When Your Job Makes You Sick: Employees Find Little Leverage in Today's Workplace

Consider these signs of the times:

-- The Gallup-Healthways Well-Being Index registered 47.1 in August for the category titled "work satisfaction" -- the lowest it has been since the measurement was introduced in January 2008. The number means that less than half the respondents surveyed last month answered "yes" to four questions: Are you satisfied with your job; are your natural aptitudes aligned with the job you are asked to do; does your supervisor treat you like a partner, and does he or she create an environment that is trusting and open? "We thought we had reached the bottom back in the latter half of 2010 when we were in the 47 and 48.5 range," says Dan Witters, the Index's research director. "I would be surprised to see it go much lower than it is right now, but I've been wrong before."

-- Judith McKenzie, director of clinical practice, occupational medicine, at the Hospital of the University of Pennsylvania, treats workplace injuries ranging from broken bones to back sprains to repetitive motion injuries. Over the past few months, she has noticed two trends: First, some injured employees are taking longer to seek medical attention. Second, injured employees often insist on going back to work sooner than advised because they want to protect their jobs. "They are worried that if they lose their job, they won't find another," McKenzie says. "They don't want to draw attention to themselves as being injured in the event of a downsizing by their employer. They don't want to be on [anyone's] radar."

-- Massive layoffs once again dominate the headlines -- 12,000 jobs cut at Merck, 30,000 at Bank of America, 120,000 sought by the United States Postal Service, and 1,000 (if not more) at Goldman Sachs, to name a few. Smaller layoffs are more frequent and usually pass unnoticed: In the space of one month this spring in the Philadelphia area, Sara Lee announced 62 local layoffs; J.C. Penney announced 109; specialty chemicals company Cognis laid off 30, and Liberty Resources, a non-profit advocacy group for the disabled, cut 112.

-- According to a Wall Street Journal article this summer, the founder of Square, a mobile payments company based in San Francisco, not only asked employees to give up vacations, but also told an engineer to skip his own bachelor party so he could help meet a new-product deadline. In an article commenting on the Journal story, Business Insider wondered whether the "skewed work-life balance" at Square would help beat the competition, or lead to employee burnout.

With millions of people looking for employment, the workplace these days is an increasingly unhealthy environment for those who still have, and are trying to keep, their jobs. One key reason -- a stagnant economy that reduces the leverage employees typically have when they attempt to negotiate improved working conditions, move up in their organization or find better jobs outside the company.

"It used to be that when there were layoffs, things didn't change much for the people still employed," says Peter Cappelli, director of Wharton's Center for Human Resources. "But now everybody is worse off. The company doesn't just lay off a few people and leave you alone. They increase your responsibilities, increase your work hours, and cut your pay and benefits. It's pretty obvious why people are stressed and dissatisfied."

Studies looking at employee health in the workplace approach this issue from many different angles. One of the best-known examples is the Whitehall Study, conducted over 10 years beginning in 1967, which looked at heart disease and mortality rates among 18,000 British male civil servants. The researchers found that men in the lowest job grade level -- messengers, doorkeepers, etc. -- had a mortality rate three times higher than that of men in the highest grade level (administrators). In other words, "being at the bottom of the hierarchy can make you sick," says Cappelli.

More recently, a study published this year titled, "Work-Based Predictors of Mortality: A 20-Year Follow-Up of Healthy Employees," led by Tel Aviv University professor Arie Shirom, looked at the workplace's effect on employees' health. Its main conclusion: The risk of mortality was significantly lower for those reporting high levels of peer social support -- i.e., the support of their co-workers. The study also found that high levels of job control -- defined as "the perceived freedom permitted ... in deciding how to meet the demands" of the job -- also reduced the mortality risk for men (but increased it for women, a finding the study's authors say may be caused by differences in the types of jobs held by men versus women).

While higher death rates are clearly the most extreme evidence of workplace stress and job dissatisfaction, mental and physical ailments are also increasingly common, ranging from high blood pressure and heart disease to depression, ulcers and Alzheimer's. Employees faced with long hours, demanding bosses, unsupportive colleagues and unfulfilling work are typically advised to change supervisors, find another job, start their own company or consider other decisive moves. Today, because of the economy, these options are much less realistic.

