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Many workers and even some managers assume that showing up at work is tantamount to getting the job done. But productivity is a continuous variable, and it is apparent that many employees accomplish little or no work for part of many workdays each year.

The phenomenon of "presenteeism" is increasingly recognized as a highly significant employer cost. The concept has been gaining credibility among large employers.

It turns out that employees are affected by a number of medical and psychological conditions that may impair their engagement at work. These persistent distractions can range from repeated trips to the restroom brought on by a urinary tract infection or irritable bowel syndrome, depression, sleepiness or anxiety experienced on the job, and a long list of other disorders, in addition to nonmedical conditions such as care-giving responsibilities.

A few of the better documented examples of illnesses associated with significant presenteeism are shown in the cart below. Many other health situations, such as just having recovered from the flu, are also implicated. Consider the multitude of prevalent medical conditions that may affect presenteeism.

In addition, the modifiable or "lifestyle" risk factors for obesity are clearly associated with presenteeism--in particular, physical inactivity, poor diet and high stress, according to Nico Pronk, in an issue brief titled "Addressing Obesity and Enhancing Productivity," published in December 2005 by the National Business Group on Health's Institute on the Costs and Health Effects of Obesity.

PRESENTING THE CASE

The list of potential stressors and distractions is endless, so the employer's focus must be on providing employees with information on coping strategies and resources--starting with health information and health-improvement and risk-reduction approaches. Many companies also offer an employee assistance program to help employees with mental health issues.

The good news is that employer-sponsored programs to help employees achieve an active lifestyle, better nutrition and a healthy weight will all work toward improving presenteeism.

An important new study in 2006 demonstrated what savvy corporate health managers have long believed--that changes in health risks as perceived by the employee are associated with changes in presenteeism.

Wayne Burton and his colleagues, in an article titled "The Association Between Health Risk Change and Presenteeism Change," published in the March 2006 issue of the Journal of Occupational and Environmental Medicine, studied more than 7,000 employees and found that those who reported increased health risks in a two-year interval were less productive. Those with fewer health risks were more productive.

The Burton study used a health risk appraisal, or HRA, to collect employee data. The HRA was augmented with questions specifically designed to explore presenteeism (in this case, questions adapted from a Work Limitation Questionnaire).

Many employers nationally are using HRAs--and although most have not yet added questions to address presenteeism, this is likely to change.

If employers are going to the trouble and expense of offering and analyzing these health risk appraisals, they might want to consider adding a few more questions to assess presenteeism. Calculating the cost of presenteeism can help make the business case for prevention and health-improvement programs to reduce employee health risks. In fact, the cost of presenteeism appears to be greater than the cost of direct health-care costs and absenteeism combined.

The chart (at right) suggests that the indirect costs (presenteeism, absenteeism, and short-term and long-term disability) could amount to about 75 percent of the total cost of illness borne by employers, while the direct medical and pharmacy costs are about a quarter of the total. It is difficult for many financial managers to accept that the so-called "soft" costs are three times the "hard" costs.

However, these presenteeism costs are calculated by using employee survey data about time lost on the job due to illness, multiplied by average employee salaries. And because the Burton research showed reducing health risks will reduce presenteeism, it is worth measuring these factors in order to calculate the potential savings.

MISSING MEDICATIONS

There have been a number of research studies demonstrating the relationship of medicines and presenteeism. For example, some prescription and over-the-counter medicines for allergies can cause drowsiness in some people and reduce on-the-job productivity.

Several prescription and over-the-counter medicines are now available for allergies that greatly reduce the risk of drowsiness as a side effect. This is especially important for jobs in which drowsiness can increase the risk of serious work-related accidents or injuries.

Similarly, successful treatment for depression reduces or eliminates symptoms such as fatigue, sleep disorders and lack of energy, and can significantly improve job productivity.

Employees, though, might not take medicines as prescribed by their doctor. This noncompliance with medicines can affect presenteeism. For example, if an employee with diabetes fails to take medicines appropriately, his blood sugar could increase to levels that impede on-the-job productivity. If an employee fails to take the medicines needed to control depression, he would be at increased risk of short-term disability and presenteeism.

Migraine headaches can be so severe that an employee might be unable to work, or could only work at significantly reduced productivity. For many employees, eliminating factors that trigger a migraine can significantly reduce the risk and even eliminate migraines. For other employees, over-the-counter or prescription medications can be very important in eliminating this kind of lost productivity.

The good news is that there are proven strategies to control medical conditions and health risk factors that can reduce the cost of presenteeeism for employers. In addition, measurement techniques to allow employers to understand presenteeism in their own workplace are improving.

Standardized measures of savings from health, absence and lost productivity are available from EMPAQ, an employer benchmarking partnership of the National Business Group on Health and the Integrated Benefits Institute, on the Web at www.empaq.org.

The National Business Group on Health also sponsors the Best Employers for Healthy Lifestyles awards to recognize employer-sponsored health improvement programs at the platinum, gold and silver levels. The 2007 award winners will be announced next month. For more information, please visit www.businessgrouphealth.org.

LUANN HEINEN is director of the Institute on the Costs and Health Effects of Obesity, National Business Group on Health.

June 1, 2007

Copyright 2007© LRP Publications