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Stress and Presenteeism Among Kansas Hospital Employees

What Stress Reduction Interventions Might Hospitals Benefit From Offering to Employees?

Huff, Jessica MD; Ablah, Elizabeth PhD, MPH

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Journal of Occupational and Environmental Medicine: November 2016 - Volume 58 - Issue 11 - p e368-e369
doi: 10.1097/JOM.0000000000000872
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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.

Preferred and Previously Used Stress Reduction Strategies Among Hospital Employees
How often employees would be willing to engage in selected interventions 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.


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