# Work Design Principle #2: Tame Excessive Work Demands

Tales of employees working long hours, under intense pressure, for time-hungry organizations abound these days. How accurate are such portrayals? Although workplaces vary, research shows that, overall, work has indeed become considerably more intense since the 1970s. Employees are working faster and harder, and are more likely to say they have “too much work to do everything well” than they were in the past.1 Many report feeling overwhelmed by the demands of their work. This increased load can affect workers in a variety of ways:

• “Just-in-time” scheduling has increased pressure on many service workers to be available for work at any time, regardless of personal or family obligations.
• Many blue-collar and service workers are experiencing a more rapid pace of work due to more sophisticated productivity-tracking technologies.2,3
• White-collar professionals with well-paying jobs often work very long hours—at least 50 hours a week, and sometimes more.4
• The rise of the smart phone and other communication technologies have heightened expectations of 24-7 availability for professionals.4

## Types of Job Demands

Ideally, the demands of work produce a sense of positive challenge and mastery. However, if they are excessive or not balanced by supportive conditions at work, job demands can also become a source of stress and burnout. There are many different types of work demands that may be experienced as excessive, including time demands (such as long work hours and intensive time pressure), mental demands (for instance, tasks requiring complex decision-making or high concentration), emotional demands (such as work that requires high empathy or dealing with difficult emotions like sadness, fear, or anger), and physical demands (for example, tasks that require prolonged or intense physical effort or physical risk-taking).

## The High Cost of Heavy Demands: Why Employers Should Care

### Work Overload and Stress Can Make Employees Sick

Research has shown that high work demands such as long hours or the pressure to work very hard or fast can take a serious toll on employee health and well-being. For instance, long work hours are associated with increased risk of coronary artery disease, stroke, and other chronic diseases for workers.5 More generally, the health risks posed by heavy work demands are comparable to the effects of regular exposure to secondhand smoke.

When high workloads, time pressure, and the demand to be “always on” become a routine part of the workday, workers can become chronically stressed which, in turn, can lead to high levels of distress and feeling disengaged from their work (“burnout”). In addition, heavy work demands can impose high levels of stress and work-family conflict on both workers and their families, with cascading effects on worker mental and physical health.6

Ongoing stress can continually expose our bodies to a stew of hormones that can increase the risk of both minor sickness (such as the  common cold) and major disease (such as coronary heart disease). For instance, one recent study found that prolonged exposure to work-related stress is linked with an increased likelihood of lung, colon, rectal, and stomach cancer and non-Hodgkin lymphoma in men.

### Work Overload and Stress Hurts the Organization

Chronic work-related stress can be costly to employers, too. High and ongoing levels of work stress can diminish productivity by interfering with employees’ ability to sleep, concentrate, make decisions well, and function optimally in their work lives. As noted above, highly stressed individuals are more prone to getting sick, and sick employees are more likely to be absent, to incur higher workers’ compensation and medical insurance costs, to be less productive or unable to work effectively, and eventually, if sick enough, to quit. Even if they don’t become seriously ill, employees who are overworked and burned out are more likely to quit, imposing organizational costs in the form of lost skills, lower productivity, and the time and money needed to recruit and train new staff.7 One way employers can alleviate these burdens and costs is to invest in workplace practices that make work more manageable and less chronically stressful. Research has identified a set of promising practices for identifying and easing excessive work demands and the stress associated with them.

### Promising Practice 1: Provide Resources to Ease Demands on Employees

Providing workplace resources that reduce the burden of work pressures on existing staff can improve both employee well-being and organizational outcomes. Two high-quality studies in health care settings—one in an acute care hospital and the other in a group of clinics— support this idea. Administrators in these settings were concerned about high levels of clinician burnout and turnover due to heavy work demands. To address the problem of overload, they took a number of steps to lighten mental, emotional, and physical demands on clinical staff. Here were some of the successful measures they adopted:

• Increasing the amount of time primary care doctors could spend with their patients
• Providing improved training for new hires to reduce the burden on existing staff
• Offering psychological supports (for example, counseling) to help staff cope with the emotional demands of patient care
• Hiring additional staff to help physicians with nonessential tasks
• Shifting training for clinical care providers from off-site to on-site to reduce staff travel time.

