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Why presenteeism isn't necessarily a bad thing

With around 66% of businesses now working remotely, the importance of employers managing presenteeism is even more critical. Job flexibility has increased, but for many, so has work pressure.

Many employees are feeling compelled to demonstrate availability to their employers, and when home has become office, it becomes even harder to switch off from work. As a result, there is an increased risk of presenteeism impacting not only on employee health but also organisational productivity.

When the majority of employees were in the office, it was easier for managers to intervene when they spotted an employee struggling with a physical or mental health issue.

However, for those working from home, this can be very difficult. Employees are potentially left much more to their ‘own devices’ in managing their health and productivity.

Not only is it potentially more difficult to spot employee health issues, but the question of whether an employee should remain working or take sick leave, is a complicated one.

In the media, presenteeism is framed predominantly negatively for organisations and individuals due to its high cost in terms of lost productivity and its potential negative impacts on employees’ health and wellbeing. Indeed, if unmanaged these negative consequences are likely, and should most certainly be avoided.

However, if well-managed, working whilst experiencing ill health is not inherently bad. Recent research shows that with right adjustments, working while experiencing ill health can have positive impacts.

For example, compared to sickness absenteeism, presenteeism still provides a level of productivity. If managed appropriately, it can help improve employees’ mental health by providing a sense of achievement, structure, social support and the feeling of being included which are essential for wellbeing.

Consequently, when the work demands are adjusted to the health condition, presenteeism can aid recovery. Equally, one does not need to wait until an individual is 100% healthy before returning to work activities; adjusted working during illness can provide a means of facilitating a gradual return to full working capacity.

Research published by members of our team, Maria Karanika-Murray, and Canadian colleague Caroline Biron, suggests there are four main types of presenteeism: functional, dysfunctional, overachieving and therapeutic, some of which can be beneficial.


Functional presenteeism

This refers to engaging with work and attending to performance demands during ill health but without further taxing the presentee’s health. It is therefore sustainable and encouraged. The key to achieving functional presenteeism is a positive and supportive psychosocial working environment.


Dysfunctional presenteeism

In contrast, this puts employees’ productivity, health and wellbeing at high risk. Employees who are engaging in dysfunctional presenteeism neither meet the work targets nor recover from ill health.

Therapeutic presenteeism

This focuses more on the health demands and describes the rehabilitative and restorative effects of presenteeism. The presentee uses work as a therapy although performance is most greatly affected.

Overachieving presenteeism

When employees maintain high levels of performance (in the short-term at least), but at the expense of their health.


These types of presenteeism are not fixed: as the health condition or work demands change, the presentee can move from one type of presenteeism to another. In practical terms, the key implication for managing presenteeism is to identify high-risk presentees (dysfunctional and overachieving) and provide the appropriate resources to move them towards functional presenteeism.

This may mean reducing work demands to what the presentee can do and/or providing resources they need to ensure that they can do their work and that it does not have a detrimental impact on their health or recovery. At the same time, it is important to monitor therapeutic presenteeism to identify when the time is right to reconsider work expectations or provide further support for health.

The key to better management of presenteeism, particularly in the current conditions of widespread remote working, is to support presentees and their managers make the right presenteeism decisions.


Boosting health and productivity

Our research aims to help organisations and employees understand how they can make the right decisions to promote both health and productivity. There are several key elements in achieving this.

First is a supportive and positive psychosocial work environment in which employees feel free to speak up, raise issues and disclose health issues early without fear of negative consequences.

Presenteeism is not usually a simple substitute for absenteeism; the two are highly correlated. When people are unwell, they tend to engage in both. Programmes that aim to improve employees’ physical and mental health, such as healthy eating habits or physical activity, are likely to reduce both presenteeism and absenteeism while also enhancing productivity.

Training for mental health awareness and people skills could be provided to both employees and managers. In general, managers get promoted based on their performance, not their capability of managing people, and traditional management training often focuses on improving organisational performance. However, to enable the ability to understand needs and motivations of colleagues, certain types of training are needed.

Since presenteeism is dynamic, take a systematic approach to dealing with different kinds of presenteeism, taking account of each individual’s personal health status and work situation and adapt the approach regularly.

For example, an adjusted workload may enable an employee with mild depression or anxiety to remain at work and benefit from the structure, social support and sense of purpose offered by work (therapeutic presenteeism). The situation should be closely monitored to detect any changes in either health status or workload, and then determine whether a period of sick leave would be more beneficial, or in contrast, whether the workload/responsibilities can be increased.

We all, at some point, experience the struggle of choosing between taking a day off or continuing to work when experiencing ill health. Some find it an easy decision, others a very difficult one, and this is influenced by a range of work-related and personal factors.

These may include the organisational absence policy, perceived job insecurity, personal financial considerations, their own work ethic and sense of achievement, current workload, replaceability, plus not wanting to let clients down or add extra work to colleagues.

Employees’ decisions are also likely to be influenced by their past experience of similar situations, the atmosphere of the workplace, and what tends to be accepted behaviours in their team. Such factors may help or hinder employees in making the right decision; that is, what changes they can make to support both their health and their productivity not only in the short-term but also the longer-term.

The balance between health and productivity is not a straightforward issue- the vast majority of employees are rarely fully fit nor completely incapacitated. More often than not, we’re somewhere in between.

It’s important to move away from the potentially misleading view that presenteeism is something to be eradicated. Instead, the focus should be on promoting and managing employee health, then determining the right balance of approaches to support employee health, productivity and wellbeing.

Huijun Chen, Zara Whysall and Maria Karanika-Murray are researchers at Nottingham Trent University.