Stress, its causes in a medical/dental facility and methods and techniques for its management

How to manage stress
in medical facilities-with special emphasis on dental-
using ergonomic design, relaxation techniques and patient education

# Chapter page
1 What is Stress
2 Consequences of Stress
3 Stress Management Interventions
4 Primary Stress Management Interventions
5 Secondary Stress Management Interventions

Chapter One:
What is stress?
The non-specific response of the human body to any demand made on it.
A person under stress chooses to either fight or attempt to escape which is termed fight-or-flight reaction.
There is a two types of stress:
1. Good stress (Eustress) which provides challenges to motivate individuals to work hard and meet their goals.
2. Bad stress (Distress) which results from stressful situations that persists over time and produces negative health outcomes.
Stress mechanism of action or progression: ( General Adaptation Syndrome or GAS)
It is divided into three stages:
1. Alarm reaction: the bod mobilizes resources to cope with the added stress by increasing stress hormones such as adrenalin, noradrenalin, epinephrine and cortisol.
2. Resistance stage: the body copes with the original source of stress but resistance to other sources is lowered.
3. Exhaustion stage: overall resistance drops and adverse consequences, including burnout,severe illness, and even death can result unless stress is reduced.
Fight-or-flight reaction comes in response to type of stress that comes suddenly and is likely to last only a short time -episodic, acute stress- whereas GAS tracks the bod response to stress over a longer period of time.
Coping with stress:
Individuals cope with stress in different ways but they are typically divided into:
1. Problem-focused coping: which is directed at managing and altering the problem that is causing the stress. Such type of coping may include defining the problem , generating different solutions and weighing their costs and benefits and acting to solve the problem.
2. Emotion-focused coping: which is directed at reducing the emotional response to the problem , which can mean avoiding, minimizing, and distancing oneself from the problem.
What is a Stressor:
Physical or psychological demand to which an individual responds whereas reactions and responses to these stressors are called strains.
Types of Stressors:
Work stressors fall into two major categories
1. Physical/Task Stressors: Physical such as noise, light, heat and cold. Cohen, Evans, Stokols & Krantz,1986; have showed that uncontrollable noise is particularly stressful and leads to lower task performance and diminished motivation. Evans & Johnson(2000) have shown that low-level noise is associated with elevated levels of stress hormones and lower task performance. The importance of the increased hormone levels is that stressors may exist even when the worker is not aware of the stressor.
Task stressors such as demands of a given job ( e.g., pace of work, workload, the number of hours worked) can also contribute to the experience of stress and to subsequent strains. For example, Hurrel (1985) studied several thousand postal workers and found that those working in machine-paced jobs experiences greater stress, anxiety, fatigue and tension than those working in jobs where the pace is set by employees(e.g., hand sorting, helping customers, delivering mail).
2. Psychological Stressors: Lack of control/predictability Control is a major theme in the literature on stress(Ganster & Murphy, 2000;Landy, Quick, & Kasl, 1994). Varying levels of personal control and predictability have clear effects on job performance and work stress (Rastegary & Landy, 1993; Spector, 1986). As with any stressor, the individual’s perception of control or predictability determines his or her response to the situation, and such perceptions are affected by characteristics of the job and work environment. The scheduling and pace of work can influence feelings of control. For example, flexible time schedules enhance feelings of control over one’s schedule, even though the average arrival and departure times may differ only by minutes after a flexible time schedule has been introduced (Baltes, Briggs, Huff, Wright, & Newman,1999). Flextime also increases perceptions of control by helping employees to balance work and family commitments (Ralston, 1989). Perceptions of control in the workplace are also related to autonomy, the extent which employees can control how and when they perform the tasks of their job (Hackman & Oldham,1980). Overall, interventions that enhance perceptions of control on the job ,such as participative decision making or flexible time schedules, are likely to reduce stress and subsequent strains.
Interpersonal conflict is the negative interactions with co-workers, supervisors, or clients. It can range from heated arguments to subtle incidents of unfriendly behavior (Jex,1998). It can occur when resources at wok are scarce, when employees have incompatible interests, or when employees feel they are not being treated fairly. It can distract workers from important job tasks, and it can have physical health consequences.
Role Stressors they are role ambiguity, role conflict, and role overload. Most jobs have multiple task requirements and responsibilities or roles (Rizzo, House, & Lirtzman, 1970), and that a job is likely to be particularly stressful if these roles conflict with one another or unclear. Role ambiguity occurs when employees lack clear knowledge of what behavior is expected in their job. In such cases, individuals experience uncertainty about which actions they should take in performing their job most effectively. Role conflict occurs when demands from different sources are incompatible.
A more specific form of conflict is role overload, a stressor that occurs when an individual is expected to fulfill too many roles at the same time. It can cause people to work very long hours, increasing stress and subsequent strains.
Work-Family conflict A different type of role stressor which occurs when workers experience conflict between the roles they fulfill at work and their roles in their personal lives. Because working women and dual-career families have become the norm rather than the exception , work-family conflict has become a common source of stress . In a study of men and women n high ranking positions, women were more stressed by their greater responsibility for household and family duties. In addition, women with children at home or any of the men in the study (Lundenberg & Frankenhaeuser, 1999). One study concluded that, compared to men , women appear to have better coping strategies to handle stress (Korbaik & McDonald, 1991). In particular, women are more likely than men to have access to social support which is a critical factor in reducing stress and it’s harmful effects.
Emotional Labor Interest in role of emotions in the workplace has increased rapidly over the past decade ( Fisher & Ashkanasy, 2000). Emotions are important to consider because stress is, first and foremost , an emotional reaction. Emotional labor is the regulation of one’s emotions to meet the job or organizational demands. The study of emotional labor addresses the stress of managing emotions when jobs require that workers display only certain expressions to clients or customers ( Adelmann, 1995). Workers can regulate their actions through surface acting and deep acting ( Morris & Feldman, 1996). Surface acting consists of managing or ‘faking’ one’s expressions or emotions. Deep acting consists of managing one’s feelings including trying to feel the emotions required by the job. Imagine a telemarketer who learns during lunch break a parent has been diagnosed with a life threatening disease. The struggle to maintain a cheery demeanor with customers would require considerable acting.
Consequences of Stress
The link between occupational stress and adverse health outcomes among employees is clear ( Cooper et al., 2001). The negative consequences of chronic stress can be divided into three categories: behavioral, psychological, and physiological.
1) Behavioral consequences of Stress
Among the behavioral consequences of stress are absenteeism, accidents, alcohol and drug abuse, poor job performance, and counterproductive behaviors including workplace violence (Kahn & Boysiere, 1992). We will focus on the effects of stressors on two particularly important behavioral outcomes:
1. Information processing, which affects a variety of other critical work outcomes.
2. Job performance, which can include information processing, but often involves global measures of effectiveness.
1. Information processing The influence of stress has been widely investigated . Chronic stress has detrimental effects on memory, reaction times, accuracy, and performance of variety of tasks (Smith, 1990). In addition, individuals under stress often have difficulty focusing their attention. Stress leads to premature reactions to stimuli, restricted use of relevant cues, and increased errors on cognitive tasks (Svenson & Maule, 1993).
