Team Stress: Controlling Its Impact on Your Bottom Line

The uncertainty of the current healthcare environment has become a cause of undue stress. Although stress can have a positive im­-pact on individuals and organizations, it most often wields a negative effect. According to the American Institute of Stress (www.stress.org/workplace-stress/), up to 60% of absenteeism in the workplace has been attributed to stress. Downsizing, mergers, increased regulatory requirements, and increased work demands all contribute to workplace stress. Sarah J. Holt, PhD, FACMPE, administrator of Cape Girardeau Doctors’ Park, Cape Girardeau, MO, recently shared with practice managers the effect of stress on teams and the impact it has on the financial bottom line.

Dr Holt began by distinguishing between challenges and stressors. Some people thrive on challenges. Whereas challenges may be appropriate to a person’s skill level, ability, and knowledge, stress may result when an employee does not have the resources or skills to accomplish a task they have been given. Certainly, people react differently to stress, based on their personalities and emotional intelligence. There are, however, certain traits that are conducive to stress.

Conscientious employees, she noted, are at one end of the spectrum, while disorganized employees are at the other end. Those plagued by perfectionism can never get anything done, because they seek to attain the often unattainable. Emotionally stable employees are often levelheaded and resilient. They might be cool in the face of stress, while anxious, fidgety employees prove fragile. Others might have to walk on eggshells around them. Most of us, she explained, are somewhere in the middle, and once in a while fall out of balance. People who are open are adaptable to change and welcome it. They rally in finding new ways to do things and seek the “better way.” They are apt to be creative and curious. Others are fearful. The slightest change upsets them and sends them into retreat.

Some employees are agreeable. Others are disagreeable. Although practices might hope that everyone in their employ is 100% agreeable, they would find that these employees are of little value. If a colleague agrees with everything you suggest, you might as well be in an echo chamber. Dr Holt noted that there is no value in exchanges with overly agreeable colleagues. On the other hand, the colleague who is disagreeable for the sake of being disagreeable can become a serious annoyance and someone you would seek to avoid. “What we need on the agreeable spectrum is something closer to the middle. We want somebody with enough conviction to say, ‘Can we think about that for a minute? Can we discuss it?’ Because if they can’t and won’t, they will never serve as assets to your team,” she observed.

Introversion and extroversion are other traits that you need to distinguish. Introverts might have excellent ideas, but might require that you draw ideas from them. “The truth is, the more you know about each person on your team, the more able you will be to create a successful, high-functioning team,” Dr Holt offered. All of the traits mentioned are likely to be found in some members of your team.

Stressors
When asked to identify specific stressors at work, employees mentioned tension with coworkers, excessive work overload, role conflict, bad task design, and management style. “The number one reason why people leave organizations is bad management,” Dr Holt noted. “Good employees seek good management. When they are faced with bad management, it stresses them to the point where they cannot take it anymore and often leave the organization.”

Other negative stressors include lack of support, lack of authority for work roles, lack of direction, career concerns, unpleasant physical working conditions, impossible deadlines, demeaning colleagues, and being on call 24/7. When an employee feels they are not getting sufficient support from their coworkers or their supervisors, they feel underappreciated. When workers are given broad responsibilities without sufficient authority to achieve those tasks, their burdens increase. Not knowing what to do and not being supported in a decision can cause tension. Do I follow the needs of the organization? What is best for the patient? Should I do this to make more money?

Sometimes we have to struggle to figure out what to do, Dr Holt noted. Career concerns might arise when someone realizes there is no room for advancement in an organization. Other issues arise from unpleasant working conditions, such as being stuck in a cubicle with no windows. Impossible deadlines are another real problem. A colleague who took work home and stayed up all night to get a task done might feel underappreciated when their work was met without appropriate approbation.

Demeaning and abusive colleagues can create a hostile work environment. It is important to pay attention and be alert to situations where abuse is not readily apparent. “Some abuse occurs on a subtle level. One should do everything possible to prevent abusive behavior and potential lawsuits that might arise from it,” Dr Holt said.

Being unable to unplug from work is a huge problem. “Getting a call from the office at night while at home sends a message to your family that they come in second. This creates stress for you and your family,” Dr Holt warned. Related issues occur when you are continually tired and complain of being exhausted and unable to sleep. The next thing you notice is that you function below par and just do not care anymore. Be aware that burnout is imminent.

