By Zhao Hao

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. It also varies across different countries and regions. For example, European researchers are more concerned with the impact of unemployment and layoffs, while American scholars typically focus on how health insurance and employee assistance programs help mitigate the adverse effects of presenteeism.

However, researchers worldwide have agreed upon on how to address the decreased productivity caused by presenteeism. Debra Lerner and David Adler argue that medical interventions should be adopted to help depressed workers improve work function and reduce productivity loss. Paul Hemp thinks that, before making any intervention, managers and employers should thoroughly identify the productivity loss caused by employees working while ill. 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.

Pitfalls and hazards

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 well-being 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 business 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.

Working while sick = saving money?

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

First, if an employee suffers from a sudden illness while on duty, it is likely to be defined as 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 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 the virus company-wide or to a customer.

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

What can companies do?

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.

First, optimise sick leave management and alternative 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.

Second, offer health education for employees. 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.

Third, 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.

Fourth, establish better employee assistance programmes. Studies have shown that men have a higher risk of cardiovascular disease than women, while women are more prone to depression 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 at CEIBS. For more on his teaching and research interests, please visit his faculty profile here.