“It's the fear of the unknown. As an organization, as a nation, as a world, we were all grappling with it at the same time.”
- DeLinda Washington, Vice President of Human Resources at Kaiser Permanente
Humans are creatures of habit. We tend to be healthier and happier when we know what’s coming and feel prepared for it. But in uncertain times, feeling prepared can be challenging. The past year has been defined by uncertainty, from the covid-19 pandemic changing how we live and work to widespread protests and natural disasters.
Over the course of the year, the American Psychological Association has been keeping tabs on how the nation is dealing with these overlapping crises. It has found that the average level of stress among American adults has risen significantly compared with 2019. Major sources of stress include personal and family health, adapting to new routines, and isolation. In May, 70% of American adults reported that the economy was a significant source of stress, comparable to levels of economic stress during the recession in 2008.
“It's the fear of the unknown,” says DeLinda Washington, vice president of human resources at Kaiser Permanente, the Mid-Atlantic region’s leading health system.1 Like many companies, Kaiser Permanente faced the challenge of keeping its employees safe while continuing to provide essential services. In addition to regular benefits, the company provided temporary housing for frontline employees and grants to help with childcare costs. But the early days of the covid-19 pandemic were difficult, explains Ms Washington: “As an organization, as a nation, as a world, we were all grappling with it at the same time.”
Some of the most common work-related stressors pre-covid-19 include career and work, personal finances, the economy, and discrimination. Over the course of this year, uncertainty and fear around covid-19 have exacerbated many of those pre-existing stressors, and new ones have emerged as well. For example, many people have amplified concerns around environmental safety and job security. Others may be concerned about such social factors as housing instability and food insecurity due to being furloughed or laid off. Parents are struggling to balance work with homeschooling or distance learning. Around the country, concerns about racial injustice and discrimination have been brought to the forefront. And though we have learned more about the virus and how to limit its spread, as Ms Washington explains, “the biggest stressor is there is no end date."
To address fears, companies must consider the unique needs of their employees and ensure the work culture is inclusive and supportive. For office workers who have transitioned to remote work, that includes everything from office ergonomics to disruptive pets. According to Amy Arnold, East Coast director for the Workforce Health Consulting Group at Kaiser Permanente, figuring out the best strategy involves open communication: “Are employees still feeling connected, do they feel safe, do they feel heard, included?” Frequent check-ins with staff are critical to understand their needs, concerns, and ideas, which will help make the work environment psychologically healthy. Developing a strategy around creating a psychologically healthy workforce and stigma reduction will help create a culture where people feel safe to talk about their challenges and take care of their emotional well-being as much as their physical health.
For frontline workers whose jobs involve interacting with the public, the considerations are different. “There’s added stress and complexity to address,” explains Ms Arnold, which requires additional solutions to help workers feel safe and supported.
Though recent events have pushed conversations about stress to the forefront, it’s not a new issue. The Centers for Disease Control and Prevention identifies stress as the leading workplace health problem.2 Work is cited as a main source of stress for Americans. It encompasses individual stressors such as heavy workloads or difficult coworkers, and organizational stressors such as company restructuring or economic uncertainty. To understand why stress is such a pervasive issue, first we need to understand what it looks like on a biological level.
“The body recognizes stress in one way,” says Julie Isaacs, a psychotherapist and regional director of behavioral health at Kaiser Permanente. No matter what the trigger is, “your body’s going to react in a similar fashion.”
You could be staring down a grizzly bear or a big presentation at work, and your body would start up the same chain of events. Stress hormones such as adrenaline and cortisol flood your system, redirecting resources to prepare you to respond to a challenge. You might feel your heart pound, your muscles tighten, your breath get faster. Stress hormones also suppress bodily functions that your body deems inessential during an emergency, such as your digestive and immune systems. All of these changes make up the “fight-or-flight” response, and they’re your body’s way of enhancing your ability to respond to danger, either by confronting the source of stress or running away from it.
Stress is a normal part of life. It can be helpful when you’re faced with situations where you need to act quickly. But it’s meant to be a temporary response. If it feels like you can never get a break from your stressors, that fight-or-flight reaction stays turned on.3
“At first, you’ll experience stress that left unmanaged can result in anxiety. Untreated anxiety places you at risk of such things as profound sleep disturbance, abusing substances, or developing further comorbid mental health diagnoses such as depression,” says Ms Isaacs. When the stress response system stays activated, it disrupts your body’s regular processes, which can negatively affect physical and mental health.4 Chronic stress has been linked to higher risk of depression, heart disease, diabetes, and memory impairment, among other issues.
Businesses have invested in strategies that reduce the risk of physical injuries in the workplace. Now they are also investing in mental health resources. In the US, the share of organizations that provide mental health coverage to their employees increased from 69% in 2014 to 87% in 2019.5
“It's never too late to start implementing steps,” says Ms Isaacs. The workplace culture could make it easier to practice good stress management. Employers can build mindfulness practice into the workday, encourage employees to take time off, and provide services such as employee assistance programs and health screenings.
Putting these strategies in place is in the best interest of employees and the company’s bottom line. There are financial costs to stress, including higher healthcare premiums and lost productivity. High levels of stress among workers has been associated with higher absenteeism and increased rates of turnover.
