoretical standards without resorting to clinical notions of acute stress and subsequent mental disorders. In a peer-support system overseen by qualified occupational health managers, a more comprehensive approach can be taken to mental health needs than the medical model can offer. A peer-led approach will likely strengthen the unique affective bonds common to cohesive, self-identifying teams (Henry, Arrow, & Carini, 1999). Where the delivery of crisis intervention and its inherent social support processes are successful, a return to duty can be expected within the four-week watchful waiting period and obviate the need for formal psychiatric assessment. This is not to dismiss assessment as an option but social support carries none of the complications of a clinical approach such as misdiagnosis, removal from duty, and the side-effects of medication. The prospect that post-traumatic stress symptoms indicate adaptive responses to life-threatening situations (Castro & Adler, 2011) carries a number of implications. Pre-incident education informing first responders that reacting in ways that resemble being mentally ill is to be expected should bring some comfort to those concerned with how they might react during operations. It would also assure them of a rapid

Occupational health and safety: in crisis, or in charge?  289 recovery after the critical incident’s conclusion, the availability of peer support, and confidence in the use of crisis intervention. Knowing that reactions can be confused with symptoms will likely attribute concerns to the situation rather than the individual. Even if responsibility for managing post-incident reactions can be abdicated for four weeks by mental health experts, this is not so for the occupational health manager. Their responsibility covers the preparation, response, and early aftermath periods for all critical incidents, and remains constant thereafter. In the real-world settings referred to above, this OH&S framework should capture the moderating, mediating, and other influential variables that clinical researchers have largely failed to identify by statistically testing symptom development, treatment, and changes over time. Many clinical studies have ignored the impact of psychosocial conditions and mechanisms evident to those in the field. With up to 40 percent of first responders failing to benefit from current treatments (Barratt et al., 2018) there are other factors at play not captured in the research that informs clinical guidelines. Early reactions such as shock, initial coping, and efforts to function could more appropriately be addressed within an OH&S framework where interventions tried and tested in the field are employed. If early crisis intervention can arrest symptom development, see function restored, and obviate the need to follow clinical pathways, the relevance of expert guidelines is questionable. Work stress and demand–resource theories, their empirical research base, and the application of peer-delivered crisis intervention in large-scale critical incidents present compelling alternatives to medicalizing early reactions to a psychological shock. Until guideline authors explain how a 28-day period of watching and waiting is more protective of first responders’ mental health than fulfilling the demands of health and safety law, clinical advice might best be confined to clinical settings. If so, then peers, social support, and the oversight of OH&S professionals emerge as the collective authority for addressing reactions to critical incidents. Interventions that are rapid, targeted, and potentially life-saving better match the ethos of fire, rescue, and emergency work than delayed, clinically informed treatments that could lead to medication. The OH&S framework we describe is seen as practical, resilience-building, and fully compliant with health and safety law. Critical incidents, by definition, imply crisis. Traumatic incidents imply trauma. Crisis is amenable to intervention by trained peers who identify, intervene, and monitor affected colleagues. Trauma is amenable to expert mental health professionals who follow guidelines that delay, isolate, and manage cases. If mental health expertise is overshadowing occupational health experience, it is in crisis. If OH&S managers employ specialist peers to restore their colleagues to duty before the experts act, it will be the experts in crisis, and the occupational health manager in charge. That, according to the law, is how it should be, and we have presented theoretical, empirical, and real-world evidence that it can be done. The landscape of workplace trauma was framed within OH&S law long before expert PTSD guidelines were written. First responders willing to confront the worst of natural and human-made disasters deserve the immediate support and professionalism of their OH&S managers. In return, the manager can expect appreciation from their people and a workforce

290  Handbook of research on stress and well-being in the public sector restored to function well before the psychiatrist reaches for their checklists of mental disorders. It is for the psychiatrist to deal with long-term symptoms, and it is for the OH&S manager to deal with early reactions; the law demands no less.

NOTES 1. 2.

A ‘watch’ is the collective term for a group of firefighters on duty at the same station or base. The author (JD) supported CISDs in post-9/11 New York, led CISDs after London’s 2017 critical incidents, and trains peer-support teams in their application and use. 3. A CISD requires a mental health professional on the team. 4. Croydon tram derailment, Westminster attacks, London Bridge/Borough Market attacks and the Grenfell Tower fire. 5. JD was the psychologist employed to address the psychological reactions of 13 police officers and staff following the Westminster Bridge attacks and the killing of their colleague PC Keith Palmer. 6. Drs. Michelle Tuckey and John Durkin worked in fire and rescue and Dr. Debbie Hawker in humanitarian aid.

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Occupational health and safety: in crisis, or in charge?  291 Deployment psychology: evidence based strategies to promote mental health in the military. Washington, DC: American Psychological Association, pp. 217–242. Cobb, S. (1976), ‘Social support as a moderator of life stress’, Psychosomatic Medicine, 38(5), 300–314. Cohen, S., & Wills, T.A. (1985), ‘Stress, social support, and the buffering hypothesis’, Psychological Bulletin, 98(2), 310–357. Commonwealth of Australia (2019), The people behind 000: mental health of our first responders. The Senate Education and Employment References Committee. Accessed 25 April 2019 at https://​parlinfo​.aph​.gov​.au/​parlInfo/​download/​committees/​reportsen/​024252/​ toc​_pdf/​Thepe​oplebehind000men​talhealthofourfirstresponders​.pdf;fileType​=​application​ %2Fpdf. Cooper, C., Dewe, P.J., & O’Driscoll, M.P. (2001), Organizational stress: a review and critique of theory, research and application. London: Sage Publications. Cowman, S.E., Ferrari, J.R., & Liao-Troth, M. (2004), ‘Mediating effects of social support on firefighters’ sense of community and perceptions of care’, Journal of Community Psychology, 32(2), 121–126. De Jonge, J., & Dormann, C. (2006), ‘Stressors, resources, and strain at work: a longitudinal test of the triple-match principle’, Journal of Applied Psychology, 91, 1359–1374. Demerouti, E., Bakker, A., Nachreiner, F., & Schaufeli, W.B. (2001), ‘The job demand– resources model of burnout’, Journal of Applied Psychology, 86, 499–512. Dieltjens, T., Moonens, I., Van Praet, K., De Buck, E., & Vandekerckhove, P. (2014), ‘A systematic literature search on psychological first aid: lack of evidence to develop guidelines’, PLoS ONE, 9(12). Dollard, M. (2003), ‘Introduction: context, theories and interventions’. In M.F. Dollard, A.H. Winefield, & H.R. Winefield (Eds.), Occupational stress in the service professions. London: Taylor & Francis, pp. 1–42. Everly, G. (2011), Fostering human resilience in crisis. Ellicott City, MD: Chevron Publishing. Giardini, A., & Frese, M. (2006), ‘Reducing the negative effects of emotion work in service occupations: emotional competence as a psychological resource’, Journal of Occupational Health Psychology, 11, 63–75. Hawker, D.M., Durkin, J., & Hawker, D.S. (2011), ‘To debrief or not to debrief our heroes: that is the question’, Clinical Psychology and Psychotherapy, 18(6), 453–463. Henry, K.B., Arrow, H., & Carini, B. (1999), ‘Tripartite model of group identification: theory and measurement’, Small Group Research, 30, 558–581. HM Government (1999), The management of health and safety at work regulations 1999. Accessed 15 April 2019 at http://​www​.legislation​.gov​.uk/​uksi/​1999/​3242/​contents/​made. Hobfoll, S.E., Watson, P., Bell, C.C., Bryant, R.A., Brymer, M.J., Friedman, M.J.,. . .Ursano, R.J. (2007), ‘Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence’, Psychiatry, 70(4), 283–315. Hochschild, A. (1997), The time bind. New York: Henry Holt & Co. Janoff-Bulman, R. (1989), ‘Assumptive worlds and the stress of traumatic events: applications of the schema construct’, Social Cognition, 7(2), 113–136. Karasek, R., & Theorell, T. (1990), ‘The psychosocial work environment’. In R. Karasek, & T. Theorell, Healthy work: stress, productivity, and reconstruction of working life. New York: Basic Books, pp. 31–82. Linley, P.A., & Joseph, S. (2004), ‘Positive change following trauma and adversity: a review’, Journal of Traumatic Stress: Official Publication of the International Society for Traumatic Stress Studies, 17(1), 11–21. Llorens, S., Schaufeli, W., Bakker, A., & Salanova, M. (2007), ‘Does a positive gain spiral of resources, efficacy beliefs and engagement exist?’, Computers in Human Behavior, 23, 825–841.