All in all, these initiatives provided multiple resources to ameliorate job-related mental, emotional, and time demands. Clinicians who received the added resources experienced significant reductions in their sense of work intensity and workload, improvements in mental health (including reduced burnout) and were less likely to consider leaving their jobs. Addressing excessive work demands was key. In contrast, many studies are finding that conventional corporate wellness programs that encourage employees to work toward better health (for instance, through smoking cessation or exercise classes) without addressing underlying workplace-based sources of worker ill-health are of limited effectivness.8,9

#### Strategically Increasing Staffing: Why it Can be Good for Workers and Employers

In some cases, the best way to reduce excessive work demands is by hiring additional staff or increasing part-time workers’ hours. Many employers are understandably cautious about increasing staffing, due to concerns that higher labor costs will reduce their bottom line. However, recent research suggests that strategically increasing staffing can sometimes be good both for business and for worker well-being. MIT Sloan School of Management professor Zeynep Ton has found that, in retail settings, slack staffing (that is, staffing with enough labor hours to meet demand at peak times) can be a smart and profitable business strategy when used in conjunction with other operational strategies, such as cross-training, that increase workers’ productivity. According to Ton, “Operating with slack lets employees do their work without making mistakes, deliver great service, and have time to identify and communicate ideas for improvement.”

Conversely, excessively lean staffing—in other words, staffing at the bare minimum of labor hours—not only overburdens and demoralizes workers, but also hurts the organization. For instance, studies on lean staffing in the retail industry find that it negatively affects business execution in ways that can depress sales. Stores with lean staffing can often have the following issues:

• Customers can’t find someone to help them or help them fast enough;
• Staff can’t replenish stock accurately or fast enough;
• Staff can’t execute markdowns or keep the store looking tidy and inviting.

An understaffed retailer may fail to turn store foot traffic into sales, while a strategy of adequate staffing is more likely to keep customers coming back and boost sales. The potential costs of understaffing are often overlooked by employers because the consequences (such as poor customer service) are less concrete or unfold over a longer term (for example, in the form of lost sales revenue over time).10

A recent study at the retailer Gap Inc. provides compelling support for the positive effects of additional staffing, using a rigorous field experiment to test the effects of different management practices. The initiative increased hours for some part-time employees in a targeted manner designed to increase store sales, while also stabilizing employee schedules. Not only did these changes improve employee well-being, they were also good for business. The 19 stores that were part of this initiative had increased sales of $2.9 million over a 35-week period, at an additional labor cost of about$31,200. Sales at these stores increased 7%, while labor productivity increased 5%.

The following case highlights another high-quality study that demonstrates how strategically adding staff in a health care setting can lead to higher employee well-being and improved organizational efficiency.

 CASE STUDY: Adding Targeted Support Staff Can Enhance Physician Satisfaction and Efficiency Strength of Evidence: Promising Background: In a typical day, doctors spend about half their time on charting patient information in electronic health records (EHRs) and other deskwork, and just a quarter of their time face-to-face with patients. Studies show that one of the largest contributors to physician burnout is their growing workload related to EHR charting responsibilities; EHRs are also linked with decreased productivity and revenue. The Work Design Initiative: This study aimed to improve physician job satisfaction and productivity by adding a new role, a medical assistant or scribe, to take over some EHR charting and data entry. The scribes attended appointments and drafted all relevant EHR documentation on the patient such as medical history, examination findings, lab results, assessment, and patient plans. Doctors reviewed the notes for accuracy. What Changed? When working with a scribe, doctors were much more satisfied with how their clinic went, the length of time they spent face-to-face with patients, and the time they spent charting. Scribes even improved doctor satisfaction with chart quality and accuracy, as well as improving the efficiency of chart completion. These findings suggest that adding staff in a targeted way—with the goal of reducing work overload and burnout—is a promising strategy for improving worker well-being and organizational efficiency in a health care setting.

### Promising Practice 2: Streamline Work to Reduce Demands

Even without adding staff, making work processes more efficient can reduce workloads and improve well-being. Two high-quality studies in health care settings found that changing processes related to workflow resulted in improvements in clinicians’ mental health and lessened their intent to leave the job. Some of the workflow changes included:

• Establishing a new automated prescription phone line to free up time for nurses
• Changes in the hiring process to reduce delays in job assignments and improve team stability
• Clerks instead of clinicians tracking forms and sending faxes
• Removing bottlenecks to care in patient rooms regarding medication reconciliation and data entry
• Providing a guide to commonly used medications to address frequent questions from new nurses.

