Autopsy of a Failure: Evaluating Process and Contextual Issues in an Organizational-Level Work Stress Intervention Caroline Biron, Caroline Gatrell, and Cary L. Cooper Lancaster University
The difficulties associated with the evaluation of organizational-level work stress interventions are notorious yet little attention has been paid to the reasons why they fail. This case study took place in a department of 205 employees from a private company where an intervention was developed but poorly implemented. This paper scrutinizes the intervention to understand why it was poorly implemented and examine its effects on employees. Qualitative data (field notes and interviews with managers) was used to evaluate the intervention. Questionnaires (n ⫽ 125, n ⫽ 94, 60 full-completers) were used to evaluate the level of implementation and its effects. Results suggest partial implementation might have a detrimental effect on commitment. Poor implementation could be accounted for by the changing organizational context, low ownership of stakeholders, and flaws in the intervention design. Considering the process and context of interventions is essential to understand their effects. Keywords: organizational stress interventions, evaluation, failure, process, context
Organizational change efforts (Fullan, 2003) and social programs (Gottfredson & Gottfredson, 2002) are known to have a high rate of implementation failure. In fields such as aeronautics, failures get analyzed in great depth in order to reduce the risk of their reoccurrence (see, e.g., Columbia Accident Investigation Board, 2003). Although the difficulties associated Caroline Biron, Caroline Gatrell, and Cary L. Cooper, Lancaster University Management School, Lancaster University. We would like to express our gratitude to the Human Resources and Occupational Health departments of the participating organization for their assistance. We would also like to thank Hans Ivers, Michael O’Driscoll, Jean-Pierre Brun, Michel Audet, Genevie`ve Baril-Gingras, Susan Cartwright, and Philip Gibbs for their helpful comments during the preparation of this manuscript. Correspondence concerning this article should be addressed to Caroline Biron, Lancaster University Management School, Lancaster University, Lancaster, United Kingdom, LA1 4YX. E-mail:
[email protected] 135 International Journal of Stress Management 2010, Vol. 17, No. 2, 135–158
© 2010 American Psychological Association 1072-5245/10/$12.00 DOI: 10.1037/a0018772
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with their successful implementation and evaluation are notorious (Cooper, Dewe, & O’Driscoll, 2001; Dewe & Kompier, 2008; Griffiths, 1999), there is a striking paucity of studies considering why organizational-level stress interventions fail to be implemented. This article examines a company’s stress prevention initiative which was partly based on the Health and Safety Executive’s (HSE) Stress Management Standards (MacKay, Cousins, Kelly, Lees, & McCaig, 2004). The intervention aimed to compel managers to use a Stress Risk Assessment tool (SRA) within their team, and discuss the results with employees to find corrective solutions. The SRA tool is partly based on the Pressure Management Indicator (Williams & Cooper, 1998). Its utilization is part of a stress prevention system combining assessment and intervention which was developed by a consultancy company. This type of tool is widely available, especially in the United Kingdom (UK) where, according to legislation, employers are obliged to conduct stress risk assessments (Health & Safety Executive, 2009). In this paper, we argue that risk assessments have to be combined with an appropriate implementation plan in order to produce any positive results. Poor evaluation of the program’s feasibility coupled with an unrealistic implementation plan is a mistake likely to occur in other organizations. In the present case, implementation levels were known to be poor in the entire company (only 15% according to the organization’s administrative data). Since the difficulties associated with the implementation of interventions following a risk assessment are arguably typical, a department from a large private company was chosen to investigate in depth the reasons why it was not implemented properly and evaluate if employees in teams where the SRA tool was used would report positive changes. Given the popularity of stress management products on the market, organizations have to first consider their practical relevance and applicability before investing in them. The paper aims to illustrate how such a critical examination of the foundations of stress prevention programs can be useful to identify and correct inherent flaws before deploying them. Despite the acknowledged need to evaluate process and contextual issues in occupational health interventions (Cox, Karanika, Griffiths, & Houdmont, 2007; Griffiths, 1999), there is still little published research on the topic. According to Nytrø, Mikkelsen, Saksvik, Bohle, and Quinlan (2000), the scarcity of studies evaluating process might be due to the reluctance of organizations, researchers, and publishers to publish unsuccessful research projects, although much knowledge could be gained from them. As underlined by Noblet and LaMontagne (2008), “without a sound understanding of the factors that facilitated or undermined the program objectives, there is the temptation to simply transfer interventions from one workplace to another and expect that the outcomes will follow” (p. 467). There are also reasons to believe that organizational and work-oriented stress interventions could produce more consistent results if more attention
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was paid to the process and context in which they are developed, designed, and implemented (Goldenhar, LaMontagne, Heaney, & Landsbergis, 2001; Rossi, Lipsey, & Freeman, 2000). Evidence of the effectiveness of organizational-level interventions are still scarce and often inconsistent (Biron, Cooper, & Bond, 2008; Parkes & Sparkes, 1998). These inconsistencies are also found in other social programs and have led to reconsiderations about the appropriateness of outcome-focused evaluations which treat programs as “black boxes” (Dobson & Cook, 1980). Black box is a metaphor which is used to describe evaluations with inadequate information about the contextual factors and processes which influence the relationship between the program and the effects (Nilsen, 2007). Cox et al. (2007) argue that “there is a case for exploring the breadth of our interest beyond outcomes” (p. 353). Methodological approaches need to be articulated so that our understanding of how and why interventions succeed of fail can be enhanced. Two studies illustrate this point by considering the implementation process in the study design. Randall, Griffiths, and Cox (2005) measured the extent to which