The Study of Occupational Stress and Its Relationship with Knowledge Management Based on HSE Model

The present study aimed to examine the relationship between knowledge management and stress in Zahedan University of Medical Sciences. The statistical population included all faculty members (N = 376) among whom 190 individuals were selected using Morgan’s table. This study was conducted using a descriptive survey method. To collect data, two questionnaires including Knowledge Management Survey (Rafati et al., 2008) and Occupational Stress Questionnaire developed by England Institute of Health and Safety (2004) were used. These questionnaire’s reliability coef-ficients were 0.89 and 0.78, respectively. To analyze the obtained data, SPSS software version 18 was used. To determine the distribution of the sample, Kolmogorov-Smirnov test was used and to investigate the relationship between knowledge management and stress, Pearson’s correlation was applied. The results of the latter confirmed that there was a significant positive correlation between knowledge management and stress. Other words, it can be stated that enhancing knowledge management normally increased stress.


Knowledge Management
MaeiHotte believes that knowledge management and knowledge include activities and organizational processes which search for the combination of the capacity of processing data and information with the ability of the organization with regard to its staff's creativity and innovation.
According to Koulopoulos and Frappaolo (2000), knowledge management is associated with application and improvement of knowledge capital in an institute considering its objectives. Armstrong (2002) stated that knowledge management is the use of information to achieve business realities and the art of creating value applying intangible assets to accomplish this goal. Other words, knowledge management is the strategy of creating timely knowledge by people in real time aiding people to share information and improve their organization performance.
From Chrnieleka's point of view, knowledge management features are those depicted in Figure 1.

Types of Knowledge
Understanding various types of knowledge and distinguishing their differences are the most important contribu- tions that can be made to knowledge management ( Table 1).
• Tacit knowledge is the kind of knowledge that is not visible and roots in experiences, culture and values of an individual or an organization.
• Explicit knowledge is explicit and codified knowledge. Theoretical Knowledge is the kind of knowledge which originates from people's profound specialization. The characteristics of this type of knowledge is more like embedded knowledge (Lytras, Pouloudi, & Poulymenakou, 2002).

Components and Elements of Knowledge Management
Knowledge management elements are knowledge worker, the main units of creation, storage, and application of knowledge in an organization.
Groups-networks (formal and informal), in terms of knowledge, are significant assets that are usually intangible. Groups are made of employees who have shared experiences, usually creating a growing collection of knowledge.
An organization-the entire organization-can be considered as an institute which embodies the results of a series of knowledge. The basic components of the process of strategic knowledge management indicate that the organization must identify its knowledge network gaining some experiences as its result. All these measures should be conducted within the strategic objectives of the organization. This simple pattern has three important knowledge management dimensions, i.e. storage, transfer and conversion (HSE, 2004). The components of knowledge management are presented in the Figure 2.
Organizational objectives, creating motivation and providing facilities for knowledge workers are also considered as the most important element of knowledge management.

Stress (Mental Occupational Pressure)
Lexically speaking, stress (mental pressure) is derived from a Latin word "stringere" which means "to draw tight". In English, this term was common at least from the eleventh century and was generally used as a term to refer to physical pressure. In the early seventeenth century, this term was used with the concept of hard work and vocational suffering and in the last years of the eighteenth century, it was synonymous with pressure including work pressure, force and forced labor. In Persian, the term is known as stress (Fakhimi, 2002).
Stress is defined as a reaction to adapt to a factor or a nerve impulse and/or tension which inflicts mental or physical pressure on an individual (Jafari Moghadam, 2006). Ivancevich and Mattson defined mental pressure as interaction of organisms with the outside world. They believed that stress is an emotional reaction which becomes visible under the influence of individual differences and psychological processes (Bromand, 1995: p. 212).

HSE Model
Health and Safety Executive (HSE) presented a model of occupational stressthat explains the correlation among stress-related anomalies, individual and organizational symptoms, and its results and effects (Palmer et al., 2004). HSE standard was designed based on the 5-step risk assessment model. This standard includes six working areas which may lead to stress (HSE, 2009). HSE guideline (2001), considering six areas, helps to identify problems and provide a framework for solving them. These six working areas include: demands, control, managerial support (supervisor and colleagues), relationship, and changes (Palmer et al., 2004).  Figure 2. Components of knowledge management (Gerald, 2001).

