The Sunday stand-up at a Kathmandu business head-office starts on time. Brand managers tick through last week’s promotions; the supply team says the East route is clear after heavy monsoon. A junior analyst holds up the warranty claim dashboard. Data import-failure claims have climbed for three days, clustered in one region and one product line. She points to the chart, and the meeting just keeps going. No one asks for anomalies. The agenda sprints to deadlines. Ten minutes later, the team disperses to ‘get moving’ mode. Two weeks later, returns jump, penalties land, and a tense review confirms what the analyst had already seen. The fix took one hour. The cost of that silence will show for the next three months.
That gap wasn’t technical; it was conversational. In that silence sits the article’s argument. Results flow not just from capital and code but from the human balance sheet; which reflects the cognitive, emotional, and social conditions that decide whether people think clearly, speak candidly, and regain energy between surges of work. Ignore that balance sheet and value leaks through rework, slow decisions, avoidable incidents, and regretted attrition. Manage it and speed, quality, and retention move in the right direction. The guidance is clear. Employers should prevent harm by designing work better. They should protect people from psychosocial hazards like bullying or role conflict. Support workers with reasonable accommodations; for example, flexible scheduling, extra time for tasks, a private quiet space, regular supportive check-ins, or phased task re-entry; being consistent with WHO–ILO guidance (WHO/ILO, 2022). ISO 45003; the global standard for managing psychological health and safety at work guides how to run this like safety and quality; so that the top management defines responsibilities, sets KPIs, and authorises a final check
In Nepal, the policy and governance frame for workplace mental health isn’t starting from scratch. The Labour Act (2017) and the National Occupational Safety and Health Policy (2019/2076) set a legal baseline for safety and health in formal workplaces, while the National Mental Health Strategy & Action Plan (2020) and Nepal’s participation in the WHO Special Initiative in 2021 signal public commitment to broaden access and reduce stigma (Ministry of Health and Population [MoHP], 2020; World Health Organisation [WHO], 2022). But, there are issues with the implementation. It still lags. National surveys like National Mental Health Survey Nepal 2020 show substantial need and a treatment gap, and many enterprises treat mental health as an ad-hoc wellness perk, not a management system (NHRC, 2022; WHO, 2022). Put simply, the scaffolding exists; the operating system’s still being built.
The problem is that the top management and boards measure results but ignore the upstream factors. Many management teams track lagging indicators like revenue growth, gross margin, EBITDA, cash flow, ROE/ROCE, and cost-to-income alongside audit exceptions, a few risk/compliance numbers and customer complaints. What’s rarely on the reports and dashboards are the upstream human signals that move those numbers: psychological safety, workload balance, fairness sentiment, cycle time, quality escapes, and regretted attrition. Global surveys show, only one in five employees are engaged. The rest operate under strain or detachment, and that’s where much of the productivity loss hides (Gallup, 2024). In plain terms: when people don’t feel safe to surface weak signals, when work design chronically exceeds human capacity, and when perceived unfairness corrodes trust, the P&L does not show performance. This article translates the evidence into an operating approach that C-Suit, especially Chief Human Resource Officer can adopt in a quarter; with proper managerial systems and management routines that convert clarity, fairness, and voice into fewer escapes, faster cycles, and steadier talent.
Where the hidden costs hide
Hidden costs rarely wear badges. They slide in as quality escapes that reach the customer; as cycle-time creep when teams over-check and escalate; as presenteeism, the quiet drag when people show up but their thinking power is depleted. And, finally, in regretted attrition, when high performers quit because Monday never changed.
Three upstream drivers repeat across studies and sectors, and they’re visible in Nepal’s offices and plants too:
- Silence. When psychological safety is low, weak signals disappear. People hold back risks, skip requests for help, and swallow challenges because they expect embarrassment or backlash. I’ve often seen this happen in real life. During strategic reviews, departmental meetings, or training sessions, employees stay quiet in front of top management; even about issues they discuss openly among themselves or outsiders. They worry that speaking hard truths might invite blame or harm their standing. As a result, leaders never hear what they need to know most. The same problems keep returning, not because people don’t see them, but because they don’t feel safe to say them. Research shows psychological safety predicts team learning and performance. Leaders build it by setting the stage, inviting participation, and responding productively to bad news and dissent (Edmondson, 1999; Edmondson, 2018). Google’s large internal study ranked psychological safety as the top factor of effective teams, ahead of tenure or seniority, underscoring its primacy in modern operations (Google re:Work, n.d.).