When the economy turns sour and companies feel heightened pressure to perform well, this typically means two things, according to Wharton management professor Iwan Baranky: First, employees are required to do certain jobs even if they don't like them. Second, employees may be told to come up with something new and to make sure it is an immediate success, even though the constrained environment does not allow the luxury of conducting additional research or engaging in trial and error. "This puts a lot of stress on an employee. It's like hiring an artist and telling him to make a masterpiece. That's unlikely to happen."

And when employees feel they have little autonomy in their jobs and little hope of leaving to find new ones, the result is that "firms have more purchasing power than the employees," says Baranky. "The companies, in the lingua of economists, purchase labor on the market to [fill job openings]. They have a lot of bargaining power compared to their employees." For example, an employee looking for a new job could have significant costs associated with that search. Managers "can exploit that. They know they don't have to accommodate the desires and dissatisfactions of the employees because they know it is costly for them to find an alternative. Employees are in a weak bargaining position."

If stressed employees cannot vote with their feet, the question becomes: What can they do to make their workplace less toxic?

The Importance of Small Wins

Wharton management professor Adam Grant has done extensive research on the importance of designing work that provides individuals with a sense of control, a feeling of autonomy and the ability to develop specialized skills. He has also demonstrated how a person's knowledge that his or her work has meaning and impact on others can result in increased well-being and productivity. One example: Lifeguards who read stories about other lifeguards saving people's lives worked harder than those who were given stories to read about lifeguarding as a way to advance personal goals.

Grant recently co-authored an opinion piece for Knowledge@Wharton, along with management professor Jitendra Singh, in which they blame excessive reliance on financial incentives for many of the corporate scandals and ethical lapses that have weakened the U.S. economy. Grant cites author Daniel Pink's book, Drive: The Surprising Truth About What Motivates Us, as providing a good summary of the evidence that intrinsic motivation -- rather than extrinsic motivation, such as financial incentives -- is often supported by three key factors: autonomy, mastery and purpose. Grant also cites the importance of a fourth factor: a sense of connection with other people.

In Grant's words, autonomy "involves freedom of choice in what to do, when to do it, where to do it and how to do it." Numerous studies, he notes, "have shown that allowing employees to exercise choices about goals, tasks, work schedules and work methods can increase their motivation and performance." Mastery, he says, "involves the chance to develop specialized knowledge, skills and expertise," which leads to employees "naturally pursuing opportunities to learn and contribute." And purpose involves "the experience of contributing to a meaningful effort or cause."   

Baranky agrees with the need to find ways that employees can more actively shape their jobs. Much of the research on happiness, he points out, looks at factors -- such as income -- that help explain variations in employees' subjective well being. But the one factor "that comes out very robustly is whether people have any autonomy over their workplace -- in other words, some discretion about how their work is done and what they can focus their energies on."

Achieving that in a sluggish economy suggests the need for a more proactive approach on the part of employees. Grant points to research being done by Justin Berg and others on the subject of job crafting, which Berg, a PhD student at Wharton, defines as "active changes that employees make to their jobs to better suit their own motives, strengths and passions, resulting in more engaging and fulfilling work."

Easier said than done, but Berg offers a visual framework that asks employees to think about the tasks in their job as a set of building blocks, and then to reconfigure the blocks to emphasize productive aspects of the job and reduce sources of stress and dissatisfaction. The process opens people's eyes to opportunities for small changes that "can go a long way, especially if they are small wins," he says. An example of a small change would be limiting the amount of time spent on an unappealing task, thereby freeing up time and energy for more desirable tasks. Another example would be carving out some time each day or week to work on something new.

Employees can also benefit from reframing how they think about their jobs. Berg cites one research study by Harvard psychologists Alia Crum and Ellen Langer that divided hotel room cleaners into two groups: One group was asked to look at their work as exercise, the other as just a regular cleaning job. After a month, members of the group who viewed their work as exercise actually had better objective health outcomes than those who didn't, including a decrease in weight, blood pressure, body fat and body mass index. Yet, the two groups carried out the exact same behaviors at work; the only difference was the meaning they ascribed to the job.

One of Berg's research studies, co-authored with Grant and University of Michigan professor Victoria Johnson, is titled, "When Callings Are Calling: Crafting Work and Leisure in Pursuit of Unanswered Occupational Callings." It looks at how people fold interests from "unanswered callings" -- or occupations that have long intrigued them -- into their current jobs. People can be "very creative and clever about incorporating their unanswered callings into what they do now," Berg notes. "A lawyer who always wanted to be a teacher, for example, might take on the training of new employees or mentor an intern."

