Can presenteeism be good for health and performance?

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Scientific interpretation

The doctor has recommended rest to cure my health problem, but I absolutely need to go to work and finish my report otherwise it will be late! Almost everyone has experienced a time when they went into work while they were unwell. Most of the focus on working while sick, also known as presenteeism, has been on loss of productivity and high costs for employers. But what if presenteeism can have some positive aspects that are overlooked? For instance, what if working while sick could help employees maintain a level of productivity, and reduce anxiety over falling behind at work? What if the choice to work while sick can help them to stay meaningfully involved with work and ease their return to work? In their 2019 paper, Karanika-Murray and Biron propose 4 types of presenteeism and discuss how these 4 types are impacted by an employee’s internal capacities and work resources.


Maria KARANIKA-MURRAY, associate professor, Nottingham Trent University, UK

 Caroline BIRON, Full Professor, Université Laval, Director, Centre d’expertise en gestion de la santé et de la sécurité du travail and Research. Centre de recherche en santé durable VITAM, Quebec, Canada, 


Kimberly SHARPE, research assistant, University of British Columbia

Marie-Élise LABRECQUE, research professional, Université de Sherbrooke

This initiative was made possible through a collaboration with the Université de Sherbrooke.



The standard definition is working while sick. The authors further define presenteeism as an adaptive behavior that seeks to balance health and performance in the workplace.

It is adaptive because it serves a purpose for workers who show up despite illness. This choice is motivated by individual (e.g. guilt, financial problems, personality) and work-related factors (e.g. work overload, not wanting to let down colleagues, getting positive feedback from supervisor).


Internal capacities

The mental, physical, or physiological resources available as determined by the health condition. They help set the boundaries of what presentees (employees who work while sick) can do when they have impaired health and are specific to that health condition for that employee at that time.


Work resources

Workplace assets that presentees can draw on to support them when they are working through illness. They help define the type of presenteeism by providing employees with the flexibility to make the most of their internal capacities and adjust to performance demands.

A workplace with adequate and relevant work resources (for the specific employee at that specific challenging time) can help employees stay at work and maintain a certain level of performance without deteriorating the health problem, and even contribute to the recovery of full capacities.

Examples: social support from co-workers or flexible work arrangements that allow presentees to work from home.


Complete reference

Karanika-Murray, M. & Biron, C. (2019). The health-performance framework of presenteeism: Towards understanding an adaptive behaviour. Human Relations, 1-20.


The authors draw on existing literature and academic theory to propose 4 types of presenteeism for acute or chronic and non-contagious illnesses and to describe the role of internal capacities and work resources in adapting to presenteeism.

What are the findings of the study?

The authors propose 4 types of presenteeism:

Functional presenteeism
The optimal adjustment to balancing health constraints and performance demands – a level of productivity is maintained while recovery is supported

  • Availability of internal and external resources are key for maintaining performance because they allow employees to adjust their performance at work, while maintaining or improving their health.
  • Sustainability is achieved because employees work within their available resources.
  • A positive work environment plays a key role in promoting functional presenteeism.
  • Employees adopt presenteeism for different reasons and have different health restraints. A positive working environment fosters a feeling of psychological safety, trust, and openness to adjust and negotiate how work goals are met, and adjust the workload to the workers’ capacities during illness.

Therapeutic presenteeism
When being at work offers therapeutic value for employees’ health but there is less focus on maintaining performance

  • Engagement in the workplace, such as preserving work routines, co-worker camaraderie, or engaging in productive activities, can buffer the negative effects of presenteeism and help to preserve employees’ connection to the workplace, facilitating recovery in the long-term, despite short-term performance decline.
  • Can be thought of as similar to graduated return-to-work where being present at work can help aid recovery, as well as maintain connections to the workplace.
  • Could be more frequent in workers with difficult situation at home, such as taking care of a sick child/parent and finding the workplace to be a refuge.

Over-achieving presenteeism
Performance at work takes priority over recovery from health problems

  • Over-commitment to work in order to maintain performance levels at the expense of health can limit opportunities for recovery and result in a deterioration in health.
  • Boundary-less work, work demands and a positive orientation towards work (when employees are over-committed or over-engaged) may reduce the ability of employees to recover outside of work hours.
  • This type of presenteeism can often be linked to workaholism or work addiction.

Dysfunctional presenteeism
When being at work leads to both worsening health and poor performance

  • Unsustainable and can lead to sickness absenteeism or impaired future health. Both health and performance are affected when work demands take priority over recovery and when the health condition is unmanageable.
  • Employees with few resources to draw on, such as those who lack workplace support or adjustment opportunities, may be especially vulnerable to further declines in health and performance.

The 4 types of presenteeism are not fixed in time:

Some types of presenteeism must be temporary because they cannot be sustained in the long-term. For instance, dysfunctional presenteeism can only be adopted in the short-term because it leads to declining performance and deteriorating health.

