Ann O’Flynn, Professor Gail Kinman and others argue that providing expert psychological interventions such as clinical supervision or access to counseling can be a great help to charity helpline workers. The role of occupational health professionals is also important.
This article presents the results of a study on presenteeism by UK charity workers who work from home. In the UK, sickness presenteeism (defined as working while feeling sick) is on the rise.
It is believed that individuals who work while ill due to both physical and mental conditions are more likely to do so and cost more than those who don’t.
Hampson (2020), a UK-based company, estimates that the cost of presenteeism is PS29bn. This is four times more than the cost of sickness absence due to reduced productivity, mistakes, accidents, injuries, and duplication of effort.
Under certain circumstances, however, presenteeism may be beneficial to the wellbeing of employees, helping them recover by providing structure, social connections, and boosting self-esteem (Kinman & Grant, 2021). The distinction between functional and dysfunctional absenteeism is important (Karanika Murray and Biron, 2010).
The causes of dysfunctional presenteeism include organisational, occupational, and individual factors, including cultures that stigmatise absenteeism and encourage presence, inadequate resources or support for the job, excessive demands, a lack of control, and personal choices regarding attendance at work (Gerich 2014; Kinman and al., 2019; Demerouti and al., 2009).
Conditions of employment such as sick pay or sanctions for absences can also deter employees from taking sick time (DeRigne et. al., 2016; Oakley, 2023). Presenteeism can also be more prevalent in occupations that have a strong duty of care or ethical responsibility where the quality of service may be compromised (Kinman 2019).
The context and the aims of the study
In the study, the home-based workforce handled complex inquiries every day of the calendar year. Employees can receive up to 6 months’ full pay or 50% of their salary during sickness absence, depending on the length of service. They also have access to a private medical insurance plan, an employee assistance program, and a variety of health and wellness-related products and programs. The absence policy of the organisation includes trigger points that can be used by management to intervene.
The Contact Centre Management Association provided statistics on the organisation compared to other member contact centres. These included higher salaries, shorter work weeks, lower turnover, and three times as many hours of development and training than the average in the sector.
Around 62% have flexible work arrangements. The CCMA reported a high occupancy’ of 86%. This is a measure for job demand. It refers to the time staff spend with customers.
This rate could lead to burnout because there is not enough recovery time in between contact. But 85% of the staff said they were able to manage their work.
There are monthly clinical supervision, support and wellbeing breaks, as well as mental health first aiders, staff association representatives, and safeguarding officers.
The sickness absence rate of the organisation is comparable to that of its sector. The sector average for presenteeism was 69%. However, no information is available about the rate of sickness absenteeism at individual organisations.
Understanding the prevalence of dysfunctional sickness and why people continue to work when sick is essential for developing targeted interventions. This study was designed to explore these issues.
The method
A survey was conducted online with 444 UK-based home-based workers. The survey asked respondents whether and why they worked when ill.
A thematic analysis was conducted to examine the reasons given for working when sick.
Sample
Response rate was 79%. The survey had 350 respondents. 94% of them worked at home, and 5% were hybrids.
In terms of occupation, 53% are helpline workers. 34% are first line managers. 8% are middle managers. 5%, senior managers.
Analytical Approach
No time period was specified for the prevalence of self reported presenteeism in MH and PH.
The six-step method of Braun and Clarke (2006) was used to analyze the reasons for this, as it lends itself well to the inductive, experiential analyses of large qualitative datasets.
The study did not follow a single theory but instead drew from the framework of Karanika and Biron described above, which categorizes presenteeism into two categories: potentially harmful (inother words, dysfunctional, and overachieving), and potentially beneficial.
Findings
This workforce was plagued by presenteeism, as 78% reported having worked with a mental health condition (MH) and 62% had a physical health condition (PH).
The reasons given by employees for working when ill differed from those found in previous studies.
Presenteeism is largely attributed to two themes that are aligned with a functional and therapeutic perspective.
