Absenteeism is only one part of the problem when it comes to employee health. Presenteeism, or being on the job, but not working at full capacity also links to an impact on the direct and in-direct costs for an employer.
In a 2004 study of the problem, the Harvard Business Review noted that presenteeism is not to be confused with malingering (pretending to be ill to avoid work) or just slacking off (deliberately putting off duties at work) and should be considered a particular condition of being unable to perform at the highest level due to real physical or mental health challenges.
Unlike its close relation, absenteeism, presenteeism is more difficult to identify, and also has insidious, hard-to-track far-reaching consequences for the affected employer.
Presenteeism can occur for a variety of reasons – illness, lack of motivation, family/life pressure, high stress level, behavioral health and work overload.
Employee absenteeism can wreak havoc and impact employee productivity, increase work activities and stress for others as well as lower morale in the workplace. During the annual flu season, there is a significant increase in absenteeism rates for both full and part time employees.
Injuries, illness and medical appointments are the most commonly reported reasons for missing work (although, not always the actual reason).
When combating presenteeism in the workplace, a Towers Watson Global Staying at Work Survey suggests that establishing a culture of health is the top priority for employers. The study found that employers are recognizing that health is a total business issue that affects workforce performance.  Employers of all of sizes are realizing that worker health can be measured and leveraged for enhanced productivity and employee effectiveness. The workforce is essentially human capital and in a competitive global environment, worker health should be a top priority. 
“Employees who come to work sick, or suffering other conditions that prevent them from working productively could be costing employers more than absenteeism.”
Some studies have shown that the workplace section lost to absenteeism is dwarfed compared to productivity lost to presenteeism. Most studies confirm that presenteeism is far more costly than illness-related absenteeism or disability. Two Journal of the American Medical Association studies found that on-the-job productivity lost resulting from depression and pain was roughly three times greater than the absence-related productivity loss attributed to these conditions. 
Employers should be aware of the implications that presenteeism has on workplace performance as well as costs that don’t hit the bottom line.
Many organizations assume that if sickness rates are low, employees are generally healthy. This measurement can create a false positive because presenteeism may be high within the organization despite low absenteeism rates. Many absenteeism reduction measurements do not measure the increase in presenteeism that can accompany reduced absenteeism.
Some of the reasons employees have for presenteeism include:
- cannot afford to take the day off;
- there is no back-up plan for tasks the individual is responsible for;
- when they returned to work, there would be even more to do;
- committed to personally attending meetings or events;
- concerned about job insecurity related to downsizing or restructuring.
The impact of absenteeism is challenging to quantify for employers. However, quantifying the impact of presenteeism is even more challenging.
Presenteeism and its impact can stay under the radar for employers. Employers should focus on having the right systems in place to understand the core causes and strategies for intervention.
Employer strategies to tackle presenteeism
- Ensure managers are aware of what causes presenteeism. Large workloads or tight deadlines can reduce paid time off. Managers should be able to manage their teams’ workloads appropriately and have the necessary soft skills to promote and encourage positive work practices and quality of work life.
- Implement a technology solution such as absent management software that will assist employers in identifying presenteeism trends such as stress.
- On-site employee health clinics can be a positive resource for employees to receive just-in-time care and access for work-related and non-work related health conditions. Encounters / incident types can be measured by the clinical staff.
- Stringent policies should be in place regarding showing up for work when an employee is ill. Employers should make it absolutely clear that employees stay home when sick.
 ACOEM, Health and Productivity Management
 C. Biron et al., “At work but ill: psychosocial work environment and well-being determinants of presenteeism propensity,” Journal of Public Mental Health, 5 (2006) 26.