Thursday, March 11, 1999
1:45 p.m. - 3:00 p.m.
The Management of Occupational Stress – A Guide for Managers
Presenter: Meryl Stanton, Chief Executive Officer, Comcare, Canberra, Australia
Comcare Australia provides an integrated prevention, compensation and rehabilitation service to Australia’s Federal Government employers and employees. Comcare is both the regulator and the primary claims manager for this jurisdiction.
This paper outlines one aspect of a range of strategies adopted by Comcare to combat the rise in workplace illnesses due to occupational stress. Although recent data suggest that occupational stress may have peaked as a cause of workplace injury and illness in our jurisdiction, the costs associated with such injuries remain high.
Comcare has indicated to employers that by focussing on occupational stress, management can help counter these costs. To this end, and in concert with Comcare’s strategies in the field of claims management and regulatory reform, Comcare has prepared a ‘Better Practice Guide’ on the management of occupational stress by Federal Government employers. The guide draws on an Australian National Audit Office report on The Management of Occupational Stress in Commonwealth Employment, as well as on cooperative prevention projects conducted with Federal Government employers.
Effective management of occupational stress must be underpinned by clear senior management commitment to a healthy and safe working environment. Staff working to manage occupational stress must have the backing of senior management in fostering appropriate workplace cultures and practices. Senior management should consider how their commitment is demonstrable to their staff.
A first step towards effective management of occupational stress is knowledge of the nature and extent of any problems. It is essential that information is collected and analysed on a periodic basis to ensure that the agency is aware of where and to what extent occupational stress impacts on the employer.
In summary, employers must take a strategic approach to the management of occupational stress, focussing particularly on prevention. They should utilise management information available from the workers’ compensation scheme as well as from internal sources to ensure that stress prevention programs are appropriately targeted. They should continually review the effect and outcomes of programs in this area to ensure that the best results are achieved.
CORRESPONDING AUTHOR: Meryl Annette Stanton, Chief Executive Officer, Comcare, GPO Box 211, Canberra, ACT 2601, AUSTRALIA
Work Stress and Other Organization of Work Issues - Engaging The Occupational Medical Community
Richard A. Lippin, MD, Chair, Occupational Mental Health Committee, American College of Occupational and Environmental Medicine
Occupational physicians need to become increasingly involved in the occupational stress issues as well as other aspects of Organization of work (OOW), especially in their relationship to medical outcomes. Occupational physicians need to be more involved in research, education, and clinical practice.
This paper will explore efforts to understand and elucidate the historical and current determinants of resistance to occupational physician involvement in these issues ranging from lack of education and knowledge, impact on the economics of occupational medical practice and, perhaps most importantly, fear of accepting an emerging new bio-psycho-social model of medicine and health care.
From a more optimistic perspective, the paper will also describe some recent initiatives of the ACOEM Occupational Mental Health Committee to effectively address these issues including the sponsoring of seminars and courses at national conferences, the publication of an ACOEM Practice Guideline on Stress Related Conditions, and an ongoing effort to influence the scoring criteria of ACOEM’s new Corporate health Achievement Award to ensure inclusion of Work Stress and Organization of Work Issues.
Also, occupational physicians need to better understand how to effectively collaborate with colleagues in psychology and sociology so as to maximize opportunities to bring the most creative interdisciplinary solutions to bear on these problems of extreme importance to the health, safety, and productivity of American workers.
The Business Response to Biopsychosocial Needs of Employees: A National Survey Of Benefits Managers
Mark Attridge, Ph.D., Optum Division of United HealthCare Corporation
Employers are beginning to offer more comprehensive health services that address psychological and social needs of employees as well as the traditional focus on physical needs. This study examines the extent that this "biopsychosocial" approach (Engel, 1977; Taylor, 1995) is shared by benefits managers and is reflected in the kinds of benefits offered.
Method . The sampling frame included over 6,500 subscribers at the supervisory level to the industry magazine, Employee Benefits News. A total of 473 surveys were returned (7% response rate; sampling error +/- 4.6%). The sample was 67% female/32% male. Most respondents were between 40-49 years. The sample included 473 different companies located in all 50 U.S. states and a variety of industries and company sizes.
