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Upskilling managers to support health at work, what does it take?

By Laura Jordan and Janet O’Neill, PAM Group

Published 4 March 2024

Upskilling managers to support health at work, what does it take?

By Laura Jordan & Janet O'Neill PAM Group

Managers have become more important than ever for ensuring work doesn’t make people sick. However, according to the 2023 Health and Wellbeing report from the CIPD, some managers, unfortunately, have a negative impact on employee wellbeing. This means the single most important thing employers can do to boost the health of their workforce in 2024 is to equip managers with the skills, support and competency to manage wellbeing.

 

This article reviews the impact that managers have on employee wellbeing and the role of managers when it comes to creating a culture of wellbeing. This is followed by a discussion of a framework that has been developed to upskill managers, including tools for the wellbeing toolbox which can be implemented inclusively within the workforce.

The impact that managers have on employees’ wellbeing (PAM Group Health at Work report 2021)

Employees want help to stay healthy and believe their employer, and their line manager, is responsible for their health and wellbeing (PAM Group, 2021 Figure 1). A lot of this is driven by the fact that over half of all employees have been affected by delays in accessing support with the NHS. This puts the onus on employers to take a more proactive approach to health and wellbeing, helping employees avoid becoming sick in the first place.  This is a huge task, but, with the right tools, skills and framework, managers can support wellbeing.

 

Chart
Figure 1

One of the key barriers for managers supporting their employee’s health and wellbeing, is how comfortable employees feel in discussing these issues (Figure 2). The report by PAM Group in 2021, portrayed that two-thirds (68%) of employees don’t feel comfortable discussing workload and deadline challenges with their line manager; three out of five (61%) people feel able to discuss equality and inclusion with their manager, but just one in two employees (53%) are comfortable discussing mental health or childcare challenges. A similar number of employees feel uncomfortable discussing social health challenges, relationship challenges and neurodiversity challenges, such as dyslexia or autism (PAM Group, 2021). Lastly, it’s no surprise that financial worries emerged as the topic that most people feel uncomfortable discussing.

To address this, we need to create a psychologically safe culture. This means creating a psychologically safe workplace, where people feel like they won’t be rejected, punished or embarrassed for speaking up. An essential ingredient to creating a culture of health. This can be achieved by giving managers the appropriate communication skills to have the confidence to open conversations about loneliness and relationships. Truly knowing their team so that managers are aware and mindful of the challenges that different sex and age groups will experience. For example, research shows that women are less likely to feel comfortable discussing relationships, whilst workers over the age of 55 are less likely to feel comfortable discussing personal wellbeing issues across the board (PAM Group, 2021).

 

Figure 2

Primary intervention is essential, i.e. looking at the root cause for that organisation. Compounding elements (Figure 4) could be:

  • Workload, shift patterns, autonomy, and leadership: Are there high demands and intensity; long hours with few breaks; short staffing; lack of control; poor management and poorly managed change?
  • Support and working relationships: i.e. low support from managers; bullying and victimisation; lack of appreciation and respect; stigmatization of those who seek help.
  • Training and development: i.e. lack of opportunities for development and inadequate training.
  • Work-home interface: work-life conflict; long shifts; little time for recovery.
  • The individual: existing mental health problems; poor self-care; overcommitment; low resilience, caring responsibilities.
  • Inequalities: Although many organisations are ethnically diverse, ethnic minority staff are at greater risk of bullying and abuse which has implications for mental wellbeing.

Case Study: Paul was sent to work from home during COVID. After a few months, he started to perform below his usual standard and complaints arose. (He was in a customer service role). During the OH consultation, it emerged, that he was isolated at home with no one to speak to, he had had several managers, and poor communication meant he wasn’t sure what the latest process was and became confused. This gentleman had been a high achiever and performer previously and was found to have lost confidence, lost interest and was extremely fatigued.

Employer actions:

Managers play a role in knowing what wellbeing tools are already available and making employees aware of these benefits. There are valuable opportunities in using healthcare tools and benefits in a more proactive approach, rather than being portrayed as something managers should use as a last resort.

