Millions of Americans are going to work sick every day with colds, flu symptoms, depression, back pain, chronic headaches, stomach disorders and other ailments, and it's causing, by far, the single most costly drain on productivity in the workplace. It's a phenomenon occupational health experts call presenteeism, an opposite cousin of absenteeism in which, instead of staying home to heal, employees are reporting to work ill, overly fatigued, or for other reasons, not performing to their usual capacity.
The total cost of presenteeism in the United States is estimated to exceed $150 billion a year. Two Journal of the American Medical Association studies found that the on-the-job productivity loss resulting from depression and pain was roughly three times greater than the absence-related productivity loss associated with those same conditions.
Looking closer at the total cost of employee health to U.S. employers, studies have shown that only about 30 percent is attributed to direct medical care and pharmaceutical costs, usually in the form of premiums an employer pays to an insurer. Another nine percent is associated with short- and long-term disability and worker's compensation. Just 6 percent is the result of absenteeism. The overwhelming majority of the cost — 60 percent — is attributed to health-related lost productivity caused by presenteeism.
Even though the illnesses people bring to work with them may have lower direct health care costs, the indirect costs are far greater. That's because the illnesses common to presenteeism are so widespread, almost always go untreated and typically occur during a person's peak working years.
There's also an invisibility factor with presenteeism. Unlike absenteeism, presenteeism isn't always readily obvious. You know when someone is absent. It's harder to tell when they're present, but hindered by some type of illness or medical condition. Outwardly they may appear fine, but inwardly they are struggling and their performance is suffering.
To address the problem, a growing number of health systems and private consultants on occupational health throughout the U.S. are working with employers, from small businesses to large corporations, to evaluate its scope and implement solutions. Among the priorities being put forward are these:
- Recognize the problem. As widespread as the presenteeism issue is, many employers and employees have never heard of it. If you're the boss, educate yourself and make your managers and employees aware of the problem and its rising toll on the workplace.
- Develop a workplace policy on presenteeism. Establish and communicate clear guidelines that let employees know you don't want people coming to work sick, under what conditions they should stay home and when it's OK to return to work.
- Rethink the use of disciplinary action to control absenteeism. Absence control policies can be counterproductive. Disciplinary actions may pressure sick employees to report to work.
Set a good example. As the boss, if you are sick or unable to work effectively, stay home. Don't spread your germs to others and set the expectation that others should come to work sick too.
- Send sick employees home. Many companies address the issue of presenteeism head-on by sending sick employees home. When possible, employees are given the option to work from home when not well.
- Consider paid sick leave or time off. If you don't offer it already, this benefit can discourage people from coming to work sick, reduce exposure to others and increase overall productivity.
Presenteeism is becoming a widely recognized reality of the workplace. It isn't about goofing off on the job or faking illness to avoid work. It's a real phenomenon caused by real health problems, resulting in real productivity loss. The attention we pay to the problem needs to be just as real.
Joe Flynn is the Berkshire Health Systems Urgent Care and Occupational Health Director