When work makes people sick, and sick people come to work

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Légende: Recommendation of our expert

Expert adviser:

Caroline BIRON, associate professor, Department of Management, Faculty of Business Administration, Université Laval


Étienne FOUQUET, research assistant, Université de Sherbrooke
France ST-HILAIRE, associate professor, human resource management, Université de Sherbrooke
Maude VILLENEUVE, research professional, Université de Sherbrooke

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

We know that presenteeism is more costly than absenteeism for organizations. Yet it is rarely measured in workplaces, even though it is an important indicator of employees’ health. Presenteeism is the vicious work cycle that makes employees sick; these same employees who show up to work when they are sick are less productive.

To better understand presenteeism in the workplace, we interpreted Pohling, Buruck, Jungbauer and Leiter’s study, published in 2016. They were examining organizational factors related to presenteeism, seeking to better understand the relationships between risk factors in the work environment and presenteeism at work. To do this, they asked themselves whether

  • certain factors in the work environment directly affect the frequency of presenteeism and lost productivity related to health problems;
  • the work environment indirectly affects presenteeism and lost productivity through a deterioration in mental and physical health;
  • a relationship exists between the frequency of presenteeism and the decrease in productivity.

What do we mean by: Presenteeism ?

We speak of presenteeism when an employee comes to work even when they are physically or psychologically ill, or when they are not capable of working.

The authors of this study took into account two definitions of presenteeism – one North American and one European – to get a fuller picture of the concept, along with cultural nuances:

  1. In Europe, presenteeism is coming to work when you are sick; it is measured by the number of days that the employee came to work sick over the past year.
  2. In North America, presenteeism is expressed by lost productivity associated with one or more health problems, often measured during last 2 weeks of work.
Lost productivity

Lost productivity is demonstrated, for example, by difficulty concentrating on tasks, reduced work quality or difficulty working as part of a team because of an altered physical or mental state.

Risk factors in the work environment

The authors considered 6 risk factors in the work environment.

1)     High workload When work demands exceed the employee’s abilities. The employee must do more than is possible with the time and resources available.
2)     Low control The employee’s perception that they cannot influence decisions that affect their work, do not have sufficient professional autonomy or do not have access to the resources they need to work efficiently.
3)     Low recognition When recognition (social, professional and at times monetary) does not meet the employee’s expectations. The lack of recognition by colleagues and managers devalues the work and results in the employee feeling that they are not effective.
4)     Low sense of community Low quality of social interaction at work, including the presence of conflicts, lack of mutual support, closeness and ability to work as part of a team.
5)     Sense of injustice When work decisions are perceived as unfair and the employee is treated with a lack of respect. Fair treatment communicates respect and confirms the employee’s self-esteem.
6)     Value conflict A value conflict at work can undermine the employee’s commitment. The greater the gap between personal and organizational values, the more the employee must compromise between the work they want to do and the work they have to do.

Table adapted from: Leiter, M. P., & Maslach, C. (2003). “Areas of worklife: A structured approach to organizational predictors of job burnout,” in Emotional and physiological processes and positive intervention strategies (pp. 91–134).

What do the study’s results reveal?

The study shows that certain risk factors (increased workload, sense of injustice, conflict between personal values and the organization’s values, and low recognition) in the work environment, combined with employees’ physical or mental health problems, contribute to the frequency of presenteeism and, as a result, to reducing employees’ productivity.

  • In this study, 93% of employees engaged in presenteeism in the past year and saw their productivity diminish on days when they worked while they were sick.
  • When the workload is manageable, when employees have control, when they feel recognized and do work that fits their values, they engage in less presenteeism and have less lost productivity related to their health.
  • Employees who have a mental health or musculoskeletal health problem engage in more presenteeism and lost productivity.

The study was done with German public service workers.

Study participants had to complete a questionnaire on factors in the work environment, physical and mental health and presenteeism.

