How do employees decide between sickness presenteeism and absenteeism when they are feeling unwell? Contrary to popular belief, presenteeism is not necessarily detrimental to health. Whilst in certain circumstances taking sick leave may be beneficial, if the work environment is supportive, adequate resources are provided and any necessary adjustments made, work can provide a rehabilitative and restorative function, facilitating a return to full capacity.

Making the right decisions

Consequently, if HR professionals knew more about the presenteeism-absenteeism decision-making process, they could better support individuals to make the right decisions, given the nature of their work and their health condition. The widespread shift to hybrid working makes it even easier to work while sick, and even more challenging for managers to spot and intervene when an imbalance between work demands and health needs arises. So even though it’s easier for many of us to work while sick, the important question is, should we? 

It is not a simple decision between absenteeism and presenteeism, but one between sickness absence without any work engagement

The process of presenteeism decision-making

Drawing on research related to decision-making, sickness presenteeism, health behaviour, and organisational behaviour, we have outlined key steps of the decision-making process likely to inform and shape decisions by individuals. The process can also be used by HR practitioners and managers to better support colleagues within their organisation: 

1. A trigger that necessitates the decision (What happened? How severely am I affected?) 

2 (a) Perceived available options (What could I do? What’s possible?) 

2 (b) Evaluation of perceived benefits/risks and potential consequences (What should I do? What is the best option?) and 

(3) Evaluating the decision (Was this the right decision? Did I achieve my aims? How is my health? How is my work?)

Stage 1: Trigger

How bad is it? When we first experience symptoms, we conduct a rapid self-assessment of the health issue, based on severity. Personal factors such as commitment towards work or belief in our ability to do our job are likely to affect this appraisal, potentially influencing an individual threshold at which a health issue is deemed to necessitate sickness absence, without much deliberation over the options. For some individuals and/or some health conditions, the threshold may be low, with very few health events automatically warranting sickness absence, whereas for others it may be high. Given that our thinking is strongly influenced by emotional states, this threshold may also change situationally, for instance, if we’re experiencing stress or frustration.  

Stage 2a: Options

What are my options? What could I do? ‘Options’ refer not only to a binary choice between absenteeism and presenteeism but also to the range of options between full and partial productivity, for example attending to a limited range of tasks only, working but performing a poor job, or working reduced hours.  It is likely to include considerations such as “What tasks am I able to carry out with my symptoms?” and “How can I adapt the tasks until my health improves?”. Weighing up the symptoms, e.g., mental, physical, severe, less mild, etc. against work-related variables such as job demands, ease of replacement, and how much control do I believe I have over adjusted my tasks?

Stage 2b: Evaluation

Once identified, we evaluate options. Consideration moves from “What could I do?”, to “What should I do?”. Consequences, both positive and negative, will be evaluated not only against our own goals and motives but also against others’ interests and expectations. For example, sickness absence would give me time to rest and may speed my recovery, but this may result in an additional workload for my colleagues which could cause animosity within the team. It is not a simple decision between absenteeism and presenteeism, but one between sickness absence without any work engagement, sickness absence combined with presenteeism (bearing in mind that some individuals may officially take sick leave but still engage in presenteeism by checking emails, or undertaking other tasks) and a range of sickness presenteeism behaviours, from working while ill yet maintaining full productivity, to working at limited capacity and/or on limited duties/hours, to being physically present but completely unproductive.

Stage 3: Feedback

Here, we weigh up the choice made: “Did I make the right decision?”, and/or “Do I need to reconsider my decision?” Depending on the duration of the illness, this could take place during illness and/or after the illness has subsided. Feedback has an important role in effective decision-making, helping us to evaluate the appropriateness of the choice(s) made, assessing the extent to which the intended outcomes were achieved, and identifying links between actions and consequences.

Feedback is essential to helping us adapt behaviour, learn through this process and reinforce (positive feedback) or inhibit (negative feedback) specific decisions in the future. Unfortunately, often we don’t reflect enough or don’t receive feedback to help us reflect on our decisions. HR can play a supportive role for individuals and managers, adopting a coaching approach to promote reflection on the consequences for individuals, teams and the organization as a whole.

The question of how we make decisions to attend or not to attend work when we’re experiencing ill-health is critical to effective management of employee health and productivity

Feedback is important for ensuring that the right support and resources are provided by line managers, colleagues, or others in the workplace, to enable individuals to both support their health and attend to work demands as much as possible. Critically, feedback may help to adjust dysfunctional behaviour towards more functional presenteeism next time. 

Garnering the big picture

The question of how we make decisions to attend or not to attend work when we’re experiencing ill-health is critical to effective management of employee health and productivity, including how HR might support individuals and managers to maximize those decisions. Ultimately, this will help to promote work-related health and well-being, creating a more positive work experience for employees, and optimizing the health-productivity trade-off to enhance health and productivity, in tandem.

We’re currently testing and refining this model with data gathered through daily diary studies exploring how employees make these decisions in real time. We look forward to sharing those insights in the future.

Interested in this topic? Read Why do we still go to work when ill?

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