Presenteeism
Encyclopedia
Presenteeism is the act of attending work while sick. A topic that is at times considered its opposite, absenteeism
, has historically received extensive attention in the management sciences, but presenteeism has only recently found a place in the research literature. Management researchers in Europe, such as Simpson (1998), were some of the first to explore this topic, but those in epidemiology and other health related fields have also examined the effects of this behavior.
. In other words, when defined as coming to work while sick, presenteeism seems to relate more to logical outcome variables and correlates (Johns, 2010).
While the construct is often cited as coming to work while sick, Johns (2010) further noted that the definitions do not assign any motives to presenteeism. An employee, therefore, may come to work because he or she simply needs the money and cannot afford to take time off due to illness. Additionally, one could go to work due to a love and devotion to the job. In this case, presenteeism could be considered an act of organizational citizenship and inspire admiration from collogues (Johns, 2010). Therefore, simply viewing presenteeism as a negative act that leads to productivity loss and decreased health may be restricting potential analysis of the construct (Johns, 2010).
, which is the tendency not to show up for scheduled work (Johns, 2010). Furthermore, Johns (2010) described the notion that some believe that factors that reduce absenteeism
will increase presenteeism. He stated, however, that this is plausible but not always the case because he pointed out that Aronsson et al. (2000) found high rates of presenteeism in industries where absenteeism was also high.
Additionally, research that examines absenteeism is at times used to draw conclusions about presenteeism. For example, Virtanen, Kivimaki, Elovainio, Vahtera, and Ferrie (2003) found that employees exhibited much higher rates of absenteeism once they became permanent workers. The authors thought that this increase could have been due to decreases in the preexisting levels of presenteeism. However, they did not directly measure presenteeism. Commenting on such research behavior, Johns (2010) said in his review of the literature that researchers should not infer presenteeism from absenteeism data. Instead, the author noted that both constructs should be measured at the same time.
are often considered when examining the antecedents of presenteeism. More specifically, researchers have studied these positions with the thought that job insecurity (job security
) will cause those who do not have permanent positions to come to work more often even if they are sick (Johns, 2010). This hypothesis, however, has not received complete support. Aronson et al. (2000) discovered that permanent employees were more prone to presenteeism than those in more seasonal positions. In contrast, Aronnson and Gustafson (2005) found no effect of job type. Furthermore, Heponiemi et al. (2010) found that fixed-term employees as opposed to permanent employees were less likely to report working while ill, and the work of Bockerman and Laukkanen (2010) supported this finding. Based on these inconclusive results, Johns (2010) noted that researchers had to reconsider the job insecurity hypothesis.
, saw increased levels of presenteeism.
Certain work environments may stimulate presenteeism. To explore this topic, Dew, Keefe, and Small (2005) qualitatively examined a private hospital, a large public hospital, and a small factory. In the private hospital, there was little pressure from management to exhibit presenteeism; however, a sense of family seemed to exist between the staff, and a strong loyalty to coworkers pushed employees to come to work while unhealthy. The public hospital had a distant management, but presenteeism was fostered by “ loyalty to professional image, colleagues, and the institution as a whole” (p. 2279). Finally, in the factory, there was strong pressure from management for employees to exhibit presenteeism. Furthermore, workers often had few other employment options, which often resulted in increased presenteeism.
.
) and many demands are often associated with higher levels of presenteeism. Caverely, Cunningham, and Macgregor (2007) studied Canadian firms and noted that presenteeism was often not the result of job insecurity. Instead individuals felt they had to come to work while ill or injured because they believed they had high workloads, many deadlines, and often very little backup support. Complementing this finding, McKevitt et al. (1997) also found that individuals feared their work would pile up if they did not go to their job. Moreover, Demerouti, Le Blanc, Bakker, Schaufeli, and Hox (2009) examined job demands and found that they had a positive relationship with presenteeism. In the case of this study, the authors defined job demands as aspects of the job that require physical and/or psychological effort.