Because each of us has limited cognitive resources, stressful situations that restrict such resources will impair our ability to cope with the task at hand . Stress also correlates with lower creativity and poorer decision making , particularly under time pressure (Rastegary & Landy, 1993; Shanteau & Dino, 1993). For example, fast-food delivery drivers commonly have accidents during the rush period of deliveries (usually Thursday & Friday nights between 5:00 P.M. And 11:00 P.M.). They often report never seeing the object( e.g., car, truck, jogger, motorcycle) whose path they turned across. They simply did not ‘process’ that information when they turned left because they were looking for a street sign or a street number during the hectic evening hours
2. Job Performance For a century it has been investigated that arousal and performance have an inverted ‘U’ relationship. (Yerkes & Dodson, 1908). The hyposthesis is that as arousal increases, performance increases, but only up to a certain point, and then performance begins to decline. Thus, compared to situations with moderate arousal, both low levels of arousal (boredom) and high levels of arousal (extreme danger) result in lower performance. Alternatively, moderate arousal can lead to high motivation, energy, and attentiveness; this outcome is consistent with Selye’s concept of eustress. It is important to acknowledge that stress represents only one of many factors that may impact job performance (Jex, 1998).
2) Psychological Consequences of Stress
They include anxiety,depression, burnout, fatigue, job tension, and dissatisfaction with one’s job and life (Kahn & Byosiere, 1992). Burnout is a particularly important consequence of stress. It is an extreme state of psychological strain that results from a prolonged response to chronic job stressors that exceed an individual’s resources to cope with them ( Maslach, Schaufeli, & Leiter, 2001). Burnout was first observed in ‘caring professions’: dentists, doctors, nursing, social work, and teaching.
3) Physical Consequences of Stress:

Theories of Stress
Several theories have been developed to organize the relationships among stressors, strains and potential moderators of those relationships. Two theories that have received a great deal of attention are Karasek’s Demand-Control Model and French’s Person-Environment Fit Model. In addition, stress models have considered individual difference variables that influence the relationship between stressors and strain.
1. Karasek’s (1979) Demand-Control Model suggests that the two factors are prominent in producing job stress: job demands and control (also known as decision latitude). In this model, job demands are defined as the workload and intellectual requirements of the job. Job control is defined as a combination of autonomy in the job and discretion for using different skills. Karasek proposed that the combination of high work demands with low control results in ‘high strain’ jobs that result in a variety of health problems. Food services worker, waitperson , nurse’s aide, and assembly-line worker are considered high strain jobs. Machine-paced jobs, in particular, were highlighted as having high demands and low control. In contrast , jobs characterized by high demands also provide sufficient control create an ‘active’ job situation that is stimulating and health promoting. Active jobs include lawyer, engineer, manager, and physician. Jobs with low control and low demands (e.g., janitor, night watchmen) were labeled as ‘passive’ jobs. Finally, jobs with high control and low demands (e.g, architect, dentist) were considered as particularly low strain jobs.
Tests of the Demand-Control model are often conducted is using the Job Content Questionnaire (JCQ), designed to measure the ‘content’ of a respondent’s work (Karasek, 1985). The JCQ includes the following subscales:
‘ Role overload and role conflict (demands).
‘ Skill utilization and job decision latitude (control).
‘ Depression, job dissatisfaction, and sleep problems (health consequences).
The scales have been used extensively to investigate job-related stress and coronary heart disease in the United States and Sweden. For example, in a series of surveys involving U.S. and Swedish male workers, Karasek (1979) found that the combination of low control heavy job demands correlated positively with mental strain (i.e., depression and exhaustion) and job dissatisfaction.
Karasek and Theorell (1990) found an increased risk of illness(two to four more times more likely) for individuals whose lives or jobs make high demands on them but allow little control. Thus, an individual who has a demanding work schedule or environment and does not have have much decision latitude or control will have an increased risk of stress-related illnesses, both physiological and psychological. In contrast, individuals in active jobs that have high demands but high maintained good health and high job satisfaction. Karasek and Theorell (1990) noted that individuals in active jobs appear to participate actively in a variety of leisure activities as well, despite their high work demands. This finding is another example of the benefits of developing or designing jobs that allow workers to have control over decisions, resources, or skills that they can use.
Ganster, Fox, and Dwyer (2001) tested the Demand-Control model in a sample of 105 full-time nurses . They found that nurses with the lowest perceptions of personal control and highest workload demand were ill more often and incurred the highest cumulative healthcare costs over the ensuing five-year period. Thus, jobs that have high demands and low control are costly to both individuals and the organizations for which they work.
Person-Environment Fit Model
The Person-Environment (P-E) Fit Model (French, Caplan, Harrison, 1982) hypothesizes that the fit between a person and the environment determines the amount of stress that person perceives. A good person-environment fit occurs when a person’s skills and abilities match the requirements of the job and work environment. For example, an introvert with PhD in literature would be likely to have a good P-E fit with the job of university librarian, while an extraverted MBA have a good P-E fit with the job of sales manager. The amount of stress a worker feels is influenced by perceptions of the demands made by the environment, and by perceptions of his or her capability to deal with those demands. Using this model, French et al. found that a poor fit between a person and the environment was frequently associated with increased strains. Alternatively, employees whose skills and abilities fit well with the work environment reported less stress and fewer strains (Edwards, 1996; French et al., 1982).
Karasek (1979) did not formally emphasize perception in the Demand-Control model. In contrast, the P-E fit approach focuses explicitly on the perception of individuals concerning their skills and abilities relative to the demands of the work environment. In addition, unlike the Demand-Control model, the P-E fit approach considers external influences such as social support from family and work sources. For example, Edwards and Rothbard (1999) found that the well-being of the employees varied according to their perceptions of work and family experiences. The results of this study indicate that interventions to manage stress should consider the fit between employees and both their work and family environments, which is consistent with the research we discussed above on work-family conflict. In particular, if it is bad in both the family and the work environment, the cumulative stress is likely to lead to low job performance and high health problems.
Early work did not always specify what ‘environment’ was referred to in the P-E fit model. Recent work has more clearly differentiated between person-job fit and person-organization fit (Lauver & Kristof-Brown, 2001). Person-job fit refers to the extent to which the skills abilities and interests of an individual are compatible with the demands of the particular job. Alternatively, person-organization fit refers to whether the values of an employees are consistent with the values of held by most others in the organization. In a diverse sample of managers, Lovelace and Rosen (1996) found that perceptions of poor person-organization fit were associated with greater levels of stress, job dissatisfaction, and intentions to quit one’s job. Similarly, Saks and Ashforth (1997) found that favorable employee perception of person-job fit correlated positively with job satisfaction and organizational commitment, and negatively with stress.
It is clear that different types of fit have influence on a variety of problems, including stress, job dissatisfaction, and intentions to leave the organization. Organizations should strive to ensure that employees fit well in their jobs and have the skills necessary to complete their job tasks. In fact, fit is often increased through recruitment and selection processes that help applicants and those doing the hiring assess the likelihood that candidates will fit well in the job and in the organization (Schneider. 1987).