292  Handbook of research on stress and well-being in the public sector MacFarlane, S. (2018), ‘PTSD and traumatic stress – what we know now’. In P. Barratt, L. Stephens, & M. Palmer, When helping hurts: PTSD in first responders report following a high-level roundtable. Australia 21. Accessed 25 April 2019 at http://​australia21​.org​.au/​ wp​-content/​uploads/​2018/​06/​When​-Helping​-Hurts​-PTSD​-in​-First​-Responders​-WEB​.pdf. Mayou, R.A., Ehlers, A., & Hobbs, M. (2000), ‘Psychological debriefing for road traffic victims: three-year follow-up of a randomised controlled trial’, British Journal of Psychiatry, 176, 589–593. Mental Health First Aid Australia (2019), ‘Welcome to Mental Health First Aid Australia’. Accessed 8 March 2019 at https://​mhfa​.com​.au. Mikkelsen, A., Ogaard, T., & Landsbergis, P. (2005), ‘The effects of new dimensions of psychological job demands and job control on active learning and occupational health’, Work & Stress, 19, 153–175. Mitchell, J. (1983), ‘When disaster strikes. . .the critical incident stress debriefing process’, Journal of Emergency Medical Services, 13(11), 36–39. Mitchell, J. (2016), Critical incident stress management (CISM): group crisis intervention. Ellicott City, MD: Chevron Publishing. National Institute for Health and Care Excellence (NICE) (2005), Post-traumatic stress disorder NICE guideline. (NICE guideline CG26). London and Leicester, UK: Gaskell and the British Psychological Society. National Institute for Health and Care Excellence (NICE) (2018), Post-traumatic stress disorder NICE guideline (NICE guideline NG116). London: NICE. Accessed 8 February 2019 at https://​www​.nice​.org​.uk/​guidance/​ng116/​resources/​posttraumatic​-stress​-disorder​ -pdf​-66141601777861. Park, C.L., & Helgeson, V.S. (2006), ‘Introduction to the special section: growth following highly stressful life events – current status and future directions’, Journal of Consulting and Clinical Psychology, 74, 791–796. Paton, D. (2005), ‘Posttraumatic growth in protective services professionals: individual, cognitive and organizational influences’, Traumatology, 11, 335–346. Phoenix Australia – Centre for Posttraumatic Mental Health (2013), Australian guidelines for the treatment of acute stress disorder & posttraumatic stress disorder. Accessed 25 April 2019 at www​.phoenixaustralia​.org/​wp​-content/​uploads/​2015/​03/​Phoenix​-ASD​ -PTSD​-Guidelines​.pdf. Rizzo, A., Cukor, J., Gerardi, M., Alley, S., Reist, C., Roy, M.,. . .Difede, J. (2015), ‘Virtual reality exposure for PTSD due to military combat and terrorist attacks’, Journal of Contemporary Psychotherapy, 45(4), 255–264. Ryan, R.M., & Deci, E.L. (1995), ‘Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being’, American Psychologist, 55, 68–78. Shakespeare-Finch, J., Smith, S., & Obst, P. (2002), ‘Trauma, coping resources, and family functioning in emergency services personnel: a comparative study’, Work & Stress, 16, 275–282. South Australian Government (2012), South Australia Work Health and Safety Act 2012. Accessed 25 April 2019 at https://​www​.legislation​.sa​.gov​.au/​LZ/​C/​A/​WORK​%20HEALTH​ %20AND​%20SAFETY​%20ACT​%202012/​CURRENT/​2012​.40​.AUTH​.PDF. Tedeschi, R.G., & Calhoun, L. (2004), ‘Posttraumatic growth: a new perspective on psychotraumatology’, Psychiatric Times, 21(4), 1 April. Accessed 11 July 2019 at https://​www​ .psychiatrictimes​.com/​ptsd/​posttraumatic​-growth​-new​-perspective​-psychotraumatology. Tuckey, M.R. (2007), ‘Issues in the debriefing debate for emergency services: moving research outcomes forward’, Clinical Psychology: Science and Practice, 14(2), 106–117. Tuckey, M.R., & Hayward, R. (2011), ‘Global and occupational-specific emotional resources as buffers against the emotional demands of fire-fighting’, Applied Psychology, 60(1), 1–23.

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20. Stress in Australian universities: initiatives to enhance well-being Silvia Pignata1

INTRODUCTION Job stress is a significant issue, with a wide range of negative health, social, and economic impacts. Job-related stress is defined as ‘the adverse reaction people [at work] have to excessive pressure or other types of demand placed on them’ (Health Safety Executive, 2007, p. 7). It is an increasing challenge in workplaces globally (Mucci et al., 2016), and impacts adversely on worker health and organizational performance (Leiter, Bakker, & Maslach, 2014). A recent SafeWork Australia report found that ‘workers with psychological distress took four times as many sick days per month and had a 154 percent higher performance loss at work’ than their non-distressed counterparts, each adding an average extra cost to employers of AU$6309 per year (Becher & Dollard, 2016, p. 5). These authors also estimated that depression among employees cost Australian employers AU$6.3 billion per annum in lost productivity. The prevalence and impact of job-related stress outside of work is also high, as a national survey by the Australian Psychological Society (2014, p. 4) reported that 44 percent of 1553 Australian workers cite workplace issues as a source of stress and 48 percent cite work demands in the last year as barriers to a healthy lifestyle. Large costs to the economy associated with poor mental health indicate an urgent need to address job-related stress to promote better health outcomes in national and international communities. It is important for management to take steps to reduce the organizational work factors and interpersonal relationships in the work setting that may adversely affect the health of workers. To control psychosocial risk factors, management can implement stress management interventions to create supportive physical, social, and work environments to promote staff well-being (Pignata, Biron, & Dollard, 2014). A stress management intervention is ‘any activity, program, or opportunity initiated by an organization, which focuses on reducing the presence of job-related stressors or on assisting individuals to minimize the negative outcomes of exposure to these stressors’ (Ivancevich et al., 1990, p. 252). Interventions are classified into primary, secondary, and tertiary strategies that eliminate or reduce stress, reduce or eliminate the effects of stress, and treat those with stress-related issues, respectively (see Pignata et al., 2014). It would be intuitive to think that most intervention strategies would aim to eliminate stress, but there is a lack of evidence-based primary prevention strategies (e.g., workload management), as the majority of known interventions are focused on the secondary and tertiary levels. 294

Stress in Australian universities: initiatives to enhance well-being  295 This chapter provides an overview of job-related stress in universities across the globe and then examines the current context in Australian universities. The chapter then synthesizes longitudinal (research repeated on the same sample) and cross-sectional (research involving one sample at a given point in time) stress research at both the organizational and individual level, including changes that workers make themselves in order to reduce stress. At the organizational level, the chapter discusses initiatives taken by university management to enhance health, well-being, and morale. Such interventions are of interest to the community as well as governments, employers and managers in public and private sectors, unions, and other stakeholders. Finally, the chapter examines the implications of existing research and suggests multiple avenues for future research.

THE UNIVERSITY SECTOR Over the last decade, levels of psychological strain (stress) have increased in the university sector, hand in hand with increased workloads and work pace, reduced managerial and collegial support, increased competition, workforce casualization, and technological changes (Biron, Brun, & Ivers, 2008; Catano et al., 2010; Coetzee & Rothmann, 2005; Kinman & Court, 2010; Kinman & Wray, 2014; Liu, Spector, & Shi, 2008; Williams, Thomas, & Smith, 2017). In comparison to workers in other industries, Kinman and Wray (2014) report that employees at higher education institutions in the UK are at greater risk for mental health problems. The excessive pressure felt by some academics is shown by the increasing number of UK academics accessing university counseling services (Richardson, 2019). A modern academic’s role shows persistent and growing work demands (e.g., trimester teaching, more offshore deliveries) and complexity, such as those associated with new pedagogical methods changing the concept of what is done in the classroom and what is done off-campus (i.e., blended learning approaches, virtual classrooms). The unrealistic expectations placed on academics to excel in the individualistic and multiple domains of academic work do not reflect a sustainable model of academic careers (Bal et al., 2019). Therefore, it is surprising that a systematic review of university setting-based interventions to promote mental health found that most mental health promotion interventions at universities did not target employees but focused on students and modifying how they were taught and assessed (see Fernandez et al., 2016). Indeed, the paucity of interventions focused on university employees prevented the authors from making any recommendations. Universities can be characterized as intensive work systems with increasing demands for productivity whilst dealing with reducing job resources (de Jonge, Peeters, & Taris, 2019). From an international perspective, a recent manifesto (Bal et al., 2019, pp. 289–290) by 33 work and organizational scholars calls for work and organizational psychologists to take a central and proactive role in responding to the mental health crisis in academia. Bal and colleagues (2019, p. 291) discuss the current pressure on academics in European countries, the UK, and the US to achieve

296  Handbook of research on stress and well-being in the public sector unattainable standards and ‘be the perfect academic’ who excels in every area at the expense of personal health and well-being. With regard to personal excellence, research has shown that workers who work the hardest to reach their internal and professional goals and ideals may suffer negative health consequences, such as burnout, which causes them to fall short of their ideals (see Rose et al., 1978, cited in Samra, 2018). Moreover, Bal et al. (2019, p. 291) argue that institutional initiatives for ‘better data management, blended learning, research ethics…imply a moral obligation for academics to carry out more tasks, and to spend more time on research, teaching, scientific communication, impact generation, writing funding applications, public engagement, citizenship and so on, with limited available resources (Ogbonna & Harris, 2004)’ that compromise their work–life balance. In addition, their multiple and diverse roles (which also comprise administrative duties) can cause role conflict, which has been linked to high levels of job dissatisfaction and anxiety (Sonnentag & Frese, 2003). Bal et al. (2019) recommend ten short-term and long-term practices at individual, organizational-systemic, and societal levels for the sustainable future of academics (see pp. 289–290). The authors argue that academics and work and organizational psychologists have responsibilities towards: ●● individuals to focus on well-being; ●● protecting their own well-being due to ‘the enormous workload and pressure in academia…in the midst of the mental health crisis in academia’; ●● reducing inequality by protecting academics who do not have job security; ●● the community to share experiences and ‘show active solidarity’; ●● supervisors and managers to place well-being at the core of management and organize work to protect the health of (academic) employees; ●● how work is organized in universities, as quantitative output indicators are detrimental to scientific progress; ●● how the publication system is organized and redesigning ‘the competitive “publish-or-perish”, publication system and business model that operates on the basis of using unpaid academic labor, and create better ways to communicate about our research to the scientific and non-scientific community’ (p. 289); ●● how financing is organized by reducing the reliance on competitive grants to finance academics’ work; ●● society and how academics’ work and research impacts societal interests; ●● students and sharing an open dialogue to benefit their learning, well-being, and ability to become responsible citizens. The authors highlight the crucial need to change the working culture of universities, particularly for academics, and clearly define ‘what a healthy, dignified and reasonable job in academia looks like’ (p. 291). After looking at the state of academia at an international level, this chapter will now focus on well-being and stress in workers in the Australian context.

