Absenteeism, i. e. not showing up for work, has been the subject of much research to date. In contrast, presenteeism (defined as showing up for work when one is ill), has only received interest in recent years, with research suggesting that it might cause more aggregate productivity loss than absenteeism. Consequences of chronic presenteeism or absenteeism may include effects on downstream health status, job attendance dynamics, and organizational membership.
The present review by Gary Johns touches on the subject of defining presenteeism appropriately for organizational practice and research, attempts to summarise the two main streams of research in presenteeism, and proposes a theoretical framework which could guide future research.
Reviewing theory and research
Presenteeism has been defined in various ways, and the author emphasises that a definition should neither ascribe motives, nor consequences to presenteeism. In particular, productivity loss resulting from presenteeism should not be labeled “presenteeism” (as has sometimes been the case), firstly, because it is unhelpful to refer to cause (presenteeism) and effect (productivity loss) as one and the same, and secondly, because this implies that presenteeism is seen as a negative event by the organisation, although presentees will likely be more productive than absentees, which may – in some situations – render presenteeism an act of organisational citizenship.
Presenteeism has been researched from two main perspectives: A British/European view with a focus on the precursors of presenteeism, and an American view, which – rather than asking why people show up to work when they are feeling ill – has concentrated on the productivity loss resulting from presenteeism.
Precursors of presenteeism
Research indicates that certain factors, such as earning relatively high wages, working in a firm that is in the process of downsizing, working as a non-permanent employee, and knowing that work is piling up when one is ill, are associated with less absenteeism, thus suggesting that these factors may influence an individual’s inclination to attend their job even when they are feeling unhealthy. A growing body of evidence supports the notion that norm-based “absence cultures”, operating at a collective level, may account for variance in individual job attendance.
Different medical conditions, and whether they generate absenteeism or presenteeism, have also been the subject of research. In particular, it has been suggested that certain conditions may figure more heavily in presenteeism than others, in part because they are not generally seen as legitimate reasons to be absent.
Productivity loss attributed to presenteeism
There is widespread agreement that presenteeism accounts for more aggregate productivity loss than absenteeism: “On the face of it, this suggests an iceberg effect in which the more visible portion of work loss (absenteeism) is dwarfed by that portion beneath the surface (presenteeism)” (p. 530). This does not mean that productivity could be enhanced if people were advised not to show up for work when they are ill, but rather indicates that while productivity loss from absenteeism may be high, productivity loss from presenteeism is probably even higher, because it is more prevalent then absenteeism, but much less accounted for.
A theoretical model
The author suggests a model which “assumes that fully productive regular attendance is interrupted by a ‘‘health event’’ that is either acute (e.g., the flu), episodic (e.g., migraine), or chronic (e.g., the onset of diabetes)”, and that “to some extent, the nature of the health event will dictate whether absenteeism or presenteeism ensues” (p. 532).
Among other notions, it is identified that a theory of presenteeism should recognize the subjectivity of health, account for the relationship between absenteeism and presenteeism, give special attention to job insecurity as a precursor of presenteeism, incorporate work attitudes and experiences, as well as personality, and attend to presenteeism’s social dynamics.
How can a deeper knowledge of presenteeism be useful? The author proposes that scholars in organizational behavior, human resources, organizational psychology, and health psychology should apply their distinct skills to add to “our understanding of how absence episodes start and how decisions to return to work are effected”, and to probe “the loosely coupled but important connections among having a medical condition, defining oneself as ill, and engaging in work behaviors associated with assuming a sick role” (p. 522).
Such knowledge could contribute to more accurate estimates of employee health costs, and is required if organisations are to take informed decisions about how to manage presenteeism.
Image courtesy of Orphan Jones.
Johns, G. (2009). Presenteeism in the workplace: A review and research agenda Journal of Organizational Behavior, 31 (4), 519-542 DOI: 10.1002/job.630