Travel Stress, Psychological Health, and Work-Life - Panel Discussion, April 27, 2000

Questions and Answers

DR. QUICK: So, we are going to have some time now for Q&A, but, as we begin to do that, maybe what you could do is give the panel a standing ovation and get a little stretch break in there and decide who is going to be the first one up to the microphones with the questions.

So, let's give them a standing ovation.

[APPLAUSE]

MR. [NOT KNOWN]: Okay, we as panel members up front here all have microphones at our table. So, we can talk from there. Let's start with questions at one of the two microphones.

Yes.

MR. [NOT KNOWN]: I will be the brave one. But I have an observation, a source of stress that I think is meaningful is what we used to call in the Peace Corps days culture shock, and having traveled a lot and returned home, there is sometimes such a gap between the seeming importance of what is going on at home and what you have been involved with. Here may be a huge issue involving, you know, hundreds of thousands of people's health and you come home and the first thing is, you know, what about the kids' braces.

I think that maybe part of what could be helpful is maybe some kind of a ritual when someone comes home to find what has happened to Daddy or Mommy, what have they learned, what have they been dealing with. Everyone listens. Maybe there are some presents given and then, okay, let's talk about the braces. I just wanted to make that observation.

Thank you.

Firstly, I would like to say this was an extremely interesting symposium. It is the first time I have ever heard described in such detail a phenomenon that we here invoked as a way to explain a lot of the neuro-psychiatric events we see associated with anti-malarial prophylactics.

[LAUGHTER]

MS. [NOT KNOWN]: I am serious. I had a question specifically for Dr. Striker and Dr. Reed, and that is in the course of conducting your surveys, did you collect any information on anti-malarial prophylactics either formally with the questionnaires or through focus groups or random remarks?

Thank you.

DR. REED: Yes. I did look at anti-malarial prophylactics. It wasn't a major component of my study but I did track who prescribed to it and who actually took it in terms of the compliance.

I mentioned there is a discussion that people who are on anti-malarial prophylactics, there could be a side effect, not in direct association with travel. Yes, but your point is taken and is perfectly valid.

We don't know which ones they were on. I just know that they were on anti-malarial and it could be a number.

DR. STRIKER: We had a question on our survey that asked: Did you travel to areas that required an anti-malaria? And then a follow-up question: Did you take them? And we were actually with the sophisticated experienced travelers, we were shocked that more than 30 percent of the people did not take them when they were supposed, and mostly because they didn't like the side effects.

I know Lynn Rogers who is going to be talking tomorrow also I believe includes some information about that. She will be talking about her international business traveler questionnaire which includes a lot of health questions.

But that was the remarkable thing. There was no relationship, by the way, between people who took them or didn't and their stress, but it was a very big health concern, because we have had a very few, but any case of malaria is a serious one.

MR. [NOT KNOWN]: Let's take a question in the back of the room.

MR. [NOT KNOWN]: This was for Jonathan Reed. Now, Jonathan, you may have mentioned it and I missed it and I apologize. But what proportion of your population were single and might that play a role?

DR. REED: I didn't actually assess marital status at all, just gender.

MR. [NOT KNOWN]: I would have guessed that gas and oil workers might often be single, but I don't know.

DR. REED: No, I don't think so. I mean, the separation issues, should be looked at in quite a bit of detail in the gas and oil industry, the husband syndrome. But I didn't actually choose to go into that level of detail in my research. But I think it certainly exists and I certainly wouldn't deny that.

MR. [NOT KNOWN]: Thank you. Another question in the back of the room.

MR. [NOT KNOWN]: First, it seems to me relevant to know are staff who if expected to travel, given larger pay, has played a factor in whether you are going to travel or not in the Bank. I mean, certainly in the State Department when I was there, that was a big factor. Your life was different when you were abroad, if you were going to stay for any length of time by 10 or 20 percent.

I have a couple of other questions quickly. I just wondered if there was any consideration in the questionnaires as to whether you are traveling with any of your family, your linguistic ability when you get there -? I mean, if you are going to a Spanish-speaking country and you speak Spanish, that would seem to be a difference—and also is there a risk in the destination. If you are going to Algeria or Bogota, Colombia, that is one thing; if you are going to go to someplace where you are familiar with and there is no risk at all, it seems to me those are factors you might want to think about in making the questions.

MR. [NOT KNOWN]: Do you want to start with the first question on pay differential?

DR. FRICK: The Bank does not pay more for people who are traveling, but there are some benefits to people who are relocating for a year, two, three. But for people who are traveling, there is not greater pay. But I was going to mention that perhaps this afternoon I did uncover an incentive to travel that I hadn't been aware of in the Bank, because we have been doing something called the work program, where people basically are getting their dance card filled, so to speak. They are getting their work program filled.

