Many people, especially those with paid sick leave, stay home when they are sick.
However, even people with sick leave regularly engage in "presenteeism" -- going to work while ill. It's the opposite of absenteeism, and its effect on the workplace has been a topic long sequestered in academic journals.
As the nation heads into winter's cold and flu season, presenteeism is gaining interest in the American workplace for good reason: More costly than absenteeism, it is detrimental to employees and employers alike.
The U.S. Bureau of Labor says 39 percent of all American workers -- or 41 million people -- do not have paid sick leave. That means a lot of people show up for work while under the weather.
In September, President Barack Obama signed an executive order forcing companies that hold federal contracts to provide paid sick-leave benefits to their employees.
On the face of it, being sick at work might sound like something employers might favor, with some work preferable to none at all. Besides, such employees display a strong work ethic, job dedication and loyalty. But research generally finds health consequences associated with present-but-ill employees, with higher medical costs and greater reductions in productivity than absenteeism would cause.
A Society for Human Resource Management online article said presenteeism costs are "higher than the combined costs of medical care, prescription drugs and absenteeism," with estimated annual costs of $150 billion to $250 billion a year. That represents 60 percent of all productivity losses.
"Unhealthy workers are unproductive workers -- and they're expensive," said Scott Wallace, a distinguished fellow at the Geisel School of Medicine at Dartmouth University. And the cost of poor health, he said, can be three to 10 times the total cost of all employee benefits.
That's why focusing on wellness rather than absenteeism represents a progressive workplace trend.
"This issue is multifaceted, and I think people who ignore it do it with their heads in the sand," Wallace said. "The impact on employees is tremendous when they show up at work sick. The stress makes them sicker, and their performance levels at work are in the gutter.
"People around them get sick, and it increases stress and gets into a death spiral for employers," he said. "I'm mystified that employers can't figure this out in 11 seconds."
Employees who recover at home are more productive than persistently ill employees struggling at work to meet job demands, research shows.
"Organizations need to think about this, develop policies and get first-level managers involved who are closest to the source," said Gary Johns, a department of management professor at Concordia University in Montreal. He has reviewed the academic literature addressing corporate and employee impacts of presenteeism.
"Giving employees accommodation and support can be good all the way around," he said. "They are under so much pressure to go to work that they are contaminating the place or are affecting their own health downstream. But this needs to be managed so you do not burn people out physically and abuse them and create problems.
"It takes a sensitive hand," he said.
His own published studies note that "a sore throat will stimulate absenteeism for a singer and presenteeism for a pianist." Reaction from colleagues and clients also affect presenteeism, both as encouragers and discouragers. Teamwork tends to encourage presenteeism.
People earning higher wages generally exhibit less absenteeism. People facing financial difficulties generally are more likely to show up for work when sick.
Ill employees make more mistakes, communicate less effectively and produce lower-quality work, studies find. Presenteeism among pharmacists, one study found, resulted in more prescription errors. Downsizing increases absenteeism, and research shows a higher propensity for medical workers to be on the job, even when they have contagious illnesses.
Job insecurity, strict attendance policies, teamwork, demanding clients and a positive attendance culture are among the factors that promote presenteeism. That, in turn, can exacerbate existing medical conditions, damage the quality of work life and lead to impressions of ineffectiveness because of declines in productivity.
"There's one thing we seem to know about this," Johns said. "In the aggregate, it appears that a lot more productivity is lost to presenteeism than absenteeism."
A delicate balance exists between absenteeism and presenteeism: Are co-workers and superiors aware that a person's medical condition and productivity are connected? Are accommodations made in job design or adjusted performance appraisals?
While many companies lack absentee policies beyond forbidding it, few companies have presenteeism policies despite growing evidence of its impact on productivity, said Johns, who holds a doctorate in organizational psychology.
"Excitement concerning the subject has been fueled by claims that working while ill causes much more aggregate productivity loss than absenteeism," states a study he wrote in the Journal of Organizational Behavior. "Managing presenteeism effectively would be a distinct source of competitive advantage."
SundayMonday Business on 01/03/2016