By Prof. Zhao Hao, Professor of Management, CEIBS

Working while sick is academically known as presenteeism. It refers to the productivity loss when employees are not fully functioning in the workplace because of an illness, injury, or other medical conditions. Even though the employee may be physically at work, they may not be able to fully perform their duties and thus cause a significant drain on productivity.

Presenteeism is the opposite of absenteeism. The latter means the habitual non-presence of an employee at their job, or being away from the office for days beyond legitimate leave.
Absenteeism is when an employee pretends to be sick to avoid going into work, while presenteeism is when workers disguise their sickness when pressured to be present at work.

It is only in the last two decades that Western scholars have begun to study presenteeism from the perspectives of management, medicine, organisational behaviour, psychology, etc. Research also varies across countries and regions. European researchers, for example, have paid more attention to the impact of unemployment and layoffs, while American scholars have typically focused on how health insurance and employee assistance programmes can mitigate the adverse effects of presenteeism.

Despite these different approaches, researchers broadly agree that the productivity loss caused by presenteeism needs to be addressed. Debra Lerner and David Adler argue that medical interventions can help employees with depression improve work function and reduce productivity loss. Paul Hemp emphasises the importance of identifying the productivity loss caused by employees working while ill before deciding how to intervene.

Gary Johns believes that to solve the presenteeism-related productivity issue, corporate managers must understand the meaning, cause, and consequences of presenteeism.

I believe that while it's crucial to address productivity loss caused by presenteeism, the economic costs involved must be clear to attract management's attention to this problem.

Why Working While Sick Is a Safety Risk

Presenteeism becomes a safety risk when illness affects an employee's ability to perform safely in roles where lapses in concentration or physical condition can have serious consequences.

People working in the public transportation industry often work long hours and irregular shifts, putting their physical health in jeopardy. Several high-profile traffic incidents have been reported in China in recent years due to the poor health of the drivers. While the media praises the sense of responsibility of bus drivers in prioritising the safety and wellbeing of passengers, more attention should be focused on the health risks and leave needs of grassroots employees.

Working while sick not only harms the employees' wellbeing, but also costs businesses money and can result in public safety crises, especially when they work in stressful positions such as bus drivers or airplane pilots. Thus, it is in everyone's best interest for companies to be generous with leave for employees who need it.

The False Economy of Presenteeism

Many companies deny employees' sick leave to save money, but there is a miscalculation behind this argument. Can presenteeism truly save an organisation money? Here are a few things to consider.

First, if an employee suffers from a sudden illness while on duty, it is likely to be defined as a work-related injury, and the company must compensate accordingly in accordance with the law.

Second, if a sick employee's health condition worsens due to a lack of timely treatment, the organisation may need to grant a longer leave in addition to the compensation, increasing associated costs.

Third, even if the employee comes to work, being ill hinders productivity and concentration. In industries such as public transportation, where a few seconds of distraction may lead to a major disaster, companies must take safety hazards into account when calculating financial costs.

Fourth, working while sick may have other unintended consequences. For example, a sick employee may dampen the mood of colleagues; a presenteeism-caused productivity loss may result in increased work for co-workers; a sick worker in the catering industry may spread a virus to colleagues or customers.

The wider economic costs can be substantial. In 2004, Paul Hemp reported that, by some estimates, presenteeism was costing US companies more than $150 billion a year. More recently, an IPPR analysis found that the combined annual cost of employee sickness in the UK had risen from £73 billion in 2018 to £103 billion in 2023, with £25 billion of that £30 billion increase linked to lower productivity among people working through sickness.

Presenteeism is penny-wise and pound-foolish. Instead of saving money, presenteeism will incur higher costs, damage reputations, hinder leadership, and risk labour lawsuits.

What Employers Can Do About Presenteeism

Apart from building a sophisticated management and benefits systems, organisations should pay greater attention to health education, both mental and physical. Insufficient health awareness hinders the actual impact of any measures taken by the company. Therefore, companies need to invest more in health education, combined with initiatives to improve health benefits to make up for any productivity loss.

Optimise sick leave and shift arrangements

For special positions like drivers, companies should provide extra unconditional paid leave on top of their regular vacation. When the employee proposes to take leave, companies should approve and arrange alternative options rather than reacting with suspicion or in an un-cooperative manner. More importantly, even if an employee does not propose leave, managers should force him/her to take time off when they find the employee is physically or emotionally abnormal.

Offer health education

Organisations should emphasise work-life balance, reduce over-time, and organise regular medical check-ups for their employees. It is also beneficial for enterprises to offer fitness programmes.

Train managers and employees

Companies need to provide training so that both employees and managers can understand the connection between illness and reduced productivity. They also need to provide protection mechanisms to encourage employees to speak out if feeling unwell. It will also make work arrangements easier for employers if employees report their problems in a timely manner.

Establish employee assistance programmes

Sex differences in health can help inform targeted support. Research shows that men tend to develop cardiovascular disease earlier than women, while the World Health Organization reports that depression is about 1.5 times more common among women than men. If an employee develops a severe occupational disease, others in similar positions may have the same problem. Managers should measure their workforce composition, assess risk, and conduct targeted screening and health counselling for specific populations to promptly identify potential problems.

Increased education and investment in employee health can mitigate long-term risks and save potential costs in the future. An organisation that cares about the health of its employees can balance cost control and high productivity for long-term growth.

Early birds get early advantages. If a company takes the lead in investing in and protecting employees' health, it will be more competitive in the market. People are more concerned about their health than ever before. Therefore, investing in physical and mental health allows companies to eliminate presenteeism, while also benefitting from employee satisfaction and employer branding to achieve a win-win result.

Zhao Hao is a Professor of Management and Programme Co-Director of the Advanced Management Programme at CEIBS. His research interests include leadership, innovation and entrepreneurship, artificial intelligence, and human resource management.

Frequently Asked Questions

What is presenteeism?

Presenteeism refers to the productivity loss that occurs when employees continue working despite an illness, injury, or other medical condition that prevents them from functioning fully. They may be physically present at work, but their health can reduce their concentration, performance, and ability to carry out their duties effectively.

What is the difference between presenteeism and absenteeism?

Presenteeism occurs when employees remain at work despite being unwell and cannot perform at their full capacity. Absenteeism refers to employees being away from work beyond legitimate leave. Presenteeism can be harder for managers to recognise because the employee is still physically present even though their health is affecting their work.

What does presenteeism cost employers?

Presenteeism can create substantial productivity costs. Paul Hemp reported in 2004 that it cost US companies more than $150 billion a year. In the UK, the combined annual cost of employee sickness rose from £73 billion in 2018 to £103 billion in 2023, with much of the increase linked to working through illness.

How can employers reduce presenteeism?

Employers can reduce presenteeism by improving sick leave and shift arrangements, providing health education, training managers and employees to recognise the connection between illness and productivity, and establishing employee assistance programmes. Employees also need clear protection mechanisms so they feel able to report health problems and take necessary time away from work.