Stress in Australian universities: initiatives to enhance well-being  297

AUSTRALIAN UNIVERSITIES Australia’s 37 public universities receive funding from the Australian Government, and as not-for-profit organizations they reinvest their surplus funds into higher education and research (Universities Australia, 2017). The sector is an important context in which to study increasing levels of job-related stress, as it is of great significance to Australia’s economy and directly boosts jobs and wages. For example, in the financial year to June 2018, international students (secondary and tertiary) injected $31.9 billion into Australia’s economy, with the majority of 548 000 international students enrolled in Australian universities (Universities Australia, 2018a). Therefore, it is crucial that the sector thrives, as universities generate benefits on the local, national, and global scale. For example, universities deliver high-quality research and teaching to over one million enrolled students to equip them with the knowledge and skills to contribute to society. Academics make a vital contribution to the national innovation and science agenda by generating and disseminating knowledge that enhances productivity and improves living standards (Deloitte Access Economics, 2015). The escalation of job-related stress in the Australian higher education sector due to increased competitiveness, measures of research performance, technological advances, reduced and demand-driven funding opportunities, and reduced government financial support are highlighted in several publications (see Gillespie et al., 2001; Pignata et al., 2018). Job stress research undertaken in 2000–04 by Winefield and colleagues in Australian universities showed improvements in organizational commitment, work pressure, job insecurity, job involvement, autonomy, perceived procedural justice, and trust in senior management (Winefield et al., 2008). However, there was a deterioration in levels of psychological strain and work–home conflict. Therefore there is a clear need to provide deeper insights into those issues and for the first time, explore top-down factors like organizational climate (so-called psychosocial safety climate [PSC]), and the experiences of all university workers, which may assist policy development both in universities and other complex and intensive organizations. Psychosocial Safety Climate Although there is evidence of stress levels in Australian university staff, the extent of the problem that stems from the PSC regarding the psychological health of workers is not known. As PSC refers to the organizational climate and concern for worker psychological health, it is engendered by senior managers supplying adequate resources such as social support and control and enabling the use of such resources (Dollard & Bakker, 2010). Shared perceptions of policies, practices, and procedures that impact psychological health give rise to PSC at organizational or team levels. Since PSC is a predictor of psychosocial risks it is referred to as a ‘cause of the causes’ of job stress, and senior management play a pivotal role in setting the cultural tone. According to theory, PSC is positively linked to worker engagement and psychological well-being (Dollard, Tuckey, & Dormann, 2012) via job design (at the levels of demands and

298  Handbook of research on stress and well-being in the public sector resources). In accordance to strategic human resource (HR) management theory, jobs are designed in harmony with management strategy (Morgeson, Dierdorff, & Hmurovic, 2010) so it is important to understand the concern for worker psychological health (Dollard & Bakker, 2010), or what causes HR management to intervene, or what university policies say about workloads and expectations, and their effect on staff health and well-being. Understanding and increasing PSC levels and reducing the negative aspects of workloads should yield benefits for employees and organizations by creating more productive (and less absenteeism and presenteeism) time to achieve substantive work goals. There is a need for empirical evidence of the current levels of PSC experienced by workers across universities that can be compared against national surveillance standards. Using national benchmarks, in universities with high PSC (≥ 41), it is expected that daily job demands and boundary intrusions will not be as detrimental to health as they are in low PSC contexts because of resource availability and use. On the other hand, low PSC (< 37) predicts job strain and poor worker mental health, and low levels of PSC cost Australian employers an estimated $6 billion annually (Becher & Dollard, 2016). Job Demands–Resources Theory As PSC is a precursor to working conditions, theoretical frameworks such as the extended job demands–resources (JD–R) model (Bakker & Demerouti, 2017) can assist in understanding stress. The main tenets of the JD–R model are two psychological processes: (1) the health erosion process, whereby high job demands (physical, psychological, social, or organizational) lead to strain and health impairments; and (2) the motivation process, whereby abundant job resources (physical, psychological, social, or organizational) are instrumental in achieving work goals and are intrinsically motivating. Increased motivation in turn leads to higher productivity (Bakker & Demerouti, 2017). There are also potentially ‘bottom-up’ influences on the JD–R model. For example, in an investigation of a university’s stress reduction strategies, Pignata et al. (2017, p. 7) found that some strategies reported by staff were not directly due to university initiatives but ‘focused on changes made by employees themselves’ – which they attributed to ‘positive’ strategies such as increased personal growth and strengthened psychological resources. This finding supports research by Xanthopoulou et al. (2007) on the role of personal resources in the JD–R model as employees reported being able to activate their own resources to cope with stress and reduce its effects, as they reported an improved positive outlook, increased self-esteem, and greater confidence in their ability to manage stress. As explained in conservation of resources (COR) theory (Hobfoll, 1989), stress occurs as individuals strive to build and protect their resources (i.e., social conditions, energy), when their resources are lost, resources are threatened with loss, or if individuals fail to replenish resources after a significant investment. Therefore, it is important to examine coping mechanisms in dealing with job-related stress – which can be linked to job crafting,

Stress in Australian universities: initiatives to enhance well-being  299 a new concept in JD–R theory, where employees attempt to modify demands (e.g., seeking the challenges of a new project) and resources (e.g., asking for feedback) inherent in their job (Bakker & Demerouti, 2017; Tims, Bakker, & Derks, 2015). Job crafting may provide practical skills to knowledge workers in university and various employment settings to improve their own outcomes. Academic Culture The data-led surveillance of teaching performance and research outputs coupled with resource constraints, demonstrate the clear need for mechanisms to change academic culture. It is not surprising that the attractiveness of an academic career is diminishing for Australian academics (Hugo & Morriss, 2010). A comparative analysis of 25 countries (Coates et al., 2009, p. 18) on the attractiveness of academia found that ‘Australian academics were among the most likely to have taken steps towards an academic position in another country (30.9%)’ and 28.2 percent reported that they had sought a position outside the sector. Academics who work in healthy and sustainable environments and feel engaged in their work can impact student engagement and the provision of high-quality teaching and research. As the recruitment and retention of high-quality academic staff has been identified as an important issue (Bradley et al., 2008), and given the Australian Government’s decision to cut funding to universities so that it no longer rises in line with inflation (Universities Australia, 2018b), multilevel research is crucial to address the root causes of stress and enhance academics’ well-being. Research in the Australian Context Pignata and colleagues (2014; Pignata, Boyd et al., 2016, 2017; Pignata, Winefield et al., 2016a, 2016b, 2018) used a combination of quantitative and qualitative data and longitudinal and cross-sectional analyses to investigate relationships between stress interventions (such as perceived organizational support [POS]) and university employees’ levels of psychological strain and positive work attitudes (including perceptions of procedural justice). The researchers also looked at the relationship between POS and organizational tenure and occupational group. Their work provides an insight into the types and effectiveness of organizational stress reduction interventions implemented at universities from an employee’s perspective. The following sections review this research. Perceived organizational support Within the social exchange process, there is a reciprocal tendency for individuals to respond positively to the valued resources that they receive from others. By using the social exchange model of POS, Pignata, Boyd et al. (2016) viewed positive employee perceptions of interventions as an aspect of POS, as the organization’s policies regarding the treatment of employees signals the extent to which the organization cares about their welfare (Gillespie & Dietz, 2009; Kraimer & Wayne, 2004).

