A woman viewed from behind touching a sore shoulder. The soreness is indicated by red colour

The Costly Pitfalls of Workplace Stress and Presenteeism

Bill is a manager of a department of 50 people in a SME. For the last few months a project involving most of his department has been quite busy, forcing many employees to work overtime a few days a week. Bill knows that many of the employees in the department have therefore started their workdays earlier than normal, taken care of their kids in the early evening and then worked a few more hours after having put the kids to bed.

Unfortunately some are starting to show signs that the stress is getting to them. There has been less information flow between different parts of the projects as well as less communication between individual employees. Team manager David has accused Laura’s team of purposefully withholding information and his stress-induced mood swings haven’t helped the situation. This has led to David and Laura having some public conflicts in online meetings. Bill has talked to them about the unprofessionalism of their behaviour and hopes the situation is now resolved. At the same time there have also been frequent complaints of headaches and muscle pains and some project members seem to have problems sleeping.

This morning Bill got an email from Claudia, another team lead in Bill’s department, saying she has some back pain and will therefore take some breaks during the day so as to be able to rest a bit. But Bill shouldn’t worry, she will make up for the breaks by working a bit longer in the evening. Claudia says that she is sure it will not affect the project or her team members in a negative way as they will be taking the breaks in between meetings and always be available on the phone. Is that ok?

Thinking of what is best for the company and the project, what should Bill answer?

A: That is a horrible idea. I expect you to work full-time as that is what we are paying you for. Some back pain never killed anybody.

B: That is a great idea! Thank you for thinking it through so as to not impact the project in a negative way at this stage, I really appreciate it. If there is anything I can do to help let me know. We’ll chat more during our one-on-one tomorrow.

C: Take all the time you need to take care of yourself and take the time off. The project will manage without you until you are well again. You can return to work once your back is back to normal.

Presenteeism behaviour rises when stress levels rises

Bill should answer C and this is why:

When employees are stressed it is common that they work even when they are not feeling well, be it the onset of a cold or something more severe. A study of a Dutch trade firm found that over 7% of the workforce experienced health problems while working an average day and a Swedish study of police officers found that 47% of the respondents had been working while ill at least twice in the last 12 months. The occurrence or behaviour of attending work when ill1, is called presenteeism. Presenteeism behaviour rises when stress levels rises.

At a first glance presenteeism could seem beneficial for both the company and the employee: Claudia’s work would get done without her job overflowing onto other colleagues, and she wouldn’t have to take sick-days with associated pay deduction or pay loss.

However… Presenteeism affects the company negatively in several ways:

1) Productivity and quality of work output will go down

Bill has himself worked while having the beginnings of a cold, with headaches and muscle pains, and knows from experience that he didn’t operate on optimal levels at these times. When he has been feeling better again he has usually discovered a few not so great decisions and less than great pieces of work. Looking back at these presenteeism days Bill can recognise that he was often more distracted, had a reduced attention span, low energy levels and was irritated during these times.

Loss: 35% productivity, 20% quality

Working while feeling like Bill has will have caused increased risk of mistakes and injuries, and even if Bill didn’t notice it during these days, the illness did affect him and his work negatively.

Employees with musculoskeletal disorders1, whether caused by stress or not, show a productivity loss of between 20% and 56% on presenteeism days.

When surveyed SME owners and managers under low to moderate psychological distress reported a 35% productivity loss on presenteeism days. Psychological distress is associated with stress stemming from low job control and low social support at work as well as work-life imbalance. A study in the US on presenteeism and associated costs found a productivity loss of 15% per employee per year due to depression/ sadness/ mental illness and an average of 21% due to migraine and headaches. Several other studies have also shown a clear connection between quality loss and the amount of pain experienced by the employee practicing presenteeism.

The quality loss is harder to measure but in a self-report study among dentists, the participants estimated a 20% loss in quality of their work when practicing presenteeism.

Bill therefore feels that it is better if Claudia doesn’t work. The project can manage the 100% productivity loss for a few days but not 20%, or worst case, 56% productivity loss and the added 20% quality loss for weeks or even months if her back continues to bother her.

2) Long-term employee health will decline

As Claudia has suffered from back pain before, Bill is wary about how her working today will affect the business in the long run. She is a very talented manager and it would be a pity to lose her.

Loss: 1 to 3 years

Even after taking base-line health into account, employees who often practice presenteeism have more and longer ensuing sick periods. To practise presenteeism more than five times in a base-line year will increase the risk of having more than 30 sick leave days per year. The long-term effects of this behaviour have been shown to last from one to three years. So, presenteeism today will not only affect the employee and the business baseline this year, but also next year and possibly another two years on top of that.

For Bill and the company it would therefore be better if Claudia instead of working visits a GP or a physiotherapist and gets her back sorted before she returns to work again. This way the company will fare better in the long run.

3) Costs will increase

Bill knows the project is right on budget but also knows there is little margin in it. How would Claudia being off affect the project timeline and budget?

Loss: Several thousands of dollars

Presenteeism cost companies more both in monetary value and working time than absenteeism2. Presenteeism is estimated to cause 1.5 times more lost working time than absenteeism and cost employers more, as presenteeism is more common among higher-paid staff and difficult to spot.

In a US study, the cost of presenteeism stood for 71% of all depression / sadness / mental illness related costs and for 89% of all migraine and headache related costs. When the cost of productivity and quality loss was added, it summed to several thousands of dollars per employee per year.

What makes employees more prone to presenteeism?

Bill knows Clauda well and is not surprised by her offer. Claudia is a very conscientious colleague who enjoys her work and is greatly appreciated by her team members.

Characteristics and Situation

An employee’s personal characteristics and situation will influence how prone they are to presenteeism. Older employees are less prone to presenteeism, while employees that are: unwilling to risk burdening colleagues; have a feeling of being indispensable; and/or enjoy work are more prone to presenteeism. Employees that are on fixed-term contracts; that can’t afford pay deduction or pay loss associated with a sick day; that have a child; and/or are highly-educated, are also more prone to presenteeism.

The employees’ role in the company also makes a difference. An employee is more prone to presenteeism if they have a “white collar” job; has a role where their input affects the productivity of an entire team; is a “high-responsibility” employee or is a specialist; or has a unique role difficult to substitute for.

Hence, Claudias personality and position as a manager in an SME makes her an almost perfect candidate for presenteeism behaviour.

Presenteeism prone work-environment

Bill knows there has been stress in the project for a while now and that David and Laura’s behaviour most likely is caused by stress. They might not be best friends normally, but they can usually get along ok.

Managers and Stress

The work environment influences employees well-being and behaviour in many ways and will affect employees tendency for presenteeism.

Managers play a significant role in inciting presentism behaviour. Managers who practice presenteeism will influence their employees to also do so, which in turn increases employee sick leave occasions and the number of sick days. Ironically, managers in SMEs are also more prone to presenteeism which, off course, will encourage their juniors to do the same.

However, most influential on presenteeism behaviour is work-place stress: low decision authority, low social support at work, time pressure, high workload, job insecurity, poor ergonomics, lack of resources, work problems, too much responsibility, managing work demands, negative behaviour from manager and more has been identified as increasing presenteeism propensity.

Hence Bill knows the most important thing for him to do in order to reduce presenteeism and to increase the quality of the project and its chances of success, is to get a grip on employee stress levels and find ways of managing them by primary interventions.

More articles


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  1. Employees with a chronic physical or mental illness will, of course, work ill every day. Their corresponding behaviour would be to work during a flare-up / relapse. ↩︎

  2. Absenteeism is “the practice of regularly staying away from work or school without good reason” and often occurs among stressed employees. ↩︎