coffee didn't help, still tired. Supporting hands are needed.

Actor Woody Allen once said that 80% of but, because of illness or other medical conditions, not fully functioning—can cut individual productivity by one-third or more.

In fact, presenteeism appears to be a much costlier problem than its productivity-reducing counterpart, absenteeism. And, unlike absenteeism, presenteeism isn’t always apparent: You know when someone doesn’t show up for work, but you often can’t tell when—or how much—illness or a medical condition is hindering someone’s performance.

Managing Director of Amos International Pte Ltd Danny Lien says major causes of presenteeism can largely be attributed to the “unwritten” rule of the organisation where absenteeism is viewed negatively even though the person is genuinely sick. Policies discouraging employees from abusing medical leave will invariably affect those who genuinely need medical leave to prevent the spread of the illness.

“This can also be attributed to the shortage of manpower. Every one person on medical leave means the team members have to double up. Team members might also feel guilty that their colleagues have to cover their duty while they are on medical leave and prefer to show up at work,” he adds.

Dr Paul Lim, a lecturer of Organisational Behaviour & Human Resources, Lee Kong Chian School of Business at Singapore success in life can be attributed to simply showing up. But a growing body of research indicates that—in the workplace, at least—this wry estimate may be somewhat optimistic.

Researchers say that presenteeism — the problem of workers’ being on the job market dynamics may also lead to presenteeism, where a high demand for workers in a position may lead them to turn up at work in order not to compromise high levels of work. This stems from the perception that the worker is easily replaceable and that ‘being present’ (face-time) is a sign of showing job commitment.


The workplace environment and culture may have an impact on presenteeism. Organisations that have strong collectivist cultures of working in groups and value co-operation may lead the employee to possess feelings of guilt and obligation if they are not able to be physically present at the workplace.

“Organisations that possess high power distance between supervisor and employee might also discourage the sick employee from engaging the supervisor to negotiate for re-assignment of work or time off. This results from employees seeking to respect organisational hierarchy and being seen as complying with top-down orders rather than being difficult,” says Lim.

PERSONAL FACTORS: Personal factors play a strong role in an employee coming to work in spite of illness. For instance, employees might perceive that missing work is a sign of weakness and that they are able to overcome this illness by being physically present at work.

“This is known as the ‘Iron Man Mentality’. Another personal angle that might contribute to presenteeism is the ‘Indispensable Man Theory’. This is the belief that organisation cannot run without the employee’s presence,” he adds.

President of Singapore Human Resources Institute, Erman Tan, meanwhile, says that in order to understand presenteeism, we need to first understand the structural shifts in our labour market and identify root causes:

  • Demographics: Singapore’s declining birth rate and ageing population has resulted in a slowdown in workforce growth, hence, a shift towards a manpower lean economy. Net entry of younger locals in the working ages will fall and successive cohorts entering the workforce will shrink in numbers.
  • Workers now handle multiple roles within organisations, due to the lack of manpower coupled with high manpower costs for SMEs. Lack of skilled, specialist and knowledge workers also places greater burden on these groups as they are hard to find and harder to replace.
  • In today’s “leaner” workplaces, some workers trudge off to work when sick because they fear one or more of the following: appearing less committed to their jobs, receiving disciplinary action, or even losing their jobs. A day or more off can also mean burdening co-workers with job duties, coming back to a heavy backlog of work responsibilities, or missing work deadlines due to a lack of replacement options. In an uncertain economy, job insecurity also plays a part.
  • A fast-paced and intensely competitive globalised world of work: Singapore is the world’s second-most competitive economy for the fifth year and Singapore workers work some of the longest hours, faced by pressure and deadlines.
  • There is an Asian mind-set of staying back as long as the boss is present to demonstrate ‘productivity’. Other factors could be personal financial difficulties, work-related stress or perceived pressure (from managers and colleagues) to attend work when unwell. Creating a ‘guilt-free’ culture is therefore necessary.

“More diverse aspirations of the workforce – these days, individuals seeks jobs which provide not just good career and wage progression but also provides opportunities for them to continually learn, develop new skills and discover their passions (as their families are financially stable). Hence, ‘workaholism’ on the part of dedicated employees contribute to presenteeism,” adds Tan.


According to Lim, a British study released in 2015 observed that while awareness of presenteeism has risen amongst employers, presenteeism rates have also increased for five years in a row.

“This suggests that despite increased awareness of presenteeism amongst employers, they are choosing to ignore it; or do not know how to mitigate it,” he says.

“For employees, a common reason for presenteeism behaviour is attributed to perceptions of a poor economy that leads to reduced job security. The ease of worker replacement is also another factor.

