How does presenteeism affect my organization?

(by Elizabeth Rupprecht & Matthew J. Grawitch, PhD)


According to Johns (2010), presenteeism is a major issue in contemporary organizations. As an example, EU-OSHA (2011) reported the costs of presenteeism at around 225 billion euro per year for one of Europe’s biggest economies – Germany. Costs are also high in the United States; according to Hemp (2004), presenteeism costs $150 billion per year for U.S. companies.


The concept of “presenteeism” was first used to describe the opposite of absenteeism, or the act of not being absent from work (Johns, 2010). The term is now being used to describe the practice of going to work even when feeling under the weather (Aronsson, Gustafsson, & Dallner, 2000). Even though most people use the latter definition of presenteeism, discrepancies still exist as to whether the focus should be on the causes or consequences of presenteeism. Most British and European researchers focus on the causes of presenteeism, whereas most American researchers focus on the consequences of presenteeism (Johns, 2010). Even newspaper and magazine articles and blogs tend to fall along these divisions.


Cause and consequence


It is important to know both the causes and consequences of presenteeism – only by identifying both can researchers and practitioners know how to prevent costs to the organization. The focal causes of presenteeism studied in most research relate to physical health-related issues, while a major focus of the research on the consequences of preseenteeism relates to losses in employee productivity that result when people currently experiencing acute or chronic health problems attend work (Turpin et al., 2004). In recent research focusing on well-being at work, much of the theory and research has viewed the relationship between well-being and productivity as circular. Furthermore, according to Johns (2010), the concept of presenteeism has expanded out beyond a focus merely on physical well-being. More research is demonstrating that a combination of physical and mental well-being provides more accuracy in predicting productivity loss at the organizational level.


This focus on well-being also reflects a movement towards re-defining presenteeism as employee inefficiency at work (Johns, 2010). Individuals who define presenteeism as employee inefficiency have opened the field to include anything that results in a loss of employee productivity.


But isn’t presenteeism better than absenteeism?


Employees who attend work while sick are still working, while employees who are not at work are not working, so presentees are more productive than absentees, right? That means that absenteeism should be worse for the organization overall. Recent research by EU-OSHA (2011) suggests that presenteeism costs twice as much for organizations as absenteeism. Hemp (2004) also made much the same argument when focusing on U.S. companies.


Results from a SHRM study suggest that the estimates of employee presenteeism costs may be low (Gurchiek, 2009). Out of 522 employees surveyed, 45 percent said that they go to work sick “very frequently,” while managers stated that they thought only 17 percent of employees go to work sick “very frequently.”


What causes presenteeism?


Some researchers believe that the factors causing absenteeism and presenteeism are the same: anything that influences employees to be present if they should be absent will cause presenteeism (Caverley, Cunningham, & MacGregor, 2007). Supporting this belief, research conducted for Cigna (2008) found that 40 percent of workers who report presenteeism experiences do so because of their “work ethic” or “dedication to the organization,” while 25 percent came to work while ill because they “needed the money.” Other reasons included: “toughing [the sickness] out” and not being able to find someone to cover their shift or duties.


Organizational characteristics usually are strongly related to presenteeism. Organizations that increase regular employee pay or try to control the attendance of employees may decrease their absenteeism rates, but they may unknowingly increase the rate of presenteeism (Johns, 2010). Also, if employees are permanent workers (not temporary staff or under the threat of falling prey to downsizing), they exhibit less presenteeism (Aronsson et al., 2000). Employees under higher job demands, employees who work in teams and employees who feel that their work is piling up when they are absent also have higher levels of presenteeism (Aronsson et al., 2000; Demerouti, Le Blanc, Bakker, Schaufeli, & Hox, 2009). Some organizations also have cultures that promote few absences, or even no absences, among employees. These organizations may be influencing employees to practice presenteeism. For example, primary school teachers, who may be under the influence of the no-absence type of culture, have a presenteeism rate of 55 percent, while engineers and computer scientists have a presenteeism rate of 27 percent (Aronsson et al., 2000).


How do I reduce the amount of presenteeism in my organization?


Hemp (2004) suggested some steps that could be taken to reduce presenteeism:

  • Make managers aware of the existence of presenteeism.
  • Identify the health concerns that affect employees, either via a survey or by analyzing the types of employees within the organization. Certain populations (e.g., women, older persons) may have different health concerns than other populations.
  • Educate employees about the costs and perils of presenteeism and provide them the resources to manage illnesses through wellness activities (this is especially true for chronic illness).


In addition, there are other steps that can be taken, which would include:

  • Increasing the number of sick days employees have at their disposal. Having fewer sick days decreases absenteeism, but it may also increase presenteeism (Johns, 1997).
  • Improving wellness programs so that sickness or illness prevention is also improved.
  • Paying special attention to those employees who are involved in higher presenteeism-risk jobs, such as those with higher demands or employees who work in teams.
  • Identifying the characteristics of the organizational culture as they relate to absenteeism and presenteeism. For example, does the organization have a no-tolerance policy when it comes to absenteeism? If so, the organization may be driving employees to be presentees.


Though presenteeism is a major issue in contemporary organizations, it can be managed and improved. Obviously, not all solutions are going to work for every organization. However, many organizations do not even incorporate the concept of presenteeism into their measures of employee well-being or productivity. Therefore, building awareness within an organization is likely to be the first step to addressing the costs associated with presenteeism.


Aronsson, G. Gustafsson, K., & Dallner, M. (2000). Sick but yet at work: An empirical study of sickness presenteeism. Journal of Epidemiology and Community Health, 54, 502-509.

Caverley, N., Cunningham, J. B., & MacGregor, J. N. (2007). Sickness presenteeism, sickness absenteeism, and health following restructuring in a public service organization. Journal of Management Studies, 44, 304-319.

Cigna (2008). The 2008 health leadership series: Absenteeism and presenteeism. Retrieved from

Demerouti, E., Le Blanc, P.M., Bakker, A. B., Schaufeli, W. B., & Hox, J. (2009). Present but sick: A three-wave study on job demands, presenteeism, and burnout. Career Development International, 14, 50-68.

European Agency for Safety and Health at Work. (2011). Presenteeism costs twice as much as costs due to sickness absence, says German study. Retrieved from

Gurchiek, K. (2009). Managers, employees view presenteeism differently. Retrieved from

Hemp, P. (2004). Presenteeism: At work – but out of it. Harvard Business Review, 82(10), 49-58.

Johns, G. (1997). Contemporary research on absence from work: Correlates, causes, and consequences. International Review of Industrial and Organizational Psychology, 12, 115-174.

Johns, G. (2010). Presenteeism in the workplace: A review and research agenda. Journal of Organizational Behavior, 31, 519-542.

Turpin, R.S., Ozminkowski, R.J., Sharda, C.E., Collins, J.J., Berger, M.L., Billotti, G.M., et al. (2004). Reliability and validity of the Stanford Presenteeism Scale. Journal of Occupational and Environmental Medicine, 46, 1123-1133.


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