Presenteeism: The Costs of Going to Work When Sick
Reporting To Work Ill: What Are the Costs?
Hey, Don't Spread the Love ...
Sick with the flu, she has dragged herself to the office again ... coughing, snotty, and feeling ragged. Arming herself with a box of tissues and a pack of throat lozenges, she retreats to her cubicle to produce what work she can.
She attends meetings, commiserates with coworkers on her symptoms, and touches the same door handles, chair arms, and copier buttons as office mates. Although she may see it as an act of devotion to her job, when this employee reported to duty sick she subjected coworkers, customers, her employer, and even herself to unnecessary risks.
Tomorrow, she'll do it again.
Just Stay Home
If you go to work not feeling well, what is your primary reason?
Presenteeism: What Is It?
Presenteeism refers to reporting to work when ill and thus not working to full capacity.1 Common examples of illnesses that fail to keep employees at home include allergies, migraines, the cold and flu, back pain, and Norovirus (winter vomiting virus).2
When employees work sick they fail to work mindfully—that is, in the present moment, giving focused attention to the task. Instead, they are less productive because they are distracted by thoughts and sensations of their illness. Symptoms of their illness thus compete for their attention, on top of all the usual office distractors.
Working sick may result in
- decreased work output
- reduced time spent on work tasks
- lower quality work
- more mistakes and
- poorer staff morale while the sick employee is present.3
This may be a special concern if the employee is on medications that induce drowsiness or if she has lost significant sleep due to her illness. The cost of such presenteeism is estimated at $150 billion annually.
Signs of a Presentee Worker
Whom Does It Hurt?
Sick Employees Suffer Greatest
Risks for the sick employee and employer include the possibility that the employee will work until exhaustion. Studies have found that there is a greater likelihood that employees who report to work ill will later suffer poor future health—including serious coronary events—and will require subsequent sick leave.4,5
Additionally, by reporting to work ill, the employee becomes a higher on-the-job accident risk. According to a study by the National Institute for Occupational Safety and Health (NIOSH), workers with access to paid sick leave were 28% less likely to suffer nonfatal workplace injuries.6
Impacts On Colleagues and Customers
Presenteeism may likewise carry consequences for the employee's colleagues and customers when the illness carries the risk of contagion. Those who work with food, for example, can become vectors of infection by transferring their germs to food preparation surfaces, the food itself or through the air (as through coughing).
Each year, nearly one in six Americans is infected with a foodborne illness, according to the Centers for Disease Control and Prevention (CDC), and Norovirus causes almost half of all foodbourne illnesses in the United States.7 Norovirus can spread when small particles of feces or vomit are transferred through direct or indirect contact.
The virus may be passed to others for as long as three days after symptom recovery. A 2011 CDC study found that 12% of nearly 500 food service workers surveyed acknowledged reporting to work with vomiting and diarrhea for two or more shifts.8
Sick Restaurant Workers: Hazardous to Your Health?
Hazards for Vulnerable Populations
Whether food service staff, retail workers or school teachers, sick employees whose jobs require that they interface with large numbers of people can therefore pose a hazard to the public.9 When vulnerable populations are involved, further complications can arise. Such vulnerable populations include those with weakened immune systems and chronic health conditions.
The sick employee may not realize that she works alongside people struggling with chronic health conditions. Such disabilities are not always visible or disclosed in today's workplace. For example, it is very possible to work alongside someone with lupus, diabetes, MS, asthma, or cancer and yet be unaware of your coworker's diagnosis.
Coworkers who live with underlying health conditions risk exacerbations of their diseases as well as complications that lie far beyond the mild illness plaguing their "presentee" colleague. There may be similar health ramifications for pregnant women, older people, and young children who may be clients, for example. A bad cold constitutes a nuisance for an otherwise healthy individual but can trigger a downward health spiral for such vulnerable populations.
No Choice but to Report to Work Sick?
Why Do Employees Work Sick?
Several key factors motivate employees to report to work sick:
The U.S. Bureau of Labor Statistics reports that only two-thirds of American workers have access to paid sick leave.10 Workers without paid sick leave may feel like they cannot afford to lose income by staying home to recuperate.
Presenteeism may be more likely for financial reasons among part-time employees and those in the following professions who have less access to paid sick leave: service, sales, maintenance, production, transportation and material handling. However, even workers who do have sick leave benefits may not take the time off for themselves.
About half of middle-aged adults are "sandwiched" between a young child they are raising (or an adult child they are supporting) and a parent who is 65 years of age or older.11 Members of this "sandwich generation" may feel obligated to save their sick days for when their child or parent is ill, particularly in cases when the family relies upon a single breadwinner.
High Job Demands
As today's employers require their workforce to "do more with less," many employees face high workloads, limited back-up support, pressing deadlines, and low control over the pace of their own work. Some sick employees may perceive presenteeism as a better option than facing a backlog of work upon returning to the office.
Perception of Need or Irreplaceability
Presenteeism becomes a more viable choice when an employee feels there is no one who can easily take her place -- for example, because of unique skill or educational requirements of the job.12
Workers who are more educated and those employed in higher risk positions with more physical workload or stress are more likely to report to work sick. Ironically, employees in the health, helping and teaching professions -- the very employees who typically serve at-risk populations -- are more likely to report to work ill.13 A poll by the American College of Physicians found that over half of resident doctors queried came to work with symptoms of the flu during the prior year.14
Company leaders may model presenteeism so that it becomes awkward for employees to take sick leave if the boss never does it. Management may also exert pressure on sick employees to meet important deadlines and other work obligations except in the most extreme circumstances.
Also, employees may feel a responsibility to their already overburdened colleagues. They may reason that it is better to "push through" their cold or flu with presenteeism than to add to coworkers' workloads.
Broader Pattern of Unhealthy Individual Lifestyle Choices
Presenteeism appears to be part of a pattern of poor personal health factors. Employees who work while ill tend to exercise less, are more likely to be overweight, have a poorer diet, and are more likely to smoke.15
They also experience poorer work/life balance, tend to base their self-esteem heavily on their performance, and have poorer interpersonal relationships with both colleagues and management. Presenteeism thus seems to be part of a broader syndrome of behaviors that have both short and long-term health consequences.
What Can Employers Do?
Employers can have a major impact in discouraging presenteeism.16 Providing employees with paid sick leave is an important step in supporting workers to make smart choices. Companies can also offer clear, practical guidance on what conditions should prompt employees to stay home, and they can educate employees about the many risks of presenteeism.
Because organizational leaders set the tone, management should advocate a culture of being focused by not working sick themselves. Employers can also seek collaborative and creative options when employees are recuperating (e.g., work from home options, schedule changes). Additionally, companies can provide hand sanitizer stations and comprehensive wellness programs that include flu vaccinations, Employee Assistance Programs, and fitness centers.
Reader Poll: Presentee Workers
What type of presentee workers personally concern you the most?
Wash Your Hands: One of the Best Preventive Tips
Flourishing in a Presentee Workplace
The individual employee can flourish in the presentee workplace by taking several practical steps. In a supportive manner, encourage coworkers who insist on working sick to go home where they can recover.
Or, for those who need a friendly reminder, send an anonymous e-card from the CDC on hand washing after restroom use or covering one's coughs and sneezes.17 If a co-worker insists on staying at work ill, physically separate yourself as much as practical from him or her and be tactful about your concerns regarding wellness.
Also, regularly wash your hands with soap and water and avoid touching your face, as this is a common means of transmitting germs between surfaces and the eyes, nose and mouth. Do not share food or eat at your desk.
Clean work surfaces regularly with antibacterial wipes. One study found that the six dirtiest places in the office are break room sink-faucet handles, microwave door handles, keyboards, refrigerator door handles, water fountain buttons, and vending machine buttons.18
Finally, get a flu shot, make healthy diet, exercise and lifestyle choices, and stay home yourself when ill. With a little bit of effort from employees, coworkers and employers, everyone involved can flourish at work -- even during the height of cold and flu season!
1Schaefer, Patricia. "The Hidden Costs of Presenteeism: Causes and Solutions." Business Know-How. Accessed March 4, 2013. http://www.businessknowhow.com/manage/presenteeism.htm.
2All One Health. 2013. "Presenteeism." Webinar All One Health. Accessed March 5, 2013. http://www.allonehealth.com/about.aspx.
3 Schultz, A. B., C. Y. Chen, and D. W. Edington. "The Cost and Impact of Health Conditions on Presenteeism to Employers: A Review of the Literature." Pharmacoeconomics 27, no. 5 (2009): 365-378.
4"Press Release - Going to Work When Sick May Lead to Future Absences." American College of Occupational and Environmental Medicine (ACOEM). Accessed March 3, 2013. http://www.acoem.org/Page2column.aspx?PageID+7392&id=6111.
5Kivimaki, Mika, Jenny Head, Jane Ferrie, Harry Hemingway, Martin Shipley, Jussi Vahtera, and Michael Marmot. "Working While Ill as a Risk Factor for Serious Coronary Events: The Whitehall II Study." American Journal of Public Health 95, no. 1 (2005): 98-102. Accessed March 3, 2013. www.medscape.com/viewarticle/496911
6Asfaw, Abay, Regina Pana-Cryan, and Roger Rosa. "CDC - NIOSH Science Blog – Making the Case for Paid Sick Leave." CDC - Blogs - CDC Blogs. Last modified July 30, 2012. Accessed March 2, 2013. http://blogs.cdc.gov/niosh-science-blog/2012/07/sick-leave.
7Centers for Disease Control and Prevention. "Norovirus: Facts for Food Handlers." Centers for Disease Control and Prevention. Accessed March 3, 2013. http://www.cdc.gov/norovirus/downloads/foodhandlers.pdf.
8Jayaraman, Saru. "Fight flu, give restaurant workers paid sick leave - CNN.com." CNN.com - Breaking News, U.S., World, Weather, Entertainment & Video News. Last modified January 30, 2013. Accessed March 5, 2013. http://www.cnn.com/2013/01/30/opinion/jarayaman-flu-food-workers.
9Widera, Eric, Anna Chang, and Ellen L. Chen. "Presenteeism: A Public Health Hazard." Journal of General Internal Medicine 25, no. 11 (2010): 1244-1247. Accessed March 2, 2013. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2947637.
10U.S. Bureau of Labor Statistics. "Table 6. Selected paid leave benefits: Access." U.S. Bureau of Labor Statistics. Last modified March, 2012. Accessed March 7, 2013. http://www.bls.gov/news.release/ebs2.t06.htm.
11Parker, Kim, and Eileen Patten. "The Sandwich Generation | Pew Social & Demographic Trends." Pew Social & Demographic Trends - Public Opinion Polling, Survey Research, & Demographic Data Analysis. Last modified January 30, 2013. Accessed March 7, 2013. http://www.pewsocialtrends.org/2013/01/30/the-sandwich-generation.
12Jena, Anupam B., DeWitt C. Baldwin, Stephen R. Daugherty, David O. Meltzer, and Vineet M. Arora. "Presenteeism Among Resident Physicians." Journal of the American Medical Association 304, no. 11 (2010): 1166-1168. Accessed March 8, 2013. doi:10.1001/jama.2010.1315.
13 Aronsson, Gunnar, Klas Gustafsson, and Margareta Dallner. "Sick but yet at work. An empirical study of sickness presenteeism.." Journal of Epidemiology and Community Health' 54 (2000): 502-509. Accessed March 8, 2013. http://jech.bmj.com/content/54/7/502.
14The University of Chicago Medicine. "Doctors Cite Concern for Patients, Colleagues Top Motives for Working Sick." Newswise: News for Journalists. Last modified June 18, 2012. Accessed February 26, 2013. http://www.newswise.com/articles/view/590499.
15Merrill, Ray. "Merrill: Curbing employee 'presenteeism'." The Salt Lake Tribune (Salt Lake City), January 15, 2013. Accessed March 3, 2013. http://www.sltrib.com/sltrib/opinion/55586128-82/health-presenteeism-employees-employee.html.csp.
16All One Health. 2013.
17Hosier, Fred. "Tell co-workers -- anonymously -- to take their coughing and sneezing home » Safety News Alert." Safety News Alert - OSHA and safety news for workplace safety professionals. Last modified May 13, 2009. Accessed March 8, 2013. http://www.safetynewsalert.com/tell-co-workers-anonymously-to-take-their-coughing-and-sneezing-home.
18DeNoon, Daniel J. "The 6 Dirtiest Places in Your Office: Where Office Germs Lurk in Break Rooms, on Desks." WebMD. Last modified May 22, 2012. Accessed February 26, 2013. http://www.webmd.com/news/20120523/the-6-dirtiest-work-places.
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