The P-E fit model suggests mechanisms by which individuals can protect themselves from the stress that accompanies the mismatch between the person and the environment. One of these protective mechanisms is social support. For example, employees who have seemingly impossible deadlines might seek informational and emotional support from co-workers. By reducing their experience of stress in this way, employees might be able to focus better and come closer to meeting their deadlines than if they were overwhelmed and suffering from strains. Overall, the P-E fit model allows us to examine work stress by looking at the interaction between the person and stressors in the work environment. This approach specifically acknowledges that stress can influence individuals differently depending on their preferences, values, and abilities (Edwards, 1996).

Individual Differences in resistance to stress
When you have been part of a group in a stressful situation, not everyone responds to stress in the same way. Several individual characteristics has been studied as the potential moderators of stressor-strain relationship. A moderator is a variable that affects the direction or strength of the association between two other variables. For example, if stressors led to strains for individuals with low self-esteem but not for those with high self-esteem, then self-esteem would be a moderator of the stress-strain relationship. If moderators reduce strains for only certain types of individuals, they are said to have an indirect effect on the reduction of strains. Individual difference characteristics that have received the most attention as moderators of the stressor-strain are locus of control, hardiness, self-esteem, and the Type A behavior pattern.
Locus of control (LOC) is a construct that refers to whether individuals believe that happens to them is under their control or beyond it (Rotter,1996). Individuals characterized as internals believe that outcomes are result of their own personal effort and ability, whereas persons classified as externals believes that outcomes are determined laregely by other people, luck, or fate. Many elite professional atheletes are confident-sometimes overconfident- that success lies completely in their hands (i.e., they have an internal LOC). In team sports, they like to be thought of as the ‘go to’ person. Several studies have indicated that internal experience lower strains than do externals. Researchers have proposed that because internals believe they can control a stressful situation to achieve their goals, they experience fewer strains than externals exposed to the same stressors. Overall, evidence indicates that having an internal locus of control moderates the relationship between stressors and strains (Horner,1996; Kahn & Byosiere,1992).
Hardiness is a set of personality characteristics that provide resistance to stress(Kobasa,1979). Specifically, individuals described as having a ‘hardy personality’ possess three characteristics:
1. They feel they are in control of their lives.
2. They feel a sense of commitment to their family and their work goals and values.
3. They see unexpected change as a challenge rather than an obstacle.
Cohen and Edwards (1989) observed that hardy individuals actively adopt problem-focused and support-seeking strategies. Kobasa, Maddi, and Kahn (1982) found that hardy individuals had fewer physiological reactions to stressors, reported fewer illnesses, and had higher levels of general well-being than those who were not hardy personalities were found to have significantly fewer strains than those who were not hardy. Among executives and lawyers who were under a great deal of stress, those who were hardy personalities were found to have significantly fewer strains than those who were not characterized as hardy (Maddi & Kobasa, 1984). Overall, evidence indicates that hardiness moderates the relationship between stressors and strains ( Cohen & Edwards, 1989). A key component of hardiness is transformational coping, which involves actively changing perceptions of a stressful event by viewing it as a challenge that can be overcome. For example, hardy students facing an important and stressful exam might cope by interpreting their exam as an opportunity to show their knowledge, thereby exerting control through preparation and good study habits (Quick et al.,1997).
Self-esteem, or positive self-worth or self-concept, is considered an important resource for coping. Individuals with high self-esteem are more likely to adopt more effective coping strategies in the face of stress than individuals with low self-esteem (Ganster & Schaubroeck,1995). Thus when faced with the same environmental stressors, individuals with low self-esteem will experience more strains compared to those with high self-esteem. Overall, research generally indicates that self-esteem is a moderator of the stress-strain relationship (Cooper et al., 2001). Although high self-esteem is clearly important in reducing the effects of stress at work, there is some evidence that the effects of high self-esteem are not always positive. Although many people assume that low self-esteem is related to work-place violence, Baumeister, Smart, and Boden (1996) conducted an extensive literature review that indicated that aggression and workplace violence were most characteristic of individuals with high self-esteem.
Type A Behavior Pattern
The potential moderator of stress-strain relationship that has been most intensively studied is the Type A behavior pattern (TABP), which was first identified in the late 1950s by two cardiologists, Meyer Friedman and Ray Rosenman (1959). Fifteen years later, Friedman and Roseman wrote Type A Behavior and Your Heart (1974), in which they described the Type A behavior pattern as a set of characteristics exhibited by ‘individuals who are engaged in a relatively chronic struggle to obtain an unlimited number of poorly defined things from their environment in the shortest period of time and, if necessary , against the opposing of other things or persons in the same environment’ (p.67).
The Type A behavior pattern is also known as the coronary-prone personality because of its proposed links to coronary heart disease and heart attacks. Individuals who exhibit this behavior pattern ( known as Type As) are characterized by ambitiousness, impatience, easily aroused hostility, and time urgency. Friedman & Roseman (1974) suggested that the core characteristic of TABO is an incessant struggle to achieve more and in less and less time. In fact, descriptions of Type As who are overly obsessed with saving time are common. For example, Typpe A men have been known to use two electric razors (one for each side of the face ) at the same time to shave more quickly as possible (Bluedorn,2002; Gilberth & Carey, 1948). Generally Type As seem to thrive on ‘life in the fast lane’ as they focus on quickly doing things that result in occupational and material success. In contrast, Type Bs are often described as relaxed patient, and easygoing.
Sapolsky (1998) described the history of how Friedman and Roseman missed an opportunity to identify some of the typical characteristics of Type As in the early 1950s. In the waiting room outside Friedman and Roseman’s Cardiology office, the lining of the chairs was worn down so much that the upholstery needed to be replaced frequently. Only years later that they began their formal work on Type A behavior pattern and thus realize that their heart patients had a consistent pattern of behavior , including nervous energy and fidgeting, that was related to heart disease. Research has indicated that Type As do tend to desire control and responsibility, and they prefer to work alone (Clark & Miller, 1990; Strube, Lott, Heilizer, & Gregg,1986). As for the outcomes compared to Type Bs, Type As are more punctual , work at faster rates, and are high achievers in college and in their professional careers (Gastorf, 1980; Taylor, Locke, Lee & gist,1984; Yarnold & Grimm,1982). So, although the Type A behavior pattern was initially because of its association with health problems, it also appears to be associated with positive outcome such as high work performance and career success.
It was important to have a clear evidence that these positive outcomes came at the cost of high stains and sucdequent health problems. Specifically, researchers were interested in whether Type As respond to stressful situations with greater physiological arousal and thus suffer greater strains than Type Bs. Accordingly, many studies have attempted to link TABP to increased physiological arousal and to the development of coronary heart disease. However these efforts were slowed by the use of imprecise, global TABP measures that attempted to assess several TABP subcomponents (Booth-Kewley & Friedman,1987). This led researchers to focus on identifying specific subcomponents of the TABP that were most predictive of coronary heart disease. Subsequent studies indicated that hostility is the primary TABP subcomponent associated with increased secretion of stress hormones as well as increased risk of coronary heart disease and other long-term, harmful health outcomes ( Krantz & McCeney, 2002; Miller,Smith, Turner, Guijarro, & Hallet, 1996). Thus, Type As who exhibit hostility pay a price for their accomplishments in terms of increasing their likelihood of suffering from a variety of long-term health problems.
