Presenteeism at the workplace

Determinants of presenteeism

In order to get a basic understanding of the presenteeism phenomenon, some studies have asked workers to explain their decision to work despite being sick. In a study for Canada, workload and deadlines as well as professionalism and guilt were the most frequent reasons given by respondents to explain their presenteeism [5]. Workers stated that their work would accumulate if they were absent, that they could not be replaced by a colleague, or that they felt guilty toward their colleagues and superiors when not coming to work. Other reasons that seem to play a certain role include a sense of commitment toward the organization or to the job per se and interest in and pleasure derived from work [11].

When looking at multivariate empirical analyses of the correlates of presenteeism, it is possible to distinguish between two groups of determinants already mentioned above: person-related factors and context- or work-related factors [2]. Starting with person-related factors, individuals’ health status has been found to be a prominent correlate of presenteeism in many studies [4], [5], [6], [8]. A meta-analysis of extant research based on more than 100 samples and nearly 176,000 participants shows that presenteeism is negatively correlated with health, that is, people in poorer health are more likely to work when ill or record more presenteeism days [11]. One purely statistical reason for this association could be that being sick is a necessary condition for exhibiting presenteeism. But, the negative relationship identified in cross-sectional studies could also reflect reverse causality, in that going to work when sick exacerbates existing health problems.

Admittedly, presenteeism is not fully determined by individuals’ medical condition, but is also associated with further personal characteristics and work features. According to the meta-analysis mentioned above, individuals’ job attitudes, including organizational commitment, work engagement, and higher levels of job satisfaction, are associated with a greater probability of showing presenteeism [11]. Personal resources like optimism also correlate with presenteeism, whereas there is conflicting evidence on the role that job control (i.e. the ability to influence what happens on the job) and work autonomy play [4], [11]. Presenteeism is further related to some sociodemographic variables like sex, age, education, occupation, and household context [4], [7], [8], [11].

Looking at gender differences, Figure 2 indicates that in most EU countries women report more often than men that they work while being sick. This difference between the sexes also holds in many (but not all) multivariate studies that control for additional correlates of presenteeism besides sex [4], [6]. A compelling explanation for the different presenteeism behavior of men and women is currently lacking.

Context- and work-related factors that were found to correlate with presenteeism in the meta-analysis mentioned above comprise elevated job demands, experienced stress, and constraints on absence from work [11]. Job demands include physical, social, and organizational work features that require mental or physical effort. They include a higher workload and understaffing, which are usually associated with more presenteeism [4], [5], [11]. The same applies for higher levels of time demands reflected by overtime work, long work hours, and time pressure [4], [6], [7], [8], [11]. Elevated job demands elicit presenteeism via two paths: by impairing workers’ health and by affecting their intrinsic motivation and job attitudes [11]. In a similar way, working when sick also relates positively to the emotional exhaustion dimension of burnout and to workers’ felt stress [6], [11].

Individuals are more inclined to come to work when sick if they are supervisors [4], [11], whereas presenteeism is somewhat lower if absent workers are easy to replace [8], [11]. Whether it is workers with permanent or temporary contracts who more often work while sick is an open question—the empirical evidence is inconclusive [4], [7], [11]. Interestingly, the size of the firm or organizational unit does not seem to make a difference for presenteeism [4], [7], [11], but if firms apply stricter absence policies like monitoring attendance and punishing absence, this is associated with higher presenteeism [11].

The latter result points to the substitution hypothesis, which states that if the absence option in response to sickness is restricted, more workers will come to work despite being ill, in such a way substituting presenteeism for absenteeism [11]. At the level of an individual worker, a mutual influence of presenteeism and absenteeism seems obvious since both are the outcome of a single decision which rules out the alternative, so that they should be negatively correlated [2], [8], [11]. In a between-person sense, however, individuals who are in poorer health can be expected to show both higher absenteeism and presenteeism. Consequently, the meta-analysis mentioned previously reports a positive correlation between both sickness states [11].

Strangely enough, apart from absence policies, the relevance of incentives for presenteeism behavior (which play a major role in theoretical research) remains under-researched in empirical work. Therefore, how to best incentivize people so that presenteeism approaches the optimum requires further research.

