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Is presenteeism a problem? You may be encouraging it — do this instead

September 27, 2022 - 18 min read
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    It would be hard to pinpoint whom to credit for the phrase, “Showing up is half the battle.” That advice has been branded into many of us since we were young. We live in a world that rewards showing up from a very early age. Children are handed perfect attendance awards for never missing a day. As adults, we often carry that expectation into the work world. The unspoken agreement is that attendance equals achievement and commitment. We fear that our absence, meanwhile, might be taken as a sign that we don't care — or are underperforming.

    The reality, showing up matters, but merely being present — physically or virtually “in your seat” — isn’t enough for good performance or job satisfaction. And such “presenteeism” can actually work against team and individual performance, as well as well-being.

    In 2020, the working day actually got longer, yet employees took less time off. Millions of vacation and sick days go unused every year. Statistically, we know that several million people have been ill over the last few years, and that’s caused a ripple effect in the needs of caregivers and mental health support. So why all the time left on the table?

    Unfortunately, the more uncertain workers feel about their circumstances (in and out of work) the more likely they are to show up when they’re really not able to participate effectively in their work. It’s not just that they aren’t at their best, but that they are consumed by physical or mental distress or distraction for themselves or someone close to them. In the past, this was seen as a sign of commitment. Now, as researchers have begun to track the impact of employee well-being on productivity, it’s starting to become clear that presenteeism is costly. The costs of presenteeism likely outweigh the cost of a couple missed days of work or direct investments in employee well-being.

    Unlike absenteeism, however, presenteeism is difficult to measure. After all, you can tell when someone’s not at work. But when they’re in-office (whether virtually or otherwise) it’s not easy to see how much personal circumstances are affecting their ability to show up at their best. By focusing on outcomes, HR and managers can better understand the impact presenteeism has on organizations, what it looks like, and what to do about it.

    What is presenteeism in the workplace?

    Have you ever been in this situation?

    You wake up with a migraine headache. You’re exhausted and in pain, but unfortunately, migraines are nothing new for you — especially not during allergy season. Sniffling and bleary-eyed, you drag yourself to your desk. You may not feel 100%, but “something is better than nothing,” right? 

    Not so fast.

    You may think that the best approach is to “show up unless you can’t,” but presenteeism can have a far-reaching impact. HR Magazine reports that coming to work sick or unwell can:

    • Trigger a workplace epidemic (getting one employee after another sick)
    • Increase the number of errors a sick employee makes on the job
    • Increases risk of psychological harm to employees

    Presenteeism is distinct from employee disengagement or even employees who are ultra-motivated, but exhausted. These employees are physically or mentally not well in a way that affects their abilities, motivation, and decision-making. Personal circumstances, illnesses, and other factors are in the way of them doing their best work — or sometimes, any work at all.


    Which factors lead to presenteeism?

    Presenteeism is largely an issue of workplace culture. After all, most of us know that we’re not doing our best work when we show up sick or exhausted. So why do we show up anyway?

    Many workplaces — even unconsciously — reward the people who show up early and leave late. In fact, it’s been found that managers tend to show a preference for people who work in-office over remote workers. This proximity bias is creating a divide in hybrid workplaces and could encourage the wrong behaviors or drive good employees to leave. 

    When company culture — implicitly or explicitly — makes employees feel like they’ll be penalized for taking a day off, people often respond by showing up (even when they shouldn’t). Here are five factors that contribute to presenteeism in the workplace:

    Reasons for presenteeism

    1. Modeled behavior

    What do managers and leaders do when they’re sick? If your manager routinely shows up to work sick or tired, team members will see the example and follow suit. Eventually, this will be seen a s a value and become part of the culture, making it harder for anyone to make a different choice. 

    When leaders and managers show that they are comfortable taking sick leave or mental health days as needed, others will do the same.

    2. Lack of sick time or benefits

    If your healthcare and paid time off policies don’t include sick time, people won’t take it. Furthermore, workers without paid sick leave are more likely to need care for major health issues and visit emergency rooms. Conversely, employers that implement paid sick leave often see a boost in workplace productivity. Taking a day or two off at the onset of an illness often shorten its duration (and prevents getting others sick). 