Another high-quality study used similar strategies by conducting team training for overworked IT professionals to streamline or cut activities the team perceived as ‘low value.’ Managers and employees were trained to critique inefficient and time-consuming practices and to identify new ways of working more efficiently to achieve the same goals. These changes included reducing time spent in meetings and recognizing that not all team members needed to be on certain client calls. IT workers whose departments received the training felt less squeezed for time, were less burned out, and were less likely to look for other jobs than their peers in the same company who did not get the training.

The lean management strategy, kaizen, can be useful in streamlining work. Kaizen, which focuses on reducing unnecessary procedures in the work process with a participatory approach, is traditionally used to improve productivity. With kaizen, workers identify inefficiencies and then test different approaches to streamline the work. However, kaizen also holds promise as a means of improving employee well-being when process changes focus on streamlining work to reduce the demands of a job. One high-quality study of Danish postal workers found that when kaizen was used to promote worker well-being in this way, it resulted in higher employee job satisfaction and better mental health. However, when lean management strategies focus exclusively on improving productivity, they can result in increased work pressure and reduced well-being. To avoid this outcome, lean strategies should prioritize worker well-being and build in time for healthy socializing and some staffing slack to adjust for seasonal variations in work demands.11

Whatever approach you use to address excessive work demands, the bottom line is that chronic work overload and stress can harm employee health and ultimately be bad for business. If you think your workforce may be experiencing these dynamics, it makes sense to explore strategies for reducing high-intensity work demands or offering targeted training and resources to support employees in better managing work-related stress.

### Helpful Resources

#### Are Your Employees Facing Excessive Work Demands?

One way to gain a better sense of employees’ experience of work stress is to survey them. Here are two resources containing survey questions that you can adopt and customize:

• What Works Wellbeing Question Bank: This set of questions from What Works Centre for Wellbeing can be used by employers to measure workplace climate and employee well-being. Scroll to page 16 to see questions about workload and pressure.

• CIPD Good Work Index 2020 – This set of survey questions on workplace climate and employee well-being was developed by the Chartered Institute of Personnel and Development (CIPD). Relevant questions about job demands can be found on pages 12 and 13.

#### Reducing Work Demands

• Thrive at Work’s SMART work design model, developed by the Future of Work Institute at Curtin University in Australia, provides research-backed strategies for reducing job demands in the workplace, links to case studies, and further reading.

• The New South Wales workplace health and safety government regulatory body, SafeWork, provides a tip sheet on work demands and work-related stress, with advice on how to mitigate the stress associated with time pressure as well as other mental, physical, and emotional work demands.

#### Assessing the Adequacy of your Staffing Levels

• The Good Jobs Strategy Diagnostic is a questionnaire from the Good Jobs Institute designed for CEOs, executives, and managers. It identifies strengths and areas for improvement in your current job design and people management strategies. The diagnostic also includes questions to help you determine the adequacy of your staffing levels relative to employee workload.  At the link above, you can email to receive a copy of the questions, which includes a section on operating with slack.

#### Using Lean Management Strategies to Streamline Work and Ease Demands

The following resources provide further background information on how to implement Lean management strategies like kaizen in your workplace. Remember, the goal of these improvement strategies should be to enhance worker well-being, not simply productivity. Otherwise, lean management strategies may reinforce excessive demands by heightening productivity expectations.

• The Lean Enterprise Institute’s What is Lean? introduces the concept of Lean and helps businesses get started with how to think and act with Lean principles.

• Quality-One International’s (Q-1) Introduction to Kaizen provides a broad overview of kaizen, reasons to adopt kaizen methodology, and some concrete guidance for implementing change.

• The Institute for Healthcare Improvement’s Quality Improvement Essentials Toolkit provides tools (short descriptions, instructions, examples, and templates) needed to launch a quality improvement project. Tools include a diagram to aid in analyzing root causes of an outcome, methods for identifying potential risks and their impact, charts to monitor performance, and a Plan-Do-Study-Act worksheet to systematically assess whether a change leads to improvement. Free registration is required to access this toolkit.

### References

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8. Jones D, Molitor D, Reif J. What do Workplace Wellness Programs do? Evidence from the Illinois Workplace Wellness Study. QJE. 2019;134(4):1747-1791. doi:10.1093/qje/qjz023
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10. Ton Z. The Good Jobs Strategy: How the Smartest Companies Invest in Employees to Lower Costs and Boost Profits. Boston: New Harvest/Houghton Mifflin Harcourt; 2014.
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