- Overload. Burnout isn’t a personal failing; it’s a work-design mismatch. The Job Demands-Resources (JD-R) model shows two paths: the health-impairment path; excess demands with thin resources produce burnout and errors and the motivational path; autonomy, feedback, and support lift engagement and performance (Bakker & Demerouti, 2007). Decades of research reduce it to six mismatches – workload, control, reward, community, fairness, values (Maslach & Leiter, 2022). In practice, chronic overload produces quiet mistakes, deferred maintenance, and brittle decisions.
- Unfairness. When people experience incivility or perceive opaque promotions, tasking, or pay, strain rises and loyalty falls. Recent studies show that toxic behaviour and role conflict are major reasons why people plan to leave their jobs; often stronger factors than perks or workload (McKinsey Health Institute, 2023; NICE, 2022). Experts suggest fixing this through clear processes and quick, fair handling of issues (McKinsey Health Institute, 2023; NICE, 2022). When people feel treated unfairly, it clouds judgement and weakens loyalty. The same pattern is visible in Nepal’s mix of formal and informal workplaces.
Nepal’s job market has its own realities. Formal and informal jobs exist side by side in Nepal. Small and mid-sized enterprises operate next to big business groups, each with very different HR systems and cultures. In both settings, however, when it comes to mental health, many employees still hesitate to ask for help. The National Mental Health Survey, 2020 reported significant unmet needs. The unmet needs are practical and immediate: only about one in four facilities offer any mental-health service, and overall readiness is just 22.2%; with 16% reporting trained staff, 12% having guidelines, and fewer than half stocking essential medicines; access clusters around Bagmati and lags in provinces like Madhesh. A thin workforce, limited secondary-level services outside cities, and low mental-health emphasis in medical training constrain scale-up. Funding is tight (health spending ≈ 2.4% of GDP; about USD 25 per capita), and stigma still delays help-seeking, with few 24/7 supports. In short, strategy exists but implementation is early and uneven. Similarly, WHO’s situational assessment pointed to workforce and financing constraints in public systems (NHRC, 2022; WHO, 2022). For employers, the message is simple: mental health can’t be handed off to overstretched and overburdened public systems. Upstream conditions at work must be managed, not wished away.
Evidence for three levers that reverse the leak
The turning point arrives when leaders stop treating mental health as a benefit and start taking it as performance infrastructure. Across guidance and research evidence, three levers stand out: speak-up practices, thoughtful work redesign, and structured managerial routines.
Lever 1: Speak-up Practices (psychological safety, operationalised).
Psychological safety is often mistaken for comfort. It is not. It’s a shared belief the team is safe for interpersonal risk-taking, which enables error reporting, fast learning, and innovation in complex work (Edmondson, 1999). It’s not about posters or slogans. The real practice is in how meetings run: agendas that start with risks, discussions that welcome different views, help surface minority views and reviews that focus on systems, not blame (Edmondson, 2018). stress standards bring a preventive approach. They focus on six key areas: demands, control, support, relationships, role, and change; which can be tracked and improved through clear action plans (HSE, 2025). In plain terms: when leaders ask, acknowledge, and act, candour becomes routine, and costly surprises shrink.
Lever 2: Thoughtful Work redesign (balance demands and resources, quarter by quarter).