- The illness was not severe enough to warrant time off from work.
- When ill, work was a way to focus, motivate, or distract.
This section will explore these themes in more depth.
1. No legitimate excuse for absence.
Respondents felt that their illness was not severe or serious enough to warrant absence. This was true for both mental and physical health. One respondent referred to presenteeism in a spectrum, which doesn’t feel like a reason for being sick.
One participant said: “It has to be extreme to take time off.” This issue was further explored by identifying sub-themes.
Living with a chronic condition. This subtheme was cited by 30 people for MH, and 13 for PH.
Participants reported enduring conditions such as anxiety, cancer and migraines. They also experienced functional bowel disorders, menopause symptoms, and chronic fatigue.
Others found it hard to decide if they were sick enough to take time off.
One respondent said in relation to the symptoms of MH: “You can feel well enough to go to work, even if you are unable to stop crying.”
Some were more fatalistic and accepted that their symptoms would not improve, so they “had to live with” them.
Working while ill for a short time. 21 people cited it as a cause for absenteeism in relation to PH, but only one for MH. This person described a temporary panic disorder.
The respondents reported that they had worked through colds, “bugs” and other ailments, such as headaches and back pain, but did not take time off due to them.
Some people were able to continue working in some capacity despite being unwell by performing certain work tasks. Many people mentioned that disturbed sleep can affect health, but it is not serious enough to warrant taking sick leave. For example: “I sometimes do not sleep well and this can make workdays more difficult.”
The idea that taking time off is unsustainable. Participants with long-term conditions said they would “never be able to stop” if they took time off.
One person said: “It is a long-term illness, so I manage and adjust even on bad days.” Another added “If I were off every time I experienced (symptoms), I would hardly be working.”
2. Work as a therapeutic activity for wellbeing
The second most common theme was presenteeism, especially in relation to MH. There were 39 comments on MH and only 11 for PH.
The participants generally agreed that working was therapeutic for MH and considered “a good diversion”. One person said: “By continuing to work, it can lift negative feelings/emotions at times.” Subthemes were also identified.
Feeling worse at work than when working. 19 people gave this as a reason to continue working, such as: “Not going to work would have worsened my mental health”.
Work can be a way to distract from problems. 14 people said that work could act as a diversion when life is difficult. Examples include: “Work can help you to forget about things going wrong in your life” or “I find work a place where I can escape”.
Work gives structure and purpose. Seven people said that their work gave them a sense purpose and boosted their self-esteem. They considered this beneficial to wellbeing.
Work is a place where I am more confident about myself and my abilities.
Some people found that the structure and routine of their work helped them when they were ill. For example, “Attending to work and keeping to schedules is beneficial for my mental well-being.”
The analysis also revealed a few minor themes that provided further insights into why people worked when sick.
There were a number of reasons for this, including a fear of the absence management procedure, owing a duty to the people who use the service, or to their colleagues, as well as not wanting to disappoint people.
Only one person, and only for MH, cited the ability to work from home.
Comment: “Working at home allows me the flexibility to work despite health issues, as I do not have to commute and can take breaks. My health is also not put at risk due to face-to-face interactions with others.”
One respondent pointed out that working at home is beneficial for infection control: “because I work from home, I’m not a threat to others in terms of infection control so I’m more likely to have a cold or the flu when I go to work.”
Some less positive factors, however, were also identified. For example, the blurring boundaries when working from home encourages dysfunctional presenteeism. As an example, “I push myself as much as I can because it is harder to know where my limit is when working at home.”
Few people have mentioned that there is a lack support from their managers, peers, or the organization itself. This indicates they believe adequate support exists.
Summary of Findings
The study revealed that presenteeism was common among UK-based charity helpline workers who work from home, particularly for mental health issues.
Two main themes emerged from the reasons for presenteeism. First, the work was seen as a useful distraction when ill. It provided structure, meaning, and connection with other people. Second, people believed that their illness, whether it was long-term, episodic or both, wasn’t severe enough to warrant absence.