Arbitrary management decisions that do not make apparent sense are often difficult to complete. When a seemingly senseless edict comes down, workers might ask:

  • “What is this all about?”
  • “Who decided this?”
  • “Why were we cut out of the loop?”
  • “Why didn’t we have some say in this decision?”

Ever-rising expectations also add an undue amount of stress. If the bar keeps getting higher and higher with less and less downtime, employees might have no opportunity to take a break or a breath before the next pile of work arrives.

Stress often manifests physically, but sometimes also psychologically or behaviorally. These include sleeping problems, stomach upset, hypertension, depression, anxiety, cognitive difficulties, lack of judgment, inability to make decisions, disinterest, and isolation (eg, having lunch in the car and not with the group).

The Team
A good team thinks, acts, and feels together. Members of a good team trust each other and perform like one—“just like a good family,” observed Dr Holt. Teams are essential, but they are also fragile. You might put together an excellent, high-functioning team, only to see it dissolve in an instant. Like all families, problems arise. “When teams are put under a tremendous amount of stress, they soon lose their focus on ‘we’ and narrow their focus onto ‘I,’” she said. The thinking together stops, performance becomes independent, and the team deteriorates. Without the right leadership, the team will remain uncoordinated and cease productivity. When a team falls apart, management might feel the need to micromanage only to deteriorate the trust of team members further. “If you don’t trust me to get the work done, then I don’t trust you.”

The US Bureau of Labor Statistics found that when employees leave work because of stress, they typically stay away from work for a period of 20 days. “Unfortunately, when 1 person vacates his or her desk, someone else must fill in. And someone else must fill in for them and so on down the line,” Dr Holt explained. She described how as many as 4 or 5 workers might be displaced, possibly for a period of 20 days, preventing efficient operation.

Management Must Lead
The fact of the matter is that “management has the authority and the responsibility to make things in the workplace function differently and well,” Dr Holt reminded the audience. One of the things management must do is “lead by example.” She urged managers to look on the bright side, look for things to be grateful about, and focus or refocus on team building. Although she noted that managers might not be able to change what is happening in the C-suite, they can change how their own department functions and reacts to it. Working together, bringing relief to each other, and renewing the focus on your team can make all the difference. “Strive to be a good leader. And strive to address problems in a way that will be seen as appropriate. This is a tough call,” Dr Holt noted, “but your efforts will be appreciated if you attempt to be genuine. Dis­ingenuousness does not work.”

Managers must be careful not to ignore the signs and symptoms of stress. And they might consider stress reduction programs, either formal or informal. Dr Holt recommended planting the seeds for instituting a stress reduction program in the future if having one now is not possible.

Managers should attempt to clarify who is responsible for each operation and then hold that person accountable. “When a team member has not been accountable, the leader must step into the role—in private. This is how trust is built,” said Dr Holt. When trust is broken—and this will happen—the manager must make the effort to repair it. It will be important to realign your purpose, encourage professionalism, and develop an alternative course of action. Ul­-timately, you must manage yourself—possibly a lifelong goal. Dr Holt urged practice managers to admit when they have made a mistake. “When you identify that there is a problem with the team, you must decide what the outcome should be. When you intervene, be intentional—determine whether you should coach, counsel, or discipline. But act promptly before a problem becomes too big or too intense.”

In short:

  • Express gratitude
  • Celebrate small successes
  • Seek honest feedback
  • Define problems
  • Attempt to learn the scope of stress
  • Implement interventions, where possible
  • Evaluate the interventions
  • Give your team a measure of freedom; it is OK to tweak the rules and change the goals.

Dr Holt cautioned not to let your ego get involved: “Take 2 steps back and realize that this is not necessarily about you. It’s about the team and the organization—both are a whole lot bigger than you.” She urged attendees to use appropriate body language and to avoid lecturing. “Reconvene when you think the team has heard enough or has had enough. Your ultimate goal is to create a safe working environment. In the midst of a crisis, it is important to stay calm. Use humor to diffuse a tense situation. And don’t take yourself too seriously—remember, anything you do to elevate our profession, elevates us all.”

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