The Epidemic of Presenteeism: Rethinking Sick Leave

Human resource departments across North Florida and the country are becoming acquainted with a term called “presenteeism.” It’s absenteeism’s cousin, and it’s proving to be even more costly — and contagious.

The Epidemic of Presenteeism Encouraging employees — whether by policy or by culture — to show up for work when they are sick can have a domino effect on your bottom line by Triston V. Sanders Originally published in the Feb/Mar 2010 issue of 850 Business Magazine


“Wow, he’s really dedicated to the job. He comes in even when he’s as sick as a dog.”

“She has such a good work ethic — she could be on her deathbed and she’d still come to work.”

You probably know someone who fits these descriptions, a co-worker who has been held up as a role model in the workplace. But brace yourself. More and more research suggests that not only is this a faulty thought process, it could also be a prescription for disaster.

Human resource departments across North Florida and the country are becoming acquainted with a term called “presenteeism.” It’s absenteeism’s cousin, and it’s proving to be even more costly — and contagious.

“Presenteeism” was coined to define the practice of workers reporting to work even when they’re sick and not operating at their usual level of productivity. An October 2004 Harvard Business Review article, “Presenteeism: At Work — But Out of It,” featured a study analyzing Lockheed Martin employees and how 28 medical conditions affected their productivity. The findings showed that employees who came to work sick that year cost the company about $34 million. Allergies and sinus problems were the biggest troublemakers, causing $1.8 million in losses.

Even if a company with a good sick policy encourages its employees to stay home when they’re sick, why would an employee feel the need to succumb to presenteeism? A 2004 study found that 66 percent of those surveyed said that “having too much work” and “fear of missing deadlines” were the most common reasons they came to work when sick. Another 56 percent cited lack of anyone to cover their workload as the reason, and 36 percent were showing up out of company loyalty.

Human resources experts say the first step in solving the problem is acknowledging there is a problem in the first place. Employers who support presenteeism may not know just how detrimental it can be to the bottom line. Businesses need to scrutinize their own policies and make sure that those in a position to influence their employees are aware of the problem and how costly it can be.

Mary Barley, director of corporate wellness for Gold’s Gym and Women’s World, also is chairwoman of the Working Well Initiative. This voluntary group is committed to getting the community’s work force healthier and is helping to familiarize local companies with presenteeism.

“When a company’s employees are sick or not performing well due to discomfort, illness or mental distraction during work hours, their downtime affects overall organizational productivity,” Barley says. “Lost productivity from days at work while sick is significantly greater — 72 percent — than days missed due to illness, which is 28 percent. Presenteeism costs U.S. companies more than $150 billion a year and accounts for up to 60 percent of employers’ health care costs. But even though the numbers are overwhelming, organizations can begin to control those costs by thinking of their employees as an investment that needs to be well managed instead of a business expense.”

The World Health Organization declared the H1N1 virus a global pandemic on June 11, 2009. Because H1N1 and many other illnesses remain contagious longer than many companies’ paid sick leave time frames, many companies have had to rethink their policies. The U.S. Department of Labor’s Bureau of Labor Statistics reports that in 2006, just over one-half — 57 percent — of private-industry workers had access to paid sick leave. The Families and Work Institute also reports that only 39 percent of low-wage employees are given paid time off for personal illness. That means people are forced to go to work if they want to get paid, even if they are sick. According to the National Partnership for Women & Families, the nation’s economy would experience a net savings of

$8.2 billion per year if workers were provided just seven paid sick days per year.

Joyce Chastain, the human resources director for Mainline Information Systems in Tallahassee, says employees react differently to illness.

“Some are motivated to work while suffering with significant symptoms,” she says. “Even though they may not be as productive as if they were healthy, they are intrinsically motivated to continue to produce. Others have a much lower threshold. There are also different business demands related to specific individuals within the company that may drive their desire to report to the office.