“People with chronic health conditions may benefit from more flexibility in their work schedules, particularly individual scheduling.”
The study found that presenteeism is a result of a number of factors, including job demands, lacks of resources, poor policies, and a lack in support.
It is surprising, given the high rate of work highlighted in the CCMA Report, that more respondents didn’t cite heavy workloads as a cause for presenteeism. Several respondents mentioned the challenges of managing workloads, and their concern about work being left unfinished upon return.
Demerouti and colleagues (2009) suggest that to reduce presenteeism risk, it is important to provide task variety, allow adequate breaks and recover time, as well as increase autonomy in terms of where, when, and how the work is done.
Kinman et. al. (2019), in a study on the UK prison system that is likely to be applicable to other sectors as well, identified the necessity for an adequate, equitable absence policy, and maintaining staffing levels including covering for absences to reduce presenteeism.
The same study highlighted the negative impact on absent employees of poor communication. They may view well-intentioned contacts from managers as intrusive surveillance.
This perception may stigmatise absenteeism and increase presenteeism. Some respondents in the study expressed concern about the possibility of triggering absence management procedures and the burden placed on their colleagues by taking sick leave. These were not the predominant themes. Instead, the diverse support offered may help mitigate the negative effects of the job design.
Findings revealed that many people work when they are ill for functional and therapeutic reasons. This is a way to maintain a normal life.
In remote settings where signs of illness may be less obvious, it can be difficult for employers to determine whether presenteeism has a positive or negative impact. Presenteeism can be hidden and have long-term effects on employee productivity and wellbeing.
Kinman and Grant’s guidance for the Society of Occupational Medicine (2021) recommends managers of home-based employees be trained to detect signs of struggle, and to teach them how to help their employees set boundaries so they can detach from work when ill.
People with chronic health conditions may benefit from a more flexible work schedule, and especially individual scheduling.
Asynchronous working is particularly useful as it doesn’t require all employees to be in the same place at once. This allows for greater flexibility and can reduce work pressure. Kinman & Grant (2021) outline the practical steps that organizations can take to reduce absenteeism.
They include identifying causes and risks through consultation with staff, including them in the decision-making process, ensuring policies and practices are appropriate, monitoring work load and providing flexibility to work patterns.
It is also important to highlight the role played by occupational health professionals in reducing presenteeism due to dysfunctional illness. The most important thing is to create a culture of health and self care, while encouraging employees to take time off when needed.
The conclusion of the article is:
It has both theoretical and practical implications that the presenteeism observed in this case wasn’t primarily caused by factors identified in previous research such as job design or policy, organisational cultures, or demands at work.
“Occupational health can play a key role in ensuring that employees and managers are genuinely motivated to work while not fully fit and not because of pressure or unrealistic expectations from others or themselves.”
This suggests that the right support and interventions could act as buffers to these factors, reducing the possibility of dysfunctional absenteeism. The availability of supportive resources for wellbeing and a culture of support within the organization may also encourage employees to take sick leave if they feel it is necessary.
It is important to note that presenteeism is more prevalent in mental illnesses than physical ailments, which suggests that targeted support could be required.
In this case, it appeared that providing expert psychological interventions such as clinical supervision or access to counselling to employees who have high emotional demands helped them.
The occupational health department has a role to play in this situation. It must work with managers and employees to ensure that the reason for working when not fully fit is not because of pressure or unrealistic expectations from others or themselves, but rather due to a genuine therapeutic purpose.
The findings of this research are theoretically important, as they provide distinct reasons for absenteeism in a workforce that is primarily public-facing and works from home, which contrasts with earlier research, which focused on roles based in offices.
It may also encourage employers to create work that allows for flexibility and latitude, as well as a degree of agency. This will help to reduce the emotional strain on employees.
- Thanks to Dr Jonathan Houdmont at the University of Nottingham who oversaw the research for this article.
References
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