Definition of Each Dimension of HSE Model
Demands: What a job demands you to do. Indeed, it means what the job imposed on you and the task you have been hired to do.
Control: It simply means that how much control and dominant you have on your work (HSE, 2004). Managerial support: In the workplace, support means that to what extent others support you. Relationship: When one mentions relationship, it refers to the way people interact with their colleagues. Changes: Work environment always requires change to improve. For instance, business processes may change and/or production technologies may alter and/or the work environment of an employee may alter, as an example he/she may be transferred from one unit to the other.
Among the reasons for selecting the HSE model in the current study the following can be stated: • Coordination of this model with the current study; • Various studies conducted to obtain the content validity of the questionnaire; • Diverse areas and small number of questions compared to rival questionnaires; • Acceptable reliability; • Working areas.

The Research Conceptual Model
Based on what was mentioned earlier, a model (Figure 3) is depicted in this way that knowledge management can be correlated with stress. Since in the current study, tacit and explicit knowledge and transformation of knowledge are important for knowledge management, therefore, considering Nonaka and Takeuchi's model (1995), four components of socialization, externalization, internalization and combination were selected. With regard to the second variable, since pressures caused by a job and mental states related to it were considered; hence, the researchers searched for some variables with the stated characteristics and finally five components including demands, control, managerial support, relationship and changes were selected among all components derived from the HSE model.

Overall Objectives of the Study
• Introducing knowledge management and mental occupational pressure (stress) and recognizing the theoretical framework of research; • Investigating the relationship of knowledge management with mental occupational pressure (stress) and its components in the study population; • Providing appropriate recommendations based on the research findings in order to use and guide knowledge management in various organizations.

Main Hypothesis
There is a significant and positive relationship between knowledge management and stress (mental occupational pressure) in faculty members of Zahedan University of Medical Sciences.

Subsidiary Hypotheses
1) There is a significant positive relationship between knowledge management and demands in faculty members of Zahedan University of Medical Sciences.
2) There is a significant positive relationship between knowledge management and control in faculty members of Zahedan University of Medical Sciences.
3) There is a significant positive relationship between knowledge management and managerial support in faculty members of Zahedan University of Medical Sciences. 4) There is a significant positive relationship between knowledge management and relationship in faculty members of Zahedan University of Medical Sciences. 5) re is a significant positive relationship between knowledge management and changes in faculty members of Zahedan University of Medical Sciences.
The present study aimed to examine the relationship between knowledge management and stress in Zahedan University of Medical Sciences.

Methods
This study aimed to examine the relationship between knowledge management and stress (mental occupational pressure) in faculty members of Zahedan University of Medical Sciences in 2014. To collect data and evaluate variables under study, two questionnaires including Knowledge Management Survey (Rafati et al., 2008) and Occupational Stress Questionnaire developed by England Institute of Health and Safety (2004) were used. To calculate these questionnaires' validity and reliability coefficients, Cronbach's alpha was used, applying SPSS software version 18, the results of which are presented in Table 2 and Table 3.
In the current study, after examining the obtained data, data analysis was applied using SPSS software version 18. To investigate the correlation among the variables, Pearson's correlation was used.
The statistical population of the current study included all faculty members of Zahedan University of Medical In the present study, after determining the statistical population, the researchers selected the sample using simple random sampling method.

Data Analysis
Descriptive data analysis was conducted using mean and standard deviation. Moreover, for inferential data analysis, the Pearson correlation coefficient and stepwise regression analysis were applied. All these statistical data analyses were conducted after entering the obtained data into the SPSS software version 18.
For analyzing the responses related to questions 1, 2, and 3, the Pearson correlation coefficient and for analyzing the responses associated with questions 4 and 5, stepwise regression were used. Table 4 indicates the descriptive statistical data demonstrating the demographic information of 190 faculty members of Zahedan University of Medical Sciences, as the statistical sample of the current study, based on the mentioned questionnaires.

Demographic Information
Based on Table 4, considering participants' age, the highest frequency was for the age group 45 -54 years old and the age group of 54 and higher had the lowest frequency (9.3%). With regard to their gender, 135 individuals (66%) of the respondents were males and 70 individuals (34%) of them were females. Moreover, considering participants' level of education, 161 individuals (64.4%) of the respondents had a PhD degree and 89 individuals (35.6%) had a MA degree.

Research Hypotheses
To test the hypotheses (examining the relationship between knowledge management and dimensions of occupational stress), Pearson's correlation was used, the results of which is presented in Table 5.