Results. Areas of Employee Concern. Managers were asked to estimate how concerned they thought their employees were about a variety of topics. The percentage of managers who gave ratings of high or very high concern for each area is as follows: Money (80%), Family (74%), Daily hassles (53%), Physical Well-being (49%), Work/School (44%), Life in General (43%), Friends (37%), Intimate Relationships (20%), Legal issues (14%), and Feeling Sad (12%). Provision of Services. Of 17 services evaluated, companies offered an average of 7.5 services and planned to add 1.1 services. Substance abuse treatment was provided most (81%), followed by mental health counseling (78%), relationships and family counseling (74%), training workshops (67%), and health promotion screenings (63%). Perceived Value. Managers were asked if they agreed that each type of service "helps to improve employee performance" and also if it "helps to reduce overall health care costs." The most performance enhancing services included substance abuse (88%agree), mental health (84%), relationships (84%), and workshops (84%). The cost-saving services included substance abuse treatment (85%), health promotions (84%), pregnancy education (79%) and mental health (76%). Value ratings were positively correlated with provision of the service.
Conclusions. A nationwide sample of managers yielded a profile of American employee benefits services. Money, family relationships, work, and daily life hassles are as important to employees as physical health. Most companies do offer services in these areas and most managers also feel that these "biopsychosocial" services boost employee performance and cut health care costs.
CORRESPONDING AUTHOR: Mark Attridge, Ph.D., United HealthCare Corp., Mail Route MN10-S203, P.O. Box 1459, Minneapolis, MN 55440, USA.
Environment, And Safety Work In Enterprises
Kjell Nytrö*, cand.psychol., SINTEF Institute of Social Research in Industry, Per Öystein Saksvik, Ph.D., Norwegian University of Science and Technology, and Hans Torvatn, Ph.D., SINTEF Institute of Social Research in Industry.
In 1992 a new regulation was introduced in Norway claiming that every enterprise should implement internal control (IC) of their health, environment and safety work (HES). The regulation says that any enterprise, regardless of size and business sector, must undertake systematic actions (at the enterprise level) to ensure and document that the activities for the continuous betterment of health, environment and safety are accomplished in accordance to requirements specified in laws and regulations. The systematic actions are to be described as administrative procedures. An evaluation study conducted one year after the regulation was set into force, showed that the majority of the enterprises had not started any implementation efforts (Saksvik and Nytrö, 1996). The low level of implementation, and employer complaints on the presumed incomprehensibility of the regulation (written in judicial terms), led the authorities to focus more on the pragmatics of implementation three years after the regulation was set into force.
The present study, which is part of an evaluation four years after the introduction of the regulation, was conducted among a representative sample of 1184 private and public enterprises. The main objective was to uncover what organizational factors were feasible in predicting success in managing and sustaining systematic HES-work. The present study focuses on enterprises’ experiences in their efforts to implement IC of HES. First of all the results showed that 45% of the companies in Norway had implemented IC four years after the onset of the regulation. Thirty-six per cent were underway, while 19% had not started yet. In 1993 the corresponding figures were 8%, 25% and 67%, respectively. Secondly, and more important, it was hypothesized that four broad factors would influence implementation of IC, namely: 1) Company competence on HES and organization development, 2) Internal motivation and perceived need for implementation, 3) External push and pull factors for implementation (labor inspection and client demands), and 4) Management capacity for developing/sustaining IC
The results showed that available internal HES-competency with professional training was the strongest predictor for success in managing systematic HES-work. Thereafter followed factors like external push and pull factors (customers, labor inspection and business partners). Time elapsed since implementation of the regulation was also of importance. Size of enterprise and absenteeism previous year had no significant influence on IC-implementation in this model. The model explained 68% of the variance in the dependent variable (systematic HES-work) and must therefore be considered a strong model. The results are discussed in terms of future public strategies for supporting enterprises in developing favorable work environments that promote both well being and productivity.
CORRESPONDING AUTHOR: Kjell Nytrö, SINTEF Institute of Social Research in Industry, 7034 Trondheim, Norway.
Reconsidering Burnout in a Global Economy
Chair: Michael P. Leiter, Acadia University
Dr. Christina Maslach, University of California, Berkeley, and
Wilmar Schaufeli, University of Utrecht
Céleste M. Brotheridge and Raymond T. Lee*, University of Manitoba.
The globalization of economies has prompted major changes in the nature of work. People in a wide range of occupations are coping with greater uncertainty and more intense demands for increased productivity.