They continued on examine other TABP subcomponents in their attempts to predict work and short-term health outcomes in Type As. Two TABP subcomponents that have received attention are achievement striving and impatience/irritability (Spence, Helmreich, & Pred, 1987). Achievement striving is the tendency to be active and to work hard in achieving one’s goals, whereas impatience/irritability reflects the intolerance and frustration that results from being slowed down.
The Achievement striving dimension is positively corelated with academic performance, sales performance, and job satisfaction (Bluen, Barling, & Burns, 1990; Spence et al., 1987). The impatience/irritability dimension is associated with health problems such as insomnia, headaches, poor digestion, and respiratory difficulties (Barling & Boswell,1995; Bluen et al.,1990). These studies indicate that achievement striving and impatience/irritability are independent from each other and that these TABP subcomponents can be used to differentially predict performance and health outcomes.
An additional TABP subcomponent that appears to be related to important work and health problems is time urgency, which refers to the feeling of being pressured by inadequate time. Time-urgent individuals check their watches repeatedly, even when they are not under the pressure of deadlines, and they are concerned with saving relatively small amounts of time (often measured in minutes or seconds). Time-urgent individuals seem to always know what time it is even when they are not wearing a watch. Increasing evidence indicates that individuals differ widely from one another in the degree to which they concern themselves with the passage of time and how to cope with it in accomplishing work-related and personal goals (Conte, Mathieu, & Landy, 1998). For example, some individuals are constantly making schedules, lists, and deadlines for themselves, whereas others do not pay attention to such temporal concerns.
Recent evidence suggests that time urgency has multiple dimensions including time awareness, eating behavior, nervous energy, list making, scheduling, speech patterns, and deadline control. Landy, Rastegary, Thayer, and Colcvin (1991) developed Behaviorally Anchored Rating Scales (BARS) for these dimensions of time urgency. Research indicates that these time urgency dimensions are relatively independent, which means that individuals can be high on some dimensions are relatively lower on others (Conte, Landy, & Mathieu, 1995; Landy et al.,1991). For exampple, workers may eat very quickly during a brief lunch break, but they may not focus much on making lists or following schedules very closely. Alternatively, some task-oriented individuals may work quickly and focus closely on schedules and deadlines, but they may not speak quickly or exhibit nervous energy.
Research also indicates that certain time urgency dimensions (e.g., list making, scheduling) are related to work outcomes, whereas other time urgency dimensions (e.g., eating behavior, nervous energy, speech patterns) are related to health outcomes. Menon, Narayanan, Spector (1996) related time urgency to occupational stress and health outcomes in a sample of nurses and physicians. They found that rapid talking and eating behaviors were positively correlated with arguments on the job and with lowered resistance to physical illness. In contrast, scheduling, list-making, and time-awareness behaviors were positively related to job satisfaction indicating that some time urgency dimensions can result in positive work outcomes.
Conte, Schenneker, Dew, and Romano (2001) found that the deadline control time urgency dimension was significantly related to work pace, that is, individuals who were focused on deadlines worked faster than those who were not controlled by them. This finding is likely to be usedful in organizations and industries in which a fast work pace is crucial. For example, there are immense pressures for efficient and timely development of new products in computer industry. Time-urgent individuals who have experience working under time constraints may be able to withstand a higher level of time pressure when the work situation requires it (Freedman & Edwards, 1998). However, difference in the way team members approach and utilize time may be a source of tension and may make it difficult for teams to function well under deadline pressures (Waller, Conte, Gibson, & Carpenter, 2001).
Overall, specific TABP subcomponents do a better job of predicting particular criteria than a global Type A measure that combines a variety of different subcomponents. Thus researchers and practitioners concerned about health and performance outcomes will have more success using TABP subcomponents to predict health and performance outcomes.
In summary, research on TABP subcomponents indicates that :
‘ Achievement striving is positively related to desirable work outcomes.
‘ Impatience/irritability is related to short-term health problems.
‘ Hostility is most predictive of long-term health outcomes ( e.g., coronary heart disease).
‘ The multiple dimensions of time urgency are related to a variety of work and health outcomes.
Reducing and managing stress
In 1990 stress was listed for the first time as one of the top 10 occupational health risks in the United States. As a result, concerns about stress at work became much more prominent in public and government discussions of health(Sauter, Murphy, & Hurrell, 1990). These concerns led to the development of the field of Occupational Health Psychology, which involves the application of psychology to improving the quality of work life, and to protecting and promoting the safety, health, and well-being of workers.
Occupational health psychologists often divide their approaches to stress reduction and management into three major categories: primary, secondary, and tertiary interventions (Cooper et al., 2001; Quick et al., 1997)
Primary Prevention Strategies
They are concerned with modifying or eliminating stressors in the work environment and therefore said to be ‘stressor-directed’ (Cooper & Cartwright, 2001). Primary interventions are the most proactive and preventative approaches to stress management (Cooper et al., 2001). Many primary intervention strategies give workers increased control over the job and work environment, which directly lowers stressors and increases employees satisfaction and well-being.
Primary prevention approaches include redesigning the task or work environment, encouraging participative management, developing clearer role descriptions, and modifying or changing Type A thought patterns. Another primary prevention strategy involves providing flexible work schedules which can be seen in recent trends toward flextime, shorter work weeks, and job sharing. Primary prevention approaches are aligned with problem-focused coping strategies, which are directed at managing or altering the source of stress (Lazarus, 2000).
Work and Job Design
Work and jobs can be designed or redesigned to reduce such stressors as noise, interruptions, time pressure, role ambiguity, and the number of hours worked (Sparks, Cooper, Fried, & Shirom, 1997). In addition, jobs can be redesigned to increase worker participation in decision making and to increase autonomy on the job. Decades ago, restaurant owners decided to reduce the stress on stress on short-order cooks by requiring waitpersons to clip their orders to a small, circular, revolving order stand. The cooks could then spin the stand around, see what orders were pending, and decided to pull off first. This principle was extended to auto manufacturing by Saab and Volvo. Automobile bodies circled work teams on oval track, and the teams decide which ones to pull off first for assembly and paint operations. Another example of redesigning of is the common ‘queuing’ process that is found at many service centers. Customers stand in one line and are not permitted to approach a service desk until their number is flashed or an available agent is identified by electronic screen. This process increases the customer service agent’s control over how quickly customers are served and thereby reduces the agent’s stress. Such changes can help workers feel that their work is more meaningful and that they have control over work outcomes. This in turn leads to a higher motivation and satisfaction as well as lower stress at work (Hackman & Oldham, 1980).