 

Figure3
Figure 3

The PAM Group (2021) report survey, (Figure 3) shows the uptake of benefits, from flexible working to private GP access, DSE assessments and wellbeing webinars. Flexible working, paid-for optical or dental care and mental health counselling services are the top three wellbeing benefits for around half the workforce. This is closely followed by access to a private GP, health screening and blood tests, private health insurance and occupational health services. Organised sport/walking/cycling groups and wellbeing webinars emerged as the least popular benefits, although over a third of employees still valued this form of support. This shows the importance of offering a wide range of benefits to meet everyone’s needs and to be inclusive.

Critical to turning this around is proactively promoting health and wellbeing benefits as tools for wellness, rather than sickness. For example, by encouraging people to get physiotherapy advice when they change their working environment, or at the first sign of a twinge, rather than waiting until their back hurts them too much to work.

  • Make sure employees know the support is to help them stay healthy, not just if they get sick.
  • Work with benefits providers who are willing and able to proactively promote services to employees.
  • Reassure people that sensitive services, such as debt or emotional counselling, are fully confidential.

 

Creating a culture to thrive

Figure 4
Figure 4

Burnout is a key outcome when workplaces aren’t proactive in wellbeing support. Individuals become emotionally exhausted, cynical, and disengaged from the job and feel a sense of ineffectiveness and loss of purpose. Retaining and recruiting people is difficult as has been the experience of the NHS where there are significant levels of burnout. But there isn’t a one-size-fits-all approach; for example, in healthcare compassion fatigue is a known phenomenon that you may not get in other industries.

Primary intervention is essential, i.e. looking at the root cause for that organisation. Compounding elements (Figure 4) could be:

  • Workload, shift patterns, autonomy, and leadership: Are there high demands and intensity; long hours with few breaks; short staffing; lack of control; poor management and poorly managed change?
  • Support and working relationships: i.e. low support from managers; bullying and victimisation; lack of appreciation and respect; stigmatization of those who seek help.
  • Training and development: i.e. lack of opportunities for development and inadequate training.
  • Work-home interface: work-life conflict; long shifts; little time for recovery.
  • The individual: existing mental health problems; poor self-care; overcommitment; low resilience, caring responsibilities.
  • Inequalities: Although many organisations are ethnically diverse, ethnic minority staff are at greater risk of bullying and abuse which has implications for mental wellbeing.

Case Study: Paul was sent to work from home during COVID. After a few months, he started to perform below his usual standard and complaints arose. (He was in a customer service role). During the OH consultation, it emerged, that he was isolated at home with no one to speak to, he had had several managers, and poor communication meant he wasn’t sure what the latest process was and became confused. This gentleman had been a high achiever and performer previously and was found to have lost confidence, lost interest and was extremely fatigued.

A wellbeing framework (Figure 5)

Organizational health is a continuous cycle, everything interacts. But if we had to have a starting place it would be with business awareness and building the business case, which requires stakeholder engagement. Often businesses put effort into ESG (Environment, Social and Governance), focusing efforts externally. However, the S i.e. social in ESG applies as much to employee wellbeing as it does to community wellbeing (Personnel Today, 2023). Supporting the internal community will influence the external community which is the moral perspective for business awareness. Then there is the business perspective which includes maximising productivity, cost savings, and efficiency. If an organisation focuses on the moral and the business perspective, the business case almost writes itself.

Engaging stakeholders is crucial for a culture of wellbeing. But this needs to be top-down and bottom-up. Although the top can influence wellbeing with decent work practices and encouraging a culture of awareness, the top cannot dictate wellbeing, there must be buy-in.

The strategy comes from the bottom-up approach. Having a voice and being involved helps to contextualize solutions, making them appropriate for the organisation. This includes the tasks, people, risks, and concerns relating to that business, not that of the competition and therefore running the risk of being tokenistic. Involving the people of the business in planning and problem-solving.

Aligning and integrating with existing systems and ways of working helps to make initiatives easier to accommodate, improve or elevate as opposed to complete change. An example in PAM is our triage process; – we brought together a working group top, bottom, and middle within a certain team to look at making this more effective. This made a significant difference not only to the process but to the engagement of the team and retention.