    3. Blurred lines for remote teams

    It’s a good idea to take a day off when sick — even if you work from home. However, many employees report that since transitioning to remote work, they feel that “the bar to call out for the day has been raised.” But the increased flexibility that comes with working from home doesn’t eliminate the risk of making mistakes while logging in sick. 

    4. Job insecurity

    Early in the pandemic, when unemployment was at a high, employees worried that taking a day off sick would put them on the chopping block. But even though job seekers (arguably) have more leverage during the Great Resignation, many still feel insecure about keeping their jobs. With a potential recession looming, workers are more likely to go to work when they should be home sick.

    5. Workload

    Whether remote or in-person, one of the biggest reasons workers don’t feel comfortable calling out is the fear of the inbox waiting for them when they return. When expectations are high and deadlines are tight, employees tend to push through instead of taking time away from work. This gives rise to another phenomenon called leavism — where people use their time off to catch up on work.


    What is presenteeism vs. absenteeism?

    Absenteeism is a term used to describe an employee’s unscheduled time away from the office. This can be due to illness, family emergency, lack of childcare, or disengagement. In any workplace, some absenteeism is to be expected. People will get sick and have emergencies, and a day or two off to handle these issues is typically accommodated by employer policy.

    Whereas an absent employee is not in their seat, presenteeism refers to employees that are showing up to work but are unproductive. These individuals are trying to fulfill their jobs, but due to health problems or other circumstances can’t work at full capacity. The main concern with both absenteeism and presenteeism is productivity loss. However — paradoxically — the costs of presenteeism are estimated to be far more than that of absenteeism.

    Consequences of presenteeism

    As mentioned, presenteeism isn’t as easy to measure as absenteeism. However, several studies have been conducted to attempt to determine the prevalence of presenteeism, as well as its short and long-term impact.

    In one longitudinal study conducted on a group of nurses, researchers found that presenteeism “directly led to individual fatigue, tension, anxiety, and depersonalization.” The negative effects didn’t stop there, and the authors of this meta-analysis cite “serious physiological and psychological consequences” as a result of their continued presence at work.

    Additionally, some of the consequences of presenteeism include:

    Lost productivity

    It can’t be overstated — turning up to work when sick isn’t “better than nothing.” In fact, long hours and exhaustion at work are already likely to lead to diminished productivity — an effect compounded by illness. Sick and overtired employees are far more likely to make mistakes. Mistakes and poor decision-making lead to misunderstanding, thrash, and rework for others. In certain environments, like healthcare or construction, these errors could be life-threatening.

    Prolonging — and spreading — illness

    If you work in the office, staying home when sick is critical. Germs spread fast at work. Researchers at the University of Arizona found that a single sick employee could infect 50% of high-touch surfaces within just a couple of hours of being at work. Taking just a day or two off at the onset of an illness can shorten its duration — and prevent infecting countless others.


    Impact to morale

    Being sick tends to drag down your mood already, so going to work when you should be resting doubles that impact. Low mood makes it harder to interact productively with coworkers, receive feedback, or be open to new ideas or approaches. In addition to the crankiness that comes with being under the weather, the discomfort of being ill may make it harder to get into a flow state. So when you feel like you can’t “get into work” because your physical health is distracting, both your work and experience of work will suffer. 

    In addition, working while sick sets an example for the rest of your colleagues. In a presenteeism culture, employees will (consciously or unconsciously) compare their symptoms to their coworkers. If Jordan showed up with the flu, who are they to stay home with a migraine? This lack of “choice” in the matter can further decrease employee morale.

    Undermines inclusion

    A workplace is made up of many types of people — each with their own responsibilities and concerns outside of work. Employees with children or other caregiving responsibilities may be hesitant to use their sick time for themselves, preferring to “save it” for when their loved ones need support. Employees with disabilities and mental health conditions may worry about the frequency of sickness absences and try to “power through.” They may worry that the time they need to take away from work reflects badly on them, and — as a result — they show up if they don’t “absolutely need” the time away.

    How to reduce presenteeism

    Workplace culture is at the heart of presenteeism. There’s a subtle mix of expectations, personality, and modeling that culminate in an employee’s decision whether or not to come to work. 