If the demand for a certain position is low and worker supply high, employees tend to get anxious that they might be made obsolete.

The global economy has not been at its ideal state since the Great Recession of 2007-2009. This may have contributed to increased presenteeism,” he adds.

Tan believes the implementation of work-life integration policies such as work from home allowance or flexible working hours has made some impact on reducing presenteeism.

He shares that at SHRI, the average is for staff to use five days out of the 14 days medical leave entitlement, thanks to the implementation of various work-life integration initiatives, such as:

■ Allowing staff to work from home for two days a month.

■ Compensating overtime worked by allowing special ‘time-off’ for staff to rest and recuperate after busy periods.

■ Tailor made arrangements especially for returning mothers, as well as staff who may have special requirements (elderly parents or health conditions).

■ Health screenings organised on an annual basis, as well as special briefings for staff from medical experts.


Lim says some employees feel that the organisation is not able to carry on in their absence. On the other hand, the reality is that countries with strong collectivist work cultures may require its people to exhibit a stronger demonstration of unity and team work in organisations.

“One of the ways to help mitigate presenteeism behaviour is to have a work culture that places more focus on delivering results than on facetime and attendance.”

Tan concurs that even when employers are understanding, there are often real pressing matters to attend to at work and employees’ concern may have to do with clients, customers, partners or external parties. For example, those in sales or working on ‘real-time’ projects and time-sensitive matters.

“Of course in some cases, the organisational culture ‘frowns upon’ frequent MCs. In this case, employees do feel forced to turn up at work so as not to leave a bad impression, be labelled as an MC king or queen, and not to get in the bad books of the employer which could harm future career growth,” Tan adds.

Lien says companies that have a back-up plan for employees who are absent due to illness or other commitments will not require sick employees to show up at work.

“In the case where unwarranted medical leave can adversely affect the employees’ appraisal, another consideration is to penalise employees who show up at work even though they are ill as they can create a pandemic and affect the entire organisation,” he adds.

He points out that the culture of a company is influenced by the policies that govern behaviour. Positive policies will create positive cultures. It is important that the policies be thoroughly thought through to encourage a positive culture.

Lien reveals that at Amos International, the Head of Departments are tasked to ensure all team members that show up for work are fit for work.

“Any employee that does not look well will be sent home or instructed to see the company appointed doctor near the office. The employee is subsequently counselled and explained the possible consequences of showing up at work ill,” he says.


The global economy has not been achieving its potential since the Great Recession of 2007-2009. Similarly, business cycles have been turning even faster than before, putting pressure on industries to react faster whilst cutting costs and increasing profits.

Lim says the pressure that employers are facing will inadvertently be projected onto their staff.

“Employers need to first acknowledge that this is a problem that is affecting their bottom line and personal well-being; and begin to educate staff members about it. Secondly, employers must be consistent in delivering their message and practise it too. For instance, a key to mitigating presenteeism behaviour is to focus on delivering results rather than on facetime and attendance.

If supervisors continue to practise otherwise by praising ill staff members who come to work, the communication process is disrupted and mixed signals are received,” he stresses.

Tan, meanwhile, says employers should take an all-rounded approach to measuring employees’ performance or productivity, with KPIs including both quantitative and qualitative measures. “The reason we measure performance in organisations is because “you can’t manage anything unless you measure it”. Thus, KPIs are often associated with quantifications and numbers.”

However, this seems to work in some areas better than in others. Many find it easy to quantify things like employee presence or absence, revenue earned or number of complaints received.

“Some things though, are not easily measured.”

Contact with other employees may cause them to also become unwell, so the extent of presenteeism and absenteeism are greater (e.g. contagious flu) and the problem multiplies.

Motivated employees, whether well or unwell, will give their best, whether they are present in the office or not. Those lacking in motivation, even if present at work, may not be contributing. Hence, we should never mistake activity for accomplishment or in this case, presence for productivity.

Tan says that employers need to realise that an employee’s performance can be better measured in a variety of ways other than their ‘presence’ at work. Especially, when unproductive presence can actually cost the organisation. Presenteeism is often unrecognised by employers who may not realise the extent of loss it can cause. Traditionally, it has not been addressed as the focus has been on direct health care costs and absenteeism.

Bosses need to understand the consequences of presenteeism:

■ By attending work, the employee exacerbates his/her health problem and later has to take a longer period of sick leave to recover.

■ Contact with other employees may cause them to also become unwell, so the extent of presenteeism and absenteeism are greater (e.g. contagious flu). Hence, the problem multiplies and drags on.

■ Business leaders need to be aware that presenteeism due to a lack of flexibility might be a bigger drain on productivity, through poor employee engagement and collaboration.

