Presenteeism: Why are employees coming to work sick more and more often?

In many companies, the motto is: if you are there, you do something. But this principle is long outdated - and can be dangerous. More and more employees are turning up to work sick, be it with a cold, migraine or even mental exhaustion. What looks like commitment at first glance is called Presenteeism - and costs companies more in the long term than the classic Absenteeism.

Definition of presenteeism?

Presenteeism describes the phenomenon that Employees turn up for work despite illness. In contrast to absenteeism (i.e. absence due to illness), they are physically present, but are clearly less efficient - with consequences for their own health, the company's productivity and the team climate.

Causes: Why do employees come to work sick?

There are many reasons for this - and they are often structural. We have summarised the most common causes below:

• Performance culture and pressure: "I can't afford to miss out now." Such thoughts are particularly widespread in performance-orientated environments. Many fear being seen as weak or letting their colleagues down. There is often a corporate culture characterised by pressure to perform, excessive ambition and tight deadlines.
  
• Lack of representation: In small teams or with a high workload, there is often a lack of structured cover arrangements. The fear of a backlog of work means that people prefer to drag themselves into the office or home office sick instead of having to catch up on everything later and possibly having to work a lot of overtime.
  
• Unclear rules and expectations: If managers are still writing emails even when they have a fever, are constantly available or employees are never encouraged to rest, this creates silent peer pressure. Managers are often not even aware that their own behaviour can subconsciously put the team under pressure. This increasingly leads to employees turning up to work sick.
  
• Remote work & home office: Since the pandemic, presenteeism has shifted to working from home. People who are ill but "only sit at their laptop" often underestimate their own stress - and are still less productive. Many people play down their illness - especially if they are working from home. After all many tasks from the sofa or even from bed, without leaving the house. However, it is often overlooked that the body not only loses physical strength during illness, but also Mental calm to make a full recovery. If you drag yourself through the working day while ill, you not only risk a longer period of illness, but also a significant loss of productivity. Slump in performance and a noticeable Loss of productivity.

Consequences of presenteeism: short-term gain - long-term damage

Presenteeism is no longer an individual problem, but a silent burden with enormous damage to health and the company. After all, anyone who turns up sick to work - whether in the office or working from home - is neither really productive nor on the road to recovery.

• Loss of performance: Studies show that employees who work despite illness less productive are. They take longer to complete their tasks, make more mistakes and make fewer well-founded decisions. This can lead to a reduction in the company's productivity. According to a Study According to Iverson and Krause (2007), 12% of a company's total productivity is lost due to health problems. Presenteeism accounts for twice as much as absenteeism.
  
• Prolonged course of the disease: Anyone who does not take sufficient care risks a significant longer healing process or even a Chronification. A "simple" flu-like infection can turn into protracted pneumonia or persistent exhaustion - with the result that the person concerned is ultimately unable to work, just later and often for much longer.
  
• Risk of infection: Especially in the office, there is an additional risk: Infections spread quickly. What starts with one employee suffering from a mild cold can affect half a team in a short space of time. This not only affects the operational organisation of the company, but also creates a Domino effect with sickness absences - especially in open-plan office concepts or where there is close customer contact.
  
• Mental exhaustion: Long-term presenteeism can also Psychological consequences have. If you never get to rest, are constantly energised and "work" even when you are ill, you run the long-term risk of Burnout, depressive symptoms or anxiety disorders. Managers or employees with high intrinsic motivation are particularly at risk of exceeding their limits - often out of a sense of duty or fear of consequences.
  
• Massive economic damage: A study by the University of Zurich puts the economic damage caused by presenteeism in Europe at many times the cost of absenteeism. While absenteeism is visible - for example through sickness absence - presenteeism often goes unnoticed, although the economic losses can be significantly higher. The hidden costs arise from inefficient work, errors, repetition and rising follow-up costs in the healthcare system.

Presenteeism vs absenteeism: which is more "harmful"?

