Presenteeism: Physical presence and psychological absence combined

Sickness at work
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Presenteeism has been described as extremely costly, in monetary, health, and performance terms. In monetary terms, presenteeism can cost businesses up to three times as much as absenteeism. In health terms, presenteeism can lead to long-term health consequences, sickness absenteeism, contamination among colleagues, and increased future incidence of coronary heart disease. In performance terms, working at a reduced capacity due to illness means that employees are not as effective as they could be.

There is an allure around presenteeism that implies a strong work ethic, a dismissive attitude to being sick, or simply a strong drive to achieve. Indeed, presenteeism can be tempting for a number of reasons. Employees may show what is referred to as ‘face time’ in order to gain esteem from colleagues and managers. Presenteeism may also prevent an accumulation of workload and a disruption in workflow. Businesses too may prefer employers to be present and underperforming than absent and not performing at all.

But evidence that comes from rigorous prospective studies is consistent in the conclusion that in the longer term presenteeism can only be deleterious to health. For example, presenteeism is strongly linked to future sickness absence of over 2 weeks’ duration and with spells lasting over two months. Because presenteeism has also been associated with the spread of infectious disease, some have described it as a public health hazard.

Presenteeism as psychological absence

There are two approaches to presenteeism. The dominant UK/EU view is that of presenteeism as a health impairment (showing up for work when you are too sick to work and should otherwise be recovering), whereas the dominant US definition focuses on presenteeism as productivity loss due to illness. However, productivity loss is an outcome of presenteeism rather than presenteeism itself and causes should not be confused with their effects.

An alternative is to define presenteeism as being physically present but psychologically absent. It is the effort to remain psychologically present at work (despite illness limiting work capacity) that can impact on performance and a range of work-related outcomes. In other words, ‘the lights are on but there is nobody in’. Of course, performing work mindlessly may be possible for some minor tasks, but it depletes the capacity and attention necessary to carry out a job well, which can accumulate in the longer term.

Presenteeism impacts on work outcomes

We adopted this view in a recent study of office workers, and looked at the effects of presenteeism on a range of work outcomes (job satisfaction, work engagement, and addiction to work). We found that presenteeism is negatively linked to job satisfaction. The effort to remain psychologically present despite illness can impact on how we view our jobs.

We also found that presenteeism is negatively linked to work engagement. Presentees do not engage with work as they would if working at full capacity. In addition, we found that presenteeism can fuel addiction to work. The effort to remain psychologically present and productive can be linked to tendencies to work excessively and compulsively, both of which are characteristics of addiction to work.

This new evidence is important as it moves away the focus from financial costs, health, and performance, and shows that presenteeism can reduce job satisfaction, block work engagement, and potentially encourage work addiction tendencies.

Although the study was based on a small number of participants, the statistical results were strong and provided good evidence for the effects of presenteeism on a range of outcomes not examined in tandem before.

So what do we know about the management of presenteeism?

Finding ways to manage presenteeism is paramount. Unfortunately, we do not know yet what may work in practice. Despite substantial research on the costs of presenteeism, possible benefits, and harm to health, we still know little about the factors that lead to presenteeism or about its outcomes that can be reasonably put into practice.

Intervention studies aimed at reducing presenteeism have found that offering health and wellness programs does not impact on the prevalence of presenteeism. To complicate things, there are a number of parameters to consider, including severity of the illness and its prognosis, the individual’s fitness for work, temporary replaceability of the role, and the resources available in the workplace to facilitate return to work.

We have all been and will be presentees at various points in our working lives. Wanting to do well and to continue with normal life and work despite the disruption of illness is natural. Indeed, carrying on despite illness can be viewed as a sign of resilience and – if managed well – encourage positive adjustment and return to work. But not allowing oneself to recover can have its costs too. We can probably tolerate a small degree of presenteeism but we ought to be aware of the knock-on effects that it can have on a range of other work-related outcomes.

The results of this study are presented in: Karanika-Murray, M., Pontes, H., Griffiths, M., & Biron, C. (2015). Sickness presenteeism determines job satisfaction via affective-motivational states. Social Science & Medicine, 139, 100-106. doi: 10.1016/j.socscimed.2015.06.035 

About Maria Karanika-Murray

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07th Mar 2016 14:52

It's good to see the subject of presenteeism being discussed, especially at this time of year when many people are sick.

I'm no expert but from my own recent experience (have been battling a cold and all sorts of things for nearly 3 weeks), I can say that what helps to manage presenteeism is having a company culture which supports (and encourages!) people to stay at home, or even work from home, if they are unwell.

Luckily at my work I feel supported in being able to say - "I'm going to WFH today". Granted I haven't been doing this the whole time I've been unwell, only on days when I felt particularly bad. But there were probably additional days I should have just stayed at home, mainly to prevent the spread of germs. When I didn't it was because of something like a meeting I didn't want to miss or because for me to work at home, I need to have taken my work laptop home.

Combating presenteeism is a two-way street, companies need to empower and encourage employees to take time off/WFH when they are unwell, and individuals need to be brave and take advantage of those opportunities and not see it as a weakness.

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