This session provides new perspectives from researchers from the USA, Canada, and Europe on the nature of burnout in this changing work world. New psychological contracts at work have implications for the three dimensions of energy, involvement, and effectiveness experience at work. While existing research on burnout has examined the negative end of these dimensions in experiences of exhaustion, depersonalization, and reduced personal accomplishments, recent work has expanded the research agenda. One issues is the expansion of the burnout construct into occupations other than the human service professions that provided the original definition of the syndrome. A second research issue is to consider the full range of the three dimensions of energy, involvement, and effectiveness. On the positive end of the three dimensions appears to be a state of engagement with work in which individuals feel energetic, involved, and effective.
This broadened perspective raises a cluster of conceptual, measurement, and practical issues. This session presents current thinking of major researchers on burnout on these questions, and provides direction for subsequent research.
Corresponding Author: Michael P. Leiter, Centre for Organizational Research & Development, Acadia University, Wolfville, Nova Scotia, Canada B0P 1X0
The Impact on Staff Members of a Hospital Merger in Dublin
Michael P. Leiter, Ph.D., Acadia University
Staff surveys assessed the impact of a merger of four long-established health care institutions in Dublin, Ireland into a new facility. The merger brought together two general hospitals that had operated since the late 1700s with a more recently established children’s hospital and a residential mental health facility in downtown Dublin. The new site in the southern suburbs represented a major transition for employees. It involved a greatly improved workspace, integration in work units with staff from other facilities, and distinct approaches to health care.
The study supported a model that predicted acceptance of organizational change as a function of individuals’ energy, involvement, and professional efficacy, which in turn were predicted by the management and communication environment of the hospital. The analysis of survey data led to the establishment of working groups to address problems during the transition to the new facility. These groups dealt with issues including management roles, the impact of new medical technology on working life, and changing expectations of supervisors. An ongoing dialogue of hospital personnel with the researchers extended the practical utility of the survey exercise for people in the hospital.
The research provided the first test of an English language version of the MBI-GS in Europe. The analysis confirmed the three-factor structure of the MBI that was the basis of the original human service version of the scale. The results indicated that the scores of Irish health care workers on the scale were more similar to those of their North American counterparts than to those of European health care workers.
The results are discussed in terms of the fundamental qualities of energy, involvement, and effectiveness that span a range from burnout to engagement with work. The placement of individuals on this continuum within an organization is influenced by mismatches between individuals and their work settings in terms of the six areas of workload, control, reward, community, fairness, and values. This analysis demonstrated the impact of disruptions in these six area during a major organizational transition during a merger.
Rethinking Job Burnout
Christina Maslach, University of California, Berkeley
For many years, burnout has been recognized as an occupational hazard for various people-oriented professions, such as human services, education, and health care. Recently, as other occupations have become more oriented to "high-touch" customer service, and as global economic realities have changed organizations, the phenomenon of burnout has become relevant in these areas as well. On the one hand, organizations increasingly need the creativity and involvement of their employees. On the other hand, organizations have been undertaking major changes that interfere with their employees’ capacity to be engaged with their work.
Job burnout is the outcome of this mismatch between workers and the workplace. This problematic relationship between the individual and the situation, as captured by the notion of job-person fit, has been at the heart of many models of organizational stress. However, prior conceptualizations of job-person fit are limited in terms of their application to burnout. Thus, the theoretical challenge is to extend the job-person paradigm to a broader conceptualization of both person and job, and to combine that with models of job stress.
This challenge is beginning to be addressed by a new model of the causes of burnout (Maslach & Leiter, 1977). It proposes that the greater the gap, or mismatch, between the person and the job, the greater the likelihood of burnout. One new aspect of this approach is that the notion of mismatch (or misfit) is framed in terms of several constructs that are comparable between the worker and the workplace (e.g. values, job expectations) and thus allow a better evaluation of the individual within an organizational context. Secondly, whereas prior models of job-person fit predict that such fit produces certain outcomes (such as commitment, satisfaction, performance, and job tenure), this new model hypothesizes that burnout is an important mediator of this casual link. In other words, the mismatches lead to burnout, which in turn leads to various outcomes. A third new aspect of this model is that it specifies not one, but six areas in which this mismatch can take place. In each area , the nature of the job is not in harmony with the nature of people, and the result is the increased exhaustion, cynicism, and inefficacy of burnout. On the other hand, when better fit exists in these six areas, then engagement with work is the likely outcome. The six areas in which mismatches can occur are: workload, control, reward, community, fairness, and values.