■ Motivated employees, whether well or unwell, will give their best – whether they are present in the office or not. Those lacking in motivation, even if present at work, may not be contributing. Hence, we should never mistake activity for accomplishment. Or in this case, presence for productivity.

However, many employers still believe in Singapore’s traditional business culture, where job commitment is demonstrated through long hours.


Lien says the biggest fear of any company is to be quarantined because of a pandemic. The events of SARS is still very clear in many business owners. Although hidden, it will have a huge and tremendous impact on companies if the situation gets out of control.

Lim says that when presenteeism is not addressed at the work place, staff morale can easily be affected due to a perceived lack of care and concern for employees. This might possibly lead to lower productivity for the organisation.

“Additionally, ill staff members turning up at work are likely to deliver less than optimal work results. This could result in mistakes and errors. In other instances, it might lead to injury or harm to other people, like in the case of doctors making errors in drug dosage prescription; or when an infected employee compromises on food safety,” he reasons.

Tan agrees that presenteeism is a much costlier problem than its productivity-reducing counterpart, absenteeism. It is harder to identify and quantify, however, the costs to businesses and the economy are estimated to be greater.

It causes losses (of employee productivity and employer dollars) to employers. The major issue is that it costs the same amount in wages and benefits as it does for those working at full capacity -so the cost is the same while the output of work is reduced.

“Such costs can be a real and potentially significant drain on a company’s financial well-being. Employers need to make a concerted effort to develop a healthy work culture and a workplace with highly functioning workers – this will go a long way toward meeting goals for company productivity and competitiveness,” he adds.

Employers should be aware of the economic impact of health conditions on business and the economy and implement (preventive) measures to start with:

■ Develop a workplace policy on presenteeism and educate/communicate it with employees – employees need to know where your company stands on coming to work sick, and how doing so can infect others.

■ Create a comprehensive workplace wellness programme, comprising a mix of: benefits plan with employee assistance services, health risk appraisals, health fairs, lunch and learn seminars on a broad range of health topics; screening programme to help employees identify conditions that may cause future health problems. Offer a flu vaccination program – one way for employers to combat presenteeism is to pay for medical measures that can either prevent common illnesses or reduce existing symptoms.

■ Rethink the use of disciplinary action to control absenteeism: employers need to examine and ensure that absence control policies are not counterproductive. Programmes such as disciplinary action may in fact pressure sick employees to report to work; this inadvertently encouraging presenteeism. Evaluate the influence of cultural factors. For example, is too much pressure placed on employees to attend work when they are not well enough to be there? Conversely, is there an ‘entitlement mentality’ among employees that influences them to use up their sick leave entitlements and have none left to use when they are genuinely unwell?

■ Boost employee morale by providing some degree of flexibility in employees’ work arrangements. Employers who do so, help employees meet the pressing demands of both work and family, and aid in their achievement of a healthy work-life balance. Offer the option to telecommute and work from home when not well. Provide (sufficient) paid sick leave and/or paid time off to workers to reducing the spread of contagion in the workplace. Provide flexible working hours to help employees manage doctor’s appointments, specialised treatment, or symptoms that interfere with their ability to work.

■ Many of the most commonly suggested preventive measures include providing tissues and hand sanitizers to employees. Employers can educate employees on proper ways of washing hands and what to do if flu-like symptoms develop. Communication with employees should occur frequently on these precautions, and employers should hang posters in bathrooms and eating areas on the proper way to stop the spread of germs. Depending on the industry and employee’s proximity to others, an employer may also wish to provide respirators or masks to employees in the workplace to further hinder the spread of airborne germs.

■ Moving to cloud-based IT infrastructures is one way to remove the restriction of only being able to work from the office. Cloud computing lets businesses and users store and access programs and data via the Internet, allowing employees to access all documents and applications they need to do their jobs remotely, when unwell. Cloud-compatible printers, scanners and projectors make it possible for employees off-site to view and amend shared documents in real time.

■ Benefits considerations – Before an epidemic strike, employers should review their existing paid leave policies to determine whether modifications should be made to their leave benefits.

■ Business continuity planning – Employers should prepare for the possibility that a large portion of their workforce will be unable to work during the flu season. The business continuity plan should have the solution to this problem as its primary focus. Some questions the plan should answer include: How many absences can we handle before business operations are interrupted? How do we keep operations running? What changes can we make to keep the business operating? A business continuity plan is a logistical plan that details how an organisation will recover interrupted critical business functions after a disaster or disruption has occurred. Employers should take actions to review existing business continuity plans currently in place to ensure that the plan will work in the event of an epidemic. If no business continuity plan exists, employers should begin to develop a plan for a worst-case scenario that may occur during the flu season.


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