In the interviewing process for his research, Berg turned up other cases of employees pursuing "unanswered callings" through job crafting. One factory mechanic who has always wanted to be a process engineer pitches ideas for improving processes to top management, even though his job is equipment maintenance. A brand manager pursues her calling to be a stand-up comic by using humor in her marketing campaigns. A university lecturer reframes his teaching to be like a musical performance, allowing him to pursue his calling to be a rock star. "By job crafting, these employees did not have to switch jobs to fulfill their unanswered callings," says Berg. "They found a way to work in a different occupation without leaving their current one."

Organizational politics, of course, are always a concern whenever the workplace status quo is challenged. Berg advises anyone engaged in job crafting to beware of encroaching on someone else's territory. "You want to do the opposite. You want to think about how to job craft in ways that are good for you and others, including not just managers but also co-workers." Indeed, employees should explain to others "the kinds of changes they want to make and the rationale behind them," Berg says. Even if all the suggestions are not approved, "again, a few small changes can make a big difference." For high-level jobs that are already quite complex, he adds, "the strategy should be to not only reduce the number of undesirable tasks, but also to add projects and develop new skills to help those projects succeed. This allows for bigger, more meaningful changes."

Speaking Up, or Not

Nancy Hanrahan, a professor in the University of Pennsylvania's School of Nursing who specializes in healthy work environments, suggests that "the magnitude of the work-stress problems is much worse than it has ever been before." Nurses are burned out "by hospitals that do not have sufficient support in place for them to do the practices they have been taught." The consequences of that for patient healthcare are obvious.

Hanrahan is studying five areas that hospital managers can focus on to help nurses better cope with stress as well as improve patient outcomes. Two are applicable to any workplace environment. First: Involve employees in policy discussions so that they understand what they are being asked to do. This also makes people feel that they are important members of the decision-making team. "Many hospitals have dropped that approach by the wayside," Hanrahan says. Second: Ensure that managers "are trained and educated." Unskilled and uninformed managers can add to the stress of an already understaffed workplace. "The environments are so complex and intense, and the volume [of work] is so high," according to Hanrahan, "that you need someone there who is making logical decisions."

Yet even when employees can help shape the meaning and nature of their work, a depressed job market limits their options. For example, employees stuck working with too many unproductive or incompetent colleagues may find little relief. "The fact is, sometimes there is nothing you can do about it," says Cappelli. "You could try going to your supervisor and saying, 'This person is not doing his job.' But there is likely to be some reason your supervisor doesn't want to [take any action]. So it comes down to Eastern religious notions of 'letting go' and accepting that this is not your problem."

In circumstances where an employee feels overloaded with work, "it's easy to say you should just speak up, but the problem is, you are in a down economy," Cappelli adds. "People are getting laid off all around you. You need to find a way to phrase your [complaint] in a positive way. Say something like, 'Here is what I think would help me do a better job.'"

Whether people actually do make such suggestions may be related to whether, and under what circumstances, employees are motivated to speak up. David Lebel, a PhD student at Wharton, studies "interpersonally risky proactive work behaviors -- those that may come with negative consequences and risk for the individual despite being intended to benefit the organization." An example would be employees who offer suggestions of how to improve the workplace but find that that their bosses or co-workers resent or disagree with these suggestions.

A focus of Lebel's research is exploring how emotions and organizational conditions influence whether employees voice their concerns and also to whom they voice them. Existing research, Lebel says, suggests that workplaces marked by fear and distrust will lead employees to remain silent. His own research, however, challenges that assumption by exploring the conditions under which fear may lead to an increase in employees' willingness to speak up.

Lebel's main finding so far is that when employees are worried about their jobs, they will, in fact, voice their concerns -- but only when their boss is supportive. "It's what we would expect," Lebel notes. "People are comfortable speaking up when there is support to counteract feelings of fear."

It is hard to overstate the benefits of having such conversations, Lebel adds. Speaking up, even if one's idea is never implemented, "gives one a sense of control, and of coping. You are also expressing some of the negative emotion, even if you are not speaking up for yourself but for a team member."

In tough economic times, says Berg, thinking in new ways is crucial. "A bad economy makes everything harder. We live in less abundance and it's difficult to switch jobs. That makes job crafting more important but also more risky.... The key is to do things in your current job, even small things, that make the most of what you have. That is fundamentally what job crafting is all about."

Knowledge@Wharton