Main Hypothesis
There is a significant and positive relationship between knowledge management and stress (mental occupational pressure). According to Table 5, since the level of significance is less than 0.05, H0 is rejected and H1, indicating that there is a significant relationship between knowledge management and stress (mental occupational pressure) in Zahedan University of Medical Sciences, is confirmed. As it can be seen, the correlation between knowledge management in Zahedan University of Medical Sciences and stress (mental occupational pressure) is significant at the 99% confidence level and its correlation coefficient is 0.692.

First Hypothesis
There is a significant positive relationship between knowledge management and demands.
Based on Table 5, the results show that knowledge management and demands are significantly correlated. There is a direct relationship between knowledge management and demands (r = 0.542) which is significant at the p ≤ 0.05 significance level. Therefore, the results suggest that there is a significant positive relationship between these two variable. Other words, it can be stated that when knowledge management increases, demands increase as well.

Second Hypothesis
There is a significant positive relationship between knowledge management and control.
According to Table 5, since the level of significance is less than 0.05, therefore, H0 is rejected and H1 (research hypothesis), indicating that there is a significant relationship between knowledge management and control in Zahedan University of Medical Sciences, is confirmed.
As it can be seen, the correlation between knowledge management in Zahedan University of Medical Sciences and control is significant at the 99% confidence level and its correlation coefficient is 0.501.

Third Hypothesis
There is a significant positive relationship between knowledge management and managerial support.
Based on Table 5, since the level of significance is less than 0.05, hence, H0 is rejected and H1 (research hypothesis) demonstrating that there is a significant relationship between knowledge management and managerial support in Zahedan University of Medical Sciences is confirmed.
As it can be seen, the correlation between knowledge management in Zahedan University of Medical Sciences and managerial support is significant at the 99% confidence level and its correlation coefficient is 0.487.  190 190 190 190 190 190 190

Fourth Hypothesis
There is a significant positive relationship between knowledge management and changes.
Considering the results presented in Table 5, since the level of significance is less than 0.05, hence, H0 is rejected and H1 (research hypothesis) demonstrating that there is a significant relationship between knowledge management and changes in Zahedan University of Medical Sciences is confirmed. As it can be seen, the correlation between knowledge management in Zahedan University of Medical Sciences and changes is significant at the 99% confidence level and its correlation coefficient is 0.446.

Fifth Hypothesis
There is a significant positive relationship between knowledge management and relationship.
With regard to the findings presented in Table 5, since the level of significance is less than 0.05, hence, H0 is rejected and H1 (research hypothesis) demonstrating that there is a significant relationship between knowledge management and relationships in Zahedan University of Medical Sciences is confirmed. As it can be seen, the correlation between knowledge management in Zahedan University of Medical Sciences and managerial support is significant at the 99% confidence level and its correlation coefficient is 0.440.

Main Hypothesis
There is a significant and positive relationship between knowledge management and stress (mental occupational pressure) in faculty members of Zahedan University of Medical Sciences.
As it is indicated in Table 5, the correlation coefficient between knowledge management and stress was r = 0.692 which was significant at the 99% confidence level. Therefore, knowledge management and stress were significantly correlated. This means that when knowledge management is increasing, the level of stress increases. Other words, the researchers' hypothesis claiming that there is a relationship between knowledge management and stress in faculty members of Zahedan University of Medical Sciences was confirmed. This result that there was a correlation between knowledge management and occupational stress is in line with the results of other studies including Najafi (2011) who believed that stress was more evident in knowledge work and that generally knowledge and stress can be each other's generating source. Moreover, the finding is consistent with the results of Craig, Sommerville, and McCarney (2004). Considering this consistency between the results of the current study and those of previously conducted studies, it can be stated that this was supported by a strong theory and this hypothesis was based on a reliable theoretical basis. To avoid the removal of the concept of knowledge management, like other managerial concepts, occupational stress should be managed correctly 7. Conclusion

First Subsidiary Hypothesis
There is a significant positive relationship between knowledge management and demands in faculty members of Zahedan University of Medical Sciences.
As indicated in Table 5, the correlation coefficient between knowledge management and demands was r = 0.542 which was significant at the 99% confidence level. Therefore, knowledge management and demands were significantly correlated. This means that when knowledge management is increasing in an organization, the level of demands increases. This result, indicating that knowledge management and demands were correlated, is in line with the results of Shanhong (2004), asserting that ever since knowledge has become the driving force from social development, the society has paid growing attention to information and knowledge and individuals' demands for information and knowledge are increasing step by step.

