The Cost of Presenteeism at Work: Do We Show Up Just for the Sake of It?

Ever come into work feeling under the weather because you thought you felt OK enough to do your job? Presenteeism refers to workplace culture and values that cause employees to come into the office despite illness, work excessive overtime, and decline to use personal or vacation leave.

Although some employers push for presenteeism and stress the importance of supposed “dedication” to the job, presenteeism has demonstrable negative effects on both well-being and productivity. In fact, according to the Harvard Business Review, presenteeism costs the American economy approximately $150 billion annually.

In addition to financial costs, presenteeism is detrimental to both the physical and mental health of employees. Tess Brigham, MFT, BCC, says, “Presenteeism can impact productivity in the workplace in many different ways. It's very easy for one sick person who comes to work instead of staying home to greatly impact an entire organization. When you're not feeling very well - either physically or mentally - it's impossible to show up as your best self.”

Those who are physically present but burned out or unwell cannot adequately function in the workplace and risk burnout. Read on to learn more about problems of presenteeism and how to address this culture in the workplace.

The Impact of Presenteeism on Productivity

If presenteeism is an over-emphasis on being physically present in the workplace even when one’s physical or mental health does not allow for productivity, absenteeism is when employees are overly absent. An emphasis on presenteeism may lead to workers calling out more often than is absolutely necessary or having an increased need for absences due to burnout.

Brigham shared: “Being physically and/or mentally ill triggers our prefrontal cortex which controls executive functioning which is in charge of decision-making, motivation, setting goals, making plans. This is our management system. Think about it like a machine, if a section or part of the machine isn't working quite right or is completely broken - the machine can't run.”

Brigham also noted that presenteeism can increase physical illness in the workplace: “If the culture of the organization is such that people feel like they have to show up, no matter how they feel, inevitably the physically ill person will get someone else sick and before you know it the flu or cold spreads throughout the office.” Even more employees get sick and are less productive. It is a net loss for everyone involved.

What Causes Presenteeism?

Workplace culture shifts do not happen overnight. Presenteeism emerges over time when it is reinforced and modeled, starting at the top. Brigham notes that presenteeism is typically modeled by managers, sending unspoken expectations to the rest of the staff: “If employees see that managers and leaders show up when they're sick and never take days off, even after something tragic has happened in their lives it unconsciously says, ‘Don't take time off. You don't need it. I'm not taking it so neither should you.’”

Even if management does not directly engage in presenteeism, many workplaces encourage this mentality and behavior through reinforcement. According to Brigham, “If the organization continues to promote and praise the employees that never miss a day of work, even when they are sick as a dog, the organization is saying (without words) this is how you need to behave if you want to be promoted or seen as a valuable member of the team.” Rewarding employees who show up even when it is not a healthy choice fosters a culture of presenteeism.

A third contributor to presenteeism is inadequate compensation and benefits. As Brigham points out, “Another factor is many people have jobs where they won't be paid if they don't show up. For some people they would love to stay home but financially that's impossible.” If employees do not receive paid sick leave, it does not matter how flexible management is with time off requests. An employee who cannot afford to lose income cannot afford to call out.

Presenteeism and Disability

The Americans with Disabilities Act protects disabled workers in the United States and requires employers to make reasonable accommodations, including around attendance policies. However, disabled workers often feel pressured to come in anyway even if they are experiencing an episode or flare of their illness.

In other words, even with accommodations, disabled employees still often feel pressured to overextend themselves due to presenteeism, especially those with chronic conditions like allergies, migraines, pain problems, gastrointestinal disorders, and chronic mental health issues.

Addressing Presenteeism

More work hours does not translate to more productivity. A global study from 2022 showed that employees were able to complete all work responsibilities in less time, and 86% of companies that participated in the study indicated that they were likely or extremely likely to continue the four-day workweek due to its success. Seventy-eight percent indicated that the transition was smooth or extremely smooth. Additionally, 46% indicated that the shortened workweek maintained productivity, and 49% indicated that productivity improved.

Furthermore, approximately 9 out of 10 employees reported improving their work-life balance, getting more exercise, spending more time with their families, and feeling an increased sense of satisfaction with their jobs.

Of course, a four-day workweek is not the only way to address presenteeism and improve employee well-being. Flexible scheduling, allowing employees to work at the times that best suit them, can also improve well-being and reduce presenteeism. Additionally, management must take an active role in encouraging employees to take time off when needed, approving time off requests without argument or guilt and not contacting employees outside of work hours with requests.

Employers' Role in Promoting Employee Health

Is it the boss’s responsibility to care about and foster their employees’ mental and physical health? In short, yes! According to Brigham, “Employers have a duty to foster healthy physical and mental health in the workplace. Just like work environments need to be physically safe so people can move around freely without fear of being hurt, they also need to be psychologically safe as well.” When you take on a leadership role, you take on the responsibility of fostering employee well-being.

This can be done in many ways, including:

• Streamlining processes for disability accommodations requests
• Approving time off requests without requiring a reason
• Providing benefits packages that cover mental health care
• Promoting managers who have shown they can effectively create a psychologically safe workspace
• Training leadership on psychological safety

Brigham says it is also vital for management to model good habits: “Employers need to talk about the negatives of presenteeism. Don't make showing up to work sick a badge of honor and don't praise someone for working through their vacation. Make it the standard that when someone is sick they take the time they need. Plan company-wide days off - once or twice a quarter have a company-wide mental health day and encourage employees to do something for their mental health.”

Bottom Line

Presenteeism is harmful for employee well-being, and it hurts profits. Essentially, there is no upside. Fortunately, leadership can take direct steps to counter a culture of presenteeism and promote a healthy balance. Management can model a healthy balance and shift away from reinforcing presenteeism in employees, as well as offering appropriate benefits that allow employees to create their own balance.

It is on leadership to make and foster these changes, which in the end benefit everyone.