Presenteeism Reloaded – We Need a Revised Presenteeism Approach

Abstract

Free AccessPresenteeism Reloaded – We Need a Revised Presenteeism ApproachJanosch A. Priebe and Miriam HägerbäumerJanosch A. PriebeJanosch A. Priebe, Department of Neurology, Center for Interdisciplinary Pain Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675 München, Germany, janosch.priebe@tum.deDepartment of Neurology, Klinikum rechts der Isar (MRI), Technical University of Munich, GermanySearch for more papers by this author and Miriam HägerbäumerDepartment of Psychology, Europäische Fernhochschule Hamburg, GermanySearch for more papers by this authorPublished Online:April 05, 2023https://doi.org/10.1026/0932-4089/a000410PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMoreBackgroundThe term “presenteeism” refers to “the behavior of professionals to continue working despite the presence of symptoms of illness” (Hägerbäumer, 2011, 2017, p. 91). Originating in the 1950 s (Uris, 1955), the concept of presenteeism has gained increasing attention in work psychology and has become a hot topic in the past few decades. Yet, the concept of presenteeism has been revised and developed on the basis of a growing body of evidence (e. g., Aronsson & Gustafsson, 2005; Dew et al., 2005; Emmermacher, 2008; MacGregor et al., 2008). Historically two branches of conceptualizing presenteeism prevailed.First, especially in the United States, the concept of presenteeism adopted the perspective of the employer and therefore focused on a loss in productivity by employees who work despite illness or health problems (e. g., Burton et al., 1999; Koopman et al., 2002; Lohaus & Habermann, 2019; Vingård et al., 2004). Accordingly, instruments for quantifying this presenteeism approach mostly focus on the economic consequences of presenteeism (Loeppke et al., 2003; Lofland et al., 2004).The second concept of presenteeism, which originated in European countries, adopted a psychological perspective instead and centered on the individual employee who engages in presenteeism. Subsequently, the individual health-related and psychological consequences of presenteeism are focused on rather than the economic consequences. Accordingly, the research branch of the psychological presenteeism approach refers in particular to individual and work-related factors fostering or inhibiting presenteeism behavior (e. g., Aloia & Priebe, 2022; Aronsson & Gustafsson, 2005; Johns, 2010).A behavioral approach should be taken into account when measuring presenteeism (Hägerbäumer, 2011, 2017). In the scale developed by Hägerbäumer (2011), presenteeism is operationalized as a “behavioral habit.” Therefore, the items refer to particular behavior that may have occurred in the last 12 months such as “going to work despite being ill,” “working in spite of severe symptoms,” or “taking medication in order to enable oneself to work.” Individuals respond to the six items on a 5-point Likert scale from never (0) to very frequently (4) in the case of illness, and a score between 0 and 24 is calculated by summing up the items. For individuals who have not been ill in the last 12 months, no presenteeism score can be calculated (Hägerbäumer, 2011).ObjectiveAlthough the behavioral approach can be considered the most suitable approach when conceptualizing and assessing presenteeism (Hägerbäumer, 2011), we have observed a need for revising or at least extending the concept of presenteeism.The COVID-19 pandemic has disrupted working environments in Germany and throughout the world. The measures of social distancing aimed at reducing the incidence of COVID-19 infections also affected organizational environments. Work-from-home policy and remote work in general have become common in Germany. Since the pandemic has been brought under control, remote work is still frequently allowed and even encouraged. As a consequence, “working” and “being present at the traditional workplace” have diverged.This strongly affects the concept of presenteeism. In most definitions, the term “presenteeism” means or at least implies “physical presence” at someone’s workplace. In our opinion, however, this approach does not account for the changes that have occurred in the work environment.ThesesTherefore, we consider three problems that have to be solved for a modern presenteeism approach.Presence ProblemThe first question is: What is presenteeism in remote work and/or home office? Imagine that you are suffering from a mild cold. In the past with a less flexible work environment, you had to take an either–or decision: physically show up (clearly presenteeism from the traditional point of view) or sign off sick and stay at home. This reflects the focus of the concept of presenteeism on physical presence. Yet, when remote work is possible or even encouraged by employers it becomes trickier. What is presenteeism in the context of remote work? Again, imagine