Psychological Health and Safety in Canadian Healthcare Settings
Psychological health and safety are growing priorities in Canadian workplaces, including Canadian healthcare settings. The workplace has a key role to play in promoting mental health. The Canadian Healthcare Association recently adopted a position statement strongly encouraging members and all health stakeholders to adopt and take action to implement the new voluntary standard, outlined in Psychological Health and Safety in the Workplace.
The Canadian Healthcare Association (CHA) recently adopted a position statement (2013) strongly encouraging members and all health stakeholders to adopt and take action to implement the new voluntary standard outlined in Psychological Health and Safety in the Workplace (CSA Group 2013). (On January 1, 2014, CHA is merging with the Association of Canadian Academic Healthcare Organizations [ACAHO] to create a new national health organization). Championed by the Mental Health Commission of Canada (which has applauded "CHA for its leadership on developing this position paper and highlighting the importance of psychological health and safety in the workplace" [CHA 2013, November 26]), the standard was developed collaboratively by the Bureau de normalisation du Québec and CSA Group.
Psychological health and safety are growing priorities in Canadian workplaces, including Canadian healthcare settings. One in five people will experience a mental health problem or illness in any given year (Government of Canada 2006). Nearly half of all Canadians will have had some form of mental illness by the time they turn 40 (Mental Health Commission of Canada 2013).
The workplace clearly has a key role to play in promoting mental health. Many Canadians spend more waking hours at work than at any other place (Mental Health Commission of Canada 2012). Those most at risk for mental illness or problems are often in their prime working years. Promotion and prevention efforts in the workplace can therefore make a real difference in the health and lives of Canadians.
Promoting a Well-Functioning Health System
Promoting and protecting the psychological health of workers is essential to a well-functioning health system, as well as being the right thing to do. Like physical illness, psychological illness can lead to absenteeism, lost productivity, loss of skilled workers, presenteeism ("where an employee is physically at work but not fully productive due to physical or mental conditions" [Towers Watson 2010: 4]) and high levels of staff turnover – all to the detriment of the overall healthcare system. A significant and growing portion of disability claims is related to mental health issues (Bradley 2013).
Good psychological health is also integral to being an effective healthcare worker (MacLeod and Shamian 2013). It is difficult, for instance, for a health worker to provide high-quality patient care if she or he is overly stressed or emotionally exhausted. The psychological health of individual workers also affects the day-to-day dynamics of the entire workplace. For example, people who do not feel well may not behave well, and there may be heightened interpersonal conflicts. Good psychological health may contribute to fewer medical errors and patient-safety incidents. It may also contribute to increased productivity and efficiency. Research shows that organizations that actively support the physical, emotional and interpersonal well-being of their employees are more likely to have highly engaged employees – essential to high productivity (Towers Watson 2012).
Challenges in Canadian Healthcare Settings
Many Canadian workers report rising stress levels, increasing work pressures and difficulties balancing competing work and family demands (Duxbury and Higgins 2012). Healthcare settings can be particularly challenging environments. Healthcare workers are 1.5 times more likely to be off work due to illness or disability than people in all other sectors (Casselman 2013, June 18). Chronic stress and burnout are common. Many health workers report a wide range of health conditions related to work-related stress including depression, anxiety, weight gain, substance abuse and even suicide (Canadian Medical Association 2010). Many Canadian physicians report that they are in the advanced stages of burnout (Canadian Medical Association 2003, 2010), which is also a critical issue for Canadian nurses (Greco et al. 2006; Hildebrandt 2013, April 8).
Healthcare workers often have heavy workloads, significant pressures and a lack of time and resources to adequately do their jobs (Picard 2010, January 19). Staff shortages as a result of cutbacks and layoffs are common and can lead to longer and/or more frequent working periods and an increase in personal stress. In addition to "doing more with less," work in the healthcare sector can be emotionally demanding. Ongoing work with patients and their families and helping people cope with illness and death can result in "compassion fatigue." Healthcare workers can also face challenges associated with shift work, workplace violence and bullying and rapidly changing practice environments.
Innovative Initiatives in Healthcare Settings
There is a wide range of policy and/or activity related to employee wellness within health organizations across the country. Many healthcare settings are taking important steps to address psychological health in the workplace by developing innovative programs to help address emotional and mental health. Some, for example, provide training on emotional intelligence, as well as strategies to teach employees how to pause, reflect and manage their emotions. Employee wellness programs are well established in many places. Some settings are increasingly emphasizing the importance of striving for excellence (rather than perfection) and enhancing the resilience of healthcare workers (Maunder et al. 2008).