participants were exposed to an organizational-level stress intervention. Although no overall differences were found in exhaustion, participants exposed to the intervention reported decreased exhaustion levels whereas as participants not exposed remained stable. In the same line, Nielsen, Randall, and Albertsen (2007) showed that the participants actively engage in the intervention and it is the quality of this involvement that mediates the relationship between the exposure to the intervention and outcome measures. These two studies highlight how attention paid to the implementation process provides insight regarding how an intervention produces its effects. “Process” is here used to refer to “the flow of activities; essentially who did what, when, why and to what effect” (Cox et al., 2007, p. 353). Although the term has been use to refer to various aspects of the implementation phase (Steckler & Linnan, 2002), a broader definition is used here to reflect various influences at each phase of the risk management cycle. Indeed, prior to being implemented, interventions have to successfully go through each phase of the risk management cycle (Cox et al., 2000), namely, 1) the preparation for change and the risk assessment, 2) the translation of the risk assessment results into concrete actions, 3) the implementation, and 4) the evaluation of effects and organizational learning. Contextual factors have also been shown to influence the development and implementation of interventions (Polanyi, Cole, Ferrier, & Facey, 2005). The use of the term context is used broadly here, referring to the context of the intervention, of the organization in which it takes place, and the external (macro) influences. The passage from one phase of the risk management cycle to another implies mechanisms and contextual factors have to be “activated.” According to realistic evaluation (Pawson & Tilley, 1997), it is the identification of mechanisms which were
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triggered, and the characteristics of the context in which they were triggered, which should be the focus of the evaluation. For example, instead of looking at the effects of interventions on specific outcomes, realistic evaluation aims to uncover the mechanisms by which the outcomes are supposed to be produced (Pawson & Tilley, 1997). Pawson (2002) argues that “it is not “programs” that work: rather it is the underlying reasons or resources that they offer subjects that generate change” (p. 342). To be accounted for, these factors first have to be identified as relevant (Lipsey & Cordray, 2000). There is still little research on the prerequisites for stress interventions to get carried successfully passed the risk assessment phase, so that they can be translated, implemented, and evaluated. With a view to develop a theoretical framework identifying process and contextual issues influencing each phase of organizational-level stress interventions, Biron et al. (2008) categorized the existing issues in the stress literature (Brun, Biron, & Ivers, 2008; Giga, Faragher, & Cooper, 2003; Nytrø, Saksvik, Mikkelsen, Bohle, & Quinlan, 2000; Saksvik, Nytrø, DahlJorgensen, & Mikkelsen, 2002; Saksvik et al., 2007), existing models in occupational health and safety (Goldenhar et al., 2001), and in public health (Steckler & Linnan, 2002). For each step of the risk management approach (Cox et al., 2000), the model specifies factors likely to influence the trajectory of the intervention. These factors refer to 1) the context, 2) the characteristics of the intervention project itself, and 3) the characteristics of the stakeholders. In the present study, the intervention project stalled at the risk assessment phase. Factors potentially influencing this first phase are showed in Figure 1.
RESEARCH CONTEXT AND INTERVENTION
The study took place in a UK private company which is one of Europe’s leading utilities. It employs more than 10,000 employees, but 205 worked in the department concerned. This department was chosen precisely because no intervention had taken place yet, which permitted us to follow the intervention before its instigation. According to the legislation in the UK, employers have a duty to “assess the risk of stress-related ill health arising from work activities under the Management of Health and Safety at Work Regulations, 1999 and under the Health and Safety at Work and so forth Act, 1974, and to take measures to control that risk” (HSE, 2009). The HSE offers ample guidance on risk assessments and undertakes enforcement action when employers fail to carry out the legally required suitable and sufficient risk assessment. Although inspectors can issue improvement notices and action may be taken when the law is breached, the approach is not enforcement led. It is hoped that employers will take action following the risk assessment
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Context Communication about the program Organizational capacity, resources (financial, human, expertise, skills) Motives (e.g. legal, economic, political, altruistic) Appointment of a steering committee that has sufficient influence on stress-related issues Social climate of leaning from failure, ability to detect obstacles early Characteristics of the intervention and its stakeholders Stakeholders’ support and commitment (at local and corporate levels) Stakeholders’ readiness to change Based on needs assessment Based on sound risk assessment Comprehensive (including primary, secondary and tertiary levels of prevention) Clearly defined and appropriate targets Feasible Importance of intervention in relation to other ongoing changes and projects Participative design with clearly defined roles Figure 1. Process and contextual issues in the literature influencing the development stage of an
organizational stress intervention.
given the strong business case for stress (see Bond, Flaxman, & Loivette, 2006), not to mention the costs of a successful lawsuit. To comply with this requirement, this company adopted a prevention system which allegedly effectively combines the utilization of a stress risk assessment tool with interventions by promoting ownership and responsibility for stress prevention on managers and employees. The SRA measures the stressors identified by the HSE (i.e., Relationships, Roles, Change, Demands, Control and Support) as well as mental and physical well-being, and subjective performance (Williams & Cooper, 1998). In addition to providing the managers with a team-based report depicting high, medium and low levels of problems within the team, the SRA tool also allows to benchmark the team’s results against those of the overall company. The board of directors agreed the tool was to be compulsory for all managers of the organization, and was to be administrated in a top-down approach so that each manager could experience it before using it for his or her own team.
