CHAPTER 19
Building Interventions to Improve Staff Well-Being

Gordon Tinline and Ben Moss

Robertson Cooper Ltd, UK

The research-based case for improving staff well-being in organizations is very robust (e.g. Donald et al., 2005; Cropanzano & Wright, 1999). This chapter takes that as a given and provides our perspective as experienced practitioners on the critical issues that need to be addressed to improve staff well-being, and practical advice for doing so. There are three main stages to this:

  1. Building the business case.
  2. Measuring well-being and engagement levels.
  3. Taking action to improve working lives.

19.1 BUILDING THE BUSINESS CASE

Without a business case there is little hope of engaging business leaders with the idea of investing in well-being. There will almost certainly be those in your organization who equate well-being with providing free massages and doing yoga in the workplace, rather than seeing it as a tangible and valuable process of improving levels of psychological well-being every working day. This means that it’s often difficult to present a solid business case for investing in the well-being of the workforce. However, the proof is available and when you pull it together it should be powerful enough to convince even the most hard-headed director.

A critical role of the business case is to help focus on the stakeholders of well-being in the organization and then to connect this with the business-level outcomes that are to be influenced by improving well-being. It’s a process that brings together the research evidence and integrates it with your organizational objectives for well-being. The research and case studies give the board confidence that well-being interventions really work, while the organization-specific information makes the vision and benefits of an engaged workforce feel real for their business.

When we, at Robertson Cooper, are asked to advise clients on how to build a business case for well-being we use the model shown in Figure 19.1 to structure the process.

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Figure 19.1 Process for Structuring the Well-being Business Case

19.1.1 Stage 1: Identify well-being stakeholders

Starting with well-being stakeholders helps to ensure that there is a clear focus on the needs of staff groups who will be affected by, and can affect, the levels of well-being in the organization. It usually helps to include at least one group of senior managers or leaders.

19.1.2 Stage 2: Understand your starting point

Once the stakeholders are identified, it’s important to focus on current organizational activity around well-being. At this point, it’s useful to list all current well-being initiatives and note the benefits that each delivers to the stakeholders that have already been identified. Using the matrix shown in Table 19.1 can help to do this and may reveal that either some stakeholders currently receive no benefits or that some initiatives do not deliver any benefits to stakeholder groups.

Table 19.1 Stakeholder Analysis Matrix

Initiatives Stakeholder group A Stakeholder group B Stakeholder group C
1
  • Benefits of initiative 1 to stakeholder group A
  • Benefits of initiative 1 to stakeholder group B
  • Benefits of initiative 1 to stakeholder group C
2
  • Benefits of initiative 2 to stakeholder group A
  • Benefits of initiative 2 to stakeholder group B
  • Benefits of initiative 2 to stakeholder group C
3
  • Benefits of initiative 3 to stakeholder group A
  • Benefits of initiative 3 to stakeholder group B
  • Benefits of initiative 3 to stakeholder group C

It is also important to consider the organizational context at this stage. This includes considering the business-level outcomes that are important to the organization when it comes to improving well-being and employee engagement (e.g. sickness-absence rates, turnover, patient satisfaction etc.). Which outcomes would get key stakeholders’ attention in terms of buying into the well-being improvement effort? What indicators are likely to be most effective to measure progress in relation to achieving these outcomes? This is also the right time to consider strategic drivers that are relevant to well-being initiatives. How do the business-level outcomes that you want to influence link to the organization’s mission/strategy/business objectives?

19.1.3 Stage 3: Creating and evaluating your well-being initiative wish list

Creating a wish list is all about considering what else is required in terms of well-being initiatives. It’s where you examine the matrix and identify the gaps – for example, are there outcomes that are not influenced by any of the existing initiatives?

It’s also an opportunity to feed in the thinking that has been done about current strategic drivers: what additional initiatives are suggested by them? How can they support existing well-being initiatives? It’s also a good time to think about well-being initiatives that have been considered desirable for a while, but have not yet been implemented: how can they fill the gaps in the matrix?

The aim is to end up with a wish list that combines new and existing initiatives. Review this list in the light of the target outcomes identified earlier in the process and evaluate the extent to which the initiatives deliver benefits to key stakeholder groups.