Health conditions improve or get worse over time. For instance, in therapeutic presenteeism as an employee’s health improves, they are able to focus more of their energy on performance demands and will move towards functional presenteeism.

Positive effects of presenteeism on performance may be short-lived and there may be increased risk of impaired health in the long-term. For instance, presenteeism can help employees meet deadlines but more frequent or longer spells of presenteeism can lead to future negative health outcomes, such as sickness absence or cardiovascular disease.

Flexible work resources and a workplace that supports autonomy are fundamental for presentees to move towards functional presenteeism:


1. Resources are used differently or have different effects across the 4 types of presenteeism. Employees with greater resources may be in a better position to use these resources to adjust to performance demands and protect their health.
For example: In resource-rich environments, employees can rearrange tasks and work schedules, delegate tasks, or work remotely or from home. Employees may also under-utilize available resources if other conditions are not equally supportive – for example, they make be reluctant to participate in flexible work arrangements if they fear penalties or perceive a lack of support from colleagues.

2. Availability of work resources that allow for the flexibility to adjust to performance demands given impaired health can promote autonomous motivation, meaning that the motivation is self-determined and driven by the perception that engaging in a behavior is consistent with an employee’s own intrinsic goals and drive.[1] Autonomous motivation is associated with wellbeing, job satisfaction and engagement and performance at work.

3. Work resources that support flexibility and autonomy also support the use of functional presenteeism. Organizational policies and practices, including flexible scheduling, teleworking, job sharing or part-time work, and psychosocial resources, such as co-worker and managerial support and job control, can help employees balance their responsibilities at work with their health recovery.
For example: Managers who support employees working through illness and provide them with clear goals and expectations can help to reduce productivity loss in the longer term.


Take a person-centered approach to understanding presenteeism and absenteeism behaviour

  • Organizations should cultivate openness and trust and encourage authentic leadership styles with the intention of promoting positive working environments.


  • Managers need to be sensitive and open to understanding employees’ specific individual requirements at the time. Importantly, some presentees will not self-disclose their illness and will know how to adjust their work according to their health restraints.
    • Resources and interventions to promote the adoption of functional presenteeism should be flexible and allow tailoring for individual needs.
    • An organizational culture that is open and trusting also allows presentees to explore appropriate resources without fear of reprisal.

Foster a collaborative goal-setting approach between managers and employees

  • There may be opportunities for managers and employees to work together to identify and agree upon clear goals and expectations so presentees can focus their energy on the most important tasks and priorities.
  • This approach should be employee-led and reflect reasonable goals and expectations based on the employee’s understanding of their own health state and current abilities. A manager should approach this collaborative goal-setting with discretion and sensitivity and not impose direct goals and expectations on employees.

Ensure managers and employees can identify available organizational resources to cope with illness

  • Organizations can make policies regarding what is expected during illness easily accessible either via online portals or in high traffic areas. Adjusting workload and tasks to the health condition, a supportive manager and supportive colleagues are all part of a positive environment that will foster functional presenteeism.
  • Clear guidelines will help aid managers in identifying what resources exist and how to support employees without requiring their self-disclosure. A list of organizational resources can also be made available to workplace managers.

Workplace-based programs can aid presentees in moving to functional presenteeism

  • Therapeutic presenteeism can be used as a return-to-work policy after a sickness absence or to help employees cope with a difficult temporary situation in their personal live. This implies a discussion between the employee and their manager or occupational health and human resources team, when the worker is ready to return to the workplace. For presentees with longer term illnesses, the aim is to turn therapeutic presenteeism into functional presenteeism as part of the return-to-work plan.


  • Employee assistance programs can assist with crafting and implementing return-to-work policies and programs and offering health assistance without requiring employee self-disclosure.


  • Refer employees to other resources, such as: occupational physicians (médecin du travail), social assistance, or telephone helplines.


Offer flexible work arrangements

  • Flexibility can come in many forms: choice of work tasks, moveable deadlines, schedule of work, or place of work, etc. It is important for individuals to know that they have the ability to adjust their work temporarily in order to support their health.



Karanika-Murray, M., Biron, C., Sharpe, K., Labrecque, M.-E. (2019). Can presenteeism be good for health and performance? Global-Watch Scientific Interpretation available at


Karanika-Murray, M. & Biron, C. (2019). The health-performance framework of presenteeism: Towards understanding an adaptive behaviour. Human Relations, 1-20.


1. Hagger, M., Hardcastle, S., Chater, A., Mallet., Pal, Chatzisarantis, N. (2014). Autonomous and controlled motivational regulations for multiple health-related behaviors: between- and within-participants analyses (Régulations motivationnelles autonomes et contrôlées dans le cadre de comportements multiples liés à la santé : analyses entre et parmi les participants). Human Psychology and Behavioral Medicine, 565-601. doi : 10.1080/21642850.2014.912945

Pierre Breton
Author: Pierre Breton