) tend to demonstrate higher levels of presenteeism. As defined by Schaufeli, Bakker, van der Heijden, and Prins (2009), workaholics tend to work excessively and compulsively, and they are internally motivated to work to an excessive extent. In addition to their high levels of presenteeism, Schaufeli et al. (2009) discovered that workaholics also displayed the highest burnout and lowest happiness levels relative to other groups who were not defined as workaholics.
(PBSE) has also been considered another antecedent of presenteeism. This term describes the idea that individuals’ self esteem may depend on their performance (Love, Grimby-Ekman, Eklof, Hagberg, & Dellve, 2010). Employees who demonstrate high levels of this construct have to prove their worth while on the job. Love et al. (2010) found that PBSE positively predicted presenteeism; however, the authors also discovered that the relationship between PBSE and presenteeism was strengthened when workers experienced high physical and psychological work demands. This finding suggested that demanding work environments could interact with employees’ overambitious work styles, which could result in over performance and increased levels of presenteeism (Love et al., 2010).
as opposed to those without the condition. Individuals who partook in no physical activity were more prone to report higher levels of both absenteeism and presenteeism compared to those who took part in some physical activity.
loss, and scholars have attempted to estimate these productivity numbers. While examining productivity decrements, however, it is implied that losses are measured relative to not having a particular sickness or health issue (Johns, 2010). Furthermore, in comparison to being absent from a job, those exhibiting presenteeism may be far more productive. Nonetheless, a large study by Goetzel et al. (2004) estimated that on average in the United States, an employee’s presenteeism costs or lost on-the-job productivity are approximately $255. Furthermore, the authors concluded that of all the health related costs faced by employers, one fifth to three fifths of those expenses could be attributable to on-the-job productivity losses. Complimenting that study, Schultz and Edington (2007) provided a detailed review of the effects of certain health conditions on productivity. These authors examined conditions such as allergies, arthritis, chronic pain, diabetes, and mental health disorders. The studies in the review showed, for example, that increases in pollen are associated with decreased performance (Burton, Conti, Chen, Schultz, & Edington, 2001). Moreover, Schultz and Edington (2007) noted that chronic pain had to be studied more thoroughly to better understand its effects on productivity.
. Furthermore, in their study of job demands and presenteeism, Demerouti et al. (2009) found that presenteeism resulted in increased exhaustion.
Aside from measuring the frequency of presenteeism, scholars often look to measure the effects of poor health on job productivity. The Work Limitations Questionnaire (WLQ) (Lerner et al. 2001) is often used to perform this task. With 25 items, it examines the extent to which respondents can handle time, physical, mental-interpersonal, and output demands. Additionally, The Stanford Presenteeism Scale (Koopman et al., 2002) seeks to determine the effects of health on productivity. It measures participants’ abilities to concentrate and perform work despite having a primary health problem. Using six items, respondents determine the extent to which they agree with statements that describe how their health condition may or may not affect their work. The scale measures two factors that the authors labeled as completing work and avoiding distraction. Finally, another measure often used is the World Health Organization Health and Work Performance Questionnaire (HPQ) (Kessler et al., 2003). This self-report measure acquires information about respondents’ health conditions and has them provide perceptions of their job performance. The WLQ and HPQ have become the two most popular instruments (Schultz & Edington, 2007); however, one can access more thorough reviews of instruments that have been created to estimate the effects of health on productivity (e.g., Lofland, Pizza, & Frick, 2004).
In the United States
, one other proposed response has been to require that paid sick and family leave be provided to all workers. In November 2006, San Francisco became the first jurisdiction to pass such a law.
Absenteeism
Absenteeism is a habitual pattern of absence from a duty or obligation. Traditionally, absenteeism has been viewed as an indicator of poor individual performance, as well as a breach of an implicit contract between employee and employer; it was seen as a management problem, and framed in economic...
, has historically received extensive attention in the management sciences, but presenteeism has only recently found a place in the research literature. Management researchers in Europe, such as Simpson (1998), were some of the first to explore this topic, but those in epidemiology and other health related fields have also examined the effects of this behavior.