According to one study, preventable healthcare costs associated with workplace stress add up to $44 billion a year in the US.6 “The financial impact of this can be quite large to organizations and to the nation as a whole,” says Joel Goh, a visiting scholar at Harvard Business School and coauthor of the study. He explains that his team uses mathematical models to study the human and financial costs of workplace stress, and notes that the study estimated that the US experiences at least 17,000 preventable deaths a year that can be attributed to job strain. Looking at the human costs and the financial costs, a bigger picture emerges of the toll that workplace stress has taken.
One in five adults in America live with mental illness.7 Given the right resources, many mental health conditions are manageable. But left untreated, they can lead to more serious and costly health issues. People with severe mental health issues are twice as likely to develop type 2 diabetes, for example, which costs $13,241 per employee, per year in medical bills and lost productivity.8
“If employees feel valued, cared for, and they feel safe both physically and psychologically, then they’re going to thrive.”
- Amy Arnold, East Coast director for the Workforce Health Consulting Group at Kaiser Permanente
One resource companies can consider to help ensure the well-being of employees is its healthcare provider. For example, Kaiser Permanente works with its business partners to develop a culture of health throughout the organization. In addition to coordinated medical care and coverage, Kaiser Permanente provides expertise in mental health and wellness, workforce health, and benefit guidance. These kinds of resources can help reduce stress, improve health, and attract and retain employees.
Eliminating stress completely isn’t the goal. Instead, employers should focus on helping their workers develop good stress management habits, which are key to building resilience, says Ms Arnold. “Resilience is really about this notion of being able to bounce back from adversity and stress,” she says. It’s helpful to offer employees stress management tools and resources to assist in building their resilience. Stress is unavoidable, but it can be manageable. “If employees feel valued, cared for, and they feel safe both physically and psychologically, then they’re going to thrive.”
Making mental health a priority is good for employees and good for business. One survey found that 93% of employees agreed that supporting mental health would help companies survive covid-19. But only 35% strongly agreed that their employers had increased support.9
There are a few strategies that all organizations can use to help their employees manage stress: provide and promote mental health resources, encourage use of paid leave, and offer comprehensive health insurance. Healthcare is consistently ranked as the most important benefit category, and benefits are important to employee satisfaction.10
But it’s important to remember that there is no one-size-fits-all solution. “Healthy and engaged employees do their best work,” says Ms Washington, “so engage them.” She recommends regular employee surveys, training in communication and mental health, and encouraging employees to speak up when they’re struggling as methods that can help employers determine the specific offerings or changes that will have the greatest impact. According to Ms Washington, “a business will go as far as its employees will take it.”
WHAT IS YOUR STRESS PROFILE?
Everyone has to deal with work stress. A little is manageable, but too much can lower productivity and stifle creativity. And sometimes it spills into the rest of your life. Take this quiz to see how you respond to stress and learn how you can manage it better.
1 In the National Committee for Quality Assurance (NCQA) 2019–2020 Health Insurance Plan Ratings, Kaiser Permanente of the Mid-Atlantic States’ private health plan is rated 5 out of 5, among the top 1% in the nation, and ourMedicare health plan is rated 4.5 out of 5, the highest rating in DC, MD, and VA. The 2019 Commission on Cancer, a program of the American College of Surgeons, granted Three-Year Accreditation with Commendation to the Kaiser Permanente cancer care program. The Mid-Atlantic Permanente Medical Group is the largest medical group in the Washington, DC, and Baltimore areas and exclusively treats Kaiser Permanente members. Permanente doctors are recognized as Top Doctors in Washingtonian magazine (2019), Northern Virginia Magazine (2020), Baltimore magazine (2019), and Washington Consumers’ CHECKBOOK magazine (2018). According to NCQA’s Quality Compass® 2019, we lead DC, MD, and VA in the following categories: colorectal screening, breast cancer screening,childhood immunizations combo 9, cervical cancer screening, and timeliness of prenatal and postpartum care for women. Quality Compass is a registered trademark of the NCQA.
2 CDC Workplace Health Promotion https://www.cdc.gov/chronicdisease/resources/publications/factsheets/workplace-health.htm
3 Good stress, bad stress and oxidative stress: insights from anticipatory cortisol reactivity https://pubmed.ncbi.nlm.nih.gov/23490070/
4 Suzanne Kane, Psych Central “Long-Term Effects Of Chronic Stress on Body and Mind” https://psychcentral.com/lib/long-term-effects-of-chronic-stress-on-body-and-mind/
5 International Foundation of Employee Benefit Plans, Workplace Wellness Trends 2019 https://blog.ifebp.org/index.php/mental-health-offerings-on-the-rise
6 Reducing the health toll from U.S. workplace stress https://behavioralpolicy.org/articles/reducing-the-health-toll-from-u-s-workplace-stress/
7 NAMI https://www.nami.org/mhstats
8 Mental health at work – why stigma is a workforce health issue https://insights.kpbiz.org/lead-boldly/mental-health-at-work-why-stigma-is-a-workforce-health-issue
9 New Data from Ginger Shows Nearly 70 Percent of Workers Feel More Stressed During Covid-19 Than at Any Other Point in Their Entire Professional Career,” Ginger press release https://www.businesswire.com/news/home/20200409005169/en
10 SHRM 2019 Employee Benefits Survey https://shrm.org/hr-today/trends-and-forecasting/research-and-surveys/Pages/Benefits19.aspx?_ga=2.203708752.1916064733.1599750337-1812229997.1598540769