A study by Jackson (1983) provides a good example of the benefit of participative decision making. Jackson found out that nursing and clerical employees who participated in decision making at staff meetings had increased perceptions of control and reduced role ambiguity and role conflict. With stressors reduced by this relatively simple change in the way meeting were conducted, employees had higher job satisfaction and lower emotional strain at work, which over time led to fewer absences and lower intentions to leave the job.
Cognitive Re-structuring
Several of the approaches that we have discussed, including the Person-Environment Fit model and Type A behavioral pattern, highlight the role of perceptions in the stress process. Cognitive restructuring interventions focus on changing perceptions and thought process that lead to stress. These approaches reduce stress by changing an individual’s perception of the work environment or one’s capacities to meet the demands of the environment. Cognitive restructuring approaches encourage individuals to change negative thoughts to more positive ones (Quick et al., 1997). for example, a worker who thinks, ‘ I can’t handle this heavy workload’, might be encouraged to think instead: ‘This workload is a challenge that I can handle if I break it down into manageable parts’, or ‘ I won’t be considered a complete failure if I don’t push very hard to finish this task today’.
Secondary Prevention Strategies
It involves modifying responses to inevitable demands or stressors; thus, they are said to be ‘response-directed’. Because it addresses the experience of stress rather than the stress or stressors, it’s role is often one of damage control. Thus, this type of intervention is often described as the ‘Band-Aid’ approach (Cooper & Cartwright, 2001). They are aligned with emotion-focused coping strategies, which seek to reduce the emotional response to the stressor and can involve avoiding, minimizing, and distancing oneself from the stressor (Lazarus, 2000). For example, emotion-focused coping might be used to reduce the stress experienced in a job that requires emotional labor.
Secondary prevention strategies that require no special training (but might be formally encouraged through an employer-sponsored program) include lifestyle choices such as phyiscal fitness, healthy eating, and weight control, as well as a reduction in smoking and caffiene. Skills-training programs such as negotiation and conflict resolution are another form of secondary intervention. In addition, secondary stress management methods include relaxation techniques, biofeedback, and providing or encouraging social support at work. Many approaches use a combination of the above methods.
It is important to note that secondary prevention can be proactive or reactive. For example, Cooper et el. (2001) noted that training in conflict resolution skills can be used to reduce interpersonal conflict and its effects after it has occurred. Alternatively, such training can be used proactively to prevent interpersonal conflict from developing. Similarly, individuals can be proactive in exercising and maintaining a healthy diet, which can reduce or moderate future stress.
Stress Management Training
Programs involving stress management training are very popular with employers and employees. Cooper and Cartwright (2001) noted that the continued demand for stress management programs and the increasing stress levels reported in the literature are indicative of the acceptance by organizations that stress is an inherent and enduring feature of the work environment. Stress management training programs are useful for helping employees deal with those stressors that are difficult to remove or change. They often include a variety of secondary prevention techniques and may even include some primary techniques. For example , many stress management programs are described as cognitive behavioral skills training programs.
Cognitive-Behavioral Skills Training
It’s a variety of techniques designed to help workers modify the appraisal processes that determine how stressful they perceive a situation to be, and to develop behavioral skills for managing stressors (Murphy, 1996). The most common type of cognitive-behavioral skills-training is stress inoculation, which usually consists of an educational component ‘ learning about how a person has responded to past stressful experiences; rehearsal ‘ learning various coping skills such as problem solving, time management, relaxation, and cognitive coping; and application ‘ practicing those skills under simulated conditions (Murphhy, 1996). Thus, in many cases these approaches are a combination of primary (i.e., to reduce stressors by means of cognitive restructuring) and secondary (i.e., to manage or cope with symptoms of stress through behavioral skills training) prevention strategies.
Jones et al. (1998) developed an organization-wide stress management program that was used with employees of several hospitals. The program included video modules that enhanced understand of stress and provided information regarding how to develop and improve coping skills, health behaviors, and relaxation routines. In a longitudinal investigation that evaluated the impact of this stress management program, Jones et al., found that one result was a significant drop in the average number of monthly medication errors by doctors and nurses. In an additional two-year longitudinal investigation, they found that 22 hospitals that implemented the same organization-wide stress management program had significantly fewer medical malpractice claims compared with a similar, matched sample of 22 hospital that did not participate. This study showed that well-conducted , psychological research efforts can decrease malpractice claims through stress management interventions.
Relaxation and Biofeedback Techniques
Relaxation techniques include progressive muscle relaxation and deep breathing exercises. Progressive muscle relaxation involves starting at the top or bottom on one’s body, tightening one set of muscles at a time for five to seven seconds, and then letting those muscles relax. Individuals can work through each major muscle group and thus help to progressively relax the entire body. These relaxation techniques are effective in reducing arousal and anxiety (Murphy, 1996).
Biofeedback is a stress management technique that involves teaching individuals to control certain body functions such as heart rate, blood pressure, even skin temperature by responding to feedback about their body from an electronic instrument (Quick et al., 1997). One simple and inexpensive biofeedback device is a skin-sensitive ‘biodot’ that monitors stress levels and physiological changes according to color changes. The dot darkens after individuals discuss a stressful event and lightens when they feel more relaxed (Ulmer & Schwartzburd, 1996). Thus, this device shows individuals that stress ‘ and relaxation for that matter ‘ leads to measurable changes in the body and that careful monitoring of the body can reduce anxiety and arousal.
Social Support
Is the comfort , assistance, or information an individual receives through formal or informal contacts with individuals or groups. Social support has been widely investigated as a way to reduce stress and strain at work. House (1981) identified four different kinds of social support.
1. Instrumental support ‘ direct help, often of a practical nature; for example, a friend encourages a co-worker to slow down by suggesting joint walks during the lunch hour.
2. Emotional support ‘ interest in, understanding of, caring for, and sympathy with a person’s difficulties ; this type of support is often provided by a therapist or a family member.
3. Informational support ‘ information to help a person solve a problem; this type of support is often supplied by a health care professional. In addition, an increasing number of websites are popping up with useful information.
4. Appraisal support ‘ feedback about a person’s functioning that his or her self-esteem; this often comes from a close friend, a therapist, family members, or other members of a support group.
Researchers have given considerable attention to the possibility that social support moderates or reduces health problems by protecting individuals from the negative effects of work stressors. Studying such effects is called the buffer or moderator hypothesis because it seeks to determine whether the negative effects of work can be buffered or moderated by social support (Cohen & Wills, 1985). Evidence is mixed on the buffering hypothesis, which could be due to the failure of researchers to emphasize the match between stressors and support. That is , buffering should work when there is a reasonable match between the stressors and the available social support. A longitudinal study of 90 blue-collar metalworkers found evidence for the buffering hypothesis in reducing anxiety and other strains when social support was matched directly to a social stressor such as conflict with one’s supervisors (Frese, 1999). Social support at work may be particularly important as a moderator of stress-strain relationship in the present day when traditional societal structures such as the extended family are smaller than they once were (Quick et al., 1997). For example, in the 21st century American society, many adult children no longer live close to their parents or siblings. They may see family members infrequently, usually over holiday periods that carry their own stress and strain.