Definitions
While presenteeism is often defined as attending work while sick, scholars have provided various other descriptions of the concept. For instance, Simpson (1998) claimed that presenteeism is “the tendency to stay at work beyond the time needed for effective performance on the job” (s37). Aronsson, Gustafsson, and Dallner (2000) wrote that it means attending work even when one feels unhealthy. In a recent review of the literature, Johns (2010) highlighted the lack of agreement between the many definitions. The author claimed that many of the definitions lack utility and that the term is most often defined as going to work while ill. He further noted that definitions of presenteeism, which are centered on attending work while sick, have received more evidence of construct validityConstruct validity
In science , construct validity refers to whether a scale measures or correlates with the theorized psychological scientific construct that it purports to measure. In other words, it is the extent to which what was to be measured was actually measured...
. In other words, when defined as coming to work while sick, presenteeism seems to relate more to logical outcome variables and correlates (Johns, 2010).
While the construct is often cited as coming to work while sick, Johns (2010) further noted that the definitions do not assign any motives to presenteeism. An employee, therefore, may come to work because he or she simply needs the money and cannot afford to take time off due to illness. Additionally, one could go to work due to a love and devotion to the job. In this case, presenteeism could be considered an act of organizational citizenship and inspire admiration from collogues (Johns, 2010). Therefore, simply viewing presenteeism as a negative act that leads to productivity loss and decreased health may be restricting potential analysis of the construct (Johns, 2010).
Relationship with Absenteeism
In some cases, scholars relate presenteeism to absenteeismAbsenteeism
Absenteeism is a habitual pattern of absence from a duty or obligation. Traditionally, absenteeism has been viewed as an indicator of poor individual performance, as well as a breach of an implicit contract between employee and employer; it was seen as a management problem, and framed in economic...
, which is the tendency not to show up for scheduled work (Johns, 2010). Furthermore, Johns (2010) described the notion that some believe that factors that reduce absenteeism
Absenteeism
Absenteeism is a habitual pattern of absence from a duty or obligation. Traditionally, absenteeism has been viewed as an indicator of poor individual performance, as well as a breach of an implicit contract between employee and employer; it was seen as a management problem, and framed in economic...
will increase presenteeism. He stated, however, that this is plausible but not always the case because he pointed out that Aronsson et al. (2000) found high rates of presenteeism in industries where absenteeism was also high.
Additionally, research that examines absenteeism is at times used to draw conclusions about presenteeism. For example, Virtanen, Kivimaki, Elovainio, Vahtera, and Ferrie (2003) found that employees exhibited much higher rates of absenteeism once they became permanent workers. The authors thought that this increase could have been due to decreases in the preexisting levels of presenteeism. However, they did not directly measure presenteeism. Commenting on such research behavior, Johns (2010) said in his review of the literature that researchers should not infer presenteeism from absenteeism data. Instead, the author noted that both constructs should be measured at the same time.
Temporary and Permanent Employment
Temporary and permanent employmentPermanent Employment
Permanent employees or regular employees work for a single employer and are paid directly by that employer. In addition to their wages, they often receive benefits like subsidized health care, paid vacations, holidays, sick time, or contributions to a retirement plan. Permanent employees are often...
are often considered when examining the antecedents of presenteeism. More specifically, researchers have studied these positions with the thought that job insecurity (job security
Job security
Job security is the probability that an individual will keep his or her job; a job with a high level of job security is such that a person with the job would have a small chance of becoming unemployed.-Factors affecting job security:...
) will cause those who do not have permanent positions to come to work more often even if they are sick (Johns, 2010). This hypothesis, however, has not received complete support. Aronson et al. (2000) discovered that permanent employees were more prone to presenteeism than those in more seasonal positions. In contrast, Aronnson and Gustafson (2005) found no effect of job type. Furthermore, Heponiemi et al. (2010) found that fixed-term employees as opposed to permanent employees were less likely to report working while ill, and the work of Bockerman and Laukkanen (2010) supported this finding. Based on these inconclusive results, Johns (2010) noted that researchers had to reconsider the job insecurity hypothesis.