The JD-R model hands managers a map. Teams list their top job demands (workload spikes, conflicting priorities, emotional labour) and job resources (autonomy, skill variety, feedback, social support), then rebalance each quarter (Bakker & Demerouti, 2007). ISO 45003 turns this idea into a formal management process. It asks organisations to identify psychosocial hazards such as role confusion, rude behaviour, or poorly handled change. These risks are then reviewed and improved through the same plan–do–check–act cycle used for other health and safety controls (ISO, 2021). Burnout research links risk to six mismatches between people and their work: workload, control, reward, community, fairness, and values; and turns these into practical design steps: right-size workload, give more autonomy, recognise effort promptly, build community, ensure fairness, and align tasks with stated values (Maslach & Leiter, 2022). In practice, this means starting small on Monday. Keep workloads realistic, protect time for focused work, and set clear role boundaries. During peak weeks, narrow the number of KPIs and drop tasks that add little value.
Lever 3: Structured Managerial Routines (the human balance sheet’s steward).
The manager is the transmission belt between plan and operations. Gallup’s global research shows that what managers do each week strongly affects employee engagement and wellbeing. Simple habits – like short one-on-one check-ins on workload and priorities, quick recognition for good work, and clear next steps – build positive results fast (Gallup, 2024). The UK’s National Institute for Health and Care Excellence (NICE) adds that strong manager capability is central to wellbeing. It highlights three essentials: supportive supervision, clear workloads, and an inclusive environment as the foundation for both health and performance (NICE, 2022). This isn’t motivational speaking; it is predictable cadence owned by line leaders – which is exactly what the Biratnagar pilot proved.
Practical fixes and the executive payoffs
Executives have finite attention. The winning moves are simple, auditable, and tied to metrics the board and C-Suite already care about. What follows is a compact operating system any Nepal-based firm can run in a quarter.
System element A: Speak-up rituals, formally installed.
Start with meetings and incidents. Put risks first on agendas. Then run dissent rounds before irreversible choices. After defects or near misses, hold a learning review that asks, ‘what signals were missed and why?’; not ‘who erred?’ (Edmondson, 2018). Run a short monthly survey asking one question: “Can I raise concerns without backlash?” Share the percentage of issues that get closed or resolved. This isn’t about employee mood; it’s a real measure of execution risk, recognised in both organisational psychology and safety management (Edmondson, 1999; HSE, 2025).
System element B: Team-level work redesign, quarterly.
Use a one-page JD-R check each quarter. Teams list the top three demands, the top three resources, and one pilot change to shift load and latitude (Bakker & Demerouti, 2007). Fold it into an ISO 45003-aligned psychosocial hazard map with owners, controls, and review dates (ISO, 2021). This change turns wellbeing from a vague idea into something that can be measured and reviewed. It can work just like other safety controls such as machine guarding or chemical storage. It gives HR auditors clear evidence and gives teams more room to work without pressure.
System element C: Managerial routine, weekly.
Make the following non-negotiable: (1) 10-minute one-to-one weekly (or biweekly in slower cycles) that check load, priorities, and support; (2) a recognition pass once a week that ties praise to a specific behaviour and outcome; (3) clear, written next steps at the end of key meetings. They’re light lifts that anchor the week. These tiny moves don’t add hours; they replace drift with rhythm (Gallup, 2024; NICE, 2022).
The payoffs CEOs watch.
When these systems are in place, work errors and slips fall because weak signals are caught early. Cycle time shortens as decisions move through clearer lanes with fewer delays. Regretted attrition declines when fairness and voice improve, two proven drivers of loyalty.
Global data back this up. Deloitte (2024) reports that targeted mental-health programmes can deliver a return of up to £5 for every £1 invested, while the World Bank (2024) and WHO–ILO (2022) estimate that depression and anxiety cost the global economy about US$1 trillion a year in lost productivity. These numbers show the scale of opportunity, not a guaranteed local result. Each organisation should validate its own impact through a clear benefits-realisation plan that tracks improvements in productivity, retention, and risk reduction over time.
Supplier and SME angle.
Nepal’s supply chains include SMEs and informal elements. For smaller firms, the same system scales down: one page for hazards, one routine meeting, one metric per month. The standard’s value is precisely this adaptability (ISO, 2021). In practice, many improvements cost little: clearer roles, protected focus time, and predictable manager check-ins. Where access to care is constrained, employers can still build simple, confidential ‘if/then’ pathways to reputable providers and community resources, with manager boundaries that stop short of diagnosis (WHO, 2022; Arends et al., 2022). Steady routines lead to fewer problems.
