User:MGMT90018 2015S2 Presenteeism/sandbox

NOTE: This sandbox is being edited as part of a class assignment, the content was copied from the following source: https://en.wikipedia.org/wiki/Presenteeism

Presenteeism is the act of attending work while sick. A topic that is at times considered its opposite, Absenteeism, has historically received extensive attention in the management sciences, but presenteeism has only recently found a place in the research literature.

Definitions
Presenteeism is often defined as attending work while sick. The definition is used by most scholars as explicit or implicit in all related studies in the occupational health literature. Besides, scholars have provided other definitions of presenteeism. For example:

a. Attending work, in contrast to absenteeism

b. Displaying excellent attendance

c. Going to work even when feeling unhealthy

d. Going to work even when feeling unhealthy or undergoing other circumstances that may normally force absence (e.g., child care problems)

e. Reduced work productivity because of poor health conditions

f. Reduced work productivity because of poor health conditions or other circumstances that prevent one from full productivity

These definitions are considered falling short of scientific utility. The first two definitions (a and b) are redundant when the first exhibits the antonym of absence and the latter exhibits low absenteeism. Similarly, definitions d and f, respectively, are the extension of definitions c and e by adding the idea that presenteeism may engage attendance and consequent productivity reduction in case of ill health and other factors.

It is noted that that definitions of presenteeism, which are centered on attending work while sick, have received more evidence of Construct_validity. In other words, when being defined as coming to work while sick, presenteeism seems to relate more to logical outcome variables and correlates. . Johns further noted that the definitions do not assign any motives to presenteeism. For example, an employee, may come to work because he or she simply needs the money and cannot afford taking time off due to illness. Additionally, one could go to work due to a love and devotion to the job. In this case, presenteeism could be considered an act of organizational citizenship and inspire admiration from colleagues. Therefore, simply viewing presenteeism as a negative act leading to productivity loss and decreased health may be restrict potential analysis of the construct. . Also, the above-mentioned definitions do not mention about consequences of presenteeism. However, Johns asserted that the culprits and consequences of presenteeism must be mentioned by empirical evidence rather than by definition.

History
While absenteeism has a long-time research history, presenteeism has recently come to be a subject of concern. The interest in the subject has been boosted by the claims that working while sick triggers more aggregate productivity losses than absenteeism. Hemp, P 2004, 'Presenteeism: At Work - But Out of It', Harvard Business Review

Excitement in presenteeism derives from two major but rather geographically distinct groups. The first is UK and European scholars working in management and epidemiology or occupational health who think that job insecurity due to downsize and restructure has triggered increasing work attendance that causes stress and illness. The second group is mainly American medical scholars, comprising those involved in epidemiology and occupational health, who are concerned about the effect of illness or other health conditions on work productivity. The British and Europeans have majorly been concerned about the frequency of presenteeism as a consequence of job insecurity and other occupational features, while Americans are concerned about the productivity ramifications of presenteeism as a result of various health conditions while ignoring the culprits of showing up sick.

Recently, however, the emerging cost of health care and employee health plan provision by employers, have fueled a third interest in economic impact. Therefore, employee health expenses to employers comprises direct health care costs and productivity loss due to employees’ absenteeism and presenteeism. The motivation to find measurement instruments has recently proliferated for productivity loss that are responsive to pharmaceutical intervention and may allow the US Food and Drug Administration (FDA) to accept productivity claims.