300  Handbook of research on stress and well-being in the public sector In a two-wave longitudinal study of 869 employees from 13 universities, Pignata and colleagues (2016) revealed that employees who reported that interventions had been undertaken scored lower on psychological strain and higher on job satisfaction and affective commitment to the organization than those who did not perceive the measures. The key finding was that awareness of stress interventions in and of itself was predictive of beneficial employee outcomes. Thus, employees who feel valued and believe that the organization supports them by implementing strategies to reduce stress may have increased their trust in senior management or perceived the organization’s ‘policies and practices as fair. In return, employees may have responded with greater organizational commitment and job satisfaction and/or a reduced level of psychological strain’ (p. 241). A possible implication is that organizations should also focus on communicating awareness of the HR strategies as well as putting them in place, given that robust HR systems have salient HR practices that are communicated strongly to employees (Ostroff & Bowen, 2000). Research should explore the employee experience of HR management practices (Boselie, Dietz, & Boon, 2005) in order to answer the ensuing question, is it just the awareness of the interventions that is achieved or does it increase the positive impact of the interventions? POS and employee tenure and staff type To extend the above research in a sample of 945 employees, Pignata, Winefield et al. (2016a) explored the role of staff group (academic or non-academic) and tenure in relation to POS and positive employee outcomes. Differences in groups with three lengths of tenure were identified and it was found that employees with intermediate levels of tenure (6–19 years) held more positive perceptions of their university in terms of organizational support, job satisfaction, trust, and commitment than those with either a shorter or longer tenure. For non-academic employees, awareness of interventions predicted job satisfaction, affective organizational commitment, trust in senior management, and perceived procedural justice. The results highlight the contextual factors in intervention strategies. Findings suggest that university management may need to implement new strategies and/or promote existing stress management or reduction strategies to specific target groups such as academic employees, and employees who are either new to the university or those who have been working for the organization for longer periods of time, to ensure that they are aware of organizational strategies to promote employee well-being and morale within their work environment. Procedural justice Research supports the use of the JD–R theoretical framework (Bakker & Demerouti, 2017) to understand stress as it combines a range of job demands and resources. Psychosocial theories of fairness and justice are relevant to understanding job stress (Peiró, 2008) and procedural justice has an ethical component due to the mutual exchange in the psychological contract between employee and employer. As employee perceptions of procedural justice help to shape the employee–employer relationship, Pignata, Winefield and colleagues (2016b) employed a longitudinal

Stress in Australian universities: initiatives to enhance well-being  301 design comprising 945 employees from 13 universities to investigate the predictors of perceived justice. The researchers found that job satisfaction was the strongest predictor of perceived justice for university employees: the more satisfied employees were with their jobs, the higher their perceptions of procedural justice. The authors suggest that strategies for enhancing employee perceptions of procedural justice may involve greater transparency and employee voice and participation, and clearer communication of the procedures to employees. Moreover, in a longitudinal study of the same sample, Boyd et al. (2011) found that a combination of procedural justice and autonomy was associated with higher levels of organizational commitment and lower levels of psychological distress. Organizational intervention strategies To answer a call for the content of stress reduction strategies to be evaluated in order to assess their effectiveness on employee well-being and positive work attitudes, Pignata and colleagues (2018) presented a multicase qualitative study of HR management in five universities to show the key HR well-being interventions implemented by senior university management over a three-year period. The research applied the JD–R theoretical framework, by viewing HR intervention strategies as increased organizational resources that have the potential to reduce job demands and the associated physiological and psychological costs, or aid in achieving work goals. At the organizational level, the key interventions aimed to: ●● ●● ●● ●●

enhance training, career development, and promotional opportunities; improve remuneration and recognition practices; enhance the fairness of organizational policies and procedures; improve work–life balance.

The reported strategies were mainly proactive (primary) organizational strategies to eliminate, reduce, and/or alter job-related stressors. A notable finding was that management at each of the five universities implemented numerous multilevel stress intervention strategies targeted at the individual, organizational, and individual–organization interface level. Indeed, the total number of HR interventions implemented at each university during this period ranged from 37 to 51 strategies, which suggests a targeted focus by all five universities to improve university work environments. It can be speculated that those increased or additional resources may have assisted employees to achieve substantive work goals and/or reduce job demands and may have indirectly influenced organizational productivity through employee perceptions of job resources and job satisfaction. Pignata and colleagues (2018) also identified the types of initiatives that were prioritized by HR management. They found that interventions to enhance leadership skills were a key focus for three universities as they implemented leadership development and management skills programs to enhance the capacity of leaders, particularly heads of departments, to manage employees.

302  Handbook of research on stress and well-being in the public sector Individual strategies At the individual level, commentary from a cross-sectional qualitative study of 419 tenured and contract university staff (115 academic, 304 non-academic) from 13 universities showed that key perceived causes of decreased stress levels were changes in job or work role; new head of department/supervisor/manager; the use of specific stress reduction and/or management intervention strategies; increases in staff numbers and/or resources; and personal resources in terms of coping strategies or attitudes (see Pignata et al., 2017). Intervention strategies may have played extrinsic motivational roles in helping employees to achieve work goals and reduce job demands (i.e., increased job security, improved management supervision, increased performance feedback). The strategies may also have played intrinsic motivational roles in helping to achieve work goals and reduce job demands (i.e., increased recognition, greater role clarity). Some of those individual strategies can be attributed to increased personal growth and strengthened psychological resources or to the use of ‘negative’ or protective strategies that may reduce their work performance in the long term. Forty-one participants (10 percent of the sample) reported using coping mechanisms to reduce their personal levels of stress. For example, in terms of ‘positive’ strategies, 8 percent reported increased personal growth or strengthened psychological resources with commentary such as ‘Learnt not to take it personally when I miss out on a competitive research grant’; ‘I’ve become more relaxed’. Others attempted to conserve and protect their resources, for example: ‘Mainly due to changes in my own attitude…I’m now more realistic about what I can do’. These statements appear to refer to employees reappraising their attitudes and placing lower demands upon themselves as a means of coping with existing conditions, almost as a means of emotion regulation. However, a small percentage of the sample reported using negative or protective strategies including not caring: ‘I don’t care so much about the University. I have stopped worrying about the University and I’ve stopped identifying with it’ or ‘I have deliberately chosen not to seek promotion and to avoid certain work, e.g., subject co-ordination which has caused me considerable stress in the past’. Others decided to work less, which may suggest that they had become disengaged or detached, which can lead to reduced work performance: ‘I work less and go home regardless’; ‘I have adopted a personal approach of “stuff it” to try to gain more control and more self-respect for my efforts’ (see Pignata et al., 2017).

IMPLICATIONS AND FUTURE RESEARCH Much research in the job stress field is single-source perceptual data, which may yield unverified data. As most research is cross-sectional, it limits the capacity to draw conclusions about causality, so there is a need to use longitudinal repeated measures designs, multilevel conceptualizations, and measurements and analyses combining organizational- and individual-level effects. Theory and evidence regard-

Stress in Australian universities: initiatives to enhance well-being  303 ing investigations of job stress in universities is incomplete in several significant ways as they do not clarify why stressful jobs are designed in the first place and do not probe a fundamental problem of work stress potentially being a conflict between managerial pressure for increased productivity and natural human capacity limits. Multilevel research should move beyond single-level job design theories to a multilevel framework by integrating policy level influences (i.e., PSC) with the latest advances in JD–R theory – enhancing its assessment of organizational factors – and exploring how job demands and resources relate to individual factors such as vitality, fatigue, and recovery. Research needs to advance our knowledge of these processes and explore the potential for workers to proactively make changes themselves to manage their job demands and increase their job resources. As universities are large and dynamic institutions (Coates & Goedegebuure, 2010), evaluative research on job-related stress is needed at the institutional and sector levels to address new and emerging psychosocial risks (e.g., rapidly increasing e-communications) within complex public service organizations. Studies suggest a positive association between email use and job burnout (e.g., Reinke & Chamorro-Premuzic, 2014) but little is known about the structural elements of organizations (protocols, practices, norms) related to the online and digital aspects of university activities, and an ‘always on’ culture. For example, in Pignata et al.’s (2015) qualitative investigation of email use among 251 staff in one university, 65 percent of those surveyed reported that email traffic (including bulk and unnecessary student emails) generated job stress, while 14 percent reported the need for standardized protocols and training. Communications protocols and approaches to email use may need to regulate: (1) their length so that they are no longer than a text message; (2) their delivery so that they are only delivered during working hours; (3) response timeframes; and (4) their language or writing style as the current informal language/ style of some emails may be interpreted as ambiguous, unprofessional, or even harsh. Such approaches and workloads need to be redesigned with the active participation of the workforce to be successful in developing healthier and safer workplaces. Approaches to improving systems and policies should include strategies and interventions at the individual, team, and organizational levels, with training across the entire organization and with accompanying management support (see Samra, 2018). Research is needed on the strategies used by academics, non-academic staff, and HR management to manage workload. A strong body of evidence suggests that policies are integral to safe climates that directly affect health and productivity (Guediri & Griffin, 2016), so there is a need for research to solicit input from university workers to formalize and define their concerns and address deficits in existing HR management policies. A top-down and bottom-up process will create communication both horizontally and vertically upwards and downwards to develop strategic processes to enhance HR policies (e.g., workload levels) that can only benefit universities and other industries in terms of more satisfied and productive staff. Well-being initiatives taken by management are of interest to the community, governments, employers, and unions. The key implications of the research discussed in this chapter are: (1) the need for a diverse and multilevel focus on stress prevention/

304  Handbook of research on stress and well-being in the public sector management within organizations; (2) improving relationships between employees and heads of schools/departments; and (3) promoting organizational stress and well-being interventions to staff, as awareness of interventions is predictive of positive employee attitudes.

