Zara Whysall, Senior Lecturer in Business and Management, Nottingham Business School

Be proactive! Don’t wait until employees go off sick before intervening, says Zara Whysall of Nottingham Business School.

As a business psychologist straddling both academia and practice, presenteeism raises some important challenges. On a practical level, a common concern is the financial cost of presenteeism – highlighted by our recent UK study as costing businesses just over £4k per employee in lost productivity every year. On average employees spend 2.5 weeks a year working when ill, significantly more than the average 5.6 days sickness absence.

But a question that’s less often tackled in articles on presenteeism, yet one that must cross many managers’ minds, is: ‘isn’t it better to have people at work than not at all?’

The answer, of course, is that it depends. Most obviously, it depends on the nature of the health problem that the person is experiencing. There are clearly some conditions – contagious illnesses for instance, and other serious conditions, which would make it impossible, unwise, or unsafe for an individual to come to work. To help employees make the decision about what’s best for their recovery, they need good quality advice from qualified medical, or ideally, occupational health practitioners.

It also depends on the type of work the person undertakes, and how open it is to adaptation. There’s a growing body of evidence which supports the positive impact that work can have on health. Work can be restorative, whereas worklessness can be detrimental to health and well-being.1 Consequently, in some situations, coming to work despite not feeling 100 percent could help recovery, not hinder it. The ‘fit note’, introduced in the UK in 2010, is aligned with this notion.

Yet the overwhelmingly negative view of sickness presenteeism is at odds with this concept, and the practice of vocational rehabilitation, which emphasises that: “When their health condition permits, sick and disabled people (particularly those with ‘common health problems’) should be encouraged and supported to remain in or to (re)-enter work as soon as possible…”2

There is, however, a big caveat. For work to be restorative, it needs to be well designed and well managed. HSE’s Management Standards provide a good steer in this regard, highlighting the six key areas of work design that, if not properly managed, are associated with poor health and reduced productivity:

  • Demands – workload, work patterns and the work environment
  • Control – how much say the person has in how they do their work
  • Support – the encouragement, sponsorship and resources provided by the organisation, line management and colleagues
  • Relationships – positive working to avoid conflict and dealing with unacceptable behaviour
  • Role – clarity on a person’s role within the organisation and avoidance of role conflicts
  • Change – how organisational change (large or small) is managed and communicated


The importance of ensuring that a person’s job is designed and managed in such a way that it constitutes ‘good work’ was reinforced by the findings of our recent study, which identified presenteeism as a ‘stronger predictor’ of employee health than absence. In other words, to understand and predict employee health, you’re better off looking at what’s going on with presenteeism than looking at who’s off sick. Yet whilst most companies measure absence, few measure presenteeism.

Compounding the problem, more often than not, employees engaging in presenteeism haven’t sought treatment for their ailments. The top presenteeism health condition in our study (considering both the number of people affected and the duration affected by it) was stress, depression, or anxiety, for which only 22% of sufferers had received any form of treatment or intervention. Next was hand or wrist problems, for which only 35% had received any treatment, followed by lower back pain, for which 54% had received treatment or intervention.

The key message for employers is to put more emphasis on managing and promoting the health and wellbeing of the people present in the workplace. Be proactive! Don’t wait until employees go off sick before intervening. It will pay off, not only in terms of employee health and wellbeing, but also productivity.

This highlights another important consideration in managing presenteeism – it’s important to separate out the ‘act’ of presenteeism from its impact on performance. For instance, the most common presenteeism condition in our study – reported 59 percent of employees – was colds and flu. But it affected performance for the shortest duration – 4 days over the previous 12 months. This contrasts to asthma, for example, which affected only 5 percent of employees, but for an average of 26 days over the previous year.

Furthermore, the extent to which performance is affected will vary hugely, depending on the health condition and the nature of the work. It’s important that we begin to recognise that presenteeism isn’t an inherently negative phenomenon. Aside from certain contagious or serious conditions that require employees to stay away from work, the extent to which coming to work whilst unwell has negative or positive consequences depends very much on how the situation is managed.

Employers need to be proactive and address presenteeism by encouraging employees to report health problems they’re experiencing, refer them for occupational health assessment, advice, and medical treatment as appropriate, then take steps to ensure the employee adapt their work to help them progress back to full productivity. Work can be good for health, but only if it’s well managed.

Effective, proactive occupational health advice and management is essential to ensure that employees take the best course of action, and so that if employees come to work when experiencing ill-health, doing so contributes towards their recovery rather than exacerbating the problem.

The challenge for managers is the relative ‘invisibility’ of presenteeism; often occurring without an employer’s awareness. This leaves employees to make the sickness absence or presence decision without support or advice, and possibly even without a great deal of conscious consideration. Instead, employees need to be encouraged to raise health concerns early so that they can receive appropriate support and advice as to the best course of action.


The full research paper can be accessed here, including a limited number of free full-text eprints:

Zara is a Senior Lecturer in Business and Management. She undertakes teaching, course development, research and consultancy within the Corporate and Executive Education Team in the Business School. She is Course Leader for the PG Cert/Diploma/MSc in HE Administration, Management and Leadership.

Zara is also module Leader for a number of modules including Dissertation modules on the BA (Hons) Business Management, BA (Hons) Management and Leadership and MSc (In-company) in Management and Leadership. She is happy to supervise research dissertations on master's, PhD and DBA programmes in research areas of relevance to her areas of interest and expertise.