Supervisor Behaviour
Gilbreath and Karimi researched supervisor behaviour in association with employee presenteeism and their results indicate that presenteeism is associated with the influence of supervisors on workers. In the study involving workers from two Australian hospitals, supervisor behaviour was measured using the Supervisor Practices Instrument (SPI). The SPI provides a composite score based on negative and positive supervisor behaviours. Job stress and job-stress-related presenteeism were also measured based on questions the hospital employees answered in questionnaires. Their study found that negative supervisor behaviour has a greater impact on job-stress-related presenteeism than positive behaviour and that stress at work is positively correlated with presenteeism. The supervisor behaviour with the lowest correlation with presenteeism was “helps employees keep work in perspective (e.g., there is more to life than work)” with correlation coefficient of -0.38. The behaviours with highest employee presenteeism correlation were the following:
 * "fails to properly monitor and manage group dynamics" (.58);
 * "makes decisions that affect employees without seeking their input" (.47);
 * "shows disinterest in employees' ideas and projects" (.47);
 * "is easily threatened by competent employees" (.46);
 * "remains aloof from employees" (.46);
 * "ignores employees’ suggestions" (.45);
 * "tends to be guarded (e.g. not open) in his/her communication" (.42).

Temporary and permanent employment
Temporary and permanent employment are often considered when examining the causes of presenteeism. More specifically, researchers have studied these positions with the thought that lack of job security will cause those who do not have permanent positions to come to work more often even if they are sick. This hypothesis, however, has not received complete support. Aronsson et al. found that in the Swedish workforce permanent employees that were not in their desired workplace and preferred occupation were more prone to presenteeism than those in more seasonal positions. In contrast, a later study by Aronsson and Gustafson found no effect related to job type. However, in the first study permanent employees were classified into two groups–those that were in their desired workplace and occupation and those that were not–while in the second study all permanent employees were treated as a single group. Heponiemi et al. found that fixed-term employees were less prone to report working while ill than employees on permanent contracts, with an odds ratio of 0.88. In line with Heponiemi et al., Bockerman and Laukkanen, with their study on presenteeism in Finland, found that permanent employees are 11% more likely to exhibit presenteeism than temporary workers They propose that permanent full-time workers cannot be replaced as easily when sick as can be part time and fixed-term employees because of the degree of control over their work. As a result of the contradictory findings regarding permanent and temporary employment, Johns proposes a reconsideration of the job insecurity hypothesis.

Occupations
Certain occupations may be more likely to lead to presenteeism than others. Aronsson et al. found that individuals who provide care or welfare services (nursing, midwifery professionals, nurses, nursing home aids) and instructors (compulsory school teachers, primary/elementary educators) were more likely to work while sick than individuals in other occupational categories. The authors pointed out that these employees often worked with those in more vulnerable populations such as the elderly, and that the outcome of their work depends on relationships with those they work with. In addition, workers in these categories were paid relatively poorly and mainly found working for the public sector. These occupations had also seen significant layoffs in their sector in past years. A later study by Aronsson and Gustafson showed similar results between occupation groups and presenteeism. The study shows that there is a link between sickness related presenteeism and being hard to replace at work or finding a stand in. Beyond education and healthcare, most occupations showed lower rates of presenteeism with no systematic pattern; however, the results did suggest that higher risks jobs, which had more physical workload and stress, saw increased levels of presenteeism.

Workplace
Different work environments may have an impact on presenteeism. Dew, Keefe, and Small qualitatively examined a private hospital, a large public hospital, and a small factory in New Zealand. Results showed that the manner in which presenteeism was rationalised by workers and the factors that cause it were different for each setting. At the private hospital, workers felt no management pressure that induced presenteeism, and they felt like part of a family, going to work out of loyalty to their co-workers. The hospital had mechanisms to reduce presenteeism (infection officer could send a sick worker home). Also, workers did not feel that casual workers were entitled to work at the hospital and preferred presenteeism because of previous bad experiences for not going to work and fear of future problems at work. At the large public hospital employees felt distant to management and constantly struggling in a somewhat uncontrolled environment. Workers justified presenteeism because of they felt loyal towards the hospital, their co-workers, and professional image. At the small factory, despite the size, management was perceived as distant and cold, pressuring workers to come to work and thus promoting presenteeism. Workers felt they had no choice but to go to work because they had no other work alternatives.