  • Number of participants: 885 individuals, including 709 women and 176 men.
  • Average age: between 20 and 64 years.

Principal conclusions of the study

Risk factors in the work environment
Some risk factors of the work environment are more harmful because they have an influence on presenteeism, lost productivity and employee health. Higher workload, a sense of injustice, a conflict between personal and organizational values, and low recognition are more at the root of presenteeism and an employee’s reduced productivity. Also, these same factors contribute to a direct decline in the employee’s physical and mental health.
Physical and mental health
Factors associated with presenteeism and absenteeism are similar. It is well known that several risk factors in the work environment affect physical and mental health. Sick employees not only engage in more presenteeism and have more lost productivity, they are also absent more often.
Frequency of presenteeism and lost productivity
The frequency of presenteeism and lost productivity related to a health problem have the same sources. Risk factors in the work environment lead simultaneously to a greater frequency of presenteeism and lost productivity, because of their effect on mental and physical health.
Although presenteeism is not the same as lost productivity, it can be the cause. By intervening on the risk factors, we positively influence physical and mental health, presenteeism and productivity.

Because studies must always be interpreted with caution

The study was done in a single public institution in a single country. Also, the effect of personal characteristics on presenteeism and on lost productivity was not considered.

Actions employers can take

The authors recommend taking concrete actions to reduce presenteeism by acting on the risk factors in the work environment. By preventing these risks, you can obtain positive impacts on the physical and mental health, presenteeism and productivity of your employees.


Action step
  • The workload for each employee must be manageable.






  • Hold regular one-on-one meetings between the manager and the employee to discuss workload.
  • Add systematic items to the agenda of team meetings.
  • Plan 5-minute meetings at the start of a shift.
  • Train managers on management practices to intervene on risk factors and health.
  • Incorporate selection criteria regarding managing people when hiring managers.
  • Employees must enjoy a certain autonomy and have the possibility of influencing work divisions.



  • Offer employees opportunities to improve their skills or get training.
  • Put in place mechanisms for consulting employees.
  • Increase organizational flexibility (e.g.: telework, work–life balance measures)
  • Social, professional and at times monetary (fair salaries) recognition measures must be put in place as a performance appraisal system.







  • Set up an organizational policy on recognition at work.
  • Train managers and teams on recognition and its different forms (manager towards employees, employees towards manager, between colleagues).
  • Offer ongoing training and development for employees and managers.
  • As much as possible, find ways to assign employees work that interests them and that matches their interests.
  • Use an intranet to highlight successes.
  • Systematically include successes on the agenda.
  • Organizational practices should be fair and equitable and ensure respectful treatment for all employees.


  • Plan one-on-one meetings between the manager and the employee to discuss the employee’s perceptions about their work environment.
  • Train managers.
  • Employees must be empowered to contribute to a goal that makes sense to them and to the organization.
  • Employees’ personal values must therefore be consistent with the organization’s.
  • Offer career opportunities within the organization thanks to the implementation of personal development strategies.

Reminder from the Authors of the Study

Here are two simple indicators you can use to measure presenteeism in your organizations:

  1. Frequency of presenteeism: can be measured by the number of days the employee came to work sick over the past year.
  2. Lost productivity related to health: can be measured by lost productivity associated with one or more health problems, often measured during the last 2 weeks of work. Productivity can be measured using four elements: positive mood (good humour, ability to relax), vitality (being active, waking up refreshed and rested), taking an interest in things, and activities over the last 2 weeks.


Biron, C., Fouquet, E., St-Hilaire, F., Villeneuve, M. (2018). When work makes people sick, and sick people come to work. Global-Watch Scientific Interpretation available at www.global-watch.com


Pohling, R., Buruck, G., Jungbauer, K.-L., & Leiter, M. P. (2016). Work-related factors of presenteeism: The mediating role of mental and physical health. Journal of Occupational Health Psychology, 21(2), 220‑234.

Karine Casault
Author: Karine Casault