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Sick and at work? What does presenteeism mean for your organisation and how does it impact productivity?

Thursday, 20 May 2010
08:30 - 11:00
The Work Foundation, 21 Palmer Street, SW1H 0AD

Partner Workshop:

Sick and at Work? What does presenteeism mean for your organisation and how does it impact productivity?


  • Katherine Ashby, Researcher, Health & Wellbeing, The Work Foundation
  • Stephen Bevan, Managing Director, The Work Foundation 
  • Ian Clabby, Employee Engagement Manager, AXA PPP Healthcare 

This workshop provided a great opportunity to capture partner organisations’ insights into the subject of sickness presence – going to work when ill. We also shared the findings of our new report Why do employees come to work when ill? and Ian Clabby from AXA PPP spoke about why they sponsored the report and how they tackle sickness presence in their organisation.


The subject was not something many of the organisations (both public and private sector) had considered. There was some debate over the implications of sickness presence and if it was a good or bad thing for organisations. Is it better for employees to be at work when they feel their health is such that they could have taken sick leave, than not at work at all?


The findings of our recent research with AXA PPP (involving a survey with 510 employees) showed that attending work when self perception of health justifies time off was associated with reduced psychological wellbeing, higher levels of sickness absence and lower levels of manager-assessed performance. Sickness presence was more prevalent than sickness absence – and sickness presence and sickness absence were positively related. This is important because organisations are often wary of tackling sickness presence if they think the alternative is sickness absence.


Yet our findings indicate that people with lower levels of sickness presence also had lower levels of sickness absence. This suggests that like sickness absence, sickness presence can be an indicator of employee health wellbeing. Employers may be at risk of underestimating employee ill health by focusing on sickness absence alone.


We were asked a number of times during the workshop whether employers should be measuring sickness presence?

We responded that employers definitely need to be more aware of sickness presence and that employees coming to work when their self-perception of health justifies time off may be adversely affecting their health and wellbeing and performance. It would be beneficial for employers to measure and monitor sickness presence to gain an insight into the extent and level of sickness presence in different parts of their organisation. However, accurately measuring sickness presence can be challenging and problematic. It is also important to keep in mind that measuring sickness presence (using either qualitative or quantitative data) is the starting point. It will then be crucial to look at what factors are underlying sickness presence and what can employers do to address these issues.

What is the best way to go about measuring sickness presence? Is this possible?

Research into sickness presence is still in its infancy compared to that on sickness absence and the same is true in terms of tools of measuring sickness presence.  Measuring sickness presence can be complex because it can involve exploring not only if employees are reporting attending work when they feel they should have taken time off, but also the extent to which performance is impaired by working when sick. In our research we used a version of the Stanford presenteeism scale, which requires people to think about the last time they came to work unwell and answer a number of questions about how easy or difficult it was to carry out their role in those circumstances.

So what can be done?

A starting point for organisations could be to qualitatively explore these issues. This involves talking to employees and managers about the issue of attending work unwell and ensuring managers are equipped to have these kinds of conversations and be alert to the warning signals of psychological ill health and high levels of stress. Other options include adding questions to staff surveys about the number of days employees have come to work despite their perception of health justifying time off. However, where the organisational culture is such that employees feel under a lot of pressure to not take time off work for ill health, or employees fear being perceived as not performing at 100% discussing these issues may be difficult.

It is also important to be clear about what you are measuring and recognise that self-perception is important - some people with chronic health problems and disabilities may not define themselves as 'sickness present' if their health does not impact on their work ability. Additionally work can play a positive role in maintaining wellbeing during periods of ill health for many. More information on sickness presence and how it is defined in our study is available in the report - Why do employees come to work when ill?

As mentioned above, gathering information is a starting point not an end in itself – as sickness presence, like absence is often a symptom of underlying factors. The next step is exploring what these underlying factors are and working to address them. In our research with AXA PPP some of the factors that were associated with sickness presence were,

  • work-related stress
  • perceived pressure from managers and colleagues to attend work unwell
  • experiencing personal financial difficulties

The recommendations we made to AXA PPP therefore focus on targeting these areas. Ian Clabby gave a well-received presentation on how they were taking these recommendations forward. In particular, around work-related stress AXA PPP is looking to refresh line manager training around work-related stress and psychological wellbeing. Ian mentioned how AXA PPP is also working with mental health charity MIND to raise awareness of how to deal with mental health problems employees commonly encounter. MIND is also a partner of The Work Foundation and we are sponsoring their campaign 

Steve Bevan closed the morning’s discussion by highlighting that more research into sickness presence is required and there seems scope for much innovation and action in this area. It is hoped that our project and follow up events raise awareness of sickness presence and the need to prioritise employee health and wellbeing.


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