    As a result, reducing presenteeism isn’t an easy or straightforward fix. It means creating an environment that focuses on employee health and work-life balance. Even when things are stressful and deadlines need to be met, managers have to be sure to model the behavior they want their employees to demonstrate. That means staying home (and not logging in) when in poor health. 

    Of course, presenteeism is somewhat easier to address when working in-office or dealing with physical health. Mental health concerns and hybrid workforces require a higher level of attention and sensitivity to catch the signs of presenteeism.

    Ultimately, improving employee well-being is a two-pronged approach. First, leaders need to make it feel “safe” to stay home. Secondly, organizations should take initiative where they can to support employee health, making it less likely that they’ll need a day off in the first place. Here are strategies leaders might consider implementing in their workplaces:

    1. Look at your leave policy and normalize taking time off

    If employees have to choose between coming in sick and missing a day (or more’s) pay, they’re far more likely to come to work sick. Offer paid sick leave to your employees. Educate them about situations that would qualify them for a medical leave of absence or FMLA. Policies like these often pay for themselves in increased productivity.

    2. Plan company-wide downtime

    Employees often worry that taking time away from work will result in a mountain of expectations waiting for them when they return. You can minimize professional FOMO by instituting company-wide breaks. 

    Try planning an Inner Work Day, where employees get a day off to do something that nourishes their spirit. Or shut down the office for a “summer break.” If you want to start small, try designating certain days or hours as “meeting-free” so everyone has focused, clear time on their calendars.


    3. Educate employees about the downsides of presenteeism

    The research on the negative effects of presenteeism is compelling — but so is the urge to show up to work sick. In order to drive the point home, companies may need to remind employees often that they are not expected to report in sick. Encourage them to take time off, share studies on the benefits of rest, and be sure to model this behavior if and when you get sick.

    4. Start a wellness program at work

    As the saying goes, “An ounce of prevention is worth a pound of the cure.” Stress and exhaustion can cause or exacerbate a number of health issues. You can help minimize the days that your employees need to take off by making well-being a daily focus.

    Create an employee wellness program, with access to support for both mental and physical health. Ask employees what they need for a more productive work environment. Consider investments like a work-from-home stipend, coworking membership, or gym membership. 

    5. Embrace flexible work hours

    Working remotely doesn’t mean that you can’t take a day off. But having the flexibility to skip the commute, work from home, or change your hours can make a difference in both productivity and well-being. While you should still encourage your employees to take a sick day as needed, give them the choice about where and when they get their work done if you can. For example, an exhausted employee might appreciate being able to start work a couple hours later one day in exchange for more sleep.


    6. Learn the signs of presenteeism

    As a leader, you’ll need to learn how to identify when people are “powering through” health or personal challenges to show up at work. These may not be easy to spot — for you or for your team. Some signs of presenteeism include:

    • Taking very little sick time or PTO — especially if it’s unlimited or doesn’t roll over
    • Being uncharacteristically quiet or withdrawn at work
    • Camera off in all virtual meetings
    • Sudden increase in mistakes or missed deadlines
    • Opting out of social activities or interactions at work
    • Increase in doctor’s appointments without an increase in sick time
    • Looking tired or distracted
    • Often arriving to work or logging in late

    Familiarizing yourself with these signs and developing an open, trusting relationship with your team can help you identify when your employees might need additional support. A gentle reminder from a leader they trust can help them take the time away they need.

    7. Ask for feedback

    Last but not least, ask your employees how they’re doing. Send out an anonymous questionnaire quarterly and ask about how they’re feeling. Dig into their workloads, their relationships with their managers, and whether they feel they can take time away when they need to. Ideally, these anonymous responses should give you an idea of the overall well-being of your team. You can review these answers with your human resources department to help you understand which initiatives are working and what additional support your team needs.

    Final thoughts

    Presenteeism isn’t a sign that your employees are disengaged at work. Rather, they’re trying their best to meet the demands of their role. But they shouldn’t feel that they have to put their well-being at work to do it. 

    No leader wants their employees to be burned out, ill, or exhausted — but the factors that lead to this in the workplace can be extremely subtle. Learning to spot these signs can help managers and leaders develop a work environment that runs at its best all the time.

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    Published September 27, 2022

    Allaya Cooks-Campbell

    BetterUp Staff Writer

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