Occupations and Work Environments
Individuals working in certain occupations may be more prone to presenteeism. In a study in Sweden, Aronsson et al. (2000) found that those offering welfare and teaching services demonstrated higher rates of presenteeism. The authors pointed out that these employees often worked with those in more vulnerable populations such as the elderly. Outside of education and healthcare, most of the occupations had lower rates of presenteeism; however, the results did suggest that higher risks jobs, which had more physical workload and stressStress (biology)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...
, saw increased levels of presenteeism.
Certain work environments may stimulate presenteeism. To explore this topic, Dew, Keefe, and Small (2005) qualitatively examined a private hospital, a large public hospital, and a small factory. In the private hospital, there was little pressure from management to exhibit presenteeism; however, a sense of family seemed to exist between the staff, and a strong loyalty to coworkers pushed employees to come to work while unhealthy. The public hospital had a distant management, but presenteeism was fostered by “ loyalty to professional image, colleagues, and the institution as a whole” (p. 2279). Finally, in the factory, there was strong pressure from management for employees to exhibit presenteeism. Furthermore, workers often had few other employment options, which often resulted in increased presenteeism.
Ease of Replacement
The ease with which one can be replaced on the job also affects levels of presenteeism. Specifically, if one feels that he or she cannot be replaced, that individual is more prone to attend work while sick (Aronsson & Gustafson, 2005; Bockerman & Laukkanen, 2010). Doctors are often examined in this regard. For example, Jena et al. (2010) studied residents in training and noted high rates of presenteeism, which they concluded were the result of feeling irreplaceable. Further extending the examination of the medical field, McKevitt, Morgan, Dundas, and Holland (1997) studied hundreds of healthcare professionals and found that more than 80 percent of respondents had worked while ill. Individuals listed some of the reasons they had not taken sick days, and many cited the fact that they felt large pressure to work. In some cases, general practitioners did not want to burden their partners, and many felt a strong commitment to the job that prevented them from taking sick leaveSick leave
Sick leave is time off from work that workers can use during periods of temporary illness to stay home and address their health and safety needs without losing pay. Some workplaces offer paid sick time as a matter of workplace policy, and in few jurisdictions it is codified into law...
.
Workloads and Job Demands
Jobs that have large workloads (workloadWorkload
-An amount of labor:While a precise definition of a workload is elusive, a commonly accepted definition is the hypothetical relationship between a group or individual human operator and task demands....
) and many demands are often associated with higher levels of presenteeism. Caverely, Cunningham, and Macgregor (2007) studied Canadian firms and noted that presenteeism was often not the result of job insecurity. Instead individuals felt they had to come to work while ill or injured because they believed they had high workloads, many deadlines, and often very little backup support. Complementing this finding, McKevitt et al. (1997) also found that individuals feared their work would pile up if they did not go to their job. Moreover, Demerouti, Le Blanc, Bakker, Schaufeli, and Hox (2009) examined job demands and found that they had a positive relationship with presenteeism. In the case of this study, the authors defined job demands as aspects of the job that require physical and/or psychological effort.
Workaholism
Those who exhibit workaholism (workaholicWorkaholic
A workaholic is a person who is addicted to work.The term generally implies that the person enjoys their work; it can also imply that they simply feel compelled to do it...
) tend to demonstrate higher levels of presenteeism. As defined by Schaufeli, Bakker, van der Heijden, and Prins (2009), workaholics tend to work excessively and compulsively, and they are internally motivated to work to an excessive extent. In addition to their high levels of presenteeism, Schaufeli et al. (2009) discovered that workaholics also displayed the highest burnout and lowest happiness levels relative to other groups who were not defined as workaholics.