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The main steps of the program are illustrated in the left column of Figure 2. First, managers attended a stress workshop where they learned about basic occupational stress concepts and about the SRA tool. Following the workshop, the Occupational Health (OH) department sent a login code allowing managers to invite members of their team to complete the questionnaire. A minimum of 60% of the team had to complete the questionnaire before for the manager could close this phase. Individuals had access to their own stress profiles, whereas managers received a confidential aggregated team report.
Input
Program design Workshop for managers Managers attend a stress workshop where the SRA tool is introduced. Results from two anonymous teams are used to help managers with interpretation and translation.
Output
Setup of the SRA project Each manager receives a login code to set up a project and sends his/her team a link to the SRA questionnaire so they can complete it.
Employees complete risk assessment Employees complete the questionnaire on their stressors and health and obtain their individual stress profiles.
Manager gets the group report Manager closes questionnaire phase and prints out group report once 60% of the team has completed it.
Outcomes (initial, Intermediate, long-term)
Activities
Manager and team meeting Team meeting is held to discuss problems and agree a possible action plan.
Underlying assumptions (necessary for the program to work) • • • • •
HR staff are trained to teach the workshop Managers are available and willing to attend Information is delivered correctly Managers see benefits in using the tool Managers’ understanding of stress process is raised along with commitment to use the tool.
•
Occupational health department’s data is up to date Manager perceives the need for change and consider the tool positively The team has more than 6 members (otherwise the tool cannot be used due to risk of confidentiality breach).
• •
•
Response rate is influenced by employees’ perceptions, expectations and beliefs regarding the project and the promise of improvements in work conditions inherent to it.
•
Team-based diagnostic is only valid if team composition (including manager) remains stable Manager remembers / chooses to close the questionnaire phase and prints group report Manager understands and interprets the results in a meaningful way.
• • • • • •
Implementation of action plan Agreed action plan gets implemented fully and adequately.
• • • • •
Team composition (including manager) remains stable Level of trust between employees and manager is high Group discussions are constructive not accusative Consensus is reached concerning priorities and how to improve. Team composition remains stable Manager has the human and technical skills, resources and will to implement interventions Employees support and are involved in the process Communications are made on accomplishments/changes Interventions are delivered with fidelity and are reaching their targets.
Exposure to stressors is reduced to acceptable levels, leading to improved health and well-being, leading to improvements on key performance indicators (e.g. absenteeism/performance).
Figure 2. Description of the program design and underlying assumptions for the program to be
implemented.
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The procedure was confidential as no one had access to individual data. OH staff had access to detailed feedback concerning the steps completed by managers. Managers were expected to discuss the group report in a team meeting and agree on corrective interventions for high risks levels. Once an action plan had been agreed upon, managers were expected to enter it in the system which fed it back to the OH department. Follow-up assessments were recommended to evaluate progress but this was not compulsory. OBJECTIVES OF THE STUDY
This paper first aimed to depict how the processes and contextual issues influenced the trajectory of this intervention and obstructed its implementation. This is in line with realistic evaluation principles according to which particular attention should be paid to the mechanisms by which and contexts in which programs produce their outcomes. Second, changes in employees’ working conditions and well-being were examined in relation with the implementation level. Program evaluation generally comprises three main evaluation questions (Scriven, 1993). The aims of these questions and the way in which we answered them is described below. Needs Assessment and Evaluation of the Program Design
This evaluation question aims to determine what the employees’ and organization’s needs are, and whether the strategies developed are actually meeting these needs. To assess this, each step of the intervention and the underlying assumptions which have to be met for the intervention to produce the intended results were described. Formative Evaluation
This refers to the quality of the implementation and involves determining whether the program was delivered according to plan and to which extent it was actually received by the end-users. Managers were asked to indicate whether or not they had used the SRA and the reasons why. Summative Evaluation
This concerns the effects on outcomes, side effects, the efficiency and cost-benefit analysis. In the present study, it was hypothesized that (1) no
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overall changes would be measured in employees’ exposure to stressors and well-being indicators, and (2) utilization of the SRA tool would be a moderator in that compared to employees whose managers did not use the SRA tool, those whose managers had used the SRA tool would show improvement over time.
METHOD
The difficulties encountered in this project are likely to be typical and found in other organizations. In order to understand why the project failed to be implemented, we attempted to answer the three evaluation questions described above using a case study methodology and a mixed-methods approach. According to Yin (1994), case study methodology is appropriate to answer questions like “how” or “why” and when the investigator has a little possibility to control the events, for example in a real-life context such as this one. A total of 32 managers worked in the participating business unit which, as mentioned before, was selected because no intervention had been instigated. The unit comprised two operational departments. To enhance internal validity when evaluating the effects of the intervention, one group of managers was trained to implement the program 6 months before the second group. If the program was to produce some effects, it was hypothesized that these would be stronger in employees from the first group of trained managers. Managers were split into two groups based on their operational departments, and 50% from each department were randomly allocated to each research group. Figure 3 illustrates the research design on a timeline, the number of participants, and use of each method to answer the research questions.
