Absenteeism from work costs €1.5bn a year in Ireland, but presenteeism (going to work when you are too ill to perform) costs multiple times more in lost productivity, says Isobel Butler.
A lesser known workplace problem than its cousin, absenteeism, presenteeism is turning up for work when you’re not feeling well, or are unable to work. It is a growing problem, but harder to identify. Presenteeism is also costly, and damages productivity and morale.
With presenteeism, employees are at work, but unable to function at their full capacity, due to illness, stress, emotional, or family circumstances, or ongoing medical conditions.
Presenteeism’s ‘invisibility’ makes it challenging to measure, and to manage. There is a danger in assuming that just because people are at work everything is well. Being at work, despite illness, pain, or depression reduces productivity by as much as a third.
Questionnaires measuring employees’ perceptions of their lost productivity when they come to work unwell produce results that strongly correlate with objective measures of productivity. This includes employee output and line-manager ratings. Presenteeism may be responsible for 81% of all productivity losses.
A 2016 global study on depression and presenteeism found that the link between the two was five to 10 times costlier than between depression and absenteeism. With some estimates claiming that absenteeism costs Irish business €1.5bn a year, presenteeism needs to be taken seriously.
There is also a public health hazard associated with presenteeism and illness, such as influenza and norovirus (the winter-vomiting bug): Employees can be a source of disease transmission in the workplace.
Presenteeism is high amongst healthcare workers — one UK study found 87% of GPs and 58% of hospital consultants said they would ‘definitely not’ take a day off, if they had the symptoms of a severe cold, compared to 32% of those who work in offices.
A Norwegian study of 1,000 physicians found that 80% attended work despite being unwell with an illness that would require their patients to stay at home. Two-thirds of these were contagious illnesses.
A study that investigated an outbreak of gastroenteritis in a nursing home found that 94% of the employees went to work despite their illness.
Cause and effect
Job and financial insecurity are big predictors of presenteeism. Frequently, people come to work ill because they cannot afford to take the day off. Other contributing factors include heavy workload and the knowledge that more work awaits when they return.
Concern for colleagues and feeling pressurised ‘not let the team down’ are also factors, as is the absence of a back-up plan or someone to take over while an employee recovers.
The stigma associated with mental health can also contribute to employees being afraid to admit to illness. Presenteeism is higher amongst people who have sought counselling and psychological help compared to those who have been treated for a cardiac condition. While people find it more acceptable to take time to recover after a heart problem, they are less confident of taking the appropriate time if they’re recovering from emotional and stress-related issues.
The challenge is to create a culture in which employees are not penalised for admitting to health or personal problems that might affect their performance. People need to feel they can approach co-workers, managers, or HR departments, knowing that support and help will be available.
Employers should recognise and understand the problem in their workplace, and make people aware of the impact of presenteeism.
Survey employees to establish their views and to identify problems. A number of accessible, validated scales can be included in an employee survey, such as the health and work-performance questionnaire , the work limitations questionnaire, or the ‘Stanford presenteeism scale’.
Develop policies on absenteeism and presenteeism and inform everybody about them.
Absenteeism programmes need to work towards reducing ‘unnecessary absenteeism’ without contributing to increasing presenteeism.
Ensure managers are aware of how to prevent presenteeism and have the skills to deal with it. Good communication skills are essential for facilitating an open and supportive working environment, where employees feel comfortable to discuss issues. Effective workload and deadline management are essential to prevent presenteeism and work-related stress.
Managers need training to be able to recognise signs of illness or stress and to know how to support employees in this position.
Well-designed employee assistance and wellbeing programmes can have far-reaching effects, beyond simply reducing presenteeism. Health-risk assessment can uncover hidden illness, ensuring employees get early access to treatment.
Flu vaccination reduces both absenteeism and presenteeism, with savings outweighing costs.
Providing information on mental health, and on activities to reduce stress levels and develop coping skills, fosters positive mental health and reduces the stigma around it.
Offering counselling to employees and their families provides specialised support and sends the message that there is help available.
Wellness programmes focused on promoting good nutrition, exercise, smoking cessation, and resilience can decrease both absenteeism and presenteeism, as well as boosting morale and improving general health, whilst reducing indirect costs.
Isobel Butler is an independent organisational psychologist, who works with people on workplace issues. This article first appeared in Impact trade union’s Work&Life magazine
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