Performance Based Self-Esteem
Performance based self-esteemSelf-esteem
Self-esteem is a term in psychology to reflect a person's overall evaluation or appraisal of his or her own worth. Self-esteem encompasses beliefs and emotions such as triumph, despair, pride and shame: some would distinguish how 'the self-concept is what we think about the self; self-esteem, the...
(PBSE) has also been considered another antecedent of presenteeism. This term describes the idea that individuals’ self esteem may depend on their performance (Love, Grimby-Ekman, Eklof, Hagberg, & Dellve, 2010). Employees who demonstrate high levels of this construct have to prove their worth while on the job. Love et al. (2010) found that PBSE positively predicted presenteeism; however, the authors also discovered that the relationship between PBSE and presenteeism was strengthened when workers experienced high physical and psychological work demands. This finding suggested that demanding work environments could interact with employees’ overambitious work styles, which could result in over performance and increased levels of presenteeism (Love et al., 2010).
Health Factors
Certain health factors serve as risk factors for presenteeism as opposed to absenteeism. Boles, Pelletier, and Lynch (2004) examined a variety of emotional and physical health symptoms and noted that the odds of reporting presenteeism were largest for those with high stress compared to those without stress. Those with poor diet and less emotional fulfillment also reported higher levels of presenteeism than those without these conditions. The researchers noted that individuals with diabetes tended to report higher levels of absenteeismAbsenteeism
Absenteeism is a habitual pattern of absence from a duty or obligation. Traditionally, absenteeism has been viewed as an indicator of poor individual performance, as well as a breach of an implicit contract between employee and employer; it was seen as a management problem, and framed in economic...
as opposed to those without the condition. Individuals who partook in no physical activity were more prone to report higher levels of both absenteeism and presenteeism compared to those who took part in some physical activity.
Productivity Loss
One central consequent of presenteeism is productivityProductivity
Productivity is a measure of the efficiency of production. Productivity is a ratio of what is produced to what is required to produce it. Usually this ratio is in the form of an average, expressing the total output divided by the total input...
loss, and scholars have attempted to estimate these productivity numbers. While examining productivity decrements, however, it is implied that losses are measured relative to not having a particular sickness or health issue (Johns, 2010). Furthermore, in comparison to being absent from a job, those exhibiting presenteeism may be far more productive. Nonetheless, a large study by Goetzel et al. (2004) estimated that on average in the United States, an employee’s presenteeism costs or lost on-the-job productivity are approximately $255. Furthermore, the authors concluded that of all the health related costs faced by employers, one fifth to three fifths of those expenses could be attributable to on-the-job productivity losses. Complimenting that study, Schultz and Edington (2007) provided a detailed review of the effects of certain health conditions on productivity. These authors examined conditions such as allergies, arthritis, chronic pain, diabetes, and mental health disorders. The studies in the review showed, for example, that increases in pollen are associated with decreased performance (Burton, Conti, Chen, Schultz, & Edington, 2001). Moreover, Schultz and Edington (2007) noted that chronic pain had to be studied more thoroughly to better understand its effects on productivity.
Poor Health and Exhaustion
Exhaustion and future poor health are often other consequents of presenteeism. For example, Bergstrom, Bodin, Hagberg, Aronsson, and Josephson (2009) found that sickness presenteeism was a risk factor for future sick leaveSick leave
Sick leave is time off from work that workers can use during periods of temporary illness to stay home and address their health and safety needs without losing pay. Some workplaces offer paid sick time as a matter of workplace policy, and in few jurisdictions it is codified into law...
. Furthermore, in their study of job demands and presenteeism, Demerouti et al. (2009) found that presenteeism resulted in increased exhaustion.
