The determinants of sickness presenteeism.

AuthorPalo, Sasmita


Sickness presenteeism (SP) can be defined as a state in which employees turn up for work in spite of being sick. Although presenteeism is a subject of vivid interest to scholars in occupational medicine, few organizational scholars have extensively worked on the subject. One of the reasons that could have ignited interest in researchers is the growing concern among organizations about how presenteeism leads to lower levels of employee productivity (e.g., Collins et al, 2005) and there are reports of many other hidden costs as well (Goetzel et al, 2004; Hemp, 2004). Ailments commonly associated with SP include headaches, migraines, allergies, depression, gastrointestinal problems and asthma/ breathing difficulties. These are often deemed as benign illnesses that do not force a person to stay away from work, but reduce his/her productivity (Ceniceros, 2001; Goetzel et al, 2004). The present study is aimed at identifying the determinants of SP at work. It retro-flexed some of the existing results relating to SP as well tested new hypotheses that have only been hinted in the literature.

Hypotheses Development

Johns (2009) has traced the first use of the word "presentee". According to the Oxford English Dictionary Online, the word "presentee" was first used by the famous American humorist and author Mark Twain in his famous Book, The American Claimant in 1892. Thereafter though there have been occasional use of the term, however it was not until the early 1990's that the term was used in a defined connotation. Presenteeism in earlier times was only defined as opposite of absenteeism, but gradually more refined forms of definition of presenteeism with defined constructs were available. SP has been defined by Aronsson & Gustafsson (2005) as "the phenomenon that people, despite complaints and ill health that should prompt them to take rest and take sick leave, go to work in any case". They have distinguished between 'work-related demands for presence' and 'personally related demands for presence'. Johansson & Lundberg (2004) have defined presenteeism in the same way as above. According to them, when a person attends to work in spite of being ill or under circumstances which would ideally require leave for e.g. child care. However, we have limited our discussion to cases when employees turn up for work in spite of suffering on health grounds only and does not extent to other reasons like child care. In this study, we categorized determinants of SP broadly into three categories such as work related factors, personal circumstances and personality of the employees. The study also examined the relational influence of the above three categories of factors on SP.

Work Related Factors

There are certain factors which compel the job incumbent to attend work even when sick. Organizational policies for example might not have flexi working hours which might affect an employee's decision to work. Work related factors can be further classified into factors which can be controlled by the employee and some others which are beyond his control. It can be derived that when factors are under the control of an employee, he would have the freedom to choose when to go to work and when not to and hence is expected to report lesser SP than employees who are devoid of sufficient control over tasks.

Irreplaceability can be defined in simple terms as the availability of any other worker to replace the incumbent when the latter is sick. According to Bockerman & Laukkanen (2009), worker's replaceability can be seen from an economic angle. In case a worker can arrange for a replacement when he is absent from work, he would choose to avail of a sick leave when he is ill. On the contrary, if there are no available replacements for a worker and in case of his absence, he has to come back and finish up his pending work, then he would be less likely to take a sick leave. Hence in the second case, the indirect costs of being absent are more for a worker and under such circumstances, he would choose to attend to work when sick. Hence considering the relevance of this context in the current study, we hypothesize that:

H1: Higher the irreplaceability of the job, higher is the SP reported by the incumbent.

Job Demands include physical, cognitive, and social features of a job that necessitate protracted physical and psychological effort (Johns, 2010). Many studies have also labeled it as 'role overload'. Role overload is a concept where a job incumbent is expected to perform more with limited resources and time (Rizzo et al, 1970; DeFrank & Ivancevich, 1998). In his model, Karasek (1979) has pointed out two aspects of job that has maximum effects on employee well being:job demand and control over job. Job demand refers to workload and time pressure. Job control (also termed as decision latitude) refers to the extent to which a person is capable of controlling their tasks and general work activity (Mojzisch et al, 2010). The interplay of these two effects of job demand and job control determines if the job is a "high strain job" or a "low strain job". A high strain job is one, which is high on demand and is low on control whereas a low strain job has lot of job control, but is not much demanding. High strain jobs are most detrimental to the well being of employees and might pose threat to their future health. In the current scenario, where firms focus on profits and rate of return, job demands have become huge. Jobs of the service sector like that of a doctor, nurse or a teacher are considered to be more demanding and might report more presenteeism. Resources have become unlimited, thereby putting much pressure on employees. Employees who lack resources will be reluctant to avail sick leave justifying that they will face a backlog of tasks when they return to work (Aronsson & Gustafsson, 2005). An employee faced with a dilemma of whether to attend work when sick is again an economic decision. Keeping such theoretical framework in mind, we hypothesize:

H2: Higher the pressures associated with a job in terms of scare resources and time, higher will be the reported SP.

Adjustment Latitude describes the opportunities people have to reduce or in other ways change their work-effort when ill (Johansson & Lundberg, 2004). In cases of independent professions like in a private clinic or a teacher, this adjustment latitude might be the most compelling factor leading to presenteeism. This is so because in this profession, the doctor or the teacher can manage the day by altering their load of work by attending to lesser patients or taking a class of lesser duration, in case of a teacher. Again the aspect of cost benefit economics can be brought into picture while explaining it. Hence we hypothesize that:

H3: Higher the adjustment latitude, higher is the occurrence of SP.

Team Work & Support: Employees working closely with a team under strict time schedules on important deliverables restrain from opting for a leave which is a risk to their future health status. Influence of team work and pressure from colleagues is an important factor contributing to SP (Grinyer & Singleton, 2000). Hence we hypothesize that:

H4: Higher the social support in the organization, higher is the SP.

Job Security is the feeling of job security that compels an employee to report to work in spite of being sick. In events of downsizing, an organization structure might change, for example, it might become flatter or the work design might change which might not make it viable for a person to be absent from work. Also since sustaining the job becomes important under such scenarios, promotions, performance appraisals matter. In order to safeguard against being a victim of downsizing, a person chooses to display commitment and performance through his attendance at work. We can hypothesize that:

H5: Higher the job insecurity associated with a job, lower will be SP.

Personal Circumstances

Factors outside work can also have substantial effect on an employee's...

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