Instrument and Procedure – Needs Assessment and Evaluation of the Program Design
Qualitative data (12 semistructured interviews and observation notes gathered over 12 months) was used to document the intervention process and context. Out of the 16 managers composing Group 1, 12 managers from all levels (operations, team and senior manager) were interviewed individually 6 months after they attended the stress workshop where they were trained to use the SRA tool. A consent form was provided which ensured the confidentiality of the interview. The interviews aimed to provide an account of participants’ perceptions of the intervention so they contained four broad
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Research
Company 1
*Research questionnaire Time 1 (n = 125)
3 **Observation
Preparation
**Interviews with managers in Group 1 (n = 12) *Research questionnaire Time 2 (n = 94)
Managers of Group 1 attend workshop and begin the program (n = 16)
6
9
Managers of Group 2 attend workshop and begin the program (n = 16)
12
Time (in months) Figure 3. Research design and company’s intervention timeline. ⴱ Measures of psychosocial risks and well-being using ASSET with additional intervention items, used to assess the initial need for the intervention program, its level of implementation, and its effects. ⴱⴱ Qualitative data used to analyze the program design and the perceptions of the program.
sections: 1) job description and seniority, 2) changes at work in the previous year, 3) perceptions of the company’s stress initiative, including the stress workshop, the risk assessment tool, whether or not they had used it and the reasons why, and 4) what would motivate them to use it. An additional probing question concerned their level of comfort with the requirements of the program (i.e., discussing stress-related issues in a group session with their team, agreeing on an action plan, and doing the same process with their own manager). Participants were informed at the beginning of each interview that there was no right or wrong answer. In addition to the interviews, interactions with the stakeholders from the beginning of the study until the end were saved, printed and analyzed to document the intervention process. This represented over 200 electronic exchanges and observation notes. Analysis of qualitative data was done by using transcripts of interviews and print-outs of electronic exchanges, telephone communications and observation notes. The material was analyzed (by the first and second authors) using template analysis proposed by Crabtree and Miller (1992). A list of codes was elaborated and we used this template to identify themes in the transcribed material. The template was adapted and modified after the first analysis in order to reflect the data. Then, the data was organized into the template with text segments for each of the themes that emerged.
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Instrument and Procedure – Formative and Summative Evaluation
The SRA tool was to be used by managers to obtain a confidential team report on sources of stress. For the purposes of the research, a different questionnaire was used: ASSET (Cartwright & Cooper, 2002; Faragher, Cooper, & Cartwright, 2004). This questionnaire was selected because it provides individual data, is based on established models of stress (e.g., Cooper & Marshall, 1978) and has norms for the private sector. ASSET comprises three sections, as well as sociodemographic characteristics. Cronbach reliability coefficients at Time 1 are indicated for each scale.
Exposure to Stressors This section comprised 37 items about being troubled by relationships (␣ ⫽ 85), resources and communication (␣ ⫽ .69), pay and benefits (only 1 item), work-life balance (␣ ⫽ .71), overload (␣ ⫽ .80), job security (␣ ⫽ .68), control (␣ ⫽ .81), and job overall (␣ ⫽ .72), scored from 1 (strongly disagree) to 6 (strongly agree).
Commitment This section included nine items measuring perceived commitment of the organization to the employee (e.g., feeling valued and trusted by the organization), (␣ ⫽ .83) and commitment of the employee to the organization (e.g., willing to go the extra mile), (␣ ⫽ .79), scored from 1 (strongly disagree) to 6 (strongly agree).
Strain and Absenteeism Mental (␣ ⫽ .91) and physical (␣ ⫽ .79) well-being were measured by 19 items, scored from 1 (never experienced the symptom over the last 3 months) to 4 (often experienced the ill-health symptom). The number of days of absenteeism during the last 12 months was measured.
Intervention A section was added to ASSET in order to evaluate the implementation and perceptions of the SRA tool. The perceived need for change was
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measured by using the Discrepancy subscale (4 items, ␣ ⫽ .91) proposed by Holt, Armenakis, Feild, & Harris. (2007). The subscale evaluated the extent to which one perceives the change as legitimate and needed. Items were scored on a scale from 1 (strongly disagree) to 6 (strongly agree). In line with the notion of formative evaluation, managers were asked at follow-up to indicate whether they had used the SRA tool, and to specify the reasons why in an open-ended question. Since each manager was expected to discuss the results of the SRA in a face-to-face meeting with the team, four items concerned the degree of comfort in discussing stress issues with them (␣ ⫽ .85).
Participants
A total of 125 employees completed the ASSET questionnaire after managers attended the stress workshop, and again 9 months later (n ⫽ 94) (response rate of 61% at Time 1 and of 48% at Time 2, with n ⫽ 60 full-completers). The dropout rate was 52%. This is possibly due to the fact participants already had to complete the SRA questionnaire sent by their supervisors. A total of 54 employees whose manager used the SRA completed the questionnaire, and were compared to the 75 employees whose manager did not use the SRA tool. The ASSET questionnaire was distributed by email using lists of staff provided by the HR department, and was completed online. A consent form describing the aims of the study and the measures taken to ensure confidentiality was included. Managers and senior officials (24%) and administrative/ clerical staff (33%) were the largest groups, followed by sales and customer service staff (20%). The sample included 62.8% of women, and 60.6% of the participants were aged between 31 and 40.