So, an individual goes around and gets work projects for the year. And if you are traveling, by definition you are working that entire time. So, there is an incentive; if you fill up your work program with a lot of travel, then you are what we could call programmed.

We are changing that budget incentive in the coming year, and I hope that will be addressed.

DR. STRIKER: Just very quickly on the issue of safety, we asked the general question that unfortunately combined worries about health and safety. But then, we had a write-in response. And most of the safety concerns actually were about in-country transportation, air travel or ground transportation being dangerous. But we did not look at that as a separate, although that is something we have discussed quite a lot and we would be interested in looking at further.

With regard to looking at staff who had spouses travel with them, we did not look at that. But the Bank has had something called the spouse points program, which is after a certain number—I don't know how many thousand miles—you earn points so that you can bring your spouse with you. But we haven't looked at that.

MR. [NOT KNOWN]: And language.

DR. STRIKER: The question again about language?

MR. [NOT KNOWN]: If you are going to places where you speak the language.

DR. STRIKER: In the Bank, the answer is yes, you are.

MR. [NOT KNOWN]: Thank you. Let's come up front.

MR. [NOT KNOWN]: Two questions. The first question for Dr. Striker and Dr. Liese and the second question for Dr. Reed.

The first question: Do you report these places, the psychological cases or depressions? Do you report those that are work-related illnesses here to the World Bank or to OSHA?

And the second question for Dr. Reed is where does this 90-day rule come from that you showed in your last slide?

DR. LIESE: No, we do not report these work-related issues, because they were found in a way in the review of claims. These were not people who came forward. So, in that sense, that doesn't appear. There are very few people who have come forward with a work-related travel problem, with a psychological disorder which they somehow tried to relate to work. So, that hasn't happened.

What we looked at were claims, you know, anonymous, we didn't know who the people were.

DR. REED: Yes. I also wouldn't go quite as far as attributing as firmly work-related at this stage, but there is definitely an association. I think psychological illness in travel can be slightly less strong than the physiological impact of travel. I think one of the things I am trying to get across to employers is they should treat travel as a hazard like any other work-related hazard and manage it appropriately like they would managing exposure to noise or whatever.

So, strictly speaking, you could if you took that attitude and the management decisions that occurred in the U.K., legislation really could apply. And that is just a concept we are trying to broach with our employers and also regulatory bodies to see if anyone will take that one up and run with it.

DR. STRIKER: We are probably not at the point where you could make quite a close association there. We may be talking about some accumulation of something over quite a period of time. So, the question is: How much is related specifically to travel? What is related to the management of work? And we haven't got that far yet I don't think.

DR. FRICK: And the Bank has had a guideline. I am embarrassed to say I cannot tell you exactly what it is, but it has never been a hard and fast policy. I guess it used to be enforced more and so people with a memory know that managers used to be alerted that your staff member has traveled in excess of the policy guideline and you need to pull back. But it is a guideline; it is not firm. And so, the guideline is just out there. People are aware of it, but it is not really being enforced at all.

MR. [NOT KNOWN]: Well, our company got the same guideline, but nobody knows where it comes from. That is why I asked. Thank you very much.

MR. [NOT KNOWN]: Let me just offer one comment to this, if I may, and certainly this is not a statistically validated observation but I would emphasize the point that our previous speakers have made that, at least from the medical perspective, this pre-travel stress syndrome is very real.

We see a significant number of patients who come in for stress-related illnesses prior to the travel simply because of the work that needs to be done in anticipation of this. And some of them even expressed the concept that travel is at least on a personal level if not family a decompression for them. It is an interesting concept, but I think it does validate the point that was made earlier about stress prior to travel.

DR. LIESE: I just wanted to come back for one second to the 90-day rule, because it is so telling. As Helen has said—and I have been in this institution for twenty-four years—nobody knows where the 90-day rule came from. It was there. It appeared, you know. Very few people were willing to observe the 90-day rule.

As a matter of fact in my recollection, there might be one or two years in the operational years where the 90-day rule was somewhat enforced. But then, managers and staff found excuses around it. It just shows how difficult these issues are in this institution, and in a year where we systematically tried in an old department to enforce the rule, there were constantly exceptions. You cannot believe what kind of excuses our staff members came up with why the 90-day rule should not apply. I just wanted to give that as a comment.

Thank you.

MR. [NOT KNOWN]: Thank you.

In the back of the room.

MR. [NOT KNOWN]: You have shown and presented many of the observations as a consequence of travel or related to travel. The issue that I may have missed but I was wondering if anybody had comments on is: What has been the organizational impact of travel-related problems in the employee force? That is, has there been any failure of mission? Has there been any failure of organizational performance because these people are under stress?

That is an interesting point. Corollary to this, from the investment point of view, if there has been none, who really cares from the investment point of view?