The importance of this rethinking of burnout is that it focuses attention on the relationship between the person and the situation, rather than either one or the other in isolation. It thus provides an alternative way of identifying the sources of burnout in any particular job context, and of designing interventions that will actually incorporate situational changes along with personal ones. We believe the potential of this approach is very promising as a means of dealing with individual burnout in its situational context.
Do Occupation Specific Burnout Profiles Exist?
Wilmer B. Schaufeli, Utrecht University, The Netherlands
Traditionally, it is assumed that burnout first and foremost occurs in human services. The most widely used instrument to measure burnout - the Maslach Burnout Inventory - was even designed for exclusive use in this field. It covers three dimensions of burnout:: emotional exhaustion, depersonalization, and reduced personal accomplishment. Over 90% of the research on burnout uses the MBI and approximately two -thirds of the research is conducted in teaching, social work, health care, and law-enforcement with teachers, nurses, physicians, social workers, and police officers being studied most frequently. Hence, burnout research is heavily biased towards the human services. Recently, a version of the MBI was developed for use outside the human services - the MBI-General Survey (GS).
This paper seeks to answer two questions: (1) do occupation specific burnout profiles exist in the human services?; (2) are levels of burnout higher in the human services than in other occupational fields (e.g. management and administration, industry)?
Preliminary results from a meta-analysis of over seventy US-studies conducted with the MBI in the human services suggests that teachers suffer from emotional exhaustion, whereas physicians and police officers show relatively high levels of depersonalization, and reduced personal accomplishment is most common in social work. Results from the Dutch normative MBI-database (N about 10,000) suggests that - despite significant differences in mean burnout levels - these specific profiles are similar across nations. In order to study differences in burnout levels among human-services professionals and employees working in other occupational fields, data from the Dutch MBI-database are systematically compared with those from the MBI-GS database (N about 6000) from that country. There is convincing evidence that burnout is relevant to a wide range of occupations, that burnout in other occupations shares many of the features that are observed among human service professionals, but there are distinct burnout profiles within various occupational groups.
An Examination of the Relationship Between Emotional Labor And The Dimensions Of Burnout
Céleste M. Brotheridge and Raymond T. Lee, University of Manitoba.
Over the past two years we have been developing and testing the psychometric soundness of an Emotional Labor Scale. We have conceptualized emotional labor to represent the actions employees must undertake in response to the emotional demands of their roles. In this manner, emotional labor has two dimensions - surface and deep acting- and is influenced by the extent of the frequency , intensity, variety, and duration of emotional display required by roles. When employees perform surface acting, they do not express their felt emotions. When they perform deep acting, employees consciously try to feel the emotions that they need to display. Tests of the dimensionality of emotional labor and its relationship with emotional exhaustion suggest that, as we expected, surface and deep acting are mediators of the relationship between roles’ emotional demands and emotional exhaustion. We are currently collecting data which will enable us to cross-validate our findings with all the dimensions of burnout as specified in the recently revised Maslach Burnout Inventory. This paper will examine the nature of the relationship among the dimensions of emotional labor and burnout.
Worksite Stress: Findings from Basic and Applied Research
Peter Muehrer, Ph.D., Chair, Health and Behavioral Science Research Branch, National Institute of Mental Health
The NIMH encourages research on worksite stress and the related mental health problems of depression and anxiety, as well as interventions to ameliorate these problems. This symposium will consist of four presentations. The first will examine cumulative exposures to risk factors at work and the risk of death. Data will be presented to approximate cumulative exposure to psychosocial job demands, job decision latitude, job strain, supervisor support and co-worker support, adjusting for gender, race, mean income over working life, and health status (measured as disability status in the first measured year of working life). The second presentation will examine economic pressures in rural families, especially work-related pressures, emotional distress, and marital instability. Investigations directed toward understanding mechanisms of risk and resilience for mental disorders for adults in truly disadvantaged rural populations will be overviewed. The objectives of the third presentation will be to (a) summarize recent studies that have attempted to discover important work experiences, or job demands, that may play an etiologic role in mental and physical health, and (b) enumerate the prospects for conducting prevention research as well as the important constraints that investigators in this area face. The final presentation will explore The Couples Employment Project, which promotes adaptation to the stress of job loss. Data from prior studies of individuals and couples experiencing job loss provide an important empirical and theoretical base of the risk and protective processes involved in successful or problematic coping. These findings suggest that various qualities of the couple relationship will influence the development and course of depressive symptoms in the weeks and months after job loss. Based on these findings, a multilevel theory of stress, coping, and recovery will be presented, focusing on several qualities of couple relating, including valuing and esteem maintenance, climate of openness, problem-solving style, and mechanisms for maintaining hope. This etiologic theory of risk and protective process provided a series of targets for a preventive intervention that was incorporated into the Couples Employment Project.