In a study administering a survey to LinkedIn users through Qualtrics online survey site and to employees at a European manufacturer of medical technology using a paper version of the same survey, McGregor et al. (2014) concluded that health and work environment directly impact presenteeism in the workplace. Presenteeism as the independent variable was measured based on the following work environment factors: job strain, job security, work–life balance, work engagement, commitment, support, development, communication, and leadership. The mediator variable was health burden measured through certain health conditions such as migraines, back pain, cold, flu, high blood pressure, etc. The study found that negative work environments lead to presenteeism directly or indirectly by affecting workers’ health. The authors recognise that the results of this study could be limited by the use of self-reporting in the surveys. Furthermore, they warn against generalising the results to other countries or industries since the survey was not administered to workers in a wide range of industries across different countries.

Ease of replacement
The ease with which employees can be replaced is a possible factor causing presenteeism. Several studies found that individuals who feel they cannot be replaced at work–their work is left undone if they do not attend–are more likely to exhibit presenteeism at work. One of these studies found a presenteeism risk ratio of 2.29 for those employees that reported having to do all their missed work after not showing up to work because of sickness. Bockerman and Laukkanen found that when there is a possibility for someone to be replaced by a substitute at work the incidence of presenteeism is reduced by 11%. McKevitt et al. conducted a survey of general doctors, hospital doctors, and company “fee earners”, concluding that more than 80% of the respondents had been to work while they were sick. Amongst the reasons doctors had not taken leave was a significant pressure to work and difficulty in finding someone to replace them while away. In some cases, general practitioners did not want to burden their partners, and many felt a strong commitment to the job that prevented them from taking sick leave. In line with these findings, Caverely et al. found that the top reason for presenteeism at a Canadian organization was related to ease of replacement because others depended on the employee if he or she did not attend.

Workloads and job demands
Jobs that have large workloads and many demands are often associated with higher levels of presenteeism. Caverely et al. studied a Canadian public service organization involved in a downsizing process and noted that workload (volume of work/personal workload) ranked second (18% frequency) amongst respondents to their survey–after “others depending on me” (40% frequency)–as the reason given for presenteeism at work. Having many deadlines ranked third with 11% frequency. Individuals felt they had to come to work while ill or injured because they believed they had high workloads, many deadlines, and often very little backup support. Deery et al. found similar results, with high work demands (large workload and enforcement of attendance) showing correlation with presenteeism of approximately 0.32. Complementing this finding, McKevitt et al. also found that individuals feared their work would pile up if they did not go to their job. Similarly, Demerouti et al. found that higher job demands led to an increase in presenteeism in their study conducted by surveying staff nurses working in public hospitals in the Netherlands. The study refers to job demands as “aspects of the job that require sustained physical and/or psychological (i.e. cognitive or emotional) effort on the part of the employee”.

Muckenhuber et al. studied the effect of the Human Development Index (HDI) on the association of psychological work demands with presenteeism and absenteeism. Their study found that psychological job demands have a great association with presenteeism in countries with HDI than those with low HDI. The authors suggest that different approaches should be taken regarding public health actions for countries with high and low Human Development Indices.

Workaholism
Most junior doctors experience at least one infectious illness during a six month period, yet most of them remain at work. Schaufeli et al. identified workaholics as those who work both excessively and compulsively. Through a survey that independently measured working excessively from working compulsively, the authors were able to classify participants into four categories (workaholics, non workaholics, hard workers, and compulsive workers). Participants were Dutch medical residents. Schaufeli et al. found that workaholics showed the highest levels of presenteeism–amongst other negative work related indicators–when compared to the other three categories in their study.

Performance-based self-esteem
There seems to be disagreement over Performance-based self-esteem (PBSE) and its relationship to presenteeism. PBSE refers to the concept that individuals see their performance as an indicator of their self-esteem, thus those who see their self esteem measured in this manner might have to prove their worth on the job. Love et al. found that PBSE positively predicted presenteeism; however, their study also discovered that the relationship between PBSE and presenteeism was strengthened when workers experienced high physical and psychological work demands. Love et al. suggest that demanding work environments could interact with employees’ overambitious work styles, which could result in over performance and increased levels of presenteeism. On the other hand, Ceci et al. found that PBSE does not predict sickness presenteeism. Instead the authors found that over-commitment to work is better at predicting this form of presenteeism, and even then the relationship between both factors is weak. In explaining their results, Ceci et al. propose that work factors are better predictors of presenteeism than personal circumstances. Ceci et al. note that because of their limited sample size their findings should be taken with caution.

