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Studies have identified a positive correlation between occupational stress and presenteeism,1,2 and research suggests that employer-directed stress-reduction interventions are needed to decrease the burden of stress-related presenteeism among their employees.3 Yet, no studies to date have sought to identify which stress reduction interventions are of greatest interest to hospital employees. We sought to measure stress levels of Kansas hospital employees, how this reported stress affects workplace presenteeism, and which stress reduction interventions were of greatest interest to these employees.
Potential survey respondents were identified as employees of hospitals who are members of the Kansas Hospital Association, which includes 126 community-based, nonprofit hospitals. A link to the survey was provided to each hospital by e-mail, and employees were contacted via e-mail from the hospital, inviting them to participate in the study. Those interested employees were directed to a Survey Monkey link. Workplace presenteeism due to stress was measured by the Stanford Presenteeism Scale-6 (SPS-6), a six-item instrument that evaluates worker health and presenteeism on a 5-point scale.4
A total of 399 individual surveys (n = 399) were completed. Nearly all (97.7%, n = 389) of the respondents reported some level of stress within the workplace, and most (92.4%, n = 366) respondents also reported some level of stress outside of the workplace. On the basis of SPS-6 scores, most (93.4%, n = 366) employees reported moderate to high levels of presenteeism due to work stress. Those who reported having “no” or “very little” work stress reported less stress-related presenteeism (average SPS score of 18) than those who reported having “quite a bit” or “a lot” of work stress (average SPS score of 22), t(396) = -9.818, P < 0.001.
Interventions of greatest interest included increased recognition or reward for a job well done (47.2%, n = 191), exercise room or area (36.8%, n = 149), yoga classes (35.3%, n = 143), and flex time (34.8%, n = 141) (Table 1). Moreover, employees reported willingness to participate in these interventions if given protected time to perform the activities (Fig. 1). Respondents reported that they were most likely to take advantage of increased recognition for a job well done (68% often or regularly, and 27% occasionally), an exercise room or area (61% often or regularly, and 28% occasionally), flex time (51% often or regularly, and 38% occasionally), and improved communication with employer (67% often or regularly, and 21% occasionally), if given protected time.
Most employees reported moderate to high levels of presenteeism due to stress. The errors associated with presenteeism have been estimated to cost between $2 billion and $13 billion for the United States annually.5 This is a large cost, some of which could be prevented.
Respondents who reported having no or very little work stress reported less stress-related presenteeism than those who reported having quite a bit or a lot of work stress. This is consistent with previous studies that have found a positive correlation between occupational stress and presenteeism.1,2
No previous studies have catalogued stress reduction interventions of greatest interest to employees. Respondents identified multiple strategies that would not cost hospitals—or any employer—anything, such as increased recognition for good work. Employees might not feel appreciated for their contributions, and simple recognitions can go a long way toward decreasing or preventing stressors from occurring.6,7
The other recommended stress-reduction strategies of interest to employees included providing exercise equipment and space, and opportunities for physical activity. It is clear that such access can increase employees’ likelihood of meeting physical activity recommendations,8 which can be associated with reduced absenteeism and decreases in employers’ costs.9 Another stress-reduction strategy of interest to employees was flex-time. Employees from another study report that employers’ offering of flexible work hours to incorporate physical activity into the work day is their preferred method of support for physical activity,10 and it appears that offering flexible scheduling around physical activity does help employees be less sedentary.10–13
Finally, this study is consistent with other literature that suggests greater participation if employees are given protected time to participate in various stress-reduction activities.14 As previous studies suggest that mere knowledge of stress reduction interventions can be linked to positive employee outcomes such as increased job satisfaction,15,16 hospitals and other worksites could benefit from offering and increasing awareness of such interventions.
Perceived workplace stress is highly prevalent among Kansas hospital employees, and this stress is associated with high levels of presenteeism. Interventions of greatest interest included increased recognition, offering an exercise space and yoga classes, flex time, and improved communication with employer, especially when given protected time to do so.
1. Dai J, Hua Y, Zhang H, Huang L, Fu H. Association between occupational stress and presenteeism among medical staff at grade A tertiary hospitals in Shanghai, China. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi
2. Janssens H, Clays E, de Clercq B, et al. Association between psychosocial characteristics of work and presenteeism: a cross-sectional study. Int J Occup Med Environ Health
3. Yang T, Zhu M, Xie X. The determinants of presenteeism: a comprehensive investigation of stress-related factors at work, health, and individual factors among the aging workforce. J Occup Health
4. Koopman C, Pelletier K, Murray J, et al. Stanford presenteeism scale: health status and employee productivity. J Occupat Environ Med
5. Letvak SA, Ruhm CJ, Gupta SN. Nurses’ presenteeism and its effects on self-reported quality of care and costs. Am J Nurs
6. Avey JB, Luthans F, Jensen SM. Psychological capital: a positive resource for combating employee stress and turnover. Hum Res Manag
7. Mark G, Smith AP. Effects of occupational stress, job characteristics, coping, and attributional style on the mental health and job satisfaction of university employees. Anxiety Stress Coping
8. Dodson EA, Lovegreen SL, Elliott MB, Haire-Joshu D, Brownson RC. Worksite policies and environments supporting physical activity in midwestern communities. Am J Health Promot
9. Willert MV, Thulstrup AM, Bonde JP. Effects of a stress management intervention on absenteeism and return to work-results from a randomized wait-list controlled trial. Scand J Work Environ Health
10. Blackford K, Jancey J, Howat P, Ledger M, Lee AH. Office-based physical activity and nutrition intervention: barriers, enablers, and preferred strategies for workplace obesity prevention, Perth, Western Australia, 2012. Prev Chronic Dis
11. Parry S, Straker L, Gilson ND, Smith AJ. Participatory workplace interventions can reduce sedentary time for office workers—a randomised controlled trial. PLoS One
12. Fan W, Lam J, Moen P, Kelly E, King R, McHale S. Constrained choices? Linking employees’ and spouses’ work time to health behaviors. Soc Sci Med
13. Gazmararian JA, Elon L, Newsome K, Schild L, Jacobson KL. A randomized prospective trial of a worksite intervention program to increase physical activity. Am J Health Promot
14. Lucove JC, Huston SL, Evenson KR. Workers’ perceptions about worksite policies and environments and their association with leisure-time physical activity. Am J Health Promot
15. Pignata S, Boyd C, Gillespie N, Provis C, Winefield AH. Awareness of stress-reduction interventions: the impact on employees’ well-being and organizational attitudes. Stress Health
16. Pignata S, Winefield AH. Stress-reduction interventions in an Australian university: a case study. Stress Health