At first glance, presenteeism appears to be the "milder" variant - after all, the person is present. In reality, however, presenteeism is often more harmful because it is more difficult to recognise and measure. Whereas absenteeism is visible and can be documented (e.g. through sick notes), presenteeism remains invisible - and underestimated. Basically, of course, it has to be said that neither presenteeism nor absenteeism are good for companies.

The role of occupational health management (OHM) and what HR can do

Promoting cultural change

The basis for avoiding presenteeism is a corporate culture that takes health seriously and signals it: "Recovery is part of performance."

• Open communicationInstead of tacitly expecting employees to "pull through", managers should make it clear: "Stay at home, get some rest."
• Making positive examples visibleWhen managers go offline even when they are ill, this sends strong signals to their team.
• Do not trivialise illnessStatements such as "It's just a cold" or "A little headache is fine" should be actively questioned.

Train managers

Managers have a decisive influence on how health is dealt with in the company - through their behaviour and communication.

• Training on dealing with presenteeisme.g. as part of BGM workshops.
• Learn to recognise and address your own signalsTiredness, irritability or frequent small mistakes can be the first warning signs.
• Promoting team sensitivityIf employees drag themselves to work sick, this should not be praised as "commitment", but should be addressed in a caring manner.

Establish early warning systems

Systematic structures are needed to recognise excessive workload before it results in presenteeism or subsequent absence:

• Regular employee appraisals: Talk not only about tasks, but also about workload, energy levels and resources.
• Check-ins in everyday team lifeA short morning well-being round can help to recognise tensions early on.
• Use digital tools: Offers like Isa from DeepCare support employees from any location with input on stress reduction, exercise, ergonomics and mental health - and make well-being visible and accessible in everyday life.

Creating flexibility and relief

Many people go to work sick because they feel "irreplaceable" or don't feel supported. Clear structures can help against this:

• Flexitime modelsthat allow real flexibility for doctor's appointments, short breaks or early finishes.
• Working from home with a health cultureNot every illness makes you bedridden - but even at home, sick is sick. Help here Clear rules on availability.
• Substitution plans and holiday managementIf you know that a plan is in place in the event of a breakdown, you will have less of a guilty conscience when you go into recovery.
• Renouncing "sick leave as a heroic deed"Internal communication can tell specific stories where recovery has led to better results.

Preventive programmes and health education

A comprehensive OHM goes beyond short-term measures and strengthens the resilience of employees holistically:

• Workshops on resilience, sleep, nutrition, stress management - also digital and asynchronous.
• Exercise programmes and active breaksto create physical balance (e.g. 5-minute exercise snacks via ISA).
• Education about the long-term consequences of presenteeisme.g. through articles on the intranet or expert presentations as part of a health day.

Summary of specific measures to prevent presenteeism

An effective OHM helps to recognise presenteeism at an early stage and prevent it in a targeted manner. A cultural change in which health is prioritised is crucial - employees should feel safe to stay home sick without a guilty conscience.

Managers act as role models here: anyone who writes sick emails is sending contradictory signals. Training sensitises employees to their own limits and those of the team. Early warning systems such as regular employee appraisals, short check-ins in everyday life or digital tools such as ISA from DeepCare help to recognise overload in good time.

Flexible working models, clearly regulated home office and structured substitution plans provide additional relief. Supplemented by preventative programmes such as exercise breaks, resilience training and health education, a work culture is created that is healthier and more productive in the long term.

Conclusion: Recognising presenteeism and taking it seriously

Presenteeism is not a sign of loyalty - it is often a cry for help that is ignored. Those who come to work sick today will pay the bill tomorrow - both in terms of their health and economically. Companies that consciously integrate the topic into their OHM not only promote the health of their employees, but also invest in long-term productivity and resilience. The first step: look, understand - and act.

Simon Fiechtner
I'm Simon, co-founder of Deep Care and I've been working in the fields of health and artificial intelligence for many years. After several years of experience in HR and business development at a large corporation, I decided to turn this passion into a start-up together with colleagues and friends.