Guide to good stress management

Almost every sixth employed Dane is affected by stress or work pressure in such a way, that it leads to medical leave [1]. This is some good advice from a modern Danish research project, to handle and avert medical leaves.

Article published by Ledelse i nr. 5th May 2013.
By Yun Ladegaard, work psychologist, Roy Langer, organisation consultant, and Bo Netterstrøm, senior researcher.

It may come as a chock, when an employee goes on medial leave due to stress. The manager may not have seen it coming, and with reason, because the employee who is reported sick has done everything to handle it on their own. In other cases, there may have been several signs of strain: changes in behaviour, grief, irresoluteness, and there may have been domestic issues.

What do you do as a leader? How should the contact with the employee on medical leave elapse? How do you aid the employee to return, in the best way? What about the colleagues?

This article departs in the author’s knowledge and experience, combined with the knowledge of a new Danish research project, COPEWORK [2], which has investigated what happens in a workplace when an employee is diagnosed with stress. The examination included thorough interviews and comprehensive questionnaires from managers, working environment representatives, and employees on medical leave due to stress, from 38 companies [3]. In this article, we will give a number of specific proposed solutions to handle and avert stress and stress caused notifications off illness, in the workplace.

What is stress?
• When one or more employees are affected by stress, it typically has negative social and economic implications for the workspace.
• Stress is the body’s response to strain, and a natural reaction, which prepares the body to yield its maximum.
• You become stressed when the strains/obstacles, you are exposed to, are greater than the resources you have at your disposal.
• Short-term stress can be stimulating and improving, while long-term stress weakens the immune system and can lead to depressions and cardiovascular disease.

Ensure a good, continuous contact throughout the sickness leave:
When an employee is on medical leave dye to stress, it is the leader’s responsibility to control the contact. It is naturally important to resect the employee’s boundaries and give space to restitution. On the other hand, it is important for the patient to maintain the contact to the workplace and still feel as part of the workspace, in spite of the absence.

A good continuous contact between the leader and the patient during the medical leave proved, in the research project, to be the key to fast and successful return to the job. Some leaders continuously updated the patient on the situation of the workspace, and in several cases, the patient participated in meetings and lunch breaks, to speak with the colleagues.

The research also showed that employees on part-time medical leave were faster to return to their full-time job, compared to full-time medical leave and despite the same symptom level. Amongst other things, the reason for this was that it was easier to gradually increase work time, when the employee had preserved daily contact with the workplace. The leaders wrote that the most important aspect was to “catch it in the run-up” and have the employee go on part-time medical leave, to give space for restitution and time to receive treatment.

Mandatory sickness leave conversation
As an employer, you are required to hold a meeting with the patient, before they have had four weeks of sickness leave. There are no limitations for how early in this period, the meeting may be held. The purpose is to unveil when the employee can be expected to return to work, the expected duration of the medical leave, and the possibility of a sooner return under special circumstances, i.e. a gradual start or different tasks. For more information: Retningslinjer for sygefraværssamtaler
Hvad må du spørge om?

Gradual escalation of work
After a breakdown caused by stress, it is important to have time to restore your health. You may often have issues sleeping and may feel constantly tired and exhausted, you may experience problems sleeping, due to fatigue. The memory and other contingent abilities are weakened. You may have an uneasy mind, memory loss, and even little tasks may seem too much. It takes time to recover and let the body to function again. Moderate exercise, long walks and rest, can be the solution.

After some time, the sleeping pattern has returned to normal, the weekdays seem manageable but you may not be ready to go back to work. At the same time, it is important that not too much time passes, before returning. It is an important aspect of the recovery, that you remain part of the social network and have some successful experiences at work.

Make a plan for gradual escalation of work, in cooperation with the patient
We recommend a partial reporting of fitness for duty, where the employee gradually returns to work. Some stress-patients wish to return quickly, but here it is important that the leader takes responsibility for the process. Rather less duties and more successes, than relapse.

Suggestions for a timetable:
1. Before start-up, it may be a good idea for the employee to visit the workplace, perhaps participates in the lunch break, talks to the colleagues and feels the atmosphere of the workplace.
2. The first week may consist of a few work-hours Monday, Wednesday and Friday.
3. Hereafter, you may gradually increase the number of work-hours and days. The number of working hours could be increased by two to four hours a week. It may be useful to restore Wednesday as weekly day off, for some time.
4. Expect the gradual increase of work to last over a longer period of time (depending on difficulty).

A clear agreement that it is acceptable to go home when it is too much for the employee may be a great support.

Continuously hold status meetings
A weekly status meeting may, for instance, be on Fridays (it does not need to be a long meeting, as long as it is held). Here, the focus is talking about how the week has been, about an increase of work-hours etc. It is important to continue the weekly meetings, although everything is going according to the plan. Some employees experience that after a month of having returned, it seems that their surroundings forget that they have been sick. It takes longer to recover, and this must therefore be taken into account for a longer period of time.

Which tasks?
• Start with simple, limited tasks, avoid tight deadlines, and generally give plenty of time for each task.
• Rather less tasks but more successes, than the opposite.
• Speak to the employee about what caused the stress, and avoid these for a period of time or change them, so they seem less incriminating.

Involve the colleagues
Good stress leadership involves a clear communication and involvement of the colleagues. Inform about the slow and gradual rehabilitation, how many hours the employee is working and make it a common aim, to get the employee back to the workplace.

