Present and unaccounted for: managing employee’s chronic medical conditions

Managing your employees’ chronic medical conditions and productivity

Fred Mael

Your head feels like it will explode – the throbbing, the vague nausea in the background. But there’s so much work to finish still today … if you could only close the door, close the lights, just let the meds kick in and then you could work at something close to full speed – but how can you? There aren’t any doors to your cubicle. If you slip into the office of someone who’s away on travel, the boss or someone else might walk in on you. Go try to explain a migraine to someone who’s never had anything worse than a mild beer buzz. Never mind, you’ll just push yourself to get everything done, get home somehow, cancel the plans with the kids, crawl into bed and try again tomorrow.

Presenteeism – people staying at work and trying to work even while at diminished capacity because of a chronic or episodic medical condition- has only recently become a hot topic. Recent studies in corporate America have shown presenteeism due to conditions such as asthma, allergies, migraines, depression, arthritis, gastrointestinal disorders, and chronic back pain to be costly – more costly to employers than absenteeism or direct medical costs. In a study conducted at Bank One, presenteeism accounted for 63% of corporate health costs, compared to 24% by direct costs and only 13% by absenteeism and short-term/long-term disability. Estimates of $150 billion in national lost productivity (in some companies 2-3 times the costs of direct medical treatment costs) from presenteeism have been mentioned. Companies such as International Truck and Engine, Comerica, and Lockheed Martin are finding that the issue can no longer be ignored. As the head of your organization, you may come to the same conclusion.

Why they soldier on

There are various reasons why your employees may come to work or stay at work even when they are having trouble concentrating, are feeling sluggish, or can’t sit still without being in great pain. These include:

They are trying to save their sick leave for family emergencies such as sick childcare or elder care, or they are trying to save the vacation leave.

The culture of your organization expects people to be tough and keep working through minor illnesses, however “minor” is defined. Because of the nature of the service your company provides, your employees work in roles in which they can’t cover for each other. They are made to understood that you are technically better of having them come to work, even at greatly diminished effectiveness, rather than staying at home.

Some of your employee’s direct supervisor may be unsympathetic to the employee’s condition and pressures the employee to keep working.

Simply letting people go home any time they feel less than 100% effective would be disastrous, However, simply working through such illnesses without doing something about them may work to the detriment of your employees, their families, and your organization. A number of current trends suggest that employees will continue to have more and more incentive to push themselves to come to or stay at work when feeling unwell. These include:

Escalating health care costs and companies scaling back on health insurance or comprehensiveness of coverage, providing employees with less incentive to seek preventive or nontraditional solutions to chronic problems.

Companies tightening up on qualifications for leave or sick days at a time when more employees may have both child and elder care concerns.

The number of people suffering from a number of these nagging conditions appears to be on the rise.

The workforce continues to age and retirement becomes less appealing to many.

Companies such as Bank One (now acquired by JPMorgan Chase) have made a concerted effort to deal with the problem, through a combination of educating both managers and employees, and using the services of employee health units. In many cases, making employees aware that they actually have a chronic condition and that there are available medications and non-pharmaceutical options to reduce the frequency, duration, intensity, and symptoms of the condition (including nutrition, exercise, biofeedback, and meditation) can reap significant benefits.

The Illusory Benchmark

Measuring presenteeism is still in its infancy and the less structured the job (such as managerial jobs), the harder it is to quantify loss of productivity. However, the implicit assumption behind presenteeism data is that your other employees are 100% productive throughout the day, and that the lost productivity of employees with these medical conditions is what makes them fall short of that commonly achieved benchmark. That’s a questionable assumption on two fronts. First, others may be wasting time surfing the Internet, shmoozing, and taking long lunches, among other pursuits that are endemic to many workplaces. Second, there are transient reasons why other employees are physically or mentally unable to be consistently productive. These include the effects of hangovers, late night TV watching, or late night family conflicts. For example, one company that manufactures bottling materials has documented that production is down on the morning after a Monday Night Football game. The assumption that others are always productive puts burdens on those with medical conditions to aim for a level of productivity often unmatched by others. Also ignored is the possibility that employees with these conditions compensate by working harder or more intensely, something that is feasible in some jobs. The interplay between some of these conditions and personality factors, such as being more driven to succeed, is not clearly understood at this time.

Managers’ Dilemmas

Companies that have the means to invest in their employees with chronic conditions can hope to improve their productivity, reduce their unproductive time, and avoid turnover because of these conditions. Small businesses may feel that they don’t have the resources to do any in-house training, triage, or other supportive activities. Others may simply want to wash their hands of the problem and see presenteeism data as a good reason and a good way to rid themselves of such employees. Firing or not hiring otherwise productive employees is legally problematic and would certainly have a chilling effect on the rest of the workforce. In truth, even managers of small firms can get out the message that people with chronic problems should see a doctor and be better informed about managing their conditions rather than “toughing it out” while actually working impaired.

There are dilemmas, especially during flu season. For those who can telecommute, it should be easier to reinforce the idea that coming into the office and getting everyone else sick is bad for business. For those who have to be in the workplace, with little accrued sick leave or vacation time, and no good backup for their position, the temptation (and pressure) to come in will be great. It will take some ingenuity for you to come up with creative solutions that make it worth their while and yours for them to work elsewhere or just stay home.

What You Can Do

Presenteeism research and practice are in their infancy. The problem may turn out to be overstated, and the solutions are still unclear. Still, there are some steps you can take now that can move you in the right direction. Some will work for your particular industry and workforce, some will not. These include:

Educate your employees to take responsibility for their own wellbeing and that of coworkers.

Educate the rest of management that your goal is productivity and output more than control of attendance.

Introduce and reinforce a culture that measures loyalty or motivation by better yardsticks than mere hours spent at the workplace.

Let responsible workers with chronic conditions design the work schedules that allow then to be most productive.

Start viewing health care costs and preventive medicine investments as means to spur productivity and commitment, not just as a drain on your bottom line.

Fred Mael ( is an organizational psychologist who does consulting in areas such as talent retention, organizational culture, and performance management, as well as executive and work/life coaching. This article