CONCLUSION It is important to examine the discrete context in which employees are working so there is a need to acknowledge process issues in job stress. Universities are ideally placed to promote public health approaches that can reach a large population of both staff and students. Research in the university sector has translational importance for other Australian workers, particularly sectors that employ knowledge workers, so that best practices can be implemented. Expected performance improvements include defining staff concerns, addressing deficits in existing work policies, and creating proactive and strategic risk management policies that can result in more satisfied and productive staff. But before modifying policy and practices, research first needs to assess the workplace climate that gives rise to stress levels, to identify the leading indicators. Enhancing employee well-being is a lever to improving work settings within universities. Supportive interpersonal relationships with supervisors and colleagues appear to be a salient factor in reducing stress and enhancing employee well-being. In summary, research points to the importance of multiple and diverse organizational strategies to enhance the health and positive work attitudes of employees in the Australian university sector; the findings may inform organizational policy on improving and sustaining worker health and well-being within universities at national and international levels.

NOTE 1. The author thanks adjunct Associate Professor Tony Pooley and Dr. Carolyn Boyd for their insightful contributions and assistance in editing this chapter.

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Index

absence management 21, 263, 264 academic careers 295, 299 academic culture 299 academic employees benchmarking approach 154 implications of findings 157–9 interventions 160–61 management standard approach 154–6 work-related stress in 152–4 academics in European countries 295–6 accurate self-assessment 255–6 ACEs see adverse childhood experiences (ACEs) achievement orientation 255–6 action-regulation theory 205 activation 123–4 active learning elements 206 acute stress disorder (ASD) 172, 276, 287 Adams, K. L. 111 adaptive performance 203–5, 208 definition of 201 demand for 200 effectiveness of 200 highlighting errors on 206 positive effects on 205–6 Adib, S. M. 91 adverse childhood experiences (ACEs) 59 AET see affective events theory (AET) affective events theory (AET) 109 aging in Europe 174–5 in Italy 174–5 in workplace 175–6 Ahrens, B.L. 191–2 alcohol 58, 64, 66, 84, 95, 144, 233, 265 Alderson, M. 108 Al-Omari, H. 96 American Association of Critical-Care Nurses (AACN) 222 Amigo, I. 175 AMOS 41 function in 50 structural equation modeling in 49 amotivation 76, 79, 81–2 An, Y. 90 Andrews, M. E. 90

Angood, P. 241 anti-bullying interventions 23 anti-intrusion systems 176 anxiety 296 depression and 152 Aquino, K. 89, 93, 95, 96 Arcangeli, G. 167–8, 175 Aristotle 126 ASD see acute stress disorder (ASD) Ashforth, B.E. 107 Ashkanasy, N.M. 106, 109, 110, 112, 114, 131 ‘five level model of emotion in organizations’ 106, 109 asset-focused processes 185 ASSET screening tool 154 Australia 279 psychosocial factors in 37 work environments in 33 Australian universities, stress in 294–5 academic culture 299 implications and future research 302–4 individual strategies 302 job demands–resources theory 298–9 organizational intervention strategies 301 perceived organizational support 299–300 POS and employee tenure and staff type 300 procedural justice 300–301 psychosocial safety climate 297–8 research in Australian context 299 university sector 295–6 working culture of 296 Australian Workplace Barometer (AWB) project 35–7 prior analysis of 37–8 authentic leadership 115, 222, 249 importance of 223 autonomy 77, 158, 242, 250–51, 301 and competence 82 decision-making 83 degree of 76–7 in firefighting 78–9 gradual erosion of 161 importance of 162 and professional identity 159

309

310  Handbook of research on stress and well-being in the public sector avoidance 64, 66, 95, 172, 270 AWB project see Australian Workplace Barometer (AWB) project Bailey, T.S. 37, 38, 42, 51 Bakker A.B. 34, 35, 40, 123–5, 128, 144, 162, 282, 294, 297–300 Bal, P. M. 295–6 BAME backgrounds see Black, Asian and Minority Ethnic (BAME) backgrounds bank employees 167–8, 175, 176 stress on 176 work-related stress of 176 banking sector 169 Italian see Italian banking sector level of stress in 176 Barwell, F. 235, 243 Beehr, M. 234 Beehr, T. A. 93, 96 Bell, B. 206 Bergen-Cico D. 59, 62, 64, 66, 68 Beutell, N. J. 143 Bevan, A. 140, 141 Birks, M. 90, 92 Biron, C. 81, 152–3, 294–5 Black, Asian and Minority Ethnic (BAME) backgrounds 143 Blue Light Well-being Framework (BLWF) 260, 261, 263–4 BLWF see Blue Light Well-being Framework (BLWF) Bockorny, K. 194 Bohmer, R. 240 Bolton, S. C. 114 Boucher, C. 112–13 boundary-spanning theory 113, 114 Bowers, L. 99 Bowling, N. A. 93, 96 Boyd, C.M. 162, 299, 301 bullying 15, 90, 92 workplace 39, 44, 92 Burke, R.J. 8, 10–11, 217 burnout 124, 138 syndrome 167, 168 Camerino, D. 97 Campbell, J. C. 91, 92, 96 CDMs see clinical decision-making models (CDMs) certified nursing assistants (CNAs) 98 Che, X.X. 88

child protection 266 Childs, M. 74 chronic demands 282, 284 CISD see critical incident stress debriefing (CISD) Civility, Respect, and Engagement in the Workplace (CREW) 99 Clarke, N. 243 Clements, A.J. 137–8, 140, 155 clinical decision-making models (CDMs) 108 CNAs see certified nursing assistants (CNAs) cognitive ability 204 cognitive appraisal 184, 283 cognitive judgment 109 cognitive resources 183, 285 Cohen, J. 41 cohesion 77, 80–82, 84, 176, 237, 285 collaborative culture 249, 251 and social support 252 collective bargaining 11, 15, 20–22 purpose of 20 collective efficacy 184, 187 collective initiatives 24 collective resilience 188, 193 collective strategies, forms of 23 collective workplace campaigning 23 compassion 106 empathy and 110 competence 9, 76, 79, 237 appraisals of 283 autonomy and 82 in firefighting 77 impact on 82 leadership 241 sense of 83, 241 confidence 185 conflict-based model 17 conscientiousness 204 consensual pluralist model 18 conservation of resources (COR) theory 298 ‘consumer-driven’ approach 157 continuous training 187 Cooper, C.L. 4, 5, 11, 220, 235, 260, 263, 268, 282 coping 139, 234, 276–7 capacity 237 with chronic job demands 34 mechanisms 302 problem-focused 142 skills 145, 266 task-focused 142

Index  311 COR theory see conservation of resources (COR) theory Craig, L. 189 creating team 252–3 CREW see Civility, Respect, and Engagement in the Workplace (CREW) crimes 63 critical incidents cognitive demands of 280 consequence of 282 emotional demands of 280 immediate aftermath of 281 critical incident stress debriefing (CISD) 276, 284, 287 abandonment of 277 emotional reactions 276–7 process 284 psychosocial dynamics of 276 Cropanzano, R. 109 Crossan, M. M. 200–203 culture 216–17 of development 257 health and safety research and public sector 217–19 health care via transformational leadership 223–4 safety 220–21 in health care setting 221–2 in hospital settings 222–3 data analyses 41–2 data collection 157 De Jonge, J. 285, 295 de Waal, A. A. 9 decision-making autonomy, stimulating 83 declarative knowledge 206 demand-control-support model 284 Demerouti, E. 34, 35, 124, 162, 208, 281–2, 284, 288, 298–300 depression 41, 46, 59, 74, 93 anger and 35 and anxiety 152 concomitant reductions in 66 degrees of 58 rates of 37, 59, 63 symptoms of 266 Diagnostic and Statistical Manual of Mental Disorders (DSM) 174 Diefendorff, J. M. 108, 109 disorder-in-the-making 280 distributed leadership 242

diurnal cortisol levels 68 Dollard, M.F. 10, 29, 34–5, 37–8, 42, 142, 284, 294, 297 domestic violence 266, 270 Dowden, C. 139 Dugan, A. G. 145, 146 Durkin, J. 288 dynamic operational options 281 dynamic resource-building 286 dynamic social support 286 earthquakes 58, 59 efficacy 183, 185 effort–reward imbalance model 158 Effort–Reward Imbalance scale (ERI) 40 EI see emotional intelligence (EI) election-related violence 65 emergency medical personnel (EMPs) 60 emergency medical services (EMSs) 58, 60–62 emergency medical technicians (EMTs) 58, 60 occupational hazards for 61 emergency responder resources 260 emergency services responders (ESRs) 260–62, 264, 267 activities 265 communities 260–61 environment in 264 experience of working in 268 flashbacks for 264 emergency service work 271, 275 emotional distress 108, 110, 111 adverse effects of 106 result in 110 risk of 106, 111 emotional engagement 106–9, 111, 115 demands of 111 emotional exhaustion 7, 35, 40, 124–5, 143–5, 152, 168, 222, 249 levels of 51 emotional experiences 127–8 emotional intelligence (EI) 110, 111, 122–3, 126, 253 as ability 126–7 competencies 254, 255 concept of 111 definition of 110 demands 124–5 downsides of 131–2 and emotional labor 125, 129–30 for employees 123 enacted approach 127–8 flavors of emotions 123