Employers can help build their own social support systems at work. For example, formal mentoring programs, reward and recognition system, and newcomer socialization programs can make work environments more supportive. Allen, McManus, and Russell (1999) found evidence for the important role that more experienced peers can serve in mentoring newcomers and in enhancing socialization. In turn they found a negative relationship between socialization and work stress, indicating that formal peer relationships can be critical in reducing stress and subsequent strains. Finally, the supportive relationships formed in team building have been shown to improve performance and reduce stress (Svyantek, Goodman, Benz, & Gard, 1999).
Tertiary Prevention Strategies
They are ‘symptom-directed’ and thus they are focused on healing the negative effects of stressors. Tertiary interventions include employee assistance programs and the use of medical care, individual psychotherapy, and career counseling (Quick et al., 1997).
Employee assistance program (EAPs) were originally developed by organizations to address alcohol and drug problems, and they were subsequently broadened to include stress management interventions. In most organizations, EAPs involve some form of counseling to deal with work stress, alcohol or drug difficulties, and problems outside the job (e.g., family problems, behavioral and emotional difficulties). Employee assistance programs can be provided by the human resources department within an organization, or they may be provided by an external consultants or vendors. If an organization is to have successful EAPs, its management must express support for th program, educate employees about it, provide the necessary training on its use, and make the program accessible to employees (Milne, Blum, & Roman, 1994). Organizations must ensure that confidentiality is maintained and that the use of an EAPs programs does not harm job security or advancement. These suggestions are particularly important because unhealthy work climates and distrust in EAPs often prevent employees from seeking help for alcohol or drug abuse problems. For example, police officers often avoid in-house EAPs because they are uncertain of confidentiality assurances and fear that will be stigmatized by commanding officers and colleagues. Even to be seen talking with an EAP coordinator is ‘dangerous’. Integrating positive messages about EAP into different types of training programs may be effective in improving the use of EAPs by skeptical employees (Bennet & Lehmann, 2001).
Although EAPs are not often systematically evaluated by the organizations using them, the few evaluations that have been done indicate that EAPs are successful. Cooper and Saderi (1991) found improvements in the mental health and self-esteem of employees participating in EAPs . In addition, Cooper and Cartwright (1994) found that EAP programs can be very cost effective for organizations in terms of reducing absences, accidents, and health care costs. Nevertheless, even though focusing on the treatment of strains may be an effective short-term strategy, the approach is essential reactive and reciprocative rather than proactive and preventative (Cooper et al., 2001). Because EAPs focus on dealing with the long-term outcomes of stress, they should certainly not be the only approach that organizations utilize in the stress prevention and management process.
Summary of Stress intervention strategies
Several recent studies have evaluated a variety of stress management interventions. In a study by Bellarosa and Chen (1997), 96 stress management experts evaluated occupational stress management interventions (e.g., relaxation, physical fitness, cognitive restructuring, stress inoculation, meditation, and assertiveness training) on the basis of practicality and effectiveness. Evaluations by stress management experts are useful, but psychologists are also interested in more quantitative assesments of stress management interventions (Murphy, 1996; van der Klink, Blonk, Schene, & van Dijk, 2001).
Murphy (1996) conducted a comprehensive review of effects of worksite stress management interventions on a variety of health work outcomes (e.g., blood pressure, anxiety, headaches, and job satisfaction). The stress management programs included in this review were progressive muscle relaxation, meditation, biofeedback, cognitive-behavioral skills, and combinations of these techniques. Meditation produced the most consistent results across outcome measures, but it was infrequently used in organizations. Relaxation and cognitive-behavioral techniques were found to be quite successful. Overall, the study indicated that using a combination of techniques (e.g., muscle relaxation and cognitive-behavioral skills) was more effective across outcome measures than using any single technique. In another review of stress management interventions, Bunce (1997) also concluded that combining various stress management interventions is more effective than using any single approach. A recent meta-analysis found general support for the benefits of interventions for work-related stress (van der Klink et al., 2001). This study found that cognitive-behavioral approaches worked best in reducing stress, but relaxation techniques were also successful. Overall, these studies show reason for optimism about stress management interventions, particularly when a combination of techniques is used. In addition, successful stress management interventions must accurately identify the stressors causing strains, and then actively determine ways to reduce those stressors (Briner & Reynolds, 1999). Employees should also participate in the process of identifying stressors and implementing the various interventions deigned to reduce stress ans strains.
Primary stress prevention strategies are generally preferred over the other interventions because they take an active approach to removing and reducing stressors (Quick et al., 1997). Secondary and tertiary interventions can play a useful role in stress management, but their effectiveness is limited because they fail to address the source of stress itself. Thus, identifying and recognizing the stressors and taking steps to remove or reduce them through job redesign, flexible work schedules, or other primary prevention strategies should receive the highest attention in organizations. Indeed, the limited research that has examined primary-level interventions has shown that they yield consistently positive and beneficial long-term effects (Cooper & Cartwright, 2001). Similarly, the National Institute for Occupational Safety and Health (NIOSH) urges occupational health psychology professionals to give special attention to the primary prevention of organizational risk factors for stress, illness, and injury at work.
Human Factors Engineering
The importance and meaning of human factors
Workers are exposed to a wide variety of work ‘conditions’. They included physical conditions such as heat, light, and noise. The individual worker was expected to either adapt, or at least put up with, these conditions.
The humman factors approach uses the ‘knowledge of human (Capabilities) to design systems, organizations, jobs, machines, tools, and consumer products for safe, efficient and comfortable human use’ (Helander,1997, p.4). The term ‘ human factors’ is synonymous to human factors engieering or human factors psychology. Human factors overlaps with related discilpines such as ergonomics, the study of the physical demands of work, such as reaching, streching, lifting, and carrying; applied experimental psychology; occupational medicine; and exercise physiology.
The human factors assumes that workers are constant , and that the work needs to adapt to the worker. Human capacities and limitations include physical and cognitive abilities, knowledge, presonality, and even physiology. The goal of the human factors is to develop a physical and psychological environment that is optimaly compatible with the capacities and limitations of humans. Rather than accepting the environment as a constant, and selecting those few individuals who may be most compatible with it, the human factors catalogs the human capacities and limitations and develops an environment that is ideally suited as possible to them.
This was not the case. In the early days of the factory system, machines were designed by mechanical engineers who had little concern for the capacities and limitations of humans. An exampke of that cab be seen in the design of a popular machine for working on metal parts called lathe. The purpose of a lathe is to create a shape in a piece of steel or aluminum by spining that piece at a high speed and applying a sharp bit to its surface while it is spinning. Before computers were introduced to the factory floor, lathes were operated by hand with lots of manual controls, usually in the form of wheels, levers, and buttons which were used to bring the bit into contact with the piece to be shaped.
