On health and work

profDameCarolBlackProfessor Dame Carol Black is Principal of Newnham College Cambridge, Expert Adviser on Health and Work to the Department of Health, England, Chair of the Nuffield Trust, and Chair of the Governance Board of the Centre for Workforce Intelligence. She was a keynote speaker at the recent International Conference on Physician Health

 

Whatever the nature of their work, whatever skills they bring to bear, however strong their calling and dedication, employees come under the influences of their workplace and of those who employ them. It is as true for doctors as it is for the drivers of tube trains, the builders of Olympic stadia or civil servants in Whitehall. The evidence, gathered painstakingly over many years, in such different arenas of work, is consistent and strong.   It leaves no doubt about the characteristics that we look for in identifying good work and a good workplace.

The effects of workplace influences are felt and measured to varying degrees in ways that are clear. First is the personal health and wellbeing of employees – their physical health and their mental health, the former often measurable declared, the latter often masked and hidden.

Second is the performance of the group, the team, and ultimately the institution for which they work. In health care such performance is measured in terms of the quality of patient experience, the safety of care and health outcome.

These measures correlate with features common to organisations which have achieved success in promoting staff physical and mental health and well-being. Within them we find

  • Senior visible leadership with a commitment to protect, promote, maintain and improve staff health and wellbeing
  • Managers throughout the organisation who are trained, competent and held accountable for their part in fulfilling this commitment
  • Performance that is monitored through measures of staff health and wellbeing and their improvement
  • Employees who are empowered to care for their own health

They are necessary characteristics of a good workplace.

Sir Michael Marmot has further documented particular features of good work and employment practice. All apply to employment practice in health care, the experience and wellbeing of health professionals, and the performance of institutions providing health care. They include the role of the individual in decision making, the quality and quantity of work demands, an environment where psychological needs are recognised and met, where resilience and self esteem are enhanced, and there is confidence in the response to sickness and disability.

These conditions are embraced by the concept of engagement. Engagement signifies a workplace approach to ensure that employees are not only committed to their organisation’s goals and values, and motivated to contribute to organisational success, they are also and enabled to enhance their own sense of wellbeing.

Employee engagement not only draws together the goals and aspirations of employees and employers, it is recognised as essential to achievement of those goals and aspirations. Such engagement, or its absence, is evident in attitudes, behaviours, working relationships and organisational arrangements. It determines the ambience of the workplace, at every level, affecting the outward signs of human wellbeing – and no less of service and performance.

Organisations with engaged employees tend to have employees with a real sense of where they are trying to get to; managers who are engaged at the front line, who offer clarity about what’s expected and show appreciation. Work is well organised – it is hard for employees to be engaged if it is not. There is congruity between values and actions.

Progress in employee engagement rests on several factors: leadership to maintain a strong, transparent and explicit culture and make a clear link between the overall vision and direction of the organisation and employee’s roles; employees who feel valued, equipped and supported to do their job, are encouraged to give their ideas and whose views are heard; managers who treat them as individuals recognise their contribution and offer clarity of purpose; and employees’ trust in the integrity of the organisation.

There are moral, social and economic imperatives to ensure that the links between health and work are recognised by all, with a new determination to avert the consequences of ill-health. It calls for changing attitudes and behaviour across society, encompassing health, social and employment domains. The problems are for society collectively to take up, to make organised efforts to solve.

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