Working Life Course Job Exposures and the Risk of Death: Approximating Cumulative Psychosocial Job Exposures
Benjamin C. Amick III, The Health Institute, New England Medical Center, Boston, MA; Peggy McDonough, York University, York, Canada; and Carl Pieper, Duke University, Chapel Hill, NC
To examine the relationship between working life course exposures to psychosocial job conditions and mortality, data from the on-going National Panel Study of Income Dynamics are used. Using a three-digit occupational code as a linkage variable, psychosocial job exposures have been imputed for the period 1968-1992 to create a national data laboratory. Exposure information generated from the Karasek job exposure matrix is used to approximate cumulative exposure to psychosocial job demands, job decision latitude, job strain, supervisor support and co-worker support. First, each exposure measure was divided into 4 equal parts (quartiles) that varied from low (1) to high (4). Then the percent of person's working life spent in each category was measured. These measures were used in Cox proportional hazard models to estimate the hazard of death for working life course exposures adjusting for gender, race, mean income over working life, and health status (measured as disability status in the first measured year of working life). Working in a job with high job decision latitude for more than 50% of one's working life reduces the risk of death by half. The effect is more striking in terms of decision authority. Only when little or no opportunity to exercise decision authority throughout working life exists is a worker at increased risk of dying. There are no consistent effects with psychosocial job demands or the combined effect of low job decision latitude and high psychological job demands (job strain). The more time spent in jobs with co-worker or supervisor support is protective but not statistically significantly.
Economic Pressures in Rural Families: Couple Interactions That Reduce Risk for Emotional Distress and Marital Instability
Rand Conger, Iowa State University
Investigations directed toward understanding mechanisms of risk and resilience for mental disorders for adults in truly disadvantaged rural populations will be overviewed. Also described will be the design of community prevention programs that are socio-culturally sensitive and that can target mechanisms related to risk and resilience ranging from community social networks to family interaction processes to individual dispositions and behaviors. Emphasis will be on the Family Stress Model and work-related stress.
The Stressful Workplace: Challenges for Intervention
Daniel C. Ganster, University of Arkansas
For many people their work life occupies more time and attention than any other sphere of their life. Work in many ways is central to an individual's self-concept and the individual's success or failure in the workplace has profound effects on his or her material well being and social status. For this reason scholars have examined conditions in the workplace as well as the nature of work itself to find explanations for mental and physical well being. Much of this work has been done under the general rubric of work stress and it is this work stress literature that will form the basis of this paper. My objectives are to (a) summarize recent studies that have attempted to discover important work experiences, or job demands, that may play an etiologic role in mental and physical health, and (c) enumerate the prospects for conducting prevention research as well as the important constraints that investigators in this area face.
The Couples Employment Project: Promoting Adaptation to the Stress of Job Loss
George W. Howe*, Richard H. Price**, Amiram D. Vinokur**, Robert Caplan*
*George Washington University; **University of Michigan
Data from prior studies of individuals and couples experiencing job loss provide an important empirical and theoretical base of the risk and protective processes involved in successful or problematic coping. These findings suggest that various qualities of the couple relationship will influence the development and course of depressive symptoms in the weeks and months after job loss. Based on these findings, a multilevel theory of stress, coping, and recovery will be presented, focusing on several qualities of couple relating, including valuing and esteem maintenance, climate of openness, problem-solving style, and mechanisms for maintaining hope. This etiologic theory of risk and protective process provided a series of targets for a preventive intervention that was incorporated into the Couples Employment Project. This intervention program was tested using a randomized field trial in a multi-site collaborative effort between the University of Michigan and George Washington University.