When you have a final list it’s important to evaluate it thoroughly to take into account the current organizational context. This includes thinking about dependencies in terms of whether the success of a particular initiative is dependent on something else that is happening, for example, a funding decision or critical timescales. Also, consider the people/groups who are likely to affect the success of intended interventions. Are there key groups or individuals who can play a significant influencing role in ensuring the success of an initiative – or who could possibly completely ‘derail’ it? It is essential to identify these people/groups at this point and make plans to involve them in your efforts.

19.1.4 Stage 4: Determine the value of improving well-being to the organization

The final stage of building the business case for investing in well-being and employee engagement involves generating a clear picture of how the costs and benefits balance out. This enables the organization to take a robust view on the extent to which it is ‘worth’ gearing up to make the investment.

The benefits The first aspect of this stage concerns the benefits. Where possible it’s always useful to generate cash-based figures to express the value that improving well-being will deliver to the organization. It is possible to do this using research-based information about the improvements that are possible and combining them with industry standard figures (e.g. Robertson, 2007). It is also important to try to envisage how things will be qualitatively different and improved when working life in your organization is characterized by high levels of well-being, e.g. better leadership, a stronger sense of purpose for all staff, a more supportive and healthy environment. It is often harder to generate cash figures for such outcomes, but these are not required or possible for every aspect of improvement.

The costs The second part of this stage involves identifying and quantifying the costs of the investment to the organization. Clearly, it’s almost impossible to significantly change quality of working life, leadership/management style and fundamental aspects of the prevailing corporate culture without investing in it. There are usually external costs involved in this type of work, as organizations rarely have all of the expertise they need to make a real difference internally. It is therefore important to revisit your final list of initiatives and make an estimate of the external costs required to implement them. Finally, don’t forget to take the internal resources required to successfully implement the initiatives into account and wherever possible quantify them. External consultants can play a valuable role in helping to design and implement integrated approaches to well-being, but these projects are seldom successful unless the organization in question is fully involved and committed. A good place to start is revisiting the key stakeholder groups that you identified and estimating the time required from each. After that, consider who else will need to be involved – e.g. the internal communications department.

19.2 MEASURING WELL-BEING AND ENGAGEMENT LEVELS

Once senior management is convinced of the need to invest in well-being, the first step is to measure how the workforce currently sees the well-being situation. In order to be in a position to effectively direct your investment it’s important to generate an understanding of the blockers and enablers of well-being. This usually means an organizational-level survey that is specifically designed to measure these things, because it is almost impossible to make good decisions based on a few questions about well-being in the annual staff survey. The area of well-being and engagement is far too rich and cross-cutting to be tapped adequately in this way.

The best results come from an in-depth assessment of the current well-being situation. Other tools are available, but in this section we will mention two specific approaches to measurement, both of which are well suited to this stage of well-being initiatives.

The first, unsurprisingly, comes from the Health and Safety Executive (HSE 2005) in the form of their management standards for work-related stress. They have produced an assessment known as the Indicator Tool which is specifically designed to measure whether common sources of workplace stress exist. The tool measures perceptions about the work environment related to six areas:

  • Demands – workload, work environment.
  • Control – how much say a person has in how they do their work.
  • Support – the encouragement and resources provided by the organization/line manager.
  • Relationships – promoting positive working relationships and avoiding conflict.
  • Role – whether employees have clear roles that they understand.
  • Change – how well organizational change is managed and communicated.

Straight away it should be clear how understanding perceptions of these different areas across the organization can inform your decisions about where to focus improvement efforts. Think back to the initiatives that you identified earlier – consider the extent to which they may impact employees’ perceptions of these areas.

One word of warning on a technical aspect of measuring well-being: It’s important not to over-interpret the HSE Indicator Tool assessment – it provides a good indication of how staff view their working environment in important areas relating to stress and well-being, but it does not assess the impact of these on staff. To illustrate the difference, consider an example: if a member of staff indicates that they often have to work very intensively (an Indicator Tool item) it does not follow automatically that this damages their well-being. Some people enjoy and are motivated by intense work activity, particularly if they have a clear purpose for engaging in it. Once the Indicator Tool is completed and analysed it may well be important to investigate further the impact of the perceptions it reveals on staff health, commitment and well-being.

The HSE, as is consistent with their role as a risk regulator, provide some useful guidance around their tool, but the organization will usually need to work hard at using the results to effect real change. Further information on this approach is available at http://www.hse.gov.uk/stress/index.htm.