you are suffering from a mild cold. You may not show up in the office for different reasons. Firstly, besides work, trying to reach your workplace may require further effort or be difficult (e. g., with a runny nose), which can hamper recovery. Secondly, another reason for staying at home is to avoid infecting your colleagues. Thirdly, disease management in the workplace is more difficult; for example, intermittent breaks are not easily possible.Remote work, however, differs in all aspects: Neither travelling to the office is necessary, nor is there a danger of infecting colleagues when you are at home. You can rest on the couch, if you need to. Given this, the concept of presenteeism should instead focus on carrying out work when you are ill independent of the place where this work is carried out. Physical presence at a particular workplace should not be the key component in modern presenteeism approaches.Threshold ProblemThe second problem refers to the threshold of presenteeism. The threshold for continuing to work despite illness is likely to be lower with remote work. But at what point should one begin to speak of presenteeism? Is it presenteeism when you work for, say, 1 hr? You may check your emails or take part in an important online meeting and rest afterwards. Is this presenteeism? The dissociation between home, the place where you can recover, and the place where you work may lower the threshold of what we define as presenteeism. If we refer to the present definition of presenteeism as “working despite illness,” completing only a few tasks must also be seen as presenteeism. However, the “strictness” of presenteeism may be less with remote work thanks to the greater flexibility in the organization of work.Shifting ProblemClosely related to the threshold problem, we consider another issue: the shifting problem. Remote work may foster presenteeism by providing the opportunity to shift work activities to the home environment in the case of health impairments, according to the motto: too sick for the office, but healthy enough to work from home. Obviously, this issue arises in the modern working environment only. In the traditional office, signing off sick from work was equivalent to not showing up at the workplace and working from home was often not possible due to data security issues and a lack of suitable digital infrastructure. Since the required infrastructure has been available, completing tasks from home is easily possible and even expected. Consequently, we may consciously shift our work home when we are ill independently of signing off sick or not. Therefore, we consider the work-from-home policy as a factor that may foster presenteeism.ImplicationsWhen taking the three problems together, the challenges in the modern working environment become obvious. We will face presenteeism in a new guise. Employers should be made aware of the three problems. A reduction in the number of days that employees sign off sick may not be due to better health but rather to presenteeism, which changes its appearance in modern work environments. Since the term “presenteeism” implies “(physical) presence” that, however, is not mandatory for engaging in presenteeism in the modern work environment, we may assume that a new designation for the phenomenon of “working ill” should be introduced. However, in our opinion, a well-established term should not be revised; yet, we point to the need to rethink the concept, since the changes in the work environment accelerated by the COVID-19 pandemic will remain.Finally, a further challenge arises. Presenteeism is a psychological construct that can be validly assessed by questionnaires, for example, by the presenteeism scale developed by Hägerbäumer (2011, 2017). The questionnaire operationalizes presenteeism as a behavioral habit. However, some of the items are tailored to working in presence. Therefore, we are currently working on a revision of the scale that considers the revised presenteeism concept.In summary, we assume that the modern working world, in which remote work may become the rule rather than the exception in many professions, demands a revision of the concept of presenteeism. In the present viewpoint article, we propose the first thought-provoking key points, which should be further elaborated by discussions in the research community.LiteraturAloia, R., & Priebe, J. A. (2022). Vorschlag eines umfassenden Modells zur Vorhersage von Präsentismus: Eine empirische Studie [Proposing a comprehensive model to predict presenteeism: An empirical study]. Zeitschrift für Arbeits- und Organisationspsychologie, 6, 3, 143 – 153. https://doi.org/10.1026/0932-4089/a000378 First citation in articleLink, Google ScholarAronsson, G., & Gustafsson, K. (2005). Sickness presenteeism: Prevalence, attendance-pressure factors, and an outline of a model for research. 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