Report Summary: Presenteeism: A review of current thinking

Presenteeism reportAs organisations continue to try to achieve more with less, develop leaner systems and greater efficiency, the toll it takes on employees’ mental and physical health has climbed the agenda. Increased presenteeism – employees who attend work whilst ill – is one possible outcome of the pressure on organisations to remain competitive and boost productivity.

It seems particularly important to understand the relationship between absenteeism and presenteeism, as organisations drive down the former at the risk of increasing the latter. A traditional focus on absenteeism has meant that the detriment of presenteeism is somewhat overlooked.

This report brings clarity to the problems related to negative presenteeism, and addresses how presenteeism can be measured, reported and managed, answering:

  1. How can presenteeism be usefully defined while taking into account some of the complexity of illness and the variety of work tasks, and what is its relationship to absenteeism?
  2. What drives presenteeism in an organisation, how can vulnerable groups be identified and how should managers use this information?
  3. What is the impact on productivity and how can that be mitigated?
  4. How can presenteeism be measured and reported?
  5. What actions could be put in place to ensure that presenteeism does not become a problem when absenteeism falls?

What is presenteeism and when is it a problem?

The definition of presenteeism adopted in this report is from Johns (2010),

showing up for work when one is ill’.

Presenteeism (and absenteeism) can be positive or negative, and there is a fine line between them. Negative presenteeism can have repercussions on the individual, the organisation and for colleagues, and in such cases it is important to rest and recover outside of work. Presenteeism may be positive in the cases of some chronic and psychological illnesses where integration into the workforce can be beneficial.

Research shows that people are significantly less productive when unwell. They can also be a hazard to others through passing on infection. Additionally, when an individual is ill they may make mistakes that are detrimental to the productivity of the organisation. The evidence suggests that presenteeism is both more prevalent than absenteeism, and, unlike sickness absence, is also significantly related to performance. In the long term, presenteeism may also be more damaging for employees’ health, morale and productivity.

Line managers should seek to understand the underlying drivers and provide work adjustments where necessary to optimise performance.

What drives presenteeism?

Presenteeism is a complex problem (Baker-McClearn et al 2010), that is continually shaped by individual and organisational factors including deadlines, peak periods, pressure from colleagues, managers and family members, and their own motivations. Initiatives by organisations to drive down absenteeism can have the unintended consequence of increasing presenteeism, as individuals do not recover at home and therefore remain in the workforce sick.

The drivers of presenteeism are diverse and vary between individuals and organisations, however, according to Hansen and Andersen (2008), work-related factors have a slightly greater effect. Such factors include the needs of others professionally such as in the care, welfare or educational sectors; concerns for colleagues’ workload; manager and supervisor behaviour; working cultures; and portrayal of a work ethic or organisational commitment. Organisational policies and economic climate can also be impacting factors; fixed term contracts, job insecurity, absence policies, sickness benefit, bonuses/incentives, and  working-time arrangements, are factors which organisations have a degree of control over and have the potential to be worked on with driving down presenteeism in mind. Personal factors such as financial worries about a loss of income, problems at home, and personal pressure are harder for organisations to control.

Those who are most vulnerable to presenteeism cut across the whole organisation in terms of seniority and job role, including:

  • Managers who feel they should set an example.
  • People with high sickness absence who are under pressure to reduce this.
  • People with financial problems.
  • Workaholics.
  • Insomniacs. Additionally, work-induced fatigue is worth special attention due to the mutually reinforcing impact of presenteeism and fatigue.
  •  High-skilled white collar workers, compared to the other occupational classes.
  • Those who are childless are more likely to come to work when sick compared to those who are recently married or have children.
  • Older workers.
  • People with unhealthy lifestyle choices including smoking, those with unhealthy diets and who don’t exercise very much.
  •  People with poor psychological wellbeing, including depression, which is worthy of particular attention due to its prevalence and lack of visibility.
  • Some professions and industries have higher rates of presenteeism; doctors in particular have been identified as at risk (Rosvold and Bjertness, 2001).

Organisations can benefit from awareness and patterns of presenteeism amongst employees in order to mitigate against negative presenteeism and the associated detriment to all parties.

Measurement, reporting and benchmarking

The measurement and reporting of presenteeism is clearly more difficult than that of absenteeism and the topic is still relatively new in terms of organisational interest.

Reporting presenteeism and productivity loss is highly subjective and relies on the measurement instrument and phrasing of questions. There is a wide variation in how employees have scored on different measures although many have proven validity.

Measures are likely to be more reliable as a within-company means (rather than between-company comparisons) of monitoring shifts in absenteeism and presenteeism trends and in providing data to evaluate the impact of workplace health interventions. The choice of measure depends on whether the scale will be a stand-alone survey or incorporated into another instrument, for example, the staff survey. The measures can be general or related to specific health problems. For a stand-alone study, several scales could be combined looking at specific areas of organisational interest such as employee engagement, job satisfaction, work productivity or work limitations. This approach might be used in order to test a specific hypothesis.

Line Managers hold the key

How then can organisations become more active in managing absenteeism and presenteeism together in order to promote a healthy and productive workforce?

While senior managers are important in establishing an overall health strategy, a key focus for intervention is at the line manager/supervisor level. Their behaviour is influential in providing support; return-to-work interviews and work adjustments to facilitate the return; role modelling healthy behaviours; and establishing a healthy team culture. Line managersneed to consider whether presenteeism is appropriate and what measures must be taken to assist presentees in the work place.

Recommended actions:

  • Return-to-work programmes provide the important link between absence and presence for employees who have been ill and can serve to reduce both absenteeism and presenteeism.
  • Collaboration between the employee, Occupational Health, HR and line managers is recommended in designing tailored solutions.
  • Work health promotions, unlike return-to-work programmes, are pre-emptive in promoting healthier workplaces, and there is preliminary evidence for positive effects of some WHP programmes.
  • Training and awareness-raising should be provided for both managers and employees so that they can have a better understanding of mental health in the workplace.
  • Line managers need to monitor the level of job strain and have regular and frank discussions with employees to ensure they are not suffering unnecessary stress. Managers should lead by example.

The relatively new interest in presenteeism reflects a growing interest in supporting wellbeing rather than simply controlling absence. Research tends to show that context is highly relevant when assessing both the causes and impact of presenteeism. Bespoke studies are therefore likely to be more important in the future as organisations tackle the important area of raising productivity.

For employees, this increased awareness offers the possibility of greater support when they might prefer to be with colleagues at work but reassurance that when they need to be absent they are not under undue scrutiny. For the wider economy it offers the possibility of greater productivity and a reduction in sickness benefits as organisations foster positive presenteeism alongside positive absenteeism.

The report

Presenteeism report

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Baker-McClearn D, Greasley K, Dale J, Griffith F (2010), ‘Absence management and presenteeism: the pressures on employees to attend work and the impact of attendance on performance’, Human Resource Management Journal, Vol. 20, No. 3

Hansen C D, Andersen J D (2008), ‘Going ill to work – what personal circumstances, attitudes and work-related factors are associated with sickness presenteeism?’, Social Science and Medicine, Vol. 67, pp. 956–964

Johns G (2010), ‘Presenteeism in the workplace: a review and research agenda’, Journal of Organizational Behavior, Vol. 31, No. 4

Rosvold E O, Bjertness E (2001), ‘Physicians who do not take sick leave: hazardous heroes?’ Scandinavian Journal of Public Health, Vol. 29, pp. 71–75