Utilising expertise in health, especially workplace health, provides credibility, and ensures there is a multifocal view and delivers objective advice. Programs that look at an organisation’s particular risks from a physical perspective and psychosocial perspective, health trends in the socioeconomic environment plus the community employees come from, can provide insights that may be difficult for organisations to do on their own.  Occupational Health (OH) is a strategic health partner.

However, no wellbeing interventions will be effective, OH input or not, without collecting data as evidence. Data can be both quantitative i.e. surveys and statistics that come out of e.g. OH, wellbeing and EAP (Employee Assistance Program) services and data from conversations i.e. qualitative discussions with employees. This then feeds into business awareness and stakeholder engagement.

 

Figure 5
Figure 5

A framework for upskilling managers (Adapted from International Organisation of Employers, 2023, Mental Health and Wellbeing at Work)

Figure 6
Figure 6

Line managers are fundamental to making a wellbeing strategy work (Forbes 2020). They are the most important person in an individual’s working life and keep the organisation on track with performance. A lynchpin as described by Forbes. Figure 5 is a useful starting point when building a line manager competencies framework, a strategic tool in supporting line managers to optimise mental health and wellness. Managers are commonly striving to get the task done and if competencies aren’t developed, they, as fallible human beings, may judge or label those with an invisible disability. Nonetheless, they can’t do this on their own. They need the support of the organisation, i.e. a top-down approach.

There are tools to support reshaping the environment with a risk approach such ISO 45003 and HSE management standards. A whole organisation approach ensures a wellbeing approach to organisational culture looks at the type of work and how it is carried out, the make-up of the workforce, the social environment they live in and the tasks they are required to do e.g. a patient-facing environment will be different to a rail or firefighting or logistic or manufacturing or service industry. Reducing physical and mental health risks is an essential part of line manager competencies. It isn’t much use if a manager can have a good conversation but doesn’t protect their team member from ill health or places pressure on them to take risks.

No manager will enact good wellbeing strategies if they

  • Don’t look after their own wellbeing and set an example.
  • Don’t understand the rationale.

Case Study: During COVID, M&S supported 1200 managers to complete “Mental health conversations” training and found colleagues and managers were more confident to talk about how they were feeling, creating a culture where employees could ask for help.

Therefore, organisations need to provide managers with reputable training based on evidence. This needs to include a foundation knowledge of health and safety including mental health awareness, stress management, and the impact of work on overall health. WHO (2022) researchers found evidence that suggests training managers on spotting the signs of reduced mental health, along with support routes, helps to increase their confidence and improve attitudes around mental health within the workplace.  PAM Group have a free recorded webinar: Courageous Conversations for Managers.

Managers need upskilling to support equality and inclusivity. Making sure an individual has everything they need to reach the same level of success as someone who may not need accommodations takes time and far more thought than a one-size-fits-all approach. The results are more effective and enable psychological safety, reducing the risk of work exacerbating health. (TED talk Hidden Disabilities, 2024).

 

Providing managers with the right tools For example

Internal Data:

    • Wellbeing dashboards such as Workday or Darwin
    • Engagement survey data
    • Employee representation groups
    • Exit interviews.

External Data:

    • Local socio-economic health data.
    • Wellbeing data including EAP (Employee Assistance Program); OH; MSK services; health education and promotion.
    • Consider the need to utilise people with the skills to collect and interpret data or technology to automate data collection and analysis.

Key take aways

    • Create a top-down and bottom-up culture of psychological safety
    • Enable and empower managers and colleagues to thrive
    • Consider the individual but also the collective within the environment particular to that organisation 
    • Evaluate policies and procedures to support line management and colleagues.
    • Review what is in the toolkit and upskill line managers for effective conversations
    • Review data continually to inform and develop
    • Create inclusive initiatives that are accessible to all 
Laura Jordan Headshot
Laura Jordan | Linkedin

Laura Jordan is Commercial Director of PAM Wellness and a physiologist with many years of experience in the world of Occupational Health and Wellbeing.

 

Headshot of Janet O'Neill
Janet O’Neill | Linkedin

Janet O’Neill is Head of PAM Academy, the training and development branch of PAM Group and is an Occupational Health nurse specialist.

 

OH Today Spring 2023
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