Workplace stress can be a health and safety issue

The receptionist is in your office still shaking after being verbally abused by a patient. This isn’t the first time it has happened, and they disclose to you that their ability to cope decreases with every incident. One of the GPs in your practice sees several patients with challenging behaviours. He says he cannot stop seeing them as they have nowhere else to go, but the incidents are getting more frequent, and you are concerned about the effect on the practice staff.

Psychosocial hazards

Workplace stresses such as this example are not new to medical practices. Nor will it be news to practice owners and practice managers that this situation is an important issue to address.

The growing recognition of the mental and physical risks to employees from exposure to psychosocial hazards in the workplace is presenting employers with new challenges to meet.

Managing psychosocial hazards in the workplace

Safe Work Australia’s Model Code of Practice on Managing psychosocial hazards at work (Model Code) was published in July 2022. This model code is intended to provide practical guidance for organisations on how to ensure they meet their responsibilities under work health and safety legislation.

Exposure to violence and aggression in the workplace is now recognised as a psychosocial hazard, as such exposure has the potential to cause psychological as well as physical harm.

There are many other types of psychosocial hazards, identified in the Model Code which have the potential to arise from or in relation to the workplace and may cause psychological and/or physical harm. The Model Code recognises that risks can occur in combination and suggests that ongoing chronic stressors may make a worker more vulnerable to harm from an acute incident.

Protecting workers psychological and physical health

Employers have a duty of care to look after the health and safety of their employees. Under work health and safety legislation, this includes both physical and psychological health.

However, many workplace stressors have been considered either unavoidable, or one-off human resources issues. As such, these stressors have historically been managed reactively, with responsibility placed on individuals to follow policies or to take steps to manage their own mental health.

What is new is the explicit recognition that psychosocial hazards may be part of work design and have the potential to harm all employees. Employers are now expected to proactively manage these identifiable psychosocial hazards using a risk assessment approach, and where possible, implement measures to eliminate these risks. Where it is not possible to eliminate the risk, employers should seek to implement measures to control the risks and their potential impacts.

The risk assessment process involves:

• Identifying the risk – taking proactive steps to collaboratively identify psychosocial hazards. This includes consulting with staff to understand aspects of work and situations that could harm workers or others at the workplace.
• Assessing the associated risks - utilising a risk matrix as for other workplace risks. For each of these hazards – what is the risk of harm, how likely is it that the harm will eventuate and how severe could the consequences of the harm be?
• Controlling the risk – is it reasonably practicable to eliminate the risk? If not, what steps can be taken to minimise the risk or its impact?
• Reviewing the control measures – to check that they are working, and if not, modify them.

Administrative controls such as policies will often form part of a response to help ensure everyone in the workplace understands the organisation’s processes and standards. However, on their own administrative controls are the least reliable controls because they do not address the hazard itself. Ideally administrative controls should be used in combination with more effective controls.

Managing workplace stress by offering counselling or employee assistance programs is useful but not a sufficient control measure. Employers will be asked what steps they took to change work design or systems or alter the work environment to remove or reduce work related stressors. In the example of the receptionist above, a control measure would be to ensure that this staff member’s duties were varied to ensure that she was not the only staff member who was required to continually respond to abusive patients. In addition, the patient’s treating doctor should be involved to ensure that the patient is aware that such behaviour will not be tolerated in the future and this should be recorded in the patient’s file.

Consult your team

The Model Code stresses the importance of consulting with workers to identify risks and their potential solutions. It is important to recognise that a risk may be identified by some workers and not others, however this does not negate the need for the risk to be managed. The consultation process may itself help mitigate stress by reassuring workers you are aware of their concerns – provided steps are subsequently taken to address the issues which are identified.

You and your staff will probably have many creative solutions for your practice – for example, you could consider:

• Changes to the GP’s appointment calendar – allowing longer time between patients or booking patients at particular times.
• Putting in place agreed standards of behaviour (zero tolerance for abuse) and making sure staff know you support them in enforcing those standards.
• Getting on the front foot communicating with patients – for example, letting patients know if there is a wait because a doctor has been delayed, or informing patients about policies such as not prescribing drugs of addiction at the first appointment and making it clear that there is a zero tolerance policy for abusive behaviour.
• The physical design of the practice or waiting area to ensure staff are not physically at risk and can leave a threatening situation if necessary.
• In some workplaces it may be possible to change rosters to ensure staff have breaks away from particularly stressful situations.
• Offering training or additional skills can be an effective control and help staff feel more confident that they could respond effectively and would have support if a stressful situation arose.
• Providing confidential forums for staff to raise their concerns.

Useful resources

Don’t forget to check with Avant Practice Solutions and Avant. Take advantage of our resources based on many years of experience and supporting others through the challenges of managing practice and staff wellbeing. See for example: