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You know your company has a problem with sick staff when you look around the office and half the seats are empty. But when everyone is at their desks, it does not necessarily mean your workforce is in rude health either. A slew of recent research suggests that presenteeism — when people come to work although they are unwell — is a bigger problem for employers than absenteeism. It is also far harder to measure, let alone to manage.
Take the National Health Service, Britain’s biggest employer. When it surveyed 11,000 of its staff, it found they were off sick for an average of almost 11 days a year. Yet more than 65 per cent of staff also reported they had come to work at some point in the preceding four weeks when they were sick enough to stay off.
Vitality, the health insurer that compiles the Britain’s Healthiest Workplace rankings, has found the same pattern: its UK survey concludes that presenteeism is more common than absenteeism in every sector of the economy. In media (the best performing industry among survey participants) 0.6 per cent of time is lost to absence while 7.4 per cent is lost to presenteeism. The other end of the spectrum is to be found in the public sector, with 1.4 per cent of time lost to absence and 12.3 per cent to presenteeism.
Some employers might wonder why this should be considered a problem at all. Does it not simply show that employees are devoted — or “engaged” to use the language of HR professionals — to their jobs and colleagues? Experts say this is a dangerous way to look at things. As well as the obvious risk that employees with viruses could spread them to everyone else, there is the deeper problem that many unwell workers are struggling with longer-term afflictions like depression that will worsen if they go unaddressed.
“If somebody’s not taking the time off when they’re ill, it implies they’ve not discussed the illness with their manager,” says Karen Steadman, a senior researcher at Lancaster University’s Work Foundation. “They might not be getting support from the medical profession either, therefore there’s a higher likelihood of it getting worse, and a higher likelihood of long-term absence or even job-loss further down the track.”
Sir Cary Cooper, president of the Chartered Institute of Personnel and Development, the UK-based professional body for HR, believes high levels of presenteeism also explain disappointing productivity growth in developed countries like the US and UK.
“The magic bullet for me in the productivity debate is not ‘do we have the right equipment, do we have the right IT’,” he says. “One of our problems is that even [among] the people who turn up to work, a big proportion of them are not delivering.”
Why do people go to work when they are ill? Research by Eurofound, an EU agency, has found that presenteeism across Europe correlates strongly with long work hours and shift work. It also finds it is more frequent among “high-grade, over-committed white-collar workers”. Not all the evidence points the same way, though. Vitality’s survey finds that workers who earn less than £30,000 a year are more likely to go to work when sick than higher earners.
The reasons vary by person and organisation, experts say. Senior people in some companies might worry no-one else can cover for them. Many of the nurses and midwives surveyed by the NHS were worried that patients would suffer if they were left with temporary cover. “We come in when we’re unwell because temp staff mess things up,” one said in a focus group. “They’re not the solution they’re claimed to be.”
Low-paid shift workers might fear absence will cost them money or future shifts, particularly if they are on precarious temporary or zero-hour contracts.
The British Safety Council has warned that pressures on staff might well intensify in the UK after Brexit in sectors of the economy that rely on workers from the EU, such as healthcare and hospitality. “Reduced availability of competent staff would increase the pressure on those that remain, resulting in fatigue and an adverse impact on physical and mental health,” says Louise Ward, the BSC’s policy and standards director.
The problem is not external pressures but the way managers deal with them, argues Cooper. “The underlying reason [for presenteeism] is we don’t have many interpersonally skilled managers, from shop floor to top floor. There are too many bad managers treating people badly, not being socially aware when people aren’t coping and the reasons for that, giving them unmanageable workloads,” he says.
Some of the ways that employers deal with sickness absence can also prompt more people to come into work when unwell. Take “absence management” companies, which have become increasingly popular among employers keen to become more systematic about absences. These companies run call centres that employees must ring in the morning if they are sick. A nurse in the call centre will assess whether they are unwell then notify their manager.
The promise of this approach is that is it fairer to everyone: eliminating both the soft-touch of some line managers and the unreasonableness of others. But Steadman says they can simply put people off calling in sick altogether. A research project she did recently for a large employer with an absence system like this showed that “everyone seemed genuinely scared of having to call in. They just felt like they were being judged – it was easier to just go in.”
The good news is that a growing number of employers are starting to recognise that presenteeism is a problem. They are also beginning to experiment with ways to tackle it.
Many of these efforts involve wellness initiatives to promote healthy lifestyles at work. Some employers have given workers wearable fitness trackers and challenged them to go running more while others have launched healthy eating campaigns. Wellness programmes are particularly popular in the US where employers are liable for employees’ health insurance costs. But large companies in the UK and other countries are also taking an interest.
BSC’s Ward thinks the schemes will help. “They support general wellbeing, but also promote a positive culture which supports mental wellbeing too.”
Some evidence supports this. When Vitality analysed 4,318 employees who completed its survey in 2014 and 2015, it found that among employees who moved from “obese” to merely “overweight”, presenteeism dropped by 25 per cent.
However, correlation does not prove causation. Some experts say wellness programmes fundamentally miss the point that work itself is one of the main reasons that employees become unwell, particularly through stress, anxiety and depression. Employers need to work out what they are doing to cause or exacerbate these problems, and why their employees do not feel able to take sick leave to deal with them.
Cooper runs Robertson Cooper which performs “stress audits” for companies. He is encouraged by the rising level of interest among employers in investigating the question but he fears that presenteeism cannot be fixed until the way managers are recruited and trained is changed. “We’re still not recruiting for social and interpersonal skills in managers. We’re recruiting for people who hit targets or have technical expertise,” he says. He teaches at Manchester University’s Business School and admits institutions like his are to some extent to blame. “We give people knowledge of HR, knowledge of marketing, knowledge of ops management, but we don’t actually train them in the skills they need to manage human beings. So we’re partly responsible too.”
This focus on line managers seems part of the secret to success at the University of Aberdeen. Though the public sector comes out at the bottom of Vitality’s rankings, this university ranks as the best in the sector.
Margaret Ross, vice-principal and head of college for arts and social sciences, explains that managers in universities tend to be heads of the departments that often have a vast number of academics supposedly under their wing. The university has changed the system to introduce “academic line managers” who manage a smaller group of people.
Academics can be particularly prone to presenteeism because they work on drawn-out projects and can easily work from home or pop in and out of the university facilities at any time of the day or night.
Ross says the university has made a conscious effort to persuade staff not to work if they are sick, with senior management necessarily taking a lead. “It does come from the top. The principal will say in open meetings, ‘if you’re not well you must go home and look after yourself.’”
Everyone is conscious of the culture that might make the people concerned think otherwise, she says, “but it’s right to stop if they’re feeling under-par.”
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