Measurement of Presenteeism and Its Impact on Productivity
Scholars have often measured presenteeism in terms of how often an individual attends work while unhealthy. For instance, Aronsson et al. (2000) asked participants to what extent over they past year they had gone to work despite feeling they should have taken sick leave. Respondents could choose from never, once, between 2 and 5 times, and more than 5 times. Other researchers have examined the frequency of presenteeism by asking participants a similar question. The responses, however, were on a scale of “spells of one day presenteeism, spells of 2-4 day presenteeism, and spells of 5 day or more presenteeism” (Munir et al., 2007, p 264).Aside from measuring the frequency of presenteeism, scholars often look to measure the effects of poor health on job productivity. The Work Limitations Questionnaire (WLQ) (Lerner et al. 2001) is often used to perform this task. With 25 items, it examines the extent to which respondents can handle time, physical, mental-interpersonal, and output demands. Additionally, The Stanford Presenteeism Scale (Koopman et al., 2002) seeks to determine the effects of health on productivity. It measures participants’ abilities to concentrate and perform work despite having a primary health problem. Using six items, respondents determine the extent to which they agree with statements that describe how their health condition may or may not affect their work. The scale measures two factors that the authors labeled as completing work and avoiding distraction. Finally, another measure often used is the World Health Organization Health and Work Performance Questionnaire (HPQ) (Kessler et al., 2003). This self-report measure acquires information about respondents’ health conditions and has them provide perceptions of their job performance. The WLQ and HPQ have become the two most popular instruments (Schultz & Edington, 2007); however, one can access more thorough reviews of instruments that have been created to estimate the effects of health on productivity (e.g., Lofland, Pizza, & Frick, 2004).
Implications for Practice
Given the prominence and costs of presenteeism, scholars have suggested a variety of courses of action for employers. Companies should implement wellness programs for their employees aimed at increasing health and productivity. These organizations, however, must be aware that the effects of these programs may have an immediate impact on presenteeism as opposed to simply absenteeism. Firms must be cognizant of this fact when evaluating the effectiveness of their programs (Caverely et al., 2007). Complimenting this suggestion, Schultz and Edington (2007) wrote that employees must be educated effectively so they can better manage their health. They also commented that employers need to consider the health of workers who are low risk along with those who have high-risk health conditions.In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, one other proposed response has been to require that paid sick and family leave be provided to all workers. In November 2006, San Francisco became the first jurisdiction to pass such a law.
Future Directions and Research
While progress has been made in regards to understanding presenteeism, many possible topics of inquiry still remain. In his literature review, Johns (2010) said that presenteeism had to be related to other constructs such as work attitudes and personality. Additionally, lessons from absenteeism could be applied to presenteeism. For instance, absenteeism can be defined as voluntary and involuntary, and scholars could consider applying such ideas to presenteeism. Lastly, the construct could be related to other elements of the work. Specifically, how does presenteeism relate to telework? Is an individual who works from home while he or she is sick exhibiting presenteeism?See Also
- AbsenteeismAbsenteeismAbsenteeism is a habitual pattern of absence from a duty or obligation. Traditionally, absenteeism has been viewed as an indicator of poor individual performance, as well as a breach of an implicit contract between employee and employer; it was seen as a management problem, and framed in economic...
- Sick leaveSick leaveSick leave is time off from work that workers can use during periods of temporary illness to stay home and address their health and safety needs without losing pay. Some workplaces offer paid sick time as a matter of workplace policy, and in few jurisdictions it is codified into law...
- WorkaholicWorkaholicA workaholic is a person who is addicted to work.The term generally implies that the person enjoys their work; it can also imply that they simply feel compelled to do it...
- Construct ValidityConstruct validityIn science , construct validity refers to whether a scale measures or correlates with the theorized psychological scientific construct that it purports to measure. In other words, it is the extent to which what was to be measured was actually measured...
- Self-EsteemSelf-Esteem"Self Esteem" is a song by the American punk rock group The Offspring. It is the eighth track from their third studio album Smash and was released as the second single from the album. The song was a worldwide hit, reaching #1 in Latvia, Norway, and Sweden and was one of the most successful singles...
- WorkloadWorkload-An amount of labor:While a precise definition of a workload is elusive, a commonly accepted definition is the hypothetical relationship between a group or individual human operator and task demands....