Data Analysis
To evaluate if the utilization of the SRA tool by managers was associated with longitudinal changes in employees’ stressors, commitment levels, and well-being indicators, we first matched each participant with their manager at Time 1 according to the lists provided by the HR department. We then analyzed whether employees showed differential changes in exposure to stressors, commitment, and well-being indicators over time based on the manager’s answer regarding the use of SRA (yes/no). A series of analyses of variance using linear mixed models were conducted for exposure to each of the risk factors and well-being indicators on a split-plot factorial design
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(Manager’s utilization of the SRA’ tool ⫻ Time). Mixed model analysis was favored over the traditional analysis of variance (ANOVA) method using repeated measurements due to its ability to retain incomplete longitudinal observations (thus increasing the statistical power while ensuring that the conclusions are also more representative) and its greater ability to cope with non-normal data and groups of unequal sizes (Keselman, Algina, & Kowalchuk, 2001). In order to study the moderating effect of the SRA tool, particular attention was paid to the interaction effects. Simple effects were selected to study the significance of temporal changes for each level of the moderator (Used vs. Didn’t use the SRA tool), using a corrected alpha level of .05 (simultaneous test procedure, Kirk, 1996). Effect sizes (d) are reported (Cohen, 1988).
RESULTS Needs Assessment and Evaluation of Program Design
At both baseline and follow-up, respondents’ exposure to stressors were lower (p ⬍ .01) than the norms for the UK private sector (N ⫽ 1539), except for ‘Pay and benefits,’ which was comparable to the norms (Cartwright & Cooper, 2002). Both physical and mental health scores were comparable to the norms at Time 1 (p ⫽ .24, p ⫽ .67, respectively), and Time 2 (p ⫽ .43, p ⫽ .96, respectively). Participants however reported lower levels of commitment from their organization compared to workers in the private sector at both times (p ⬍ .000). Low organizational commitment implies they don’t see why they would “go the extra mile” for this organization. Employees commitment toward the organization was also lower than the norm at both Time 1 (p ⬍ .000) and Time 2 (p ⬍ .05). We articulated the program design and the underlying assumptions (see Figure 2) for it to produce the intended results. The following section will review these assumptions by focusing on elements which influenced the trajectory of this intervention. As previously mentioned, Biron et al. (2008) suggested influences which can relate to the organizational context, the characteristics of the interventions’ and of the stakeholders.
Contextual Influences According to the program design, once managers were trained to use the SRA tool, they were to use it as a basis for discussion with the team members, implement the corrective measures, and eventually readminister the tool to
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evaluate the changes. One basic requirement for this sequence of events to take place is team stability. Interviews showed that very few (five) managers from the first group trained to use the SRA tool were in a position to use it appropriately. The others had either: changed job, most of their staff moved to a different team, their team reduced to less than six employees (which automatically stops them from using the SRA tool due to confidentiality issues), were no longer in a management position or left the company after using the tool. In fact, the level of turnover and changes in team composition was so intense that a stress risk assessment was unthinkable given the conditions of this business unit. The OH department of the company investigated the extent of these changing conditions throughout the company and found that the majority of managers who had already used the SRA tool could not readminister it to evaluate their progress due to changes in the organization.
Low Ownership of Stakeholders The first step of the intervention program required managers to attend a stress workshop, which was delivered by an HR staff. Interviews revealed that level of ownership and felt responsibility at this first stage varied. Most agreed that preventing stress at work was an important and legitimate corporate responsibility: “It is really something that the company has to look at.” However, one manager mentioned that on its own, a stress awareness workshop is not a sufficiently powerful trigger to convince managers to use the SRA tool: “Unless you use it straight away, you forget what it was about.” A manager pointed out that stress-related issues are a sensitive topic and should not be discussed in a large group with the presence of strangers: “We talked about it (stress) briefly but because there were people from other buildings and floors, we didn’t spend much time talking about it. You take it all in for a couple of hours and then you just go back to work.” As for the utilization of the SRA tool, quantitative and qualitative data converged in showing a low perceived need for the tool. Although most managers admitted its usefulness, they did not feel it was needed in their team. Some indicated it was an “eye opener”: “The quiet ones could be the ones who need to be looked at.” However, a variety of responses indicated their lack of ownership for the tool. Two managers attributed stress to heavy workload and high levels of responsibility, which are perceived to be only occurring at upper levels of the hierarchy: “Stress is important, but my staff is too laid back”; “Stress is more at senior level of management”; “Even though staff’s work is a bit tedious, it’s not stressful.” One manager thought the tool was superfluous: “If there was anything, my staff could come and
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talk to me.” In sum, the low level of exposure to stressors coupled with managers’ perception that the tool was not needed did not augur well for this intervention to be implemented. As Semmer (2006) stated, there is no need to offer smoking cessation programs to nonsmokers.