Research shows that the colleagues play a major part in getting the patient back to work. Without support from the colleagues, the patient rarely succeeds in returning. It is important that the leader involves the colleagues as early in the process as possible. Several leaders in the research project, had successful experiences with the employee coming to work, and telling the colleagues that they were diagnosed with stress, or that the leader, with permission from the patient, told the colleagues.

The research also showed that it was important for the colleagues to know, why the person was on medical leave. Sincerity about the case from the start, created understanding and opportunity for the colleagues to support the patient in the best possible way, and avoided rumours. Pay attention to the fact that the colleagues often show understanding the first month, but tend to get irritated, if no visual progress is made. Therefore, maintain the communication and involvement of the colleagues throughout the process.

In many workplaces, the colleagues are obliged to cover for the employee on sickness leave, while they are absent. This is an issue in many ways. Firstly, it can create an irritation towards the patient, and a gradual return can be problematic. Secondly, it may increase the risk that more employees go on medical leave, due to stress.
The leaders from the project that handled the sickness leave the best, “negotiated upwards” (they averted unrealistic aims and deadlines from the direction, to protect the employees), prioritised the tasks and made realistic aims for the department, during the sickness leave, so that the colleagues were not strained.

Prevent similar events from reoccurring
The research project points to several possibilities for the leader to take preventative measures of stress and medical leaves:

Apply concrete knowledge about stress to the workplace
Amongst both leaders as well as colleagues, there was, according to the research, generally limited knowledge about stress – symptoms, and – strains. The problem was that stress is often connected to personal weakness, which could lead to irritation and impatience towards the sick employee. Many of the interviewees lacked concrete knowledge and tools as to how to handle the situation, and many of the leaders did not have access to professional guidance and had to come up with a solution.

The solution in some workplaces was that changes were made that, instead of solving the stress-issue, in the worst cases, made the situation worse. In one workplace, the solution was “collective zumba”. The purpose of this was to relieve the employees and strengthen the community but did not solve the problem, as the employees were so strained that even going to the bathroom was critical. Therefore, the zumba increased the workload due to the time it took, and was an example of the lack of understanding by the leader.

Invite a professional to tell about stress
A professional will be able to inform about stress, so everyone knows what stress is, what causes it, symptoms etc. This can take away the taboo and relieve prejudice about stress. The advantages of having a person to tell about stress and control a subsequent dialogue is that it can increase the frankness of the employees, and make them willing to tell about, what makes them strained. Bear your position as a leader in mind, which can make it difficult to initiate an open dialogue about stress.

Be frank about stress and willing to take the necessary actions
Stress is often associated to weakness, and it can be difficult to admit to yourself, as well as your colleagues, but especially the leader, that you are stressed. Many people will take it far, to avoid having to confront their leader and ask for help. It is therefore essential that you, as a leader, lead the way to legitimize stress and create confidence about coming to you, when an employee is stressed.

Legitimacy about stress in the workplace is advantageous, because the employees will come to you earlier when they feel stressed, rather than waiting and trying themselves for a long period of time. If this is the case, a medical leave may be avoided, or only a part-time medical leave is necessary. If the leader previously has shown spatiality and helped employees, others will feel safer, when coming to ask for help. On the other hand, you cannot expect the employees to address the matter early if you, for instance, fire employees after 120 sick days. Therefore, openness is only achieved when there is knowledge about stress and a trustworthy willingness from the leader’s part to make the necessary changes in relation to the workloads. In the research project, many of the leaders felt that they were open about stress, while many of the employees did not want to be the first to report stress, in fear of being the first of the job cuts.

Tips from a chief executive: Is tress legitimate in your workplace?
A chief executive from the financial sector experienced a great difference in the perception of the employees’ own stress vs. the stress of the colleagues: when he worked with openness about stress, he began with a show of hands:
• “Who thinks that it would be legitimate if an colleague went on medical leave due to stress?” (Generally a big show of hands).
• “Who thinks that it would be legitimate if you went on medical leave due to stress?” (Generally a lower show of hands).

With this method, you may get an indication of, whether stress is perceived as legitimate, and work with this.

Make a medical leave policy with clear guidelines for long-term medical leaves
Research shows that a concrete, detailed policy for medical leaves is important. The policy should not segregate physical illness from psychological, but apply for all medical leaves. In the research project, we found that a clear, detailed policy for medical leaves was a support for leaders as well as employees and colleagues.

The policy should include clear guidelines for what should happen when an employee is going on medical leave. Who should make contact first, when can you expect to make contact, and how is the contact carried out? The guidelines can also describe what options the workplace has, to help the employees on long-term medical leave to return, for example, by gradual return, change of duties, time to go to treatments as well as the option of a treatment offer paid by the firm, by medical insurance. Publish the policy on the corporate intranet or the employee manual, so that everyone has access to it, when relevant.

Make stress-prevention a strategic aim
The work-environment effort should be of the highest priorities in every firm, just think how much employees on medical leave, human errors and the replacement of staff, costs.

In the research project we saw that the best work-environmental initiatives were carried out in the workplaces where the organisation of work-environment and management worked together, often with the assistance from professional advisors.

You can get more information about the results from COPEWROK-project and download the report on this webpage or by clicking here.