Disparities in Occupational Safety and Health of Minorities: A Roundtable Debate
Co-chairs: Vincent R. Nathan, Ph.D., M.P.H. and Gwendolyn Cattledge, Ph.D., National Institute for Occupational Safety & Health, Atlanta, GA
The session is scheduled to be a roundtable discussion to generate ideas, suggestions and feedback on President Clinton's Initiative on Race - Racial and Ethnic Disparities in Health. In 1997, the President committed the Nation to an ambitious goal by the year 2010, to eliminate the disparities in six areas of health status experienced by racial and ethnic minority populations while continuing the progress made in improving the overall health of the American people. The session also will focus on minority occupational health objectives for the 21st century. The roundtable will be leadoff by Louis W. Sullivan, M.D., President of Morehouse School of Medicine and former Secretary of HHS who will discuss managed care and its impact on these disparities. Responders will include Dr. Bailus Walker, Howard University, Rebecca Lee-Pethel, National Institute for Environmental Health, Dr. James Jackson, University of Michigan and Dr. Jennie Ward-Robinson, National Institute for Occupational Safety and health.
Union Perspectives on Job Stress: Symposium
David LeGrande, MA
Many leaders in the U.S. labor movement and the unions they represent are extremely concerned about the issue of work organization factors such as work load, work pace, job security, monitoring policies, and training and their relationship to and the occurrence of negative worker and organizational health outcomes. This panel session will focus upon occupational stress, its cause, related health outcomes, and organizational responses to prevent and resolve occupational stress within selected industry and occupational settings.
A large number of Unions recognize occupational stress as one of the major health hazards of the modern workplace. Workplace stress accounts for much of the physical illness, substance abuse, and family problems experienced by millions of blue and white collar workers. Also, occupational stress and stressful working conditions have been linked to low productivity, absenteeism, and increased rates of accidents on and off the job.
Work is a central part of human life. It is the expression of the basic need to accomplish, to create, to feel satisfaction, and to feel meaningful. Rewarding work is an important and positive part of our lives. However, when work denies people an opportunity to utilize their creativity, intelligence, and decision-making ability, it causes stress.
Occupational or job stress may be defined as a mechanism whereby the human body attempts to adapt to the environment. The body has a normal mechanism or method for dealing with stressful situations that is referred to as the fight or flight response. As soon as the brain senses danger, it sends electrical, chemical, and hormonal messages which stimulate the extra energy needed to fight the danger or run away from it. The stress cycle also includes the danger stimulus, the removal of the danger, and a state of relaxation. The fight or flight response is extremely functional when individuals confront short-term specific dangers. When the danger or challenge is removed or has been dealt with, the body returns to a state of equilibrium.
Many of the sources of work-related stress have a different character - they are more subtle, more pervasive, and are caused by a variety of factors. Whether it’s increased work load and work pace, eyestrain from staring into visual display terminals, unpredictable and unwarranted disciplinary action from a supervisor, inability to have meaningful input into the design of the job, or not receiving support from supervisors, these all cause the fight or flight response to be triggered. When the causes of stress can be identified, are of short duration, and can be responded to by a specific set of actions, this might be viewed a positive stress reaction. However, when the source of stress is not identifiable, becomes excessive, repeated, prolonged or continuous, it becomes distress and creates negative physical and psychological health symptoms and disorders.
Panelists from four different Unions will present techniques and results they have developed and implemented to identify and resolve occupational stress among their members.
CORRESPONDING AUTHOR: David LeGrande, M.A., Director, Occupational Safety and Health, Communications Workers of America, 501 3rd Street, N.W., Washington, D.C. 20001-2727
ONE CORPORATION'S APPROACH TO "STRESS": SMITHKLINE BEECHAM
Chair: Ann Kuhnen, MD, MPH; Presenters: Robert Carr, MD, MPH, Marian Roden, MD, Sharon Wilkie, MS. Discussant: Sharon Wilkie
This session will review how one organization approaches the issue of "stress" and managing pressure. This session will review the process for developing an assessment, interventions, and long-term strategy to enhance both the psychosocial working environment and productivity for all employees. We will discuss a brief study of the impact of "stress" on the organization using medical claims data as part of a method to raise awareness of the impact of this issue to the business. Another presenter will discuss how to raise awareness of "stress" and resilience as a business issue among senior management and how to initiate and sustain organizational change. We will review our concept of Resilience as an important business issues and discuss the use of the Pressure Management Indicator (PMI), an organizational assessment tool. Finally we will discuss an example of how the PMI was used with one business group to identify issues and develop follow-up interventions with discrete work groups within the organization to build individual nad organizational resilience.