Characteristics of the Intervention There is a consensus among researchers that intervention programs should be based on a sound risk assessment, so that groups at high risks are identified, and appropriate measures are taken (Cooper & Cartwright, 1997; Cox et al., 2000; Giga et al., 2003; Jordan et al., 2003; MacKay et al., 2004). However, translating the results of a risk assessment exercise into meaningful interventions requires time, resources, and support (Brun et al., 2008; Cox et al., 2000). In the present case, the responsibility for translating risks into feasible interventions relied on managers without a supporting infrastructure or expertise to help them. Provided that stressful conditions exist within a team, meetings to discuss solutions can be very “slippery” and would require a solid facilitator in order to reach a consensus on how to correct these issues (Brun et al., 2008; Noblet & LaMontagne, 2008). In fact, survey data at follow-up showed that 32% of managers indicated they were uncomfortable to discuss stress-related issues with their team. Another crucial flaw in the design of this intervention concerned the role of line managers in stress interventions. The SRA tool was designed on the assumption that line managers are the ones with the most authority on employees’ sources of stress. This has sound theoretical founding. For example, Yarkers, Lewis, Donnaldson-Fielder, and Flaxman (2007) developed an indicator of managers’ competencies regarding each of the HSE’s stressors. These competencies refer to specific managers behaviors (positive and negative) which are linked with stressors. Although the team-based approach used in the present case acknowledged this important role, it has three important implications. First, it implies a high level of stability within the teams which was far from being the case in this business unit. Second, a team-based approach implies managers are not the cause of stress in their employees. Managerial leadership is important for well-being but can also be a source of stress, as the leadership literature acknowledges (Dellve, Skagert, & Vilhelmsson, 2007; Nyberg, Westerlund, Hanson, & Theorell, 2008). Third, although the project received a commitment from top management and was planned to be cascaded down to all hierarchical levels, interviews revealed that not all managers could benefit from the exercise of completing the SRA tool and discussing the results with their own manager. Either they had a team inferior to six (in which case the SRA tool cannot be used) or they
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were affected by organizational changes. Participating in an intervention process might have made the potential benefits more prominent, or at least inform managers about the strengths, limits, and pitfalls of the approach (Mikkelsen, Saksvik, & Landsbergis, 2000).
Formative and Summative Evaluation: Implementation and Effects of the SRA Tool
The follow-up measure included items regarding the implementation of the intervention. The workshop was attended by the majority of managers (88%, n ⫽ 21). As for the SRA tool, 33% (n ⫽ 8) of managers indicated they invited their team to complete the SRA. As hypothesized, results showed no overall significant changes in their employees between Time 1 and Time 2 with respect to sources of stress, mental and physical health, and commitment. Absenteeism was the only exception; the number days reported increased from 2.07 at Time 1 to 5.88 at Time 2, which was significant, F(1, 59) ⫽ 10.56, p ⬍ .01. We verified if the use of the SRA tool was associated with improvements in employees’ exposure to stress and well-being indicators. It was hypothesized that even if partially implemented, the SRA tool could produce positive changes for employees. The results are more indicative of the contrary tendency. At baseline, t tests showed no significant differences on any of the study variables between employees whose manager had used the SRA tool versus those whose manager had not. The analysis of the interaction effects “Use of SRA tool” ⫻ “Time” showed tendency contrary to what we expected, with three interaction effects approaching significance (p ⬍ .10). As depicted in Table 1, employees whose manager did not use the SRA tool reported a decrease in their workload, t(1, 40) ⫽ 2.68, p ⫽ .01, d ⫽ .65, a medium effect size. Three interaction effects which approached significance were found on physical health (p ⫽ .06), organizational commitment (p ⫽ .09), and employee commitment (p ⫽ .08). Analysis of simple effects showed that employees whose manager had used the SRA reported poorer physical health at Time 2, although this only approached significance and was a small effect size, t(1, 40) ⫽ 1.84, p ⫽ .07, d ⫽ .31. Employees whose manager used the SRA tool were less committed at Time 2, a medium effect size, t(1, 40) ⫽ 2.46, p ⫽ .03, d ⫽ .62. Lower organizational commitment was noted but only approached significance, a small effect size, t(1, 40) ⫽ ⫺1.75, p ⫽ .09, d ⫽ .45). The increase in absenteeism was only significant for those whose manager used the SRA tool, a small effect size, t(1, 40) ⫽ 2.02, p ⫽ .05, d ⫽ .35. To verify if differences in use of the SRA tool were related to differences between managers, we compared managers who didn’t use the tool with
1.39 0.70 2.23
1.01 0.87 1.29 0.59 0.33 0.67
0.68 1.01
0.93 0.79
0.68
23.66 14.66 3.05
9.01 12.42 20.56 11.02 3.59 11.22
10.36 23.06
18.66 16.86
16.59
SE
Time 1
M
‡
Note. Only the interaction effect is shown. p ⬍ .10. ⴱ p ⬍ .05. ⴱⴱ p ⬍ .01.
Strain Mental health (poor) Physical health (poor) Absenteeism (days) Stressors Work-life balance Control Work relationships Job security Pay and benefits Overload Resources and communications Aspects of the job Commitment Organization to employee Employee to organization Change Readiness to change
Variable
17.32
19.21 16.92
10.62 21.81
8.43 11.49 19.22 10.19 3.08 9.03
22.0 14.22 5.11
M
0.57
0.78 0.65
0.57 0.84
0.51 0.73 1.06 0.49 0.28 0.56
1.21 0.63 0.17
SE
Time 2
0.18
0.55 0.06 .21
.12 .01
.07 .24
⫺.19 ⫺.21 ⫺.21 .28 .29 .65
⫺0.58 ⫺0.93 ⫺1.34 ⫺0.83 ⫺0.50 ⫺2.19ⴱⴱ 0.26 ⫺1.25
⫺.23 ⫺.11 .17
d
⫺1.68 ⫺0.45 2.01
Change
SRA tool not used
14.40
18.50 17.39
10.28 16.45
6.47 11.44 16.72 9.02 3.46 8.72
21.85 13.64 2.53
0.81
1.12 0.95
0.82 0.98
0.72 1.04 1.57 0.71 0.40 0.82
1.64 0.81 2.60
SE
Time 1 M
16.53
16.37 14.93
10.50 17.2
7.40 12.00 18.73 9.70 3.47 9.17
21.87 14.83 6.80
M
0.64
0.86 0.73
0.64 0.77
0.57 0.82 1.18 0.54 0.32 0.62
1.34 0.70 2.23
SE
Time 2
SRA tool used
.06 .09 ⫺.45 ⫺.62 .61
⫺2.13‡ ⫺2.46ⴱ 0.53ⴱⴱ
.30 .13 .31 .23 .00 .13
.00 .31 .35
d
0.22 0.47
0.93 0.56 2.01 0.68 0.00 0.45
.014 1.20‡ 4.27ⴱ
Change
Table 1. Longitudinal Changes in Employees Based on Managers’ Utilization of the Stress Risk Assessment Tool (SRA)
1.59
2.84 3.12
0.00 2.22
2.47 1.10 1.81 2.09 0.90 4.35
0.72 3.78 0.65
F
.21
.09‡ .08‡
.97 .14
.12 .30 .19 .16 .35 .04ⴱ
.39 .06‡ .43
p
ANOVA (SRA ⫻ Time)
150 Biron, Gatrell, and Cooper
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managers who did. Results showed managers who used the SRA tool reported better mental health, F(1, 20) ⫽ 8.64, p ⬍ .01, better physical health, F(1, 20) ⫽ 7.40, p ⬍ .05, lower exposition to stressors such as poor resources and communication, F(1, 20) ⫽ 5.92, p ⬍ .05 and poor relationships at work, F(1, 20) ⫽ 5.54, p ⬍ .05.