Effects of presenteeism

Going to work when sick can have various positive and negative effects and consequences, not only for individuals but also for co-workers, firms, and society. The literature has put a major focus on the negative productivity effects of presenteeism (see [2], [11], and the studies cited therein). Sickness may affect both the quantity and quality of work. Sick people who come to work probably work more slowly than usual, they have to repeat tasks or make more mistakes, and they are more likely to have accidents. The resulting consequences for firms include needing to correct defect products, having to address customer complaints, and experiencing a poor organizational image. According to managers surveyed in the US, the productivity impacts and costs to firms of presenteeism (as well as absenteeism) are particularly high in jobs with a large amount of team production, high requirements for timely delivered output, and substantial difficulties substituting for absent workers [12]. Although these problems suggest that the performance of workers and thus the productivity of the firm will be lower compared to the situation in which workers are healthy, firm productivity may still be higher than if sick workers stay at home. Interestingly, most of these effects have not been examined in rigorous and encompassing studies, and it is still unknown whether presenteeism is really more costly than sickness-related absenteeism, as is assumed by some authors [1].

In addition to the direct productivity effects, there are several undesirable side effects of presenteeism at the workplace [3], [4], [7]. A major problem can be that workers spread infectious diseases to co-workers if they show up at work despite being sick, with further negative consequences for firm productivity. Moreover, going to work when ill may exacerbate individuals’ bad health status and can result in long-term health problems. A review of 12 quantitative studies for different countries shows that going to work ill is associated with a higher risk of future sickness absence and decreased self-reported health [13]. If workers’ health deteriorates over the long term or they become more likely to draw a disability pension, this entails costs that must be carried by society.

It should not be overlooked, however, that presenteeism can also offer some benefits to people who work through sickness and to their co-workers [2], [3], [11]. For some individuals, such as self-employed workers and those on zero-hour contracts, presenteeism is a means of reducing financial losses that would arise from being absent from work. Working during a case of a (noncontagious) illness also signals workers’ commitment and may improve their career prospects. As a result, they can acquire a favorable reputation for being tough and get a boost in their self-esteem. Despite reduced productivity, individuals who work when sick help their firms avoid the costs of replacement workers and reduce the burden on those colleagues who would have to take over their workload when absent. This may boost camaraderie and generate approval from managers and colleagues.

To a certain extent, presenteeism can even be beneficial for workers’ health [3]. In some cases, and only if the type of sickness and the demands of the job allow, working when sick may boost the recovery and the rehabilitation of the employee. Since not many health conditions are so debilitating that they bar any engagement with work, keeping engaged with work during sickness can facilitate the return to work after long-term sickness. This rationale is also behind return-to-work programs, where workers gradually take over their work obligations once their illness is largely overcome. Finally, presenteeism may be sensible since work can be meaningful in a number of ways and is good for health and well-being.

How to address presenteeism

As presenteeism can have both detrimental and beneficial effects for workers, firms, and society, the question is not how can this behavior be eradicated or fostered, respectively, but how can an optimal level of presenteeism be reached? In doing so, relevant actors should take a long-term perspective and develop a comprehensive framework for addressing both absenteeism and presenteeism. Here, the short-term costs of sickness absence and the long-term risks of presenteeism should be balanced. Interestingly, some studies imply that presenteeism may be more controllable than absenteeism and also more sensitive to human resources policies [11]. This insight underscores that the mechanisms of presenteeism cannot be simply understood by using results from the literature on sickness absenteeism.

In order to get a better understanding of their workers’ health status and their absence and attendance behavior, firms can conduct regular well-being surveys. These surveys and internal health audits help to identify and eliminate risk factors for presenteeism. Management policies to address presenteeism should take account of the variation in this behavior, which implies that different groups of workers may respond differently to various measures. Management also should be aware that presenteeism does not disappear when more and more people work from home (as in the Covid-19 lockdowns), but may transform into a kind of virtual presenteeism that also needs to be addressed. If workers somehow feel invisible and are less inclined to report sick when doing remote work, then the health status of the workforce may be worse than reported.

Employers who want to prevent or contain presenteeism should offer healthy working conditions, a good working environment, and well-defined jobs that optimize the level of demands to which workers are exposed. This includes reducing excessive workloads, overtime work, and time pressure for individuals to a manageable amount [11]. Line managers have a role in supporting workers with health problems, and—if possible and sensible—they should help them to carry on with their responsibilities [3]. Workers should be offered health promotion programs that include measures for reducing stress as well as information about the negative effects of presenteeism. Finally, firms should review their absence policies, since very restrictive policies are associated with higher presenteeism [11]. In particular, financial incentives such as bonuses for workers who are never absent (or the lack of sick pay in many US firms) are a double-edged sword since by stimulating presenteeism in the short term, they may increase sickness absence and disability in the long term.