312  Handbook of research on stress and well-being in the public sector four-branch model of 126 and job performance 131 leadership 253 physical and mental health 122–3 Rotterdam Emotional Intelligence Scale (REIS) 129 self- and other-focused 128–9 as trait 127 value of 114–15 and well-being of employee 130 work-related well-being 123–4 emotional interaction, management of 112, 115 emotional labor 34, 107, 108, 112–13, 125, 129–30 defined 111 effects of 108 longer-term effect of 113 performance of 112 recognition of 110 strategies 129–30 emotion/emotional control 208 dissonance 125 flavors of 123 influence 122 medicalization of 276–7 numbing 64, 66 quotient (EQ) 126 reactions 94, 143, 284, 286, 288 regulation 113 resources 283 self-awareness 255–6 stability 204 support 161, 176 well-being 110 emotions in nursing 106 five-level framework between-persons individual differences 110–11 groups and teams 113 interpersonal interactions 111–13 organization 114–15 within-person temporal variations 109–10 organizational culture in health care 107–8 empathy 97, 98, 106, 110, 223, 251–7 and compassion 110 employee well-being 125, 130, 207, 248 predictors of 155 employees

empowerment 219 health 33–4 involvement 223 organizational learning 207 recognition 219, 223 satisfied 124 self-efficacy 205 employment 17, 20, 23, 25–8, 33, 36, 107, 111, 142, 156, 162, 217, 218 terms and conditions of 142 empowerment 99, 219, 221, 237 EMPs see emergency medical personnel (EMPs) EMSs see emergency medical services (EMSs) EMTs see emergency medical technicians (EMTs) engagement 40 environmental constraints 209 environmental mastery 250–51 ERI see Effort-Reward Imbalance scale (ERI) Erickson, R. J. 108 error-based training 205 ESRs see emergency services responders (ESRs) Estryn-Behar, M. 96, 97 European Commission 175 European Observatory of Working Life 167 evaluation process, negative and positive aspects of 170 evidence-based practice 37, 260–61 evidence-based well-being service 260 external scrutiny, growth of 240 extrinsic motivation 76, 77, 80–81, 83 family liaison 266 fatigue 58, 61, 63, 69, 75, 80, 82, 93, 143, 159, 167, 190, 234, 269, 272 feedforward and feedback loops 202 felt individual strains (FIS) 237 financial security 33 Finney, C. 138 fire departments 186–8 fire safety services 74, 81 firefighters/firefighting 8, 84, 186–7, 286 actions of 78 amotivation and workplace boredom in 78 autonomy 78–9 changing nature and context of 74–6 competence 79 decision-making autonomy 83

Index  313 extrinsic motivation of 83 fighting amotivation and inertia in 78 intrinsic motivation 77 limitations and future research 84–5 method 77–8 motivation 79, 80, 83, 84 organizational aspects of 82–3 personality profile of 75–6 promoting extrinsic motivation 80–81 promoting physical fitness 84 relatedness 80 self-determination theory (SDT) 76–7, 82, 83 skills development 83–4 socialization 188 unpredictable nature of 75 workloads 77 workplace boredom 81–3 first responders, stress and well-being of 8, 58–9, 67, 283–5 characterization of 60 emergency medical personnel (EMPs) 60–62 firefighters 62 mental health first aid workers 65–6 military first responders 64–5 military personnel and veterans 64 non-reactivity in 69 police and law enforcement 62–4 prevention and intervention processes 285 prevention and recovery 69 source, setting, and support 59–60 stress response for 59, 60 Firth-Cozens, J. 234 FIS see felt individual strains (FIS) Fitzwater, E. L. 98 Fletcher, J. 252 free-floating 237 Frese, M. 205, 208 Ganz, F. D. 90 Gates, D. M. 98 General Health Questionnaire (GHQ-12) 152, 173 General Medical Council (GMC) 242 ‘generic’ stressors 139 Giorgi, G. 167–8, 172–4 good leadership 271 Grandey, A. A. 111–12 Grau, A. L. 99 Greenhaus, J. H. 143 Gregory, A. 23

gross domestic product (GDP) 232–3 group-based interventions 285 Grove, W. J. C. 108 Guidroz, A. M. 97 Guldenmund, F. W. 220 Guthrie, M. 243 Hale, A. R. 217 Hammer, L. 161 Hansard, J. 4–5 Hart, J. 137–8, 140, 155 Hawver, T. 107 Hayward, R. 275, 282, 284–5 health and motivation outcomes 46 Health and Safety Act of 1974 19–20 Health and Safety Executive (HSE) 20, 154–5, 265 benchmarks 156 framework 155 Management Standards 21, 23, 145 minimum standards 158 health care biomedical model of 108 context of 234 delivery 248 organizations, traditional model of 240 systems 240 workers, hazards for 221–2 health sector doctors as leaders 239–43 historic context of medical profession 233–4 medical engagement 243–4 OSM model 235–6 interpreting 237–9 primary and secondary scales of 236–7 stress in doctors 234–5 UK 232–3 health services provision 233 healthy employees 4 Healthy Work Environment Assessment Tool (HWEAT) 222, 223 Hesketh, B. 206, 260, 263–5, 268 high-performance organization (HPO) factors 9 Hochschild, A. 111, 112 hope 183, 185 hope, efficacy, resilience, and optimism (HERO) 182 horizontal/lateral violence 89 Hovden, J. 217

314  Handbook of research on stress and well-being in the public sector HPA see hypothalamic pituitary adrenal (HPA) HR management see human resource (HR) management HSE see Health and Safety Executive (HSE) Hui, R. T. Y. 208 human-made disasters 59 human resource (HR) management 2, 8–9, 301 policies 22 practices 300 strategies 300 theory 297–8 Humphrey, R. 107 Huynh, T. 108 Hyman, R. 18 hyperarousal 172 hypervigilance 138 hypothalamic pituitary adrenal (HPA) 66 IES see Impact of Event Scale (IES) ILO see International Labour Organization (ILO) Impact of Event Scale (IES) 174 incivility, workplace 90, 92 individual proactive and adaptive performance 200 achieving 203–4 contextual influences of 206–7 demand for 200 organizational learning theory to link 201–3 selecting 204–5 stress/well-being factors related to 207–8 training for 205–6 unique demands of organizational change in public sector 208–11 individual strains, typology of 238 individual strategies 302 for developing well-being in nurse leaders 256 individual well-being 11, 143, 275 industrial relations 15 conflict model of 17 pluralist approach to 16 systems of 22 institutionalization, forms of 19 instrumental support 161 intelligence analytical and rationalist view of 107–8 intensive work systems 295 intergenerational relay 175, 176 internally displaced persons (IDP) camps 65

International Labour Organization (ILO) 167 intrinsic motivation 76, 83 intrusion 172, 176, 283, 298 Iseler, J. I. 111 Italian Banking Association 171 Italian banking sector aging in Italy and Europe 174–5 in workplace 175–6 context 169–70 occupational stress burnout syndrome 168 definition and characteristics 168 demographic characteristics 169 epidemiology, tools and evidence 167–8 social support 168–9 work characteristics 169 robberies epidemiology 171 factors influence response to trauma 172–3 Impact of Event Scale (IES) 174 psychological consequences 172 risk management 171 stress management, prospects for 176 Italian demographic balance 175 JD-R model see job demands-resources (JD-R) model Jimmieson, C. 208 job competency 112 job control 4, 8, 33, 39–40, 159, 161, 167, 169, 249 job crafting 298–9 job demands 34, 39, 43, 44, 140 job demands-resources (JD-R) model 34, 38, 49, 284, 298–9 job design theories 303 job dissatisfaction 139, 143, 158, 173, 249, 296 job experience, role of 142 job insecurity 4–5, 8, 33, 162, 219, 297 job performance 4, 8, 10, 110, 123–5, 127, 131, 142 job-related stress in Australian higher education sector 297 coping mechanisms in dealing with 298–9 overview of 295 job-related stressors, levels of 137 job resources 34, 35, 41, 45, 49, 50, 129, 285, 295

Index  315 job satisfaction 7, 10, 83, 94, 109, 110, 115, 124, 130, 138, 153, 159, 162, 173, 178, 224, 248–50 job stress 294 ‘cause of the causes’ of 297–8 defined 294 theories 282 Johnson, S. 138 Johnson, S. L. 92 Joung, W. 206 Jundt, D.K. 201, 207 K-12 education 191–3 Kang, J. 90 Karasek, R. 284 JCQ 2.0 tool 40 Job Content Questionnaire 2.0 39 model 169 Keith, N. 208 Kelloway, E. K. 219 Keyes, L. M. 254 Khamisa, N. 7 Kim, Y. K. 8 Kinman, G. 137–8, 140–44, 152–5, 157–9, 295 Kozlowski, S. W. J. 206 Langford, P. H. 154 Lawler, J. 114 leadership in Canadian Psychological Association (CPA) 218 capability 261, 271–2 process 242 skills 84–5, 241–2, 255 Leavitt, H. J. 114 Ledoux, K. 108 Leon-Perez, J.M. 172–3 line managers 161 Luthans, F. 184 Maben, J. 112 ‘macho’ jobs 142 MacLeod, D. 243 Mael, F. 107 management standard approach 154–6 Management Standards Indicator Tool (MSIT) 140, 156, 157 Mann, S. 112 Mannocci, A. 175 Martinez Lucio, M. 17, 20–21, 28 Maxwell, R. 235