Consider the two individuals depiceted in figure 16.1 The person in the top portion of the figure (A) represents a typical lathe designed by mechanical engineers in 1920s, as sketched in the lower portion (B), would look much different. The ideal operator would be slightly over 4.5 feet tall and 12 feet across the shoulder, and would have an 8-foot arm span. This ideal operator was determined by the way the mechanical engineers designed the lathe, and we can be fairly certain that few real-life lathe operaotrs resembeled the ideal. The engineers most likely began their design with standard measurements of the components from which the machine would be built. From the human perspective, this was foolish. The mechanical engineers should have begun their design with an appreciation of the range of likely characteristics, capacities, and the limitations of the operators of the lathe. The implications are clear. If the equipment and environment are not compatible with the human who will use that equipment and populate that enviroment, we also can expect problems in the form of lowered production, injuries, and accidents. We also expect to see unhappy workers who are continuallu ‘taxed’ by their work.
Figure 16.2 is a reminder of the fact that we often take human factors for granted. Imagine an elevator with such a control panel. Think of the extra time you might need to locate the button corresponding to the floor you wanted to visit. Worse than that, imagine the chaos of a telephone keypad with a rendomly arranged numbers. There are literally hundreds of devices you use every day that have been designed or modified by human factors specialits; the configuration of an automobile dashboard, the height and tilt of a chair; the keyboard and screen at a computer workstation, the arrangement of knobs and burners on the stove top, the positioning of the brakes on a mountain bike, even the way a radio dial or a TV remote control works. All of these are examples of products or objects desgined to acheive user friendliness – that is, to be comfortable, easy to use, and compatible with human capacities and limitations. In this chapter, we will consider the concept and discipline of human factors engineering as it applies to work.
Human Factors Models
Howel (1993) identified human factors as the dynamic force in both technology design ans society. We have adapted his view in Table 16.1. In the left-hand column is the ‘need’ or driving force. In the right-hand column is the himan factor, or applied, issue or area of concentration. this table provides a good overview of the substance of human factors. Two very simple models can be used to poosition human factors in the broader perspective of the study of work behavior. Consider figure 16.3. In a series of concentric circles, we see that the worker is embedded in a series of increasingly larger environments which include, respectively, equipment(e.g., computers), physical workplace (e.g., work cubicle or office), social work space(e.g., teams), and organizational work space (e.g., climate or culture). Each of these environmentshas an influence on the performance of of the individual. Traditionally, the human factors appoach has concentrated on the interface between the worker and the equipment – and in the very last several decades, the ‘equipment of choice’ has been the computer. Figure 16.4 illustrates a very basic model of the interactionof the worker and equipment.
There are several components of the model. There is a worker. the equipment, the way the worker receives information from the equipment, and the way the worker controls the equpment, the way that the worker receives information from the equipment, and the way the worker controls the equipment. Both the equipment and the worker have an input component and an output component. An everyday example of the this model is that you’re supposed to prepare a paper for one of your classes and you were preparing it on the computer. As you sit infront of the computer you see a screen and a keyboard. What appears on the screen is the output from computer ans input to you. what you type on the keyboard represents output from you, but input to the computer. You and the computer are connected through this information flow loop. You ask the computer to access information in a literature base related to industrial safety by first activating a search engine, then typing in a website, and finally inputting some key words for the search. With that instruction, the computer accompishes the search and provides you with the relevant journal articles. There have been a string of interactions between you and the computer. You truned it on, you activated its operating system, you started the search engine, you identified the website, and you listed the key words. At each point in this process, the computer asked you to make choices. You made these choices with the mouse or the keyboard, and when you made each choice, the computer ‘did its thing’. These was considerable input and output in both sides of the keyboard.
This simple example introduces two additional technical terms that are important in human factors; displays and controls. Displays (e.g., computer screen)provide an individual with information, while controls (e.g., keyboard or mouse) permit an individual to take actions. there is a rich history as well as an active current research interest in the design of the most effective methods of display and control (Salvendy,1997; Wickens, Gordon, & Liu, 1998). But displays and controls are only two components of a more elaborate model of work from the human factors approach perspective. Figure 16.5 presents a more complete systems view of the human factors approach to work.
Human factors is a global discipline. The same human factors issues affect virtually any industrialized country. Helander (1997) identified a number of human factors challenges characterise work in 25 different countries. These include the change of work organization and design, work-related musculoskeletal disorders, and human-computer interface. Muskuloskeletal disorders of the lower back and upper extremities are the most commonly studied injuries related to workspace safety. Human-computer interface (HCI) is the interaction between a human and a computer. Other factors that Helander identified are the change in social systems of work environments, high technology system design (particularly nuclear power plant control rooms), mental workload, and human reliability.
Work Schedules
The scheduling of work is under the control of the organization, and thus can be considered an issue of work design. Work schedules are playing an increasingly important role in managing work-life balance in two ways: Individuals desire the freedom to pursue leisure activities outside of work, and they often have obligations to fulfill multiple roles as spouse, caregiver, and the parent. This suggests that the scheduling of work can have substantial effects on worker well-being. There are three different scheduling formats that bear discussion: Shift work, flextime, and compressed workweeks.
Shift work
The scheduling of work according to a prticular time period is called shift work. The study of shift work and its effects on workeres has a long and rich research history. This history is well presented in a number of sources (e.g, Johnson, Tepas, Colquhoun, & Colligan, 1981; Landy, 1989; Tepas, Paley, & Popkin, 1997; Wedderburn, 1981). Much of this work has centered on the 24-hour a circadian cycle of humans, whose physiology tends to make them active during hours of light and inactive(e.g., sleeping or resting) during hours of darkness. Thus, workers assigned to shifts during daylight hours are following the circadian cycle, while those whose shift includes hours of darkness are working against the cycle. Psychologists found that, in general, the disturbance of thee circadian cycle has adverse effects on the health, performance, and general satisfaction. Shift work is categroized in to two different types: fixed shifts and rotating shifts. If workers are permenantly assigned to a particular shift, the shift is called fixed shift. Typical shifts inlude the day shift (e.g., 7:00 A.M. to 3:30 P.M.), the afternoon or evening shift – often called the ‘swing’ shift (e.g., 3:00 P.M. to 11:30 P.M.), and the night shift – often called the ‘ midnight’ or ‘graveyard’ shift (e.g., 11:00 P.M. to 7:00 A.M.). Workers who move from shift to shift are said to be working a rotating shift schedule. Shiftscan rotate rapidly (e.g., move to a different shift every week) or slowly (e.g., a worker may change shifts every three months). In union environments, worker can often bid on shifts based on seniority, resulting in more frequent shift changes for workers less seniority.
Generally speaking, rotating shifts are more likely to be associated with problems that fixed shifts (Parkes,1999). This is particularly true if the direction of the rotation is from day to night to evening (as opposed to day to evening to night). Rotating shifts and particularly rapidly rotating shifts, lead to sleep disturbances , which in turn are associated with medical (e.g., gastrointestinal) and psychological (e.g., anxiety and depression) difficulties. Rotating shifts also seem to be hard on older workers (Landy, 1989).