The other approach is ASSET, a tool originally developed by Cary Cooper and the product development team at Robertson Cooper in 2002. It measures the presence of similar barriers and enablers to well-being as the HSE indicator tool, but goes further to ask employees about whether these things actually trouble them. ASSET also measures health outcomes and self-reported productivity so that it’s possible to link the sources of stress that are experienced in the organization with reported psychological and physical outcomes. Finally, ASSET includes measures of more positive aspects of working life, such as levels of motivation and commitment to (and from) the organization.

When a whole organization completes the tool it is possible to see where the hotspots of stress are, but also where pockets of best practice lie. ASSET has an extensive norm base so it enables an objective comparison to be made with other similar organizations. This analysis can be conducted inside the client organization using online software that enables well-being professionals to compare the results from different departments, job levels, geographical locations etc. Again, the purpose of this stage is to enable you to make more informed decisions about where to invest in improving well-being. Figure 19.2 shows a standard ASSET process, but in general this is adapted to the needs of the organization in question.

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Figure 19.2 The ASSET process

To put this process in context, there are a number of additional considerations that need to be worked through successfully if a well-being audit is to prove fully effective. Key examples of these are:

  • Staff communication: many organizations regularly survey staff without fully engaging them in the process. A successful audit will have a coherent identity and be promoted effectively to differentiate it from previous surveys that may have taken place. It will be connected with existing activity and positive messages around promoting well-being. In addition, there will be a clear plan for communicating the results with staff in a meaningful dialogue.
  • Seeing the audit as a means to an end and not an end in itself : there is little to be gained by surveying staff, consulting them in focus groups and then failing to implement the actions that are required based on the results. All this does is raise expectations without fulfilling them and adds to any existing cynicism.
  • Engaging managers at all levels: quite rightly senior managers should be involved in the audit as key stakeholders. However, the organizations that get most value from audits tend to ensure line managers at all levels have access to results for their areas too. This can then be used as the lever to encourage them to enter ongoing dialogues with their staff regarding the issues that emerge. Using the audit as a mechanism to embed a climate of shop-floor communication, or tool-box talks, can be the key to real engagement.
  • Integrating support: there are usually a number of key functional specialists who have a role to play in supporting the organization in this area, such as HR, health and safety and occupational health. However, it’s easy for them to end up operating in silos where their efforts do not combine to deliver maximum value. One way of ensuring integration is to form a cross-functional well-being support group, which, amongst other things, is tasked with building and owning a strong and enduring brand for well-being improvement.

19.3 A PRACTICAL GUIDE TO TAKING ACTION TO IMPROVE WORKING LIVES

One of the biggest pitfalls for well-being initiatives is ‘consultation without action’ – staff show a lot of goodwill when they complete these surveys and they are entitled to see a clear plan of action when the results are in. But once the organization understands the well-being situation, it’s not just action plans that staff are looking for – they want to see improvement too, so it’s important to budget beyond the initial survey and include enough time and funds to actually make a difference.

Clearly, the actual actions that are taken post-survey depend on what the workforce is telling the organization and on the business-level outcomes that were identified as being important earlier in the process. In fact, many organizations we have worked with have seen this as the start of a much broader change process. The work done on the business case helps enormously at this stage because, while it doesn’t predetermine post-survey actions, it means there is a shared understanding about the starting point and goals, as well as a set of ideas for new initiatives. The results of the survey can now be put into the mix and can be used to modify plans based on the views of the workforce.

Whether the organization has conducted a well-being audit or not there is a need to produce an integrated action plan to improve well-being and engagement with clear and measurable outcomes. This should have senior management endorsement with a commitment to providing the resources to support its successful implementation.

The gradual adoption of the HSE stress management standards by many organizations is indicative of the evolving agenda in the area of well-being. As discussed earlier in this report, the starting point for this has often been a compliance mindset with the perceived need being to implement the approach recommended by the regulator. Typically, this might lead an organization to rush into issuing the HSE’s Indicator Tool survey to a sample of staff, followed perhaps by a few focus groups. However, there are risks to this approach if organizations have not properly thought through how to position the approach and how to use the results to inform a sustainable improvement plan. A compliance mindset, normally linked to stress risk management, can become a barrier to addressing well-being and engagement fully and is likely to lead to a defensive management approach of just controlling risk rather than going beyond this to realize positive benefits.

