Co-designing interventions with the workforce

Interventions developed with input from employees can be especially effective in improving wellbeing. The HSE resources include a series of case studies highlighting the benefits of co-produced solutions. For example:

• Earlier reporting of stress, due to increased awareness of the signs and symptoms

• Reduced sickness absence

• Greater ownership of change

• Improved communication, particularly between leaders and practitioners

• Increased recognition of the need to encourage peer support

• Better understanding among leaders of the importance of listening without judgement.

Using an Appreciative Inquiry (AI) approach in focus groups can be effective, drawing on key frameworks of work-related stress to generate solutions. As AI is an iterative process, several meetings will be needed to identify options for interventions and evaluate their success.

Using AI approaches to develop stress management interventions

KFP2 Sense of Appreciation describes the features of Appreciative Inquiry (AI) and highlights its potential to create options for self-determined change. The four stages of AI could be used in focus groups to identify simple, low-cost but effective strategies to reduce stress and improve wellbeing. That process might involve:

• Finding examples of current activities that work well (Discovering)

• Using them as a basis for envisioning possibilities for change (Dreaming)

• Identifying potential interventions (Designing), and

• Implementing those interventions (Delivering).

Mechanisms for evaluation are also required.

Work-related stress is often perceived as an ‘imbalance’ between key aspects of the working environment and individual capacities and needs. The three models of stress described below provide useful frameworks to help the workforce generate options for change.

1. The Job Demands-Resources model (Demerouti et al., 2001) recognises the importance of resources in helping employees to meet the demands of their work and remain healthy. Demands are aspects of the job – such as workload pressure, interpersonal conflict and insecurity – that require physical or mental effort and so have the potential to drain energy.

Resources are factors that: a) help people meet their work goals; b) reduce demands and the associated costs to wellbeing; c) facilitate personal growth. Key resources include the availability of support, control and feedback at work, as well as personal resilience-building attributes, such as self-efficacy and optimism. This simple model could be used via AI techniques to identify resources that may help practitioners meet the demands of their work more effectively and enhance their personal development.

2. The Conservation of Resources model (Hobfoll & Shirom, 2000) also recognises the value of resources in protecting workers against the negative effects of job demands. It is based on the premise that people are motivated to gain and protect things they value; stress occurs when they are threatened with resource loss or fail to gain resources despite investing considerable effort. The model specifies four types of resource:

a)  Objects (physical entities such as work equipment)

b)  Conditions (social circumstances such as status and respect)

c) Personal (skills and attributes such as self-efficacy)

d) Energies (such as knowledge).

People use their existing resources to help them manage stress currently and to develop additional resources to sustain them in future. Those with more resources are less vulnerable to resource loss and more capable of resource gain. This model could be used in focus groups to identify resources that might help to buffer the effects of stress and create individual and collective ‘resource reservoirs’ (such as resilience) to offset the risks of future resource loss and build collective strength.

3. The Effort-Reward Imbalance model (Siegrist, 2002) maintains that strain (such as mental and physical health problems) stems from an imbalance between the amount of effort that people believe they put into their work and the rewards they perceive they gain. Efforts are things that make work more demanding, such as heavy workload and frequent interruptions, whereas rewards are obtained from three potential sources: a) money (salary); b) esteem (respect and support) and c) security/career opportunities (promotion prospects and job security).

This framework could help practitioners generate options for change by identifying the features of health and social care work (e.g. meaningfulness and a sense of belonging) that help them feel rewarded and therefore could restore their feelings of equity.