Shift work is more common in some occupational groups than others. Nurses, blue collar workers, and public safety personnel have higher concentrations of shift workers than professional, managerial, or white-collar groups ( Smith et al.,1999). The most frequently studied of those occupations is the nursing profession. Barton (1994) examined the nurses who take night shifts on permanent basis and nurses who where assigned to rotating night shifts. Permanent night shift nurses reported significantly fewer problems with health, sleep, and social or domestic activities. This was particularly true for individual nurse who chose to work on the permanent night shift compared with nurses who chose to work on permanent night shift compared with nurses who chose rotating shift schedule. The most important reasons the nurses in this study gave for choosing the permanent night shift were the night shift work permitted them to more easily fulfill domestic responsibilities, and it paid better. Thus, for those who chose permanent night work, it actually improved control and scheduling of work-nonwork roles. But the nurses on a rotating shift schedule felt that their lives were disrupted every time they had to work afternoon or night shifts (Barton, 1994). It appears that night shift work provides a significant opportunity for establishing a work-life balance that is not possible for rotating shifts or, in some circumstances, day or afternoon shifts. This seems to be a particularly true of dual wage earning families with young children. In another study of nurses, Bohle and Tilley (1998) found that work-nonwork conflict was one of the strongest predictors of satisfaction with shift work.
These balancing advantages notwithstanding, some research has shown that permanent day shift tends to be more intrinsically satisfying that afternoon, night, or rotating shift work. Blau and Lunz (1999) analyzed the effect of various shift schedules on 705 medical technicians (MTs) and found that MTs who worked a permanent day shift reported that their jobs were less routine than the jobs of MTs on any other shift. To some extent, this perception conforms with the reality of this job across shifts. Night shift MTs tend to perform standardized tests on samples gathered during the day. In addition, since many medical procedures are performed during the day. Since many medical procedures are performed during the day and vary substantially from patient to patient, it makes sense that the work of the day shift MT would be less routine. The day shift MTs were also more satisfied with supervision, mainly because supervisors were available on the day shift, as opposed to the night shift, which often functioned without any direct supervision.
Flexible and compressed workweek schedules
Shift work regardless of whether it is fixed or rotating, defines the work schedule rigidly. In general, shift workers are expected to work eight hours per day, five days per week. But there are other scheduling variations that are not so rigid.
Flextime Individual workers who are given discretion over the time they report to work and the time they leave work on a given day are working a flextime schedule. Such schedules are uncommon in manufacturing organizations, since the interdependence among workers in assembly-line and continuous process operations makes the absence of a particular worker particularly problematic (Baltes, Briggs, Huff, Wright, & Newuman, 1999). A survey of a diverse sample of more than 1000 organizations in 1995 revealed that 66% of them permitted some form of flexible workday (Hewitt Associates, 1995). That percentage has probably increased since 1995. In a typically flexible work schedule, every worker is expected to be at work during a ‘core’ period (e.g., 10:00 A.M. – 3:00 P.M.) but is permitted to arrive as early as 7:00 A.M. and leave as late as 9:00 P.M. (Baltes et al., 1999). Regardless of when they arrive and leave, they are expected to be at workplace for 40 hours a week. Ronen (1984) after the introduction of flextime the average arrival time of workers was 8 minutes later than it had been before, and that the average departure time was 22 minutes later after the introduction of flextime. The benefits of flextime to the individual worker are obvious. In addition to the psychological advantages of perceiving some control over the work schedule, there is the practical advantage of achieving a better balance between work and nonwork. Most workers express satisfaction with flexible schedules.
Compressed workweek Another nontraditional work schedule is the compressed workweek, which permits an employee to work for longer than eight hours a day and fewer than five days a week. A common plan is 4/10 plan, which permits a worker to accumulate the 40 hours of the workweek in four days. For some workers, this affords the opportunity to enjoy an ongoing series three-day weekends. For others it permits them to take another jobs or pursue further education on a more regular basis while still working. A 1995 survey of 1000 companies found that 21% offered workers the possibility of a compressed workweek. This type of schedule is found most commonly in the manufacturing organizations (Baltes et al., 1999). As with flextime, workers tend to express satisfaction with the compressed workweek (Landy,1989).
Consecuqeunces of Flextime and Compressed workweek Schedules Worker satisfaction with flextime and compressed workweek schedules is well documented (Baltes et al., 1999; Landy, 1989). But are these work schedules associated with organizational outcomes such as productivity, performance, and absenteeism? The activity of creating and maintaining nontraditional work schedules inevitably incurs some administrative costs, so organizations may well ask, What’s in it for us? Baltes et al., (1999) conducted a meta-analysis of 39 studies on the effects of flextime (27 studied) and compressed workweeks (12 studies). The results of analysis are useful and encouraging for both of these scheduling variations. They found that flextime was associated with higher productivity and lower absenteeism, although the impact on absenteeism was considerably greater than the effect on productivity. For the compressed workweek, they found that while absenteeism was unaffected, supervisors’ ratings of performance were higher (though productivity was not).
Baltes et al, (1999) did some further analyses of their data and found that flextime had little effect on productivity, performance ratings, or absenteeism for professionals and managers such as accountants or sales managers. In addition, they found that for non-professional, non-sales managerial workers =, programs with extremely flexible hours were less effective than more conservative programs. They concluded that this was probably the result of the inability of employees in the workplace to communicate with absent employees. This would be problematic in organizations that depend heavily on teams and groups as opposed to single contributors. They also found that the effects of flextime tended to diminish after the initial period of adjustment (typically a few months); as workers became accustomed to the new scheduling, it became the norm. Remember also that one study demonstrated that actual arrival and departure schedules remained very much the same (Ronen,1981).
Approaches to work design and redesign
With the study of different work design issues; which included technological variables (computers and automation) and social variables ( work scheduling). Campion and Thayer (1985, 1987; Campion, 1988, 1989) have proposed that one might take many different approaches to designing and redesigning work, and since each approach has different goals, we might expect different outcomes, Campion and Thayer (1985) examined 700 different ‘rules’ that have been suggested for designing work and reduced them to four different outcome. In table 16.3, you will see the specific questions that might be asked in designing or redesigning a job. Any given design change includes several different approaches, not just one, which includes elements of motivational, mechanistic, and perceptual-motor approaches. The motivational approach to work design and redesign is used to increase worker satisfaction and reduce turnover through modification of motivational levels. The mechanistic approach to work design and re-dseign is used to increase productive efficiency through the modification of tasks or equipment. The perceptual-motor approach is used to reduce errors or accidents through knowledge of perceptual-motor skills and abilities. Finally, the biological approach is used to reduce injuries and increase the physical comfort of workers thought the reduction of fatigue and discomfort. Automation included elements of the mechanistic, biological, and perceptual-motor approaches. Work scheduling is related to the motivational and biological approaches.
Campion’s (1988,1989) models have several implications. First, we need to be clear about what outcomes we expect or desire in the design or re-design of work. If we are designing work to increase worker satisfaction and reduce turnover, we may want to choose the motivational appoach. If , instead, we are trying to reduce injuries and increase the physical comfort of workers, we would rely on the biological model. A second implication is that conflict may occur between the approaches, resulting in both anticipated and unanticipated outcomes. If you were to use the mechanistic approach to increase productivity efficiency, you would simplify work. But by doing that, you would also make the work less interesting and motivating for the worker.

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