Thinking a bit more broadly and proactively about taking action to improve well-being and employee engagement, all initiatives and interventions designed to improve organizational outcomes via the workforce can be classified into one of three categories:

  • Composition (the procedures used to recruit, select and place people into specific roles in the organization).
  • Training and development (processes for learning and development).
  • Situational engineering (e.g. the design of the work that people do, the structure and processes that operate in the organization and the work environment – including less tangible factors such as culture and climate).

This view can help you to get to grips with myriad options for intervening to improve well-being. Many organizations work hard on all of these categories – designing recruitment and selection processes to recruit the best talent; taking a strategic approach to identify training and development needs; aligning these with the strategic goals of the organization; bringing expertise to bear on issues of work design, organizational structure, change management and more besides.

We will look shortly at these different layers of intervention more closely, but before we do it’s important to highlight some more general considerations when taking action to improve well-being:

  • Wherever possible design an integrated set of interventions targeting specific areas and outcomes for improvement, employing different categories or ‘layers’ of intervention.
  • Ensure clear success metrics are in place to evaluate the success of each intervention.  Carefully consider a broad range of possible consequences that may flow from a particular intervention, in particular think carefully about any unintended consequences that may develop and adopt risk management strategies where appropriate.
  • Avoid launching interventions as new change initiatives where there is a climate of change weariness. Consider how new interventions might be woven into existing programmes of activity rather than launched as a new one. Aim to achieve measurable benefits before declaring the success of any intervention.
  • Involve all legitimate stakeholders in designing interventions, recognizing that their needs can only be met if there are clear operational and business benefits to be achieved by doing so.
  • Build well-being improvement into the fabric of the organization as a continuous improvement journey and avoid short-term ‘magic bullet’ thinking. Build a brand that defines the long-term identity and essence of well-being in the organization.

Table 19.2 illustrates how the three different categories or layers of intervention – composition, development and situational engineering – can be used to identify practical actions when applied to some of the key enablers of psychological well-being.

Table 19.2 Layers of intervention

well-being influence Layered intervention options (examples)
Composition Development Situational engineering
  • Balanced workload
  • Recruit staff with skills and work styles better suited to the required work
    Increase staff numbers
  • Develop managers to balance staff challenge and support more effectively
    Train staff in work-smarter/ time management techniques
  • Review and improve work planning and distribution mechanisms
    Reduce workload
    Improve technology and resources
  • Collaborative relationships
  • Construct work teams with a better balance of team role preferences
    Change promotion criteria to increase emphasis on team-working skills
  • Train managers and customer facing staff in conflict management techniques
    Coach managers who over-use a command and control leadership approach
  • Increase cross-functional team working
    Redesign office layout to increase space for informal collaboration
  • Enhanced control
  • Select staff with high internal locus of control
    Redeploy people who feel they cannot exert sufficient control in their current role
    Select managers who are happy to delegate control
  • Train staff using cognitive behavioural approaches to learn to control their thinking and reactions for positive outcomes
    Assertiveness training to develop staff to take control
  • Redesign jobs to maximize perceptions of control
    Reduce layers of management
  • Sense of purpose
  • Introduce realistic job previews to improve fit between candidate goals/ aspirations and organizational goals
    Promote managers based on their track record in inspiring teams to perform well above their previous level
  • Introduce training in goal-setting techniques for all new managers and supervisors
    Coach senior managers with the objective of improving their skills in articulating a compelling vision
    Board development to create shared vision
  • Design and implement a strong well-being brand
    Reduce bureaucracy
    Reduce levels of the organization so mission and vision is more visible

Going through the process of populating this kind of matrix – particularly guided by results of a well-being survey or audit – can simplify the sometimes daunting process of action planning well-being interventions. It provides a structure for considering where it is possible to leverage well-being for the benefit of the organization.

Ultimately many action plans employing multi-layered interventions will have an overriding objective of reducing sickness absence, particularly in the public sector where it tends to be significantly higher than in the private sector. One organization that adopted a multi-layered approach with a demonstrable impact on sickness absence is Kent Police (see Box 19.1).