DISCUSSION
In this case study, realistic evaluation principles were used to scrutinize the design and effects of an organizational stress intervention which failed to be implemented properly. The program consisted of a stress risk assessment tool developed by a consultancy company to help organizations in complying with the HSE’s legal requirements. Low stress levels, low perceived need for the intervention and a program design unsuitable given the context of unremitting changes appeared to have led to its poor implementation. The quantitative data suggested that conducting a stress risk assessment as a stand-alone intervention could be associated with detrimental effects on employees’ commitment, but this trend only approached statistical significance. A closer examination of the intervention’s design and underlying assumptions raised several key factors which undermined the implementation of this program. The fact that the implementation problems were widespread within this company also suggests that the problems occurring in this department were not specific, but typical.
Contextual Influences
Many organizational and internal changes affected this unit. Each time the company acquired a new business, technological system changes were introduced, causing team reorganizations. Administrative records showed organizational changes were also affecting the rest of this organization. Our survey data showed that in teams where the manager had not used the SRA tool there was a decrease in workload. This result is surprising considering there were a lot of changes for all the teams. It is possible that the introduction of new technological systems actually decreased the workload, but having to conduct or participate in a stress risk assessment was perceived as an additional job demand. Tvedt et al. (2009) showed that organizational changes increase job demands. In the same line, Brun et al. (2008) described managers’ increased workload during the implementation phase of an organizational-level stress intervention. Introducing changes as complex as the ones required by a stress intervention does not seem compatible with the
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constantly changing work environment characterizing this unit. The assumptions embodied in the program design require stability for the program to be functional. To use Bauman’s terminology (2001), the introduction of additional changes within an already rapidly changing context can be labeled as “liquid” stress prevention. Bauman’s use of the term “liquid” as opposed to solid refers to the impossibility to build knowledge and learn from the interventions due to the constant changes which prevented any solidification of changes, long-term actions, in-dept learning, or true participation. The difficulty posed by changing organizations has been noted in the literature (Griffiths, 1999). As underlined by Heaney (2003), intervention developers and researchers would benefit from considering organizational change theories when conducting interventions. In contexts of change, humans are more sensitive to new conditions brought by the change and negative events produces stronger and longer lasting effects than positive ones (Baumeister, Bratslavsky, Finkenauer, & Vohs, 2001). Although only approaching significance, the trend toward decreased levels of commitment, poorer physical health and higher absenteeism in employees’ whose manager used the SRA tool suggest that the expected improvements the program should have brought did not take place. Brun et al. (2008) discussed how they encountered employees’ reluctance to participate in a stress intervention within their department. Indeed, employees displayed a systematic doubt regarding the credibility of intervention because they had seen previous projects fail to get implemented. A history of change attempts that are not successful tends to lead to cynicism about changes (Reichers, Wanous, & Austin, 1997).
Low Ownership of Stakeholders
The lack of ownership of the project is reflected at several levels. First, line managers perceived that stress was either something individual, a phenomenon concerning only higher levels of management, or that their team members could come and talk to them if there was any problems. However, the survey data suggested that managers who used the tool actually had less communication problems and better relationships at work. The fact that they also had better mental and physical health compared to managers who didn’t use the SRA tool seems to indicate a “healthy manager” effect, in the sense that managers who use the tool might be the ones whose team needs it the less. This needs to be replicated with larger sample but the difficulties to reach the intended audience is a well acknowledged difficulty in public health interventions (Steckler & Linnan, 2002). The program theory is this case was based on the idea that the legal requirements will be sufficient to enforce the utilization of the SRA tool.
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When using it, managers would see the benefits and make it a priority if needed. Motivation theories show that external regulation (e.g., legal requirement) is not the most effective way to engage people in their actions with a full sense of choice (Ryan & Deci, 2000). In order to build managers’ intrinsic motivation to use the SRA tool, different and more theoretically founded strategies needed to be instituted to create ownership and commitment (Dawson, Willman, Clinton, & Bamford, 1988; Fullan, 2003).
