6 June 2012

Presenteeism: To be or not to be… At Work

These days, absenteeism is one of the health indicators most frequently used by organizations (Johns, 2010; Ybema et al., 2010). Many companies have set up policies and programs to decrease absentee rates as far as possible. But at the same time, for several years now, another phenomenon apparently affecting organizational health and worker productivity has been on the rise in scientific and organizational domains: presenteeism.
This article will present the information gathered through a survey of scientific documentation on the subject. More specifically, we will provide a definition of presenteeism and review the frequency and scope of the behaviour, its personal and organizational impacts, and the costs of presenteeism. A follow-up article will cover the various personal and organizational factors that determine presenteeism, the theoretical models of presenteeism and absenteeism, as well as potential paths or solutions for companies to better manage this behaviour.
Definition of presenteeism
Presenteeism is defined as “the behaviour of workers who, despite physical and/or psychological health problems necessitating an absence from work, persist in coming in to work” (Gosselin & Lauzier, 2011, p. 17). And to fully grasp the meaning of presenteeism, it’s important to understand what presenteeism is not. In other words, presenteeism is not a matter of a lack of motivation, worker laziness or professional deviance (Hemp, 2004; Gosselin & Lauzier, 2011).  Contrary to what one might think, it’s not about employees going to work to handle their own personal affairs (e.g. to pay their bills or shop online) or taking extended breaks instead of working. Although these behaviours also affect employee productivity, the productivity losses associated with presenteeism are, instead, due specifically to physical or psychological health issues (e.g. attention problems, fatigue, motor impairment, anxiety, etc.).
Scope and frequency of presenteeism
In terms of its prevalence, presenteeism appears to be far more common than absenteeism. A study by Biron et al. (2006) reported that workers go to work one out of every two times they are sick. The study also showed that when employees are sick, they go to work more often (3.9 days/year) on average than they stay home (2.9 days/year).
Because presenteeism involves having a physical and/or psychological health problem, it should be noted that certain health problems seem to be more predominant in relation to this behaviour. First, people with symptoms of depression are believed to engage in presenteeism twice as often as other employees (Sanderson et al., 2007). This information is even more striking since estimates consider approximately 60% of people in the United States are at risk of suffering from a major depressive disorder over the course of their lives (Kessler et al., 2003). In a research project conducted by Collins et al. (2005), 65% of respondents confirmed that they have or have had one or more chronic conditions. The most common conditions reported in this study were allergies (37.1%), arthritis (21.8%) and back and neck pain (16.3%). Another study found that the five health problems most often cited in conjunction with presenteeism were migraine (20.5%), depression (15.3%), diabetes (11.4%), asthma (11.4%) and arthritis (11.2%) (Goetzel et al., 2004).
Personal and organizational impacts of presenteeism
First, presenteeism appears to take a significant toll on worker productivity. A related study calculated relative “unproductivity” rates resulting from various health problems: migraines (21.0%), depression (16.0%), diabetes (2.6%), asthma (2.6%) and arthritis (2.6%) (Goetzel et al., 2004). For each of the chronic conditions studied, the cost associated with presenteeism was higher than the costs of absenteeism and additional medical treatments (Collins et al., 2005). In fact, it was found that presenteeism can lead to even greater productivity losses for companies than absenteeism (Collins et al., 2005). For example, in research conducted by Stewart et al. (2003), productivity losses linked to presenteeism stood at 72%, compared with 28% for absenteeism.
A number of researchers have also noted that depressive disorders have the greatest impact on personal productivity levels (Kessler et al., 2008; Lowe, 2002; Martinez & Ferreira, 2011).  In terms of productivity losses, Lowe (2002) indicated that depressed people lose an average of 1.8 hours of productive time per day.
Over and above the productivity losses associated with presenteeism, this behaviour can have personal repercussions. To begin with, presenteeism can aggravate health problems and even delay recovery (Johns, 2010).  According to a recent longitudinal study, general health measurements assessed on two occasions suggest that the behaviour of presenteeism has harmful effects on employees’ future state of health (Bergstrom et al., 2009), particularly as a result of stress build-up (McEwen, 1998). With regard to health, for example, a study by Kivimäki et al. (2005) found that employees with higher presenteeism levels are more likely to have coronary problems in the future. Still other studies have shown that employees with a lower rate of presenteeism tend to be healthier down the line (Gustafsson & Marklund, 2011).
Lastly, some authors believe that presenteeism could have a long-term impact on future absenteeism (Bergstrom et al., 2009; Johns, 2010). In other words, the more people engage in presenteeism, the greater the likelihood that they will eventually miss work (Aronsson et al., 2000; Ashby & Mahdon, 2010; Biron et al., 2006; Caverley et al., 2007; Gosselin et al., 2011; MacGregor et al., 2008). The existence of such a link can be explained by the scientific belief that employee presenteeism does not replace absenteeism, but rather that the two are complementary phenomena (Gosselin et al., 2011).
Multiple researchers have attempted to estimate the costs associated with presenteeism at organizations. For example, Goetzel et al. (2004) estimated that presenteeism costs organizations $255 per year per employee. Others have found that the cost of presenteeism could be as high as $150 billion per year in the United States alone (Hemp, 2004).
In short, although absenteeism is currently one of the most frequently used organizational health indicators (Johns, 2009), organizations need to give further consideration to presenteeism, given its cost and its effects on worker health and productivity. Please visit the EPSI blog again soon for the next article on the personal and organizational factors linked to presenteeism, as well as potential solutions or paths for organizations to manage it.
Stéphanie Mélançon, M.Ps. (cdt)

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