19.3.1 Senior Management Ownership – Take Responsibility but Share Power

Another frequent barrier to success is to see the well-being improvement action plan as being owned by HR, health and safety or occupational health. It is not unusual for senior managers to delegate action planning and ownership of the plan to one of, or a combination of, these specialist functions. At best this approach is misguided, and at worst it is an abdication of a key leadership role. Leaders are responsible for creating and developing organizational culture – as the management thinker Max De Pree put it they ‘define reality’ for the workforce. In this sense, well-being and the interventions that are required to maintain and improve it are matters of strategic relevance and importance.

There is a difficult balance for leaders to strike here between having a vision that encourages employees to be highly engaged and giving away enough control to enable that to happen. In this sense, traditional command and control style leadership and management is usually the enemy of employee engagement. In organizations characterized by this style of leadership employees are ‘sold to’ as if they were an external customer. In such organizations, relentless internal marketing about the next change or type of behaviour required tends to switch employees off. This is in marked contrast to more modern conceptions of leadership as an exercise in ‘co-creation’ and ‘involvement’ that aims to proactively create situations where employees are part of the solution design process – and not just in the sense of completing a staff survey. The message to staff inherent in such approaches to leadership is simple: ‘You’re involved and our job as leaders is to provide the right conditions for you to contribute your best work’ (Smythe, 2007). Clearly, many UK organizations have a long way to go to get to this situation, but the drive to get there can only come from those at the top. Once the conditions are created employees also have to accept their responsibility for behaving as productive partners in the process.

In his excellent book, Chief Engagement Officer, John Smythe provides some powerful insights into the role that leaders need to play if well-being and engagement are to thrive in organizations. He makes the point that ‘engagement’ can be defined narrowly – it’s simply an integral part of organizational and local decision making. So, what becomes key is the leader’s capacity to engage with staff in ways that add value to everyday decision making and change. But what is also critical to adding value is the way that the organization’s design opens up large-scale change to the right groups. The idea is that if the right groups are engaged they will add value to day-to day decisions and larger processes of change – but, of course, senior leaders have to learn to give some of the control away to get this reward and that can require a major mindset change for some. The author also notes that positive engagement practices such as those described above and in the case study below could pre-empt reliance on more bureaucratic consultation processes imposed by regulation and tradition. For example, you only have to look at the rise of social networking and sharing websites to see that what once was thought of as ‘chaos’ or ‘anarchy’ is now an accepted part of ‘how we do things’. Imagine a world without YouTube, MySpace or FaceBook! These revolutionary concepts were all based on a positive ethos of sharing for the good of the community – whether that be programmers, musicians, film-makers or society at large. Organizations are no different – they are just communities of people who are gathered together for a common purpose – and as with the online communities mentioned above, ways of communicating, sharing and generating knowledge have changed forever. This has profound implications for the way that businesses are organized, led and managed. To reset the bar, John Smythe introduces a good ground rule for all leaders to adhere to:

Decisions are not complete until leaders have planned the engagement of their people.

Another point that the book from which the above case study makes is that the style of leaders will either turn people on or off – both one-to-one and en masse. The idea that leaders and managers have a major role to play in defining the experience of employees is not a new one, but there is now a much better understanding of the leadership behaviours that influence well-being levels across the workforce. With this understanding comes a greater willingness to invest in ensuring that these behaviours are part of the prevailing corporate culture. Figure 19.3 shows the areas where leadership style through well-being enablers has a direct impact on staff well-being and stress perceptions (using the HSE Management Standards structure).

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Figure 19.3 Well-being drivers that leaders influence and the HSE Management Standards

So leaders and leadership behaviour is important, but equally pivotal is the role of line managers and the relationships they develop and maintain with their direct reports. There are two main reasons for the importance of the line manager role:

  1. They play a central role in building and sustaining an engaged and enthusiastic workforce.
  2. Management processes, intended to ensure that employees’ behaviour is aligned with the goals of the organization, are limited by the reactions that they produce from the workforce.

The second point reinforces the central issue in this report – that organisations need an engaged and positive approach from their people, otherwise change and other interventions, whatever they are intended to achieve, will not produce a positive reaction from the workforce and will therefore be less effective. Line manager behaviour is critical for enhancing and sustaining high levels of psychological well-being in any organization. This relationship is the most important one for all employees. The line manager is the link between the goals and mission of the organization and the day-to-day behaviour of the employee. As far as psychological well-being is concerned, the key to the success of this relationship is the extent to which the manager strikes the balance between challenge and support for the employee. Feeling suitably challenged and being able to strive to reach goals is a critical factor in building psychological well-being and self-confidence, both within the workplace and elsewhere. However, when challenge levels are too great or the goals are really unachievable people need support. Balancing these two types of behaviour is perhaps the most important managerial skill for developing a high well-being, high resilience workforce.