DR. IVANCEVICH: Let me try a response on that. I don't believe there is research available on it, who really cares, that part of the question. I think there is concern in corporations, and some firms are, in fact, now taking a look at what I referred to up at the front as the costs and the benefits of the travel. The cost/benefit model approach is just starting to be used. The cost/benefit approach has been applied for years in many, many arenas. I know of a few, and I am talking about a small handful of companies that are now applying it. So, there is some concern.

But there is no published empirical research to show that travel has an impact on performance. That doesn't mean that it shouldn't be studied. I think it is important to study it in organizations. You should be studying it because when you look at some of the career effects that have been linked and not through empirical research—I am talking about intuitively linked—to travel, the return back to the home base and what effect that has on productivity, career-wise some individuals have been affected by it.

So, if we as researchers really are going to acquire a complete picture of the effects on organizations and individuals, I think we have to look at it empirically as opposed to relying solely on intuition as we have. There is no research at this time.

I believe that within the next few years cost/benefit analysis will be applied, to the effects of travel on the bottom line in organizations.

MS. [NOT KNOWN]: I am from the U.K., and one of the things that we need to look at and hasn't been mentioned—that is an observational aspect as well here—and has a lot to do with what you are saying. I believe in the inter-disciplinary approach within an organization outside. But what about the legal perspective as well, of looking at an organization's legal duty of care, whether it be through criminal which I would like to see come into being, of there being a responsibility of organizations sending people overseas or within the organization of the civil aspect as well? This is within the U.K. legislation but I am sure there are similarities with the American legislation.

My main question is to the researchers as well as to others in the World Bank is: When you have been doing the research, are you looking specifically at staff or have you considered the many consultants that are employed by organizations? So, you have these third-party contractors and what the situation is with them, that they are actually being employed for a short-term basis all over the world.

Because this is a very important group. And if we look at legal duty of care, what is that to those people?

DR. STRIKER: The last question, we have not done studies on what I guess the general term would be contractor, short-term people. We have a fairly large minority of staff in the institution who are in that status, and they do not have insurance benefits.

And there is a challenge then to do some research and find out about their health status. But it can be done by survey certainly, and we haven't done that.

DR. FRICK: We have not looked at it empirically either. We do see staff. We used to have a category of staff, we are getting rid of it now, but we used to have something called long-term consultants who were in the institution. And that is changing this year.

But we have seen them over time, and anecdotally I will say that sometimes they feel that they have less control over their schedules. I can't tell you that that will be borne out, but certainly that is my sense of things. But we haven't looked at that either.

MR. [NOT KNOWN]: Thank you. In the back of the room.

MR. [NOT KNOWN]: This is kind of a comment. I just wanted the panel maybe to respond to it.

But I am wondering if the stress with the business traveler just might be another indication of what is just going on in society in general, families in general. Maybe Dr. Reed's study which was showing, comparing a control group of non-travelers to a travelers' group looking for psychological predispositions, maybe a better study would be doing it on a company that doesn't exclude employees who had predispositions to neuroses.

You know, maybe the traveler is self-selecting himself. Maybe the traveler is like a career-driven person who maybe values the career more than family. You know, I am wondering if that is a psychologically healthy way to be. Maybe we are just seeing the manifestations of people who are more career-driven than people who are less career-driven.

DR. REED: I absolutely agree with you that retrospectively it would be nice to go back and look at a separate population or at least compare the traveling group with those that maybe worked offshore who are leaving their families and are screened at the same level but don't actually internationally travel. I don't know whether there will be any differences there.

Just getting back to one of the points that was mentioned earlier about not much data suggesting the impact of this in terms of job performance and such like. Very crude data came out of the research I did, that about 2-1/2 to 3 percent of time was completely lost due to incapacitation while abroad, and that is broadly similar with sickness absence rates in an organization that we deal with.

So, I don't think you can argue that there is any great performance deficit likely to occur because of that. But more interestingly, about 12 percent of the total time spent abroad was spent working while unwell. And I think that is maybe an aspect that could be looked at to see whether that had any detrimental impact to job performance. These guys are out there for short periods of time to do a specific job and did that affect their ability to do it.

MR. [NOT KNOWN]: In front of the room.

MR. [NOT KNOWN]: I have a couple of questions. One of the questions is for all the researchers, I am wondering how much your results might be generalized to people with different types of job duties than the ones you primarily surveyed, the oil workers and the World Bank employees.

How do you think the results might vary depending on what kind of job duty someone has and the type of stress they have in their particular job, because lots of people travel but they are doing many different types of things when they travel.

Then, I have specific questions. One is for Dr. Striker. I was wondering about your scales used, your travel stress scales and I wondered what some of the psychometric properties were of the scales, the reliabilities and the validity of the scale.