“To protect all employees from making these type of judgment calls, we have designed a pandemic flu plan which requires absence from the office as soon as flu-like symptoms are experienced,” Chastain says. “We make provisions, where possible, for these employees to work from home during the contagious period. By having a policy that restricts attendance in the office during H1N1, we protect our otherwise healthy employees from continuous exposure to this flu.”

Barley agrees and points out that with the technology that exists today, there is no excuse for employees to come to work with an illness.

“I always encourage people to call in sick,” she says. “Many office workers have the ability to work from home now, so if they really have to get something done they can do it at home. (Although I recommend they go to bed and focus on getting well first.) And if they have a meeting, they could make arrangements to do it by phone from home — if they feel up to it. If they don’t, they need to take the time to do whatever it takes to get well, then they can go back to being 100 percent.”

Barley recently had to be confined to a friend’s home for six weeks following hip replacement surgery. She worked from home via e-mail, phone, having people meet her at home and having board meetings at home. Barley managed to pull off a successful event six weeks after she had the surgery — an event that at one point she had thought about canceling.

Steve Adriaanse, vice president/chief human resources officer of Tallahassee Memorial Hospital, says presenteeism isn’t a problem for his company because TMH’s 3,500 employees have a heightened awareness of the potential of cross-contamination.

“Additionally, we have a fully functioning Occupational Health Department that provides basic assessment, first aid and referral to our colleagues at no cost,” he explains. “The success of any organization is dependent upon the productivity of the work force. Generally, a colleague who is ill may not be as productive as one who is not ill. As a result, it is important to provide a means by which the colleague may recuperate so that they may be as productive as possible.

“Equally as important, since the success of the organization depends upon the productivity of the work force, is to maintain a consistently administered policy which addresses aberrant behaviors related to absenteeism, to ensure that you have the necessary work force in attendance to perform the duties required to provide the goods or services for which your organization is responsible,” Adriaanse says.

Ric Shriver, Hospital Corporation of America’s division vice president of human resources, manages 15 hospitals located in Georgia and North Florida, including Capital Regional Medical Center in Tallahassee. His company also mandates that employees who are ill stay away from the workplace.

“We do this first and foremost to protect our patients and their family members,” Shriver says. “But we also do this to ensure that employees who do become ill take care of themselves and minimize the opportunity to infect their co-workers. After three days of absence, an employee must present a clearance from his or her physician that he or she is able to return to work.”

Shriver advocates a preventive approach instead of a reactive one, having managers encourage their employees to take care of themselves. The company also ensures that facility infection control, sick leave and personal leave policies are clearly written, communicated, accessible and understood by both management and staff employees.

According to the 2004 CCH Unscheduled Absence Survey conducted by Harris Interactive, disciplinary action remained the single-most-used absence control program, with 91 percent of surveyed organizations reporting its use. Employers want their employees on the job and using as few sick days as possible, but CCH says employers that rely on disciplinary action to control absenteeism and abuse of sick time are unknowingly encouraging presenteeism.

“We don’t want to encourage associates who have any illness to come to work,” says Dwaine Stevens, media and community relations manager for Publix. “Customer service is our priority, and we want our associates to be in top form when they interact with shoppers. Because of the business we’re in, we are extra-sensitive to the health of our associates, because they have the potential to pass anything they have to our customers and the food they handle. That’s why we have communicated information on certain illnesses and symptoms that our managers should watch for in our associates. In the case of a large-scale concern like H1N1, we monitor and follow all CDC directives.”



How to Keep Presenteeism at Bay in Your Office

  • Review workplace policies
  • Don’t rely on disciplinary action to control absenteeism
  • Offer paid sick days
  • Cross-train employees
  • Allow telecommuting as an option

The Society for Human Resource Management offers HR professionals and their organizations a checklist at to guide them through keeping their work force as safe and healthy as possible and keeping their business running until the emergency has run its course. Companies can get guidance and answers to questions on how to handle H1N1 virus issues from the U.S. Centers for Disease Control and Prevention at