Mayer, J. D. 110 Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) 126 Mazelan, P. M. 243 McCraty, R. 145 McGivern, G. 242 medical engagement 232, 243–4 Medical Engagement Scale (MES) 243–4 medicalization 233–4, 276–7 of reactions 277–8 Medical Leadership Competency Framework (MLCF) 241–2 medical profession/professionals 7–8 dominance of 233–4 historic context of 233–4 practice of 242 role and status of 239–40 medical treatments, continuing development of 234 medical workforce 234 Meier, K. J. 112 Mensmann, M. 205 mental disorder 33, 172, 173, 275–6, 281, 284 chaotic route towards 282 mental health 140–41 decline in 33 in prison service 141–2 individual differences 142–3 presenteeism 144–5 work–life balance and recovery 143–4 professionals 287 risks 281 and well-being 261 mental health first aid (MHFA) 25–6, 277 Mental Health Foundation 26 mental health professionals 218 Menzies, I. E. 107 MES see Medical Engagement Scale (MES) meta-analysis 96, 169–70, 221 metacognitive activities 206 meta-ethnography 263 MHFA See mental health first aid (MHFA) military personnel 58, 60, 64–6 Milner, S. 23 mindfulness 254–5 interventions 218 practices 69 training 69 Mintzberg, H. 234, 240 Miranda, H. 94 mirroring 17–18

316  Handbook of research on stress and well-being in the public sector Mitchell, R. 280 MLCF see Medical Leadership Competency Framework (MLCF) model analysis 46–50 motivation 78–80, 83, 84 extrinsic 76, 77, 80–81, 83 intrinsic 77 performance and 80 types of 77 MSCEIT see Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) MSIT see Management Standards Indicator Tool (MSIT) Mucci, N. 167–8, 171, 173, 175, 294 Murphy, L. R. C. 235 mutual empowering 252 National Health Service (NHS) 233 National Institute for Occupational Safety and Health (NIOSH) 5, 88, 167 National Police Well-being Service (NPWS) 260–64, 266, 270–71 approach in 268 holistic approach 261 initial scope of 263 program 268 screening 266 strategic vision statement for 271 natural disasters 59 Neal, A. 206 negative emotions 94, 111–12, 122, 130, 143, 280, 282 negative leadership behaviors 271 negotiations 15 collective framework of 21 neoliberal economy 36, 52 neuropsychology 267–8 new public management (NPM) 75 Newman, A. 234 Newman, S. 114 NHS See National Health Service (NHS) Niessen, C. 208 NIOSH see National Institute for Occupational Safety and Health (NIOSH) Nordic Safety Climate Questionnaire 221 normative reference group 237–9 Norton, A. 139 Noseworthy, J. H. 233, 235, 243 NPM see new public management (NPM)

NPWS see National Police Well-being Service (NPWS) nurse leaders 248–50 individual strategies for developing 254–7 job satisfaction in 250 organizational strategies for developing 257 personal growth 253 positive relations 252–3 predominant factors for 250 primary factors for 251–2, 254 prior examinations of 251 purpose in life 254 survey of 250–51 Nurses Organization Alliance 249 nurses, workplace mistreatment 88 aggression 89–92 behavior 94 bullying 90, 92 consequences of 93–5 coping strategies 95 emotions and attitudes 94 frequency of 89–90 harassment and workplace incivility 92 health and well-being 93 incivility 90 individual differences 96–7 perpetrators of 88 prevention and interventions 98–9 risk factors for 96–8 sexual harassment 90 sources of 90–92 types of 88–9 violence 89–91 work-related factors 97–8 nursing dissatisfaction 249 emotions in see emotions in nursing managers 223–4 nursing staff 7, 222–3 Oatley, K. O. 107 occupational health and safety (OH&S) 281–3 dynamic and responsive social support 286 framework 278, 287 initiatives 218 mission of 216 physical job demands 283–4 psychological treatment work for first responders 279 PTSD symptoms 278

Index  317 research on 217 social support 284–6 stressors 279–80 terrorist attacks and large-scale fire in London 286–7 occupational health structures 18 role of 22 occupational stress 168–9 burnout syndrome 168 definition and characteristics 168 demographic characteristics 169 epidemiology, tools and evidence 167–8 in Italian banking sector see Italian banking sector social support 168–9 work characteristics 169 OECD see Organisation for Economic Co-operation and Development (OECD) OH&S see occupational health and safety (OH&S) optimism 184–5, 255–6 Organisation for Economic Co-operation and Development (OECD) 217–18 organizational change 20, 39, 43, 200–201, 207 in public sector 208–11 organizational climate 35, 98, 297 organizational contexts 85, 131, 201, 244 organizational culture 98, 159, 278 and safety culture 220 organizational harassment 39 organizational intervention strategies 301 organizational justice 40 perceptions of 93 organizational learning 201–2, 205, 210 value of 210 organizational performance 10, 140, 155, 243, 244, 294 organizational pressures types of 237 typology of 238 organizational psychology 2, 54, 182 organizational rewards 37, 40 Organizational Stress Measure (OSM) 235–6 interpreting 237–9 model 235–6 primary and secondary scales of 236–7 technique 236–7 various scales in 237 organizational stress, reduction 299 organizations, structural elements of 303

OSM see Organizational Stress Measure (OSM) outlier analysis 238–9 paid employment 33, 107, 111 Paller, D. A. 243 paramedical personnel 60–61 paramedics 58, 60–62 Parker, S. 205 Payne, R. 234 PCS see Public and Commercial Services Union (PCS) peer support 3, 10, 63, 141, 155, 268–9, 271, 287 Pekaar, K.A. 126–30 Pekurinen, V. 89 perceived organizational support (POS) 299–300 and employee tenure and staff type 300 and organizational tenure 299 peri-traumatic risk factors 172–3 personal development, qualities of 279 personal growth 250–51, 253 opportunities for 252 and well-being 216 personal resilience 248, 263, 264 personal satisfaction 168, 286–7 personality 266 Petarli, G. B. 175 Peters, M. 186 PFA see psychological first aid (PFA) Pfeifer, J. E. 4, 146 PHE see Public Health England (PHE) PHLAME method 84 PHRD see Public Health Responsibility Deal (PHRD) physical assaults 39, 88, 98–9, 138 physical burden 283 physical fitness 79, 81, 82, 84 promoting 84 physical health 7, 61, 66, 70, 84, 138, 154, 155, 173, 216, 222, 223 physical job demands 283–4 physical resources 283 physical stressors 61 physical training 79, 84, 187 physical well-being 254 physiological health 8 physiotherapy 262 Pignata, S. 157, 160, 294, 297–303 Platis, C. 7 pleasure 123–4

318  Handbook of research on stress and well-being in the public sector politicization, development of 17 Pollack, J. 107 POS see perceived organizational support (POS) positive relations 250–53 positive social interaction 33 post-election violence 65 post-traumatic risk factors 173 post-traumatic stress disorder (PTSD) 59, 62, 66, 68, 74, 138, 172, 261, 269–71, 276, 287 criteria for 269, 270 diagnosis of 64, 66 diagnostic requirements for 270 identification of 271 within leadership programs 270–71 military personnel and veterans with 64 preventing 280 rates of 59 support and treatment for 285 symptoms of 276–8 presenteeism 144–5 preserving 252 pre-stressor levels 143–4 pre-traumatic risk factors 172–3 prior research 51, 254 prison leaders 146 prison officers demographic factors 143 experience of 139 health and safety executive management standards 140–41 interventions 145–6 mental health in prison service 141–2 individual differences 142–3 presenteeism 144–5 work–life balance and recovery 143–4 prisons in crisis 137–8 stressful occupation 138–9 prisoner self-harm 138 private sectors 2, 6, 9, 51–3, 154, 155, 182, 210, 216, 219, 295 bullying in 44 employees, work and well-being 10–11 health and motivational outcomes for 46 job demands for 43–4 job resources 45 mainstream of 21 psychosocial factors for 43–6, 50 public vs. 36–7, 42 trade unions vs. 16

well-being of 10–11 proactive performance 207 Big Five personality trait predictors of 204–5 definition of 200–201 effectiveness of 200 predicting 204 proactive personality 204 problem-focused coping 142 procedural justice 300–301 employee perceptions of 301 process-focused processes 185 productivity, demands for 220 professional development opportunities 257 professionals, types of 222 protective strategies 302 PSAL 169 PSC see psychosocial safety climate (PSC) PSI see Public Services International (PSI) PSM see Public Sector Motivation (PSM) PsyCap see psychological capital (PsyCap) psychiatric assessment manual 276 psychiatric disorders 168 psychological approaches, types of 266 psychological capital (PsyCap) 168–9, 182–3, 188 characteristics of 182 definition of 183, 185 description of 183–4 developing 185–6 fire department 186–8 in higher education 194–7 K-12 education 191–3 mechanism for 185 overview of 183 US Air Force 189 deployment and training 190 permanent change of station 190–91 working of 184–5 psychological consequences 172 psychological distress 41 psychological first aid (PFA) 277 psychological health 8 psychological injury 265 Psychologically Healthy Workplace Awards 219 psychological maturity 254 psychological risk assessment 279 psychological screening 265, 266 psychological strain levels of 295, 297