Characteristics of the Intervention: Scope, Approach, and Target
The utilization of the SRA tool was compulsory and implemented company-wide. Although this could be interpreted as a sign of top management commitment, the lack of resources allocated to the project (i.e., no steering committee, no support to managers, and no allocated budget to implement specific interventions) did not reflect a true commitment. The intervention did meet the legal requirements of the HSE, but the lack of resources attributed to the implementation showed a “tick the box” approach with an overreliance on risk assessment as a preventative tool. It is considered best practice in the intervention literature to conduct a risk assessment to determine who is affected and how (Jordan et al., 2003). In the present case, a great amount of time and resources was spent on developing a sophisticated tool that produced a simplified, yet very complete, team diagnostic with very suboptimal utilization given that no resources were invested in the implementation phase. Indeed, after finding out the intervention was not implemented, an email was sent to the managers in the company who had already used to tool to find out if they could do a follow-up, but the majority could not due to changing contexts. As discussed by Brun et al. (2007), organizations often spend much time and efforts determining the right instruments, administration and communication modes, and debating on a continuum of positive-negative labels to ensure the proper message is conveyed. This leaves little resources, motivation and energy to pursue the rest of the phases of the risk management cycle. Saksvik et al. (2002) also report this “project fatigue,” described as the tendency for assessment without follow-ups. Since the survey data suggested that employees whose manager used the SRA tool as a stand-alone intervention can be deleterious for employees’ well-being, more efforts and resources should perhaps be paid to managing the risks of stress at work, instead of measuring them. The team-based approach putting the line manager in charge also contained a weakness. Considering the importance of good management practices on employees’ well-being and the strategic role of line managers (Yarker et al., 2007), a team-based approach might sound ideal but in the
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present case, it was inapplicable given the frequency of changes and the lack of appropriate measures to support teams and line managers in implementing interventions. For instance, technical support when administering the SRA tool or when interpreting the results may have been needed. Assistance with more complex relational issues (e.g., initiating a nonconfrontational discussion with employees on stress issues, dealing with divergent points of view), and with project management skills may have also been helpful.
Limits
This case study was conducted with a relatively small sample which is not representative, although poor implementation levels and similar problems were also encountered throughout the company. In line with case study methodology (Yin, 1994), the purpose of the paper was more focused on suggesting theoretical propositions regarding the implementation failure and verifying if data converged in support of these propositions, rather than on suggesting statistical generalization. Given the popularity of tools and products to manage occupational stress, and given the type of difficulties faced when implementing these preventative strategies, this case highlights issues likely to be found in other organizations. For example, Cox et al. (2009) also report organizations having problems with applying and implementing the HSE’s Management Standards in the way the HSE intended in practice. The time frame was quite short (12 months overall, and 9 months between the survey measures), considering organizational-level interventions are known to take time before being fully implemented (Parkes & Sparkes, 1998). Moreover, since the SRA tool was intended for managers only and provided aggregated data, another questionnaire had to be used in conjunction with the tool. It is likely that respondents confused the two, and that having to complete three questionnaires over 12 months represented a burden. The problems noted in the program design and its underlying assumptions are issued from the qualitative analyses. The list of problems is not claimed to be exhaustive, and it is not the purpose of this paper to claim they played a causal role in the implementation failure. Instead, the paper aimed to examine how process and contextual issues influenced the trajectory of this intervention and prevented it from getting beyond the risk assessment phase. As for the summative evaluation, the moderation analyses showed a trend which approached significance and has to be interpreted with caution. Further research should verify the effects of aborted interventions on various outcomes. Finally, a note has to be made concerning the term “failure”. The low percentage of managers using the tool according to both administrative records and our survey data, and qualitative data showing a high level of
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changes in teams brought us as researchers to qualify this as an implementation “failure”. From the organization’s perspective, this is not necessarily the case. Indeed, their corporate social responsibility report proudly described how they were proactively complying with the HSE’s legal requirements. CONCLUSION
Scrutinizing this “real-world” intervention provided useful insights into the components of the black box of organizational-level interventions to prevent work-related stress. From a pragmatic perspective, given that it is advocated in the literature that stress interventions should be based on a risk assessment, it is crucial to understand and identify what went wrong so that other organizations can avoid the same pitfalls. The feasibility and relevance of an intervention should be assessed contingently with the organizational context, and appropriate measures should be taken to ensure true ownership of the project by the stakeholders. From a theoretical perspective, this study contributes to the acknowledged need to consider process issues instead of strictly focusing on outcomes in stress intervention research (Cox et al., 2007; Griffiths, 1999; Semmer, 2006). Paradigmatic wars have kept researchers from using methodologies and theoretical perspectives which they perceive as irreconcilable with their own. However, as argued by Cox et al. “a more broadly conceived and eclectic framework” is needed for evaluating interventions with methods and study-designs which are “fit for purpose” and adapted to the organizational reality (p. 349). This paper adds to the scarce literature on the processes and contexts in which organizational-level work stress interventions are developed and implemented. The study identified mechanisms and contextual issues which had to be triggered for the program to get beyond the risk assessment. The paper provides an example of how a critical examination of processes and contextual issues can sharpen our understanding of why this intervention program failed and offers a plausible account regarding its effects on outcomes. A wide range of tools and systems are available on the market to support to organizations in conducting stress risk assessment and implementing interventions. However, without a careful examination of the characteristics of interventions and the context in which they will be implemented, it is highly unlikely that they will bring the intended positive effects.
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