What should change next quarter, and why now?
Over the next 90 days, the organisation moves from slogans to systems. Posters come down; practice goes in. Each business unit publishes a one-page ‘ways of working’ charter that codifies meeting norms, response SLAs (Service Level Agreements), focus blocks, and in-person purpose. Each team runs a JD-R mini-audit, logs psychosocial hazards with owners, and closes at least one control. Line managers adopt weekly one-to-ones and a recognition pass; leadership reviews begin with risk and dissent before updates. The board and top management dashboard add three leading indicators: safety-voice pulse, quality escapes, regretted attrition; backed by a benefits-realisation plan that track costs avoided and time saved (ISO, 2021; Deloitte, 2024; HSE, 2025).
Why now? Three things are coming together. First, policy and legitimacy: Nepal’s National Mental Health Strategy and Action Plan (2020), supported by the WHO, has created a clear public mandate. Employers that align their own programmes with this national direction show seriousness and can work more closely with government and health partners (MoHP, 2020; WHO, 2022). Second, capacity and resources: public health services in Nepal have limited funding and too few trained professionals. They can’t meet every mental health need on their own. That’s why preventing problems at work is not only the right thing to do but also the most practical (NHRC, 2022). Third, competitive pressure: talent markets and investors watch culture in real time, and global guidance now treats psychosocial risk as governance, not a perk (WHO & ILO, 2022; ISO, 2021). What sets a company apart isn’t a new app. It’s a way of managing that keeps people clear-minded, open, and ready to perform when it counts.
Organisations should make mental health an operating choice, not a poster. We need to instal the few routines that surface risks early and keep workloads fair, then watch cycle time, quality, and retention improve. The organisations that act now will move faster and lose less.
References
- American Psychological Association. (2023). Work in America survey 2023. APA.
- Arends, I., Baer, N., Botterrill, J., McLeod, C., & Thiele, G. (2022). Supporting workers with mental health problems at work: Challenges and avenues. Scandinavian Journal of Work, Environment & Health, 48(4), 297–301.
- Bakker, A. B., & Demerouti, E. (2007). The Job Demands–Resources model: State of the art. Journal of Managerial Psychology, 22(3), 309–328.
- Deloitte. (2024). Mental health and employers: The case for investment—2024 update. Deloitte UK.
- Edmondson, A. C. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350–383.
- Edmondson, A. C. (2018). The fearless organization: Creating psychological safety in the workplace for learning, innovation, and growth. Wiley.
- Gallup. (2024). State of the Global Workplace 2024. Gallup, Inc.
- Google re:Work. (n.d.). Guide: Understand team effectiveness (Project Aristotle).
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- Government of Nepal. (2019). National Occupational Safety and Health Policy, 2076.
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- Intergovernmental Panel on Climate Change. (2022). AR6 Working Group II—Impacts, adaptation and vulnerability (Health factsheet & Chapter 7).
- International Organization for Standardization. (2021). ISO 45003: Psychological health and safety at work—Guidelines for managing psychosocial risk.
- Maslach, C., & Leiter, M. P. (2022). The burnout challenge: Managing people’s relationships with their jobs. Harvard University Press.
- Ministry of Health and Population (Nepal). (2020). National Mental Health Strategy & Action Plan 2077.
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- McKinsey Health Institute. (2023). Reframing employee health: Moving beyond burnout to holistic health. McKinsey & Company.
- Organisation for Economic Co-operation and Development. (2021). Fitter minds, fitter jobs: From awareness to change in integrated mental health, skills and work policies. OECD Publishing.
- World Bank. (2024). Resilient health systems for better mental health (Brief).
- World Health Organization. (2022). Guidelines on mental health at work. WHO.
- World Health Organization. (2022). Special Initiative for Mental Health: Nepal situational assessment. WHO Nepal.
- World Health Organization & International Labour Organization. (2022). Mental health at work: Policy brief. WHO/ILO.
(Khatri is Management Consultant and Educator)
