High job demands, stress and job insecurity are among the main reasons why people go to work when they are ill, according to new research by an academic at the University of East Anglia (UEA).
The study aims to improve understanding of the key causes of employees going to work when sick, known as presenteeism, and to help make managers more aware of the existence of the growing phenomenon, what triggers the behaviour and what can be done to improve employees' health and productivity.
A key finding of the study, published in the Journal of Occupational Health Psychology, is that presenteeism not only stems from ill health and stress, but from raised motivation, for example high job satisfaction and a strong sense of commitment to the organisation. This may motivate people to 'go the extra-mile', causing them to work more intensively, even when sick.
One of the significant links to presenteeism is the severity of organisational 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.
Lead author Dr Mariella Miraglia, a lecturer in organisational behaviour at UEA's Norwich Business School, argues that presenteeism is associated with work and personal factors, not just medical conditions. Also, that these factors are more strongly related to, and so more able to predict, presenteeism than absenteeism.
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 organisations. It has been linked to errors, lower performance, exacerbating health problems and affecting wellbeing, with more productivity loss than absenteeism. The Centre for Mental Health calculated that presenteeism from mental ill health alone costs the UK economy £15.1 billion a year.
"This study sheds light on the controversial act of presenteeism, uncovering both positive and negative underlying processes," said Dr Miraglia, 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.
"Working while ill can compound the effects of the initial illness and result in negative job attitudes and withdrawal from work. However, the possible negative consequences of being absent can prompt employees to show up ill or to return to work when not totally recovered. Organisations may want to carefully review attendance policies for features which could decrease absence at the cost of increased presenteeism."
The research analysed data from 61 previous studies involving more than 175,960 participants, including the European Working Conditions Survey which sampled employees from 34 countries. Dr 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 of finding cover 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 positively related to presenteeism. 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, for example supportive colleagues and a good relationship with managers, felt they did not have to go to work when ill, and were both more 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 Dr Miraglia. "Workplace wellness and health programmes may be desirable to reduce stress and work-related illness. Furthermore, although increasing job resources, such as job control and colleague, supervisor, and organisational 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 defence against the behaviour.
"Organisations 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."
Dr Miraglia said 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 behaviour.
"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 organisation wanted it and were prepared to be flexible, for example by modifying job descriptions or offering flexy time."