Why can working while sick harm both employees and employers, even when the work is done from home?

Details

This evidence-informed discussion draws on previous studies and reviews to examine sickness presenteeism—continuing to work when unwell—during the COVID-19 pandemic. It does not report an original study design or sample. Its purpose is to highlight the costs to individuals and organizations, the factors encouraging presenteeism, additional pandemic risks, and ways organizations can reduce its occurrence and harm.

The pandemic has put many organizations under considerable pressure to remain productive and profitable. Although cutting sickness-absence costs may seem a priority, growing evidence suggests that sickness presenteeism is far more costly than absenteeism. There can be benefits to working while unwell: work provides structure, builds self-esteem, and offers social engagement and support. A managed approach can also be therapeutic by helping employees return gradually after sickness absence. Nonetheless, extensive evidence indicates that working while unwell can delay rather than speed recovery and increase the risk of future health problems and sickness absence. Studies also find that it can impair productivity and lead to errors, accidents, and injuries affecting employees, co-workers, and the public. Findings that people frequently work while experiencing infectious diseases raise particularly serious public-health concerns during the pandemic.

Personal, organizational, and occupational factors influence whether people keep working or take sick leave. The pandemic could worsen known risk factors and create additional challenges. Financial insecurity is a common reason for presenteeism, especially with limited sick-pay entitlement, insecure employment, or few re-employment options. The discussion describes rapidly increasing job insecurity in an uncertain job market where unemployment is expected to rise substantially. These conditions can encourage people to work while ill to demonstrate their value, loyalty, and commitment and avoid losing their jobs. Employees with substantial sickness-absence records because of chronic health problems may be particularly likely to do so during the pandemic, especially as some organizations use those records to select staff for redundancy.

People may also be reluctant to let managers down or burden colleagues, particularly when staffing is low or organizations are struggling to survive. They may keep working or return too soon because they believe managers and colleagues do not consider them ill enough for sick leave. This may affect people who had a fairly ‘mild’ case of COVID-19: some still have difficulty with daily activities and symptoms including chronic fatigue, weakness, and cognitive difficulties several months later.

Reviews identify organizational conditions that promote presenteeism. It can become entrenched where workplace cultures stigmatize sick leave and normalize long hours. It is also more likely under high workload pressure, which has increased in many organizations during the pandemic. Short staffing increases workloads and hours, compounded by covering for sick or vulnerable colleagues. Staff may also need to learn new skills quickly and extend their availability to help their organization compete. The discussion argues that these factors increase presenteeism risk and generate pressure and stress that can increase the likelihood of future health problems.

In March 2020, measures to reduce COVID-19 virus transmission meant that people able to work from home should do so. This was a major change in working practices: some experienced it positively, while others struggled to adapt to new environments and patterns. Research indicates that some homeworkers struggle to combine paid work and caring responsibilities in less-than-optimal conditions, with evidence that working hours and stress levels have generally increased. These circumstances can intensify pressure to work while ill. Without physical boundaries between work and personal life, disconnecting can be harder. Presenteeism is also less visible at home because managers may be less able to identify employees’ health problems.

Sickness presenteeism is particularly prevalent in ‘helping’ professions. These jobs often involve high workload pressure, long hours, and short staffing. A strong sense of duty and responsibility for others’ welfare can add pressure to attend work, especially during a public-health emergency. COVID-19 risk is higher in health and social care, requiring cover for colleagues who are absent or shielding. Presenteeism is also common in the gig economy, where work is frequently low-paid and lacks sickness benefits. An anticipated substantial increase in gig workers adds to the concern.

The scale and potential costs call for prevention. Employers are advised to balance immediate sickness-absence costs against the longer-term damage that presenteeism can do to employees’ health and functioning during and beyond the pandemic. Assessing presenteeism risk and its underlying factors—possibly by adapting the UK Management Standards approach—can guide interventions addressing organizational causes at their source. Sickness-management policies should also be reviewed so that, wherever possible, staff taking legitimate sick leave are not penalized.

Demand for occupational health practitioners’ services has increased since the pandemic. Services need adequate resources, and barriers to access should be identified and addressed. Closer collaboration between managers and occupational health can improve shared understanding of risks and help develop more effective sickness-absence management and rehabilitation during the pandemic. More flexible use of Med 3 ‘fit-notes’ may help when employees can do some work at home, for example while self-isolating, awaiting test results, or recovering from minor illness.

Organizations and employees should jointly establish norms that support enough sick leave for recovery. Concerns about COVID-19 transmission and the need for preventive action for the collective good might make presenteeism less socially and organizationally acceptable. Training supervisors and managers to support staff and recognize and address early stress signs could help, potentially using the Health and Safety Executive (HSE) Manager Competencies framework. Coaching-skills training may also help managers hold important well-being conversations with staff working at home or externally.

With many employees expected to work at home for the foreseeable future, guidance on healthy, sustainable homeworking is urgently needed, especially on setting boundaries and withdrawing from work communications during sick leave. More creative flexible-working arrangements could give staff greater choice and control over work patterns. People able to ‘self-schedule’ their hours tend to report less presenteeism; this flexibility can also accommodate limitations associated with long-term conditions. Effective presenteeism management is presented as a long-term investment in individual and organizational well-being, particularly important during the pandemic so employees can remain healthy and perform at their best.