Health factors
Certain health factors serve as risk factors for presenteeism as opposed to absenteeism. Boles et al. examined a variety of emotional and physical health symptoms and noted that the odds of reporting presenteeism were largest for those with high stress compared to those without stress. Individuals with poor diet and less emotional fulfilled also reported higher levels of presenteeism than individuals who did not exhibit such conditions Boles et al. noted that individuals who were not engaged in any form of physical activity were more prone to report higher levels of both absenteeism and presenteeism when compared to those who engaged in some form of physical activity. In agreement with Boles et al., Aronson and Gustafsoon argue that chronic and episodic health events lead to presenteeism in the workplace. In contrast, Pohlin et al. argue that work related factors lead to poor health which in turn leads to presenteeism. Therefore health would be a mediating factor but no the original cause of presenteeism. Their findings support their claim.

Age and Sex
Gilbreath and Karimi, in their study regarding job-stress-related presenteeism, found that age is significantly and negatively correlated with this form of presenteeism. Arronsson et al. found no relationship between sickness related presenteeism and age. Similarly, Deery et al. did not find any significant correlation between age and presenteeism (0.01), nor with sex (0.07). In contrast, Demerouti et al. found that men reported more presenteeism than women in their study using surveys to nurses in Dutch public hospitals, and no other differences in other sociodemographic characteristics.

Productivity loss
Presenteeism has regarded as a cause of on-the-job productivity loss because employees go to work sick and perform worse due to that illness. It is estimated that presenteeism reduces individual productivity by one third or even more. A number of researches using instruments have been carried out to quantify the cost of productivity loss related to various health conditions. It is said that presenteeism annually costs employers billions of dollars per year. Presenteeism-pertaining productivity losses exceed those caused by absenteeism and employers’ expenses for direct medical care. For example, studies in Hemp reveal that the on-job-productivity loss due to pain and depression costs three times more than the absence-associated productivity loss derived from these health conditions. This kind of productivity loss also is two to three times larger than direct medical care such as insurance premiums or employee claims. Also, other study conducted by Collins and his co-authors states that Dow Chemical Company expenses for average worker’s health care are $6721, $661 and $2278 due to presenteeism, absenteeism, direct health care costs respectively. In fact, given differences in cost deprivation techniques, measures and procedures, there are accordingly remarkable variations in the reported ramifications of presenteeism on productivity and the consequent costs arising from presenteeism. It is argued that managing presenteeism effectively could be a distinct source of competitive advantage.

Poor health and exhaustion
Sickness presenteeism is a risk factor for the future general health as well as future sick absenteeism. Presenteeism has exerted an effect on mental ill health, and is likely to have larger impact on mental ill health than absenteeism. Presenteeism is an expression of behaviour among a wider range of stress-associated behaviour. People that go to work during sickness, for example due to job security or a difficult personal economic circumstances, are likely to get strain that may influence this person’s biological system and health directly or indirectly due to their health damaging behaviors or less healthy behaviors. Specifically, employees that regularly go to work despite being sick may not have a needed rest and accompanying recovery from illness, that may result in allostatic burden as well as accumulated stress. Allostatic overload has been correlated with some negative health impacts, for example, on immune and cardiovascular system and brain function. The load also leads to unhealthy behaviours such as disturbed sleep, smoking and abusive alcohol consumption. Thus, sickness presenteeism may be a sign of a high stress level, but it may also maintain or heighten the stress or strain. In addition, failure to deal with an illness in its early stage (e.g. a cold) may lead to a more severe disease (e.g. pneumonia). This situation may also have future ramifications for health.

