Perspectives on presenteeism

We talk more about absenteeism. A new research trend has emerged to look into the opposite of it. There are confusing definitions and complicated diagnostics, yet the path is worth exploring. Today’s column is all about presenteeism.

Overview

Absenteeism, generally defined as not showing up for scheduled work, has a long research history. This is mainly because of its perennial cost to organisations. However, it is only recently that presenteeism has become a subject of interest. Although some definitional confusion is in existence, the most recent scholarly conception of presenteeism involves showing up for work when one is ill.

Excitement concerning the subject has been fuelled by claims that working while ill causes much more aggregate productivity loss than absenteeism and by the idea that managing presenteeism effectively could be a distinct source of competitive advantage (Hemp, 2004).

According to Johns (2010), interest in presenteeism stems from two main but somewhat geographically distinct sources: (1) UK and European scholars in management and epidemiology or occupational health who are concerned that job insecurity stemming from downsizing and restructuring forces exaggerated levels of attendance that result in stress and illness and (2) mainly (although not exclusively) American medical scholars and consultants, including those in epidemiology and occupational health, concerned with the impact of illness in general or specific medical conditions (e.g., migraine) on work productivity

Among the latter camp, presentees are people who are ‘at work, but not working,’ at least not up to their full capacity. In sum, the British and Europeans have mainly been interested in the frequency of the act of presenteeism as a reflection of job insecurity and other occupational characteristics, and the Americans have mainly been interested in the productivity consequences of this behaviour as a function of various illnesses while ignoring the causes of showing up ill. Both lines of enquiry are legitimate, yet diverse in their approaches.

In medicine, pharmaceutical and other medical interventions have traditionally been evaluated in terms of two health-focused criteria, medical efficacy, and safety. In recent years, however, the increasing cost of health care, combined with the provision by employers of employee health plans, has led to a third criterion of interest, economic impact.

Accordingly, employee health costs to an employer include the direct cost of any health plan, costs due to employee absenteeism, and costs due to reduced productivity among presentees not working at full capacity (Collins et al., 2005).

The drive to find measures of productivity loss that are responsive to pharmaceutical intervention and might permit US Food and Drug Administration (FDA) approved productivity claims has led to a proliferation of measurement instruments in a short period of time.

Presenteeism described

According to the Oxford English Dictionary Online, the term presentee was first used by the American author Mark Twain in his humorous 1892 book, The American Claimant. Subsequently, presenteeism made occasional appearances in business-related periodicals, including Everybody’s Business (1931), the National Liquor Review (1943), and Contemporary Unionism (1948). In all of these early uses, and through the 1970s, the term was clearly meant either to be the literal antonym of absenteeism, or to connote excellent attendance.

It remained until the 1980s for more contemporary definitions to emerge, and, in fact, until the current millennium for the most contemporary. Table 1 contains nine different ways of looking at presenteeism, visible in management literature.

As Johnes (2010) observes, although all of the definitions pertain to being physically present at work, they differ to a greater or lesser extent from each other, occasioning potential confusion. Presenteeism is variously portrayed as good (definitions 1 and 2), somewhat obsessive (definitions 3, 4, and 5), at odds with one’s health status (definitions 5, 6, and 7), and often less than fully productive (definitions 8 and 9).

Presenteeism and Productivity Loss

There are some interesting statistics available in the Swedish scene. Aronsson and colleagues in 2005 included an additional item in the Swedish labour-market survey as follows: “Has it happened over the previous 12 months that you have gone to work despite feeling that you really should have taken sick leave because of your state of health?”

The response format consisted of never, once, 2-5 times, or over 5 times, in line with their previous study. In the earlier Aronsson study, 37 per cent of respondents reported attending work while sick more than once. In the later Aronsson study, 53 per cent made the same declaration (38 per cent, 2-5 times and 15 per cent more than five times). The reason for this increase is not so clear but probably attributed to the accelerated change in workplaces.

Productivity loss ascribed to presenteeism is also a significant factor. As Amick and others (2000) reported, at least 14 health-related work productivity loss measures have been generated in recent years, and their most common impetus has been to serve as criterion variables in clinical trials meant to assess the impact of pharmaceutical treatment on work productivity. Instruments use to measure productivity loss generally asks respondents to self-report some information concerning their health and to estimate how their health has affected their productivity.

Some measures are ‘generic’ in that they examine the impact of general health status on productivity; others pertain to specific health conditions such as migraine, allergies, or depression.

On the productivity side, some instruments record opinions and experiences (qualitative) while others ask for or impute some estimate of time lost or percentage of productivity decrement that is in principle translatable into a monetary value. While some instruments use a job analysis-like logic to measure the impact of illness on various aspects of work functioning (e.g., The Work Limitations Questionnaire [WLQ]).

Presenteeism as an acute issue

Interesting research findings are available on the Australian scene. In 2007, Medibank commissioned Econtech to identify the costs and impacts of presenteeism on the Australian workforce and economy. This landmark report and study revealed that in 2005/6 the cost of presenteeism to the economy was estimated at Australian dollars 25.7 billion, nearly four times the cost of absenteeism.

The researchers looked at three categories of cost.

The direct costs faced by employers due to the on-the-job productivity losses caused by presenteeism

The indirect costs to the Australian economy due to lower labour productivity levels caused by presenteeism

The indirect costs to the Australian economy arising from changes in terms of capital intensity and other second round effects.

The overall cost of presenteeism to the Australian economy in 2009/10 was Australian Dollar 34.1 billion. This equates to a decrease in gross domestic product (GDP) of 2.7% compared to the ‘no presenteeism’ scenario. Private consumption – household spending on all goods and services – which accounts for 76% of total consumption in Australia – decreased by 3.3% (Australian Dollar 22.6 billion) due to presenteeism.

As the report further describes, the negative impact of labour productivity losses due to presenteeism flows throughout the economy, leading to a general reduction in levels of exports, imports and investments.

Indeed, compared to the ‘no presenteeism’ scenario, exports are lower by 2.7% ($8.2 billion) whilst imports are reduced by 2.1% ($6.0 billion). Investment is lower by 2.6% ($5.0 billion). This further illustrates the effects on the Australian trade balance, which decreases due to the fact that the decrease in exports is relatively higher than the decrease in imports.

Relevance to

Sri Lanka

To my knowledge, there has been no proper study done on the effects of presenteeism in Sri Lanka. This opens up an opportunity to explore and assess the true situation here. I have come across employees in a variety of disciplines who complain of the inability to take leave when they want, because of the shortage of people.

This is in the context of some organisations preferring to pay overtime and use a smaller workforce than deploying the actual number required. The end result is whether the person likes or not, he/she has to report to work, whilst the excessive overtime payments act like “carrots”.

One phenomenon I have clearly seen in some of the Sri Lankan workplaces is employees being physically present, but mentally and emotionally absent. Their bodies are at work but the heads and hearts are elsewhere. It can be a symptom of a deep-rooted cause and revolves around presenteeism.

(Dr. Ajantha Dharmasiri is a learner, teacher, trainer, researcher, writer and a thinker in the areas of Human Resource Management and Organisational Behaviour. He can be reached on [email protected].)