In some large healthcare organizations, clinical specialists (e.g., psychiatry, psychology, social work, nursing and other healthcare professionals with specialization in mental health issues) are working alongside administrative teams to develop and deliver best practice mental health programs for healthcare workers (M. Barton, personal communication, September 24, 2013; Maunder et al. 2008). Innovative approaches to peer support are also being considered for use in workplaces and have applications to healthcare settings (Mental Health Commission of Canada, n.d.). Greater work in this area is expected as Canadian workplaces become more and more aware of the importance of promoting psychological health in the workplace.
What Is a Psychologically Healthy Workplace?
The standard outlined in Psychological Health and Safety in the Workplace (CSA Group 2013) identifies a number of key factors involved in creating a psychologically healthy workplace. These include the following:
- Civility and respect in the workplace
- Supported and valued employees
- Praise, recognition, acknowledgement and fairness
- Growth and development opportunities
- Clear leadership and expectations
- Recognition of the need for balance (personal life, family, work)
- Manageable workloads – responsibilities can be accomplished within the time available
- Adequate resources to do the job
- Workers who have some control over how they organize their work
- Consideration of opinions and suggestions of employees – employees participate in decision-making
- Psychological services and supports available to employees with mental health issues
What Can Workplaces Do to Address Psychological Health and Safety?
CHA's position statement provides details about the new standard and its guidance for changing how mental health and mental illness are approached in the workplace. Successful workplace initiatives require leadership, commitment and the active participation of all stakeholders. It is also essential that workplaces engage in a structured planning process so that initiatives are based on clearly defined workplace and workforce needs.
The position statement outlines some of the many steps that health workplaces can take to protect and promote the psychological health and safety of their workers. Reviewing and committing to the new standard is a good start. The implementation of the standard will look different in every organization and will depend on the size and resources of the organization. Some organizations may use the standard as a starting point. Others may already have several aspects of the standard in place and will use it to build on their existing effort (Bureau de normalisation du Québec et al. 2013, January 16).
Some examples of things that workplaces can do as part of their commitment to psychological health and safety in the workplace include the following:
- Ensure the commitment of organizational leadership
- Establish a baseline profile of the organization and conduct a needs assessment
- Develop a policy/intent statement for psychological health and safety in the workplace
- Identify a workplace champion
- Provide mental health training for managers to help them recognize the signs and symptoms of mental health problems, provide initial help and refer employees who might have a mental health issue to appropriate help
- Provide mental health training to employees to help them understand the signs and symptoms of mental health problems and to learn mental health promotion practices, coping strategies, resiliency skills and how to get help when needed
- Promote awareness of available employee benefits
- Put in place return-to-work strategies to help employees go back to work after being treated for a mental illness or problem
- Undertake a communications campaign to promote mental health awareness in the workplace
- Measure successes (both in the short and long term)
- Be aware of issues related to privacy and stigma associated with mental health
CHA's position statement provides further details, as well as links to important resources available on this topic.
The Importance of Mobilizing Leadership
CHA's position statement also emphasizes the importance of mobilizing leadership across Canada's health system in support of psychological health and safety in the workplace. Leadership is fundamental for changing the culture of an organization. Furthermore, a key task of healthcare leadership is to develop its most critical assets – its workers. Leaders play a central role in promoting mental health in work settings and committing to and implementing the standard. CHA's position statement strongly encourages health leaders to play a key role in creating psychologically healthy workplaces and actively supporting the broader movement for improved mental health.
For more information, please see CHA's position statement, Psychological Health and Safety in Canadian Healthcare Settings 2013, available at https://www.cha.ca/wp-content/uploads/2012/11/CHA_Psychological-Hlth-Safety_policy-statement-FINAL.pdf).
The voluntary standard, Psychological Health and Safety in the Workplace – Prevention, Promotion, and Guidance to Staged Implementation, can be downloaded at no cost from www.shop.csa.ca.
About the Author(s)
Jennifer Kitts, BA, LLB, LLM, is the senior policy analyst in the research and policy department at the Canadian Healthcare Association, in Ottawa, Ontario. She is also a board member of the Research Ethics Board at Ottawa Public Health. She can be contacted at 613-241-8005, ext. 210, or by e-mail at firstname.lastname@example.org.
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