I also wonder how much the outcome measure, your travel stress measure might relate to some other outcomes that would lend validity like psychological measures of anxiety, depression, physical measures. Because your primary outcome measure, your criterion is a too wide a measure of stress.

I have a question for Dr. Reed which is: What are the ways in which you matched your controls? What were the criteria used to make them similar and just how matched were they? And in that vein, it might be useful to sidestep a problem of trying to match them by looking at the amount of travel and the length of travel that the particular travelers made, correlate that with your physical and psychological outcomes, if it is difficult to match them in meaningful ways.

MR. [NOT KNOWN]: Do you want to start with generalization?

DR. IVANCEVICH: Let me start on the first one. This is exactly why we are doing what we consider to be a multiple kind of study. The limitations, we have said that, all of us admitted, and you know this, that there are very few studies. So generalizing is a concern, the different kinds of jobs, the different points in the career, the cultures in the organization with regard to travel. There are all kinds of variables that you can mention there.

You cannot bet the farm or bet the house on a limited number of studies represented in this room or even outside of the room because there are not that many more. We want to look at different levels in organizations, in the hierarchies, the different types of industries, the different types of expectations and also on the front end what picture of individuals, once they come in that front door as employees in the organization, what was the realistic picture with regard to travel that was presented to the individuals.

What we find thus far in the focus groups that we are doing is that the picture that was painted in quite a few—I don't have the data in front of me with regard to these different industry vertical groups that we are in—but the pictures are painted quite differently.

Many individuals, when we asked the question did you expect to travel this much and the duration and all of that and, as I say, the majority of the responses are no. So, the realistic picture that is painted for a career in our organization, whatever the organization is, seems to be not a realistic picture.

So, whether you are studying World Bank people or offshore, those are categories in specific kinds of industries and we would want to definitely as researchers look across a lot of different industries in different countries, you know, look at different kinds of sample sets, sizes and that is in the works. And hopefully, in the future, if we have additional conferences, there will be some reports on different kinds of samples. We can talk about generalizing. .

DR. STRIKER: The second question raises probably one of the most important questions about doing research with using surveys, and that is having validated questionnaires that can be used multi-site and can be used across organizations so that we can begin to really have confidence in them and then compare some results.

We didn't validate this questionnaire. We didn't give it to a pilot group. We didn't run it a couple of times and then refine it. And that is a big flaw actually in the survey.

What we did do is a factor analysis of the items. And we found that these items you see up here and others actually grouped on three factors—work, family and health. So, that gave us a little more confidence in what we were dealing with here with the survey. We didn't report that, by the way, in the article we wrote.

But that other issue also of relating ? there is also the drawback and the problem of correlating self-report with self-report.

[sort of what you are getting at with the second part with those two stress questions. I mean, we are not really sure. Those are very broad questions. What we would need to do and perhaps some other researchers could do this and maybe we can link with each other on this would be to figure out a set of questions that we can give to a group of travelers who agree and then match it with their actual health conditions. That is very tricky to do because it is highly sensitive, but that is a direction that we have to move in to get measures that we can have any confidence in.

So, I think this is hopefully something that can come out of the meetings here.—We have referred to a couple of times—one questionnaire done by Lynn Rogers. We did one; we would like to put our ideas on how to come up with something that is reliable and useful across settings and incorporating the right questions.

DR. REED: Just very briefly, I did try to analyze whether there was any difference in occupational groups, a sort of control element to the traveling groups and analyze their GHQ responses by occupational groupings and didn't really find any significant difference between any of the groups, although I admit that the numbers might not have been large enough to detect small differences.

So, that covered often management style work to production and fairly menial engineering type manual labor even. Criteria for matching controls was really just similar occupational groupings. And there were only very few of the groupings where there was a different in proportion between the travelers and controls. And so, they were largely matched on occupational groupings, but it was fairly crude and empirical, academic levels, the types of jobs that were equivalent, onshore engineering jobs that would be very similar jobs that the offshore workers are doing just in a slightly different environment.

But I also looked at whether frequency of travel, duration of travel, somatic illness was at all seen as a risk factor and couldn't find anything at all. So, none of these issues appears to be indicative of a risk amongst the traveling group. So, that answers that.

MR. [NOT KNOWN]: In the interest of being responsive to Lennart's obsessiveness, I am going to at this point invite those who have additional questions—and it is nice to see we have more questions than time—to come up front and speak with the presenters.

I would like us to thank Bernhard for the inspiration for this whole conference and Michael for making the reality happen. Thank you very much for your attention and your response this morning to the experts.

[APPLAUSE]

[Whereupon, Session 2 was concluded.]

Disclaimer: These Proceedings have been produced from transcripts made from audio tapes. Efforts were made to check the accuracy of information with the various authors, but this accuracy is not guaranteed. If there is information that you believe requires correction, please send a message to our e-mail address.