Second Subsidiary Hypothesis
There is a significant positive relationship between knowledge management and control in faculty members of Zahedan University of Medical Sciences.
As demonstrated in Table 5, the correlation coefficient between knowledge management and control was r = 0.501 which was significant at the 99% confidence level. Therefore, knowledge management and control were significantly correlated. This means that when knowledge management is increasing in an organization, the level of control increases. This result, indicating that knowledge management and control were correlated, is in line with the results of Sarabi and Ismaeeli (2007). Zargar (2004) stated that knowledge management is taking individual experiences and knowledge of an organization's employees and timely dissemination of experiences among other employees in that organization and among those who need the knowledge and experience to conduct a task under control. This is not a product; however, it is the process of collection, management and dissemination of individual knowledge capital in an organization.

Second Subsidiary Hypothesis
There is a significant positive relationship between knowledge management and managerial support in faculty members of Zahedan University of Medical Sciences.
As demonstrated in Table 5, the correlation coefficient between knowledge management and managerial support was r = 0.487 which was significant at the 99% confidence level. Therefore, knowledge management and managerial support were significantly correlated. This means that when knowledge management is increasing in an organization, the level of managerial support increases. This result, indicating that knowledge management and managerial support were correlated, is in line with the results of Moharramzadeh, Ameri, and Asadi (2009) who asserted that the more the level of employees' cooperation and managerial support, considering employees as valued assets, the more the deployment of knowledge management.
Every employee in an organization has some raw knowledge; however, for better and complete utilization of these organization's knowledge assets, managers should collect each individual's raw knowledge. This requires having the ability of listening to the employees' ideas. In organizations where paying attention to employees' ideas is neglected, expectation of establishing knowledge management is futile.

Fourth Subsidiary Hypothesis
There is a significant positive relationship between knowledge management and relationship in faculty members of Zahedan University of Medical Sciences.
As Table 5 indicated, the correlation coefficient between knowledge management and changes was r = 0.446 which was significant at the 99% confidence level. Therefore, knowledge management and changes were significantly correlated. This means that when knowledge management is increasing in an organization, the level of changes increases. This finding confirmed that there was a significant relationship between knowledge management and changes in faculty members of Zahedan University of Medical Sciences. This result, indicating that knowledge management and changes were correlated, is in line with the results of Sarabi and Ismaeeli (2007). Considering the consistency between the results of the current study and those of the previously conducted studies, it can be stated that this was supported by a strong theory and this hypothesis was based on a reliable theoretical basis.

Fifth Subsidiary Hypothesis
There is a significant positive relationship between knowledge management and changes in faculty members of Zahedan University of Medical Sciences.
As Table 5 indicated, the correlation coefficient between knowledge management and relationship was r = 0.440 which was significant at the 99% confidence level. Therefore, knowledge management and relationship were significantly correlated. This means that when knowledge management is increasing in an organization, the level of relationship increases. This finding confirmed that there was a significant correlation between knowledge management and relationship in faculty members of Zahedan University of Medical Sciences. This result, indicating that knowledge management and relationship were correlated, is in line with the results of Barkhordar (2010). Considering the consistency between the result of the current study and that of the previously conducted studies, it can be stated that this was supported by a strong theory and this hypothesis was based on a reliable theoretical basis.

Executive Recommendations
Zahedan University of Medical Sciences is recommended to consider the following suggestions to keep the stress caused by knowledge management in the organization optimized.

In Terms of Demands
• Reducing the number of students accepted to the university; • Reducing professors' teaching time and giving them more time for conducting scientific research; • Reducing their teaching time and providing more time for advising students to avoid phone calls.

In terms of Control
• Monitoring the process of collection, management and dissemination of knowledge management of individuals working in an organization; • Observing balance when developing fields of study considering the number of faculty members.

In Terms of Managerial Support
• Encouraging staff's continuing training to create value for the organization; • Granting facilities and material and spiritual advantages in certain time intervals based on teachers' performance evaluation.

In Terms of Changes
• Paying attention to previous employees' experiences, especially during reorganization process, to prevent the irrecoverable loss of knowledge and experiences of retirees; • Involving faculty members in the process of designing service and providing credits in the Regulations on Promotion, Advancement and Converting the State; • Changing the Regulation on Promotion and Advancement using a group-oriented approach instead of an individual-oriented approach in the allocation of concessions to activities of faculty members related to training, education and service.

In Terms of Relationship
• Holding camps outside the organization to create face to face relationships, shared language and experiences, and trust and teamwork; • Interacting and cooperating with faculties and psychological health centers considering the fact that human structure should be recognized prior to health advices; • Shaping institutional relations based on friendly relationships and mutual trust between individuals; • Using facilities and formal and informal gatherings to exchange ideas and experiences related to occupational stress and problems.