Presenteeism is one of the most costly behavioural issues across the UK workforce, limiting business productivity and profitability. Yet, despite the scale of the problem, responses are often underwhelming or misguided.

One very likely reason for this is that many (both employers and employees) simply aren’t sure what presenteesim is, how it manifests, and how damaging it can be for all involved.

In this guide, we offer a clear explanation of presenteeism as a concept, as well as the real-world implications when it goes unaddressed.

What is presenteeism?

For all the confusion around presenteeism, it’s actually very simple… working while sick.

It can refer to an individual working while sick, or a broader culture that explicitly or implicitly encourages people to continue working while ill. It also applies across types of ill health, from illness to injury to exhaustion, and applies to both physical and mental health.

When people force themselves to come into work when sick, they’re unable to deliver work at their usual standard and rate. In fact, depending on the severity of their condition, their abilities may be sharply diminished and their performance well below average, harming productivity.

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Side note – In scholarly circles, there are a few differing definitions of presenteeism. For example, Ruth Simpson in her research defines it as ‘the tendency to stay at work beyond the time needed for effective performance on the job.” However, general consensus is that presenteeism describing working while sick is a more valid framework and can be more useful in terms of practical application.

Why does presenteeism happen?

There are several reasons why people feel the need work when sick, and it’s almost a given that everyone will have felt the pull of at least one of them at some point in their working lives.

For a complete understanding of motives, it’s important to split them into two distinct categories: individual & cultural. Individual motives are personal to the sick worker, while cultural motives are underlying organisational, social or economic principles that compel people to work while ill despite not wanting or being able to.

Individual motives for presenteeism:

• Love of the work – For some, work is a labour of love, something they enjoy doing and have a hard time taking a break from, even when ill.
  
• Work-related self-esteem – Work can be a great builder of self-esteem, but when people overly rely on work as a signifier of self-worth, it can lead to workaholism and presenteeism.
• Work as an escape – Work may be used as an escape from stressful or dysfunctional domestic life, even when too ill to do the job at a satisfactory level.
• The “I’ll never catch up” mentality – Some are overwhelmed by the feeling that they’ll never be able to catch up with work missed if they take time off to recuperate during an illness.
  
• Financial goals – Even if someone can technically “afford” to miss work, they may be encouraged to attend to make progress on personal finance goals.

Cultural motives for presenteeism:

• Job insecurity – If someone believes they may be at risk of losing their job or career prospects if they take time off, they’re likely to attend work while sick.
  
• Hero work culture – Some workplaces either intentionally or unintentionally over-celebrate employees who go above and beyond, implying that working while ill is both good and expected.
  
• Understaffing and lean management – When teams are stretched thin, there is no slack in the system. If one person is out, the remaining team members are overwhelmed, creating guilt-driven presenteeism.
• Importance – Key workers may feel they have to attend work while ill due to their importance or being irreplaceable. Doctors, for example, are particularly prone to this form of presenteeism.
• Following example – If managers and executives show up sick, they send a silent but powerful message that everyone else is expected to do the same.
• Financial necessity – Time away from work often means losing pay, which, for workers struggling to make ends meet, can seem like a non-option.
• Disciplinary triggers based on absences – If a business follows an absence that recommends strict disciplinary triggers based number of absences (e.g. Bradford Factor), workers may force themselves to attend while ill.
• High stakes deadlines – Project-based environments where missing a single day could jeopardise a multi-month deliverable or a client relationship.
• Mental health stigma – Workplace stigma or misunderstandings surrounding mental health could make employees feel unable to take days off work when they’re mentally unwell.
• The British “stiff upper lip” – With roots in the Victorian era and amplified during wartime, stoicism is inextricable from British culture. People may work when ill simply because they assume it’s “the done thing” across the UK.

One additional motive straddles both individual and cultural causalities – acts of organisational citizenship. This means someone is attending work while ill to coax admiration and respect from their colleagues.

Understanding the difference between presenteeism and absenteeism

Presenteeism and absenteeism are related but fundamentally different. Presenteeism describes a situation in which people are attending work when they shouldn’t due to illness, while absenteeism in the workplace describes regular absences.

Although they appear to be opposites, they’re not strictly at odds, as absenteeism doesn’t always relate to situations where a person should be in work but isn’t. For example, if an employee is struggling with their mental health and takes more than the average sick days to protect their wellbeing, this might technically fall under the absenteeism category.

Both presenteeism and absenteeism can be problems for businesses, but, perhaps surprisingly to some business owners, presenteeism is generally considered to be much more costly than absenteeism.

How much does presenteeism cost businesses?

It’s estimated that the impact of presenteeism on productivity is roughly 12 times higher than absenteeism¹, and costs are typically double those associated with absenteeism² across various causes.

In 2023, for example, presenteeism due to financial stress alone cost UK businesses £6.6 billion, 100% more than absenteeism caused by financial stress³. And presenteeism caused by mental ill health costs the UK economy roughly £15.1 billion, just shy of twice absenteeism’s £8.4 billion⁴.

Some employers may hesitate to address presenteeism because they think that, ultimately, it helps the bottom line. After all, even if someone is under performing, it stills signals greater productivity than if they were off sick and not working at all, right? Well, actually this couldn’t be further from the truth.

Yes, some work is being done when someone is working through an illness, but below capacity performance sustained over weeks or months typically results in greater overall productivity loss than a total absence over a short period.

What’s more the quality of work diminishes, and mistakes become more common place. Depending on the nature of the work, this can have far-reaching consequences, impacting several areas of operation.

There’s also the contagious factor to consider.

Sometimes, workers will come to work with a contagious illness, potentially spreading the impact from one person to the entire workforce, multiplying the negative impact several times over.

Why it can be tricky to identify presenteeism

One major problem with presenteeism is that it’s largely a covert issue.

Think about it like this… an office manager sees that all staff are present and eagerly working at their desks. There doesn’t seem to be any disruption. No one is making any complaints. Keyboards are clattering, mice are clicking… it’s your typical BAU workday.

But this is just a veneer hiding the reality of the situation that only comes to light later down the road in performance reports, client feedback, and even revenue tracking.

What businesses need to understand is that presenteeism is performative, meaning it’s more about the appearance of working than actually working.

This doesn’t mean that an employee is consciously trying to trick you. On the contrary, it’s a form of dedication. They either want or feel they need to be present at work and are often unaware of the limitations their condition places upon them.

The employer therefore plays an essential role in cultivating a culture that makes employees feel safe to take time off to recover when required. As for how to spot signs of presenteeism, see our dedicated guide, and learn how your DSE data can play a pivotal role in identifying instances of presenteeism.

How Cardinus can help to prevent presenteeism in your workplace

One of the major drivers of presenteeism due to physical ill health are musculoskeletal disorders (MSDs), primarily caused by poor ergonomics at work.

Our ergonomics solutions are built from the ground up to identify ergonomic hazards responsible for musculoskeletal injuries and support you in creating a safe, healthier, happier, and more productive workplace.

From virtual and on-site ergonomic assessments to end-to-end DSE and industrial ergonomics risk management platforms proven to reduce work related MSDs by as much as 80%, we can deliver a service tailored to your needs and the needs of your team. Contact Cardinus today to learn more.

Citations

1. 1. The three ‘isms’ costing your business money – Open Access Government
   2. The annual cost of presenteeism is twice that of absenteeism – Key Appointments
   3. How much is absenteeism and presenteeism costing your business – Aegon
   4. Managing presenteeism – Centre for Mental Health