This highlights what is often a central development need for managers that needs to be addressed, increasing their capacity and skills to balance challenge and support effectively. This is often best achieved through one-to-one coaching, but at the very least should be the subject of training. The impetus for this may be to enable managers to be more supportive to improve collaboration, as indicated in Table 19.2. Alternatively, it may stem from a need to up-skill middle managers in challenging more effectively upwards and at their peer level, as well as with their direct reports.

At Robertson Cooper we have developed the Leadership Impact approach that seeks to help managers to fully understand the impact of their leadership behaviour on the well-being and engagement of their staff. The well-being enablers in Figure 19.3 can and should be influenced by leaders. To do so effectively they need to understand their own behavioural preferences in these critical areas – and these are linked to their personality or natural style. For example, some managers will find it difficult to delegate due to a strong perfectionist streak and as a result their staff may feel they are given limited opportunity to exert influence over areas of work they feel should be within their span of control. Or, a senior manager’s desire for change and achievement may cause him or her to push people too hard on occasion. The key point is that self-awareness in critical areas is the starting point for developmental change. On its own it does not guarantee development, but it is an essential precursor.

19.3.2 Influencing Senior Managers

Probably the ultimate barrier to success in improving well-being and engagement are the attitudes and beliefs that some senior managers and directors appear to hold about these areas. There is still a tendency for some senior leaders to see them as soft issues that HR should tackle to allow them to concentrate on the performance of the business. Ultimately, well-being and engagement will take root in an organization only when the people leading it truly believe these are strategic and performance issues. The business case approach we have described earlier in this report is part of making this connection, but another important ingredient is making a personal connection with senior people, focusing on their well-being. It’s important to win their buy-in and develop open and strong relationships with the key stakeholders at the top of the organization. For example, a major global pharmaceutical company had a coach spend a year talking to all of its senior executives one to one about their well-being and work–life balance. This was originally intended as a one-off initiative, but created such a demand from the senior executives that it became a permanent role for the coach! Crucially the company also sees this as part of a climate change process which has led to a strong belief that good health and well-being is good business, and has opened the door for an ongoing programme of activity throughout the organization. When you get it right at the top level it’s possible to make big changes to how things are done in the organization.

19.4 SUMMARY

Practical benefits are clearly achievable from building and implementing well-being improvements. However, they should be entered into with a realistic time frame in mind and with maximum staff involvement and ownership at their heart.

This chapter has highlighted that there are three essential stages organizations should work through to improve well-being and engagement in a way that is sustainable:

  1. Build a compelling business case.
  2. Measure levels of well-being and engagement.
  3. Take action to improve working lives.

Inevitably this should be an ongoing cycle of activity, where the impact of actions taken is reviewed against the expected business benefits, as well as being checked with the workforce to ensure that value is being added. There is no doubt that there are significant challenges associated with taking meaningful action to improve the working lives of staff – from getting funding and senior management buy-in to overcoming initial cynicism among the workforce. However, organizations are starting to design and define processes for reaping the benefits available by investing thoughtfully in the area of well-being and engagement. The result is a range of exciting new ways of working that benefit both organizations and staff alike. And ultimately, that’s what the next phase of developing well-being in the workplace will be about in the UK: creating new ways of working that benefit everybody.

REFERENCES

  1. Cropanzano, R. & Wright, T.A. (1999). A 5-year study of change in the relationship between well-being and performance. Consulting Psychology Journal: Practice and Research, 51, 252–65.
  2. Donald, I., Taylor, P., Johnson, S., Cooper, C., Cartwright, S. & Robertson, S. (2005). Work environments, stress and productivity: an examination using ASSET. International Journal of Stress Management, 12, 409–23.
  3. HSE (2005). The Management Standards for Work-related Stress. http://www.hse.gov.uk/stress/standards/standards.htm.
  4. Robertson, S. (2007). Using business psychology to close the well-being gap. Selection and Development Review, 23(4).
  5. Smythe, J. (2007). The CEO: Chief Engagement Officer: Turning Hierarchy Upside Down to Drive Performance. London: Gower.
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