Index  319 psychological well-being 138, 224, 248, 254, 281, 287, 297–8 concept of 275 prevention and priority for 37 psychosocial factors correlation matrix for 47–8 and worker health, Australia 33–7 discussion 50–52 limitations 52 study on 37–50 psychosocial hazards 137 psychosocial risk management 35 psychosocial risk surveillance 35 psychosocial safety climate (PSC) 38, 49, 297–8 benchmark standards and prognosis 42 current levels of 298 framework 35, 36 levels of 37 proposed model of 48 PTSD See post-traumatic stress disorder (PTSD) Public and Commercial Services Union (PCS) 25 Public Health England (PHE) 263 Public Health Responsibility Deal (PHRD) 263 public sector achieving high performance in 9–10 definition of 5–6 employees 2, 10–11, 218 firefighters and first responders 8 high-stress occupations 7 human resource management (HRM) 8–9 medical professionals 7 nursing staff 7 organizations 6 performance management in 17 police officers 7–8 psychosocial factors for 43–6 stability and structures of 17 stress and well-being 6–7 work and well-being in the workplace 4–5 Public Sector Motivation (PSM) 36 public sector organizations 9–11, 208–11 feedforward and feedback loops in 202 performance of 10, 200 public service procurement 263 work, overseers of 217 Public Services International (PSI) 88 purpose in life 250–51, 254

quality of life 174 Rea, R. E. 92 REIS see Rotterdam Emotional Intelligence Scale (REIS) Reklitis, P. 7 relatedness 76, 77, 80, 82 relational practice, elements of 252–3 resilience 142, 183–5, 266, 281, 287 development 185 skills 145 well-being and 275 responsive social support 286 rewards 40 organizational 37, 40 Riley, R. 109–10 risk assessments 22, 155 risk-focused processes 185 risk management 171 Rizzo, R. 287 robberies epidemiology 171 factors influence response to trauma 172–3 Impact of Event Scale (IES) 174 psychological consequences 172 risk management 171 Robertson, N. 152 Roche, M. 91 role meaningfulness 250, 254 role modeling 161, 185, 197 Rotterdam Emotional Intelligence Scale (REIS) 129 Ryff, C. D. 254 safety culture 217, 220–21 definitions of 220 in health care setting 221–2 in hospital settings 222–3 organizational culture and 220 tool for measuring 221 SafeWork Australia report 294 Salovey, P. 110 Samir, N. 97 satisfied employees 124, 301 Schat, A.C.H. 89 screening questionnaires initial 266 ongoing 266 referral 266–7 SCT see social cognitive theory (SCT) SDT see self-determination theory (SDT)

320  Handbook of research on stress and well-being in the public sector seasoned firefighters 188 self-acceptance 248, 250–51 self-achieving 252 self-actualization 254 self-awareness 253, 254 self-confidence 176, 237 self-determination theory (SDT) 76–7, 82 in emergency services 84–5 self-efficacy 79, 187 beliefs 206 levels of 125 self-esteem 298 self-harm 61–2 sexual assault 172 sexual harassment 89 exposure rate of 90 and workplace incivility 92 sexual violence 269 Shanafelt, T. D. 233, 235, 243 Shannon, D. 241 shared ideas 217 shared leadership 242 Shea, T. 89 Shoss, M. 201, 204, 207 skills building 219 development 83–4, 268 leadership 84–5, 241–2, 255 resilience 145 technical 187–8 transformational leadership 271 sleep deprivation 58, 61 social cognitive theory (SCT) 99 social contexts 76 social support 40, 168–9 collaborative culture and 252 dynamic 286 form of 284 levels of 6–7 for nurse leaders 249 occupational health and safety 284–6 occupational stress 168–9 responsive 286 role of 175 Special Weapons and Tactics (SWAT) teams 85 Spector, P. E. 88–93, 97–8, 153, 295 Spurgeon, P. 11, 234–5, 239, 240–44 staff distributions 239 Staff Profile Analysis 237 staff well-being 146, 294 ‘standard’ academic contract 158

stress 2 cost-effective approach to tackling 239 definition of 66–7 in employees 161 evidence of 234 impact of unaddressed 67–8 interventions, awareness of 300 management network 268 management options 146 manifestations of 68 related hazards 265 strategies to eliminate or reduce 294 symptoms 282 substance use 64, 70, 270 Sue-Chan, C. 208 supervisors 206 Svensson, G. 36 SWAT teams see Special Weapons and Tactics (SWAT) teams Tang, J. S. 97 Taris, T.W. 152–3, 295 task-focused coping 142 task-performance-directed behaviors 201 technical skills 187–8 Tellier, C. 139 Thau, S. 89, 93, 95, 96 Theorell, T. 284 Thompson, M. 108 trade unionism 18 trade unions 15–16 collective dimension of trade union responses 21–4 demands 19–20 dimensions of the individual and union responses 24–7 innovation and emergent challenges facing 27–9 intervention, collective dimension of 24 levels and arenas of 18–21 levels and dimensions of 19 public sector and changes 16–18 traditional management approaches 8–9 trait emotional intelligence (EI) 127 transformational leadership characteristics of 224 concept of 114–15 health care via 223–4 presence of 223 skills 271 transforming leadership 272 transitory emotional states 109

Index  321 trauma impact of unaddressed 67–8 individual responses to 268 stimuli, avoidance of 270 Trauma Response Team (TRT) 65 traumatic stress 66 definition of 66–7 development and impact of 67 symptoms 69 Trivellas, P. 7 Trounson, J. S. 146 Tytherleigh, M. Y. 154 UK

academic employees 154 academics in 152 Health and Safety Executive Management Standards 140–41 health sector 232–3 health system 233 Labour Research Department (LRD) 15 risk for mental health problems 295 universities 156, 159 UK emergency service responders 260–61 building leadership capability 271–2 continuous improvement 271 framework for blue light well-being 263–4 peer support 268–9 planning live service 263 post-traumatic stress disorder (PTSD) 269–71 psychological risk management and screening 264–7 strategic context 261–2 trauma support and contingency 267–8 uncertainty 24, 28, 97, 111, 159, 184, 188, 190, 283 employment 23 feelings of 159 stress and 187 US Air Force 189 deployment and training 190 permanent change of station 190–91 Vessey, J. A. 92 victim-based framework 275 Villeneuve, M. 77 Vincent, C. 235 Violanti, J. M. 8 violence 15, 25, 90–91 and aggression 89–90

domestic 266, 270 election-related 65 horizontal/lateral 89 post-election 65 sexual 269 workplace see workplace violence Violence Prevention Community Meeting (VPCM) 98 VPCM see Violence Prevention Community Meeting (VPCM) Vroom’s expectancy theory 81 Wathes, R. 244 Watson, J. 108 Watt, J. D. 75 Watts, J. 152 Weiss, H. M. 109 Weiss, M.C. 109–10 well-being 2, 295–6 aforementioned decline in 260 campaigns 22 concept of 248 contemporary hazards to 157 dimensions of 248–9 individual 275 initiatives 303–4 mental health and 261 nurse leaders see nurse leaders well-being of nurse leaders 248 and resilience 275 work and 4, 10–11 West, C. M. 6 West, J. P. 6 Winefield, A.H. 35, 107, 142, 152–3, 160, 297, 299–300 Wisnivesky, J. P. 8 Wood, G. 36 work engagement 124 work–family conflict 39 levels of 43 work–home conflict 297 work intensification 22 work-life balance 158, 219 management 161 and recovery 143–4 work-life conflict 161 forms of 143 predictors of 143 work psychology, research studies in 33 work-related emotions, source of 124–5 work-related harassment 61

322  Handbook of research on stress and well-being in the public sector work-related hazards 156 work-related stress 170, 175 consequences of 167 risk of 160 source of 138 and well-being 281 work-related well-being 123–4, 130, 154 negative form of 124 workaholism 124 worker engagement 297–8 workloads 5, 16, 22, 24, 77, 162, 261, 298 management 83 workplace aggression 90 source of 91–2 workplace boredom 75, 81 powerful manifestations of 76 workplace bullying 39, 44 source of 92 victims of 92 workplace demands 35 workplace incivility 90 sexual harassment and 92 sources of 92 workplace mistreatment 88 causes of 97 coping strategies for 95

exposure to 93, 94, 97 nurses’ experiences of 91 rates of 89 types of 89, 93 victims of 91, 94, 96, 97 workplace psychology 261 workplace stress 6, 265 levels of 5 workplace violence 88–91, 96, 97 definition of 88 exposure to 97 prevention of 99 victims of 97 Wray, S. 152–3, 158–9, 295 Xanthopoulou, D. 125, 298 Yang, L. Q. 97 Yokoyama, M. 90 Youssef-Morgan, C.M. 182–5 Zeller, A. 97 Zenios, S. A. 4 Zhang, L. 96–7 Zhou, Z. E. 88, 97–8 Zohar, D. 220