High job demands, stress and job insecurity are among the main reasons people go to work when they are ill, according to new research.
Called “presenteeism,” those who go to work when they are sick often have a strong sense of commitment to their employer. This motivates them to go the extra mile, leading them to work more intensively, even when sick, according to a researcher at the University of East Anglia (UEA) in England.
In previous research, presenteeism has been associated with both negative and positive effects on employee productivity and welfare, with contradictory causes and consequences for individuals and organizations. It has been linked to errors, lower performance, exacerbating health problems, and affecting wellbeing, with more productivity loss than absenteeism.
“This study sheds light on the controversial act of presenteeism, uncovering both positive and negative underlying processes,” said lead author Dr. Mariella Miraglia, a lecturer in organizational behavior at UEA’s Norwich Business School, who worked with Dr. Gary Johns of Concordia University in Montreal, Canada.
“It demonstrates that presenteeism is associated with work features and personal characteristics and not only dictated by medical conditions, in contrast to the main perspective of occupational medicine and epidemiology.”
Employees are often conflicted on whether to go to work while ill, according to the researcher.
“Working while ill can compound the effects of the initial illness and result in negative job attitudes and withdrawal from work,” she said. “However, the possible negative consequences of being absent can prompt employees to show up ill or to return to work when not totally recovered. Organizations may want to carefully review attendance policies for features which could decrease absence at the cost of increased presenteeism.”
A significant link to presenteeism is the severity of organizational policies used to monitor or reduce staff absence, such as strict trigger points for disciplinary action, job insecurity, limited paid sick leave, or few absence days allowed without a medical certificate or note from a physician, according to Miraglia.
The new study analyzed data from 61 previous studies involving more than 175,960 participants, including the European Working Conditions Survey, which sampled employees from 34 countries. Miraglia developed an analytical model to identify the most significant causes of presenteeism and absenteeism, with work and personal characteristics relating differently to presenteeism depending on whether they followed a “health impairment” or “attitudinal/motivational” path.
Job demands, such as workload, understaffing, overtime and time pressure, along with difficulty finding someone to cover their shift and personal financial difficulties, were found to be key reasons why people might not take a day off.
Conflict between work and family, and vice versa, and being exposed to harassment, abuse and discrimination at work were also related to presenteeism, the study found. This is because these negative experiences can exacerbate stress and harm health, requiring employees to choose between going to work and staying away.
Those who had a supportive work environment, including supportive colleagues and a good relationship with managers, felt they did not have to go to work when ill. They were both satisfied with their jobs and healthier. Optimism was linked to presenteesim, in that those with a positive outlook were more willing to carry on with their work while ill.
“Because presenteeism is more predictable than absenteeism, it is easy to modify by management actions,” said Miraglia.
“Workplace wellness and health programs may be desirable to reduce stress and work-related illness. Furthermore, although increasing job resources, such as job control and colleague, supervisor, and organizational support, can be helpful in tackling presenteeism through their positive impact on health, our results suggest that controlling job demands represents a key line of defense against the behavior.
“Organizations may benefit from well-designed jobs that limit the level of demands to which employees are exposed to every day, for example by reducing excessive workload, time pressure, and overtime work, as well as making sure they have the resources they need,” she continued.
Miraglia added further research was needed to understand when going to work while ill could be a “sustainable” and positive choice, for example in the case of a gradual recovery from long-term sickness, to improve self-esteem in the face of chronic illness or being an example of citizenship behavior.
“It could be a good thing for some people, a way of integrating back into work again,” she added. “But it would depend how much the individual and organization wanted it and were prepared to be flexible, for example by modifying job descriptions or offering flex time.”
The study was published in the Journal of Occupational Health Psychology.