In addition, presenteeism can have an effect on occupational injuries for workers. A 2012 study from the National Institute for Occupational Safety and Health showed that workers with access to paid sick leave were 28% less likely overall to suffer nonfatal injuries than workers without access to paid sick leave.

Workplace Epidemics
In the case that an employee gets an infectious disease such as influenza, a culture of presenteeism will inevitably lead to further infections throughout the workforce and cause much wider problem. In a survey conducted in 2004 by Canada Life Insurance, over 80% of respondents stated that they had become ill as a result of an infection contracted in the workplace

Relationship with absenteeism
In some cases, scholars relate presenteeism to Absenteeism, which is the tendency not to show up for scheduled work. Furthermore, Johns described the notion that some believe that factors that reduce Absenteeism will increase presenteeism. He stated, however, that this is plausible but not always the case because he pointed out that rates of presenteeism are still high in industries where absenteeism is high.

Additionally, researches show that examines absenteeism is at times used to draw conclusions about presenteeism. For example, Virtanen et al. found that employees exhibited much higher rates of absenteeism once they became permanent workers. The authors thought that this increase could have been due to the decrease in the preexisting levels of presenteeism. However, they did not directly measure presenteeism. Commenting on such research behaviour, Johns said in his review of the literature that researchers should not infer presenteeism from absenteeism data. Instead, both constructs should be measured at the independently.

Measurement of presenteeism and its impact on productivity
Scholars have often measured presenteeism in terms of how often an individual attends work while unhealthy. For instance, Aronsson et al. asked participants to what extent over the past year they had gone to work despite feeling they should have taken sick leave. Respondents could choose from never, once, between two and 5 times, and more than 5 times. Other researchers have examined the frequency of presenteeism by asking participants a similar question. The responses, however, were on a scale of "spells of one day presenteeism, spells of 2-4 day presenteeism, and spells of 5 day or more presenteeism". Schaufeli et al. asked the question "How often did you go to work in the previous year despite feeling sick?" and provided respondents with ranges they could select amongst.

Aside from measuring the frequency of presenteeism, scholars often look to measure the effects of poor health on job productivity. The Work Limitations Questionnaire (WLQ) is often used to perform this task. With 25 items, it examines the extent to which respondents can handle time, physical, mental-interpersonal, and output demands. Additionally, The Stanford Presenteeism Scale seeks to determine the effects of health on productivity. It measures participants’ abilities to concentrate and perform work despite having a primary health problem. Using six items, respondents determine the extent to which they agree with statements that describe how their health condition may or may not affect their work. The scale measures two factors that the authors labeled as completing work and avoiding distraction. Finally, another measure often used is the World Health Organization Health and Work Performance Questionnaire (HPQ). This self-report measure acquires information about respondents’ health conditions and has them provide perceptions of their job performance. Lofland et al. provide additional tools for measurement in their review of instruments for the measurement of health-related workplace productivity loss.

Implications for practice
Although determining the cost of presenteeism is not as simple as determining that of absenteeism (100% los productivity), there is still a cost implicated with having workers at work who are not being productive and this, as well as other factors detrimental to the work environment and employee health, warrants taking action against presenteeism. Caverley et al. found that some “employees were substituting more than half of legitimate sickness absences with sickness presence”. Several studies suggest employers promote wellness programs for their employees aimed at increasing health and productivity because it directly impacts presenteeism, even more so than it might affect absenteeism. Complimenting this suggestion, Schultz and Edington wrote that employees must be educated effectively so they can better manage their health. They also commented that employers need to consider the health of workers who are low risk along with those who have high-risk health conditions. Deery et al. suggest that organisation should take a close look at work related factors that promote presenteeism, which in turn can lead to longer periods of absenteeism.

Future directions and research
While progress has been made in regards to understanding presenteeism, many possible topics of inquiry still remain. In his literature review, Johns suggests that presenteeism should be related to other constructs such as work attitudes and personality. Additionally, lessons from absenteeism could be applied to presenteeism. For instance, absenteeism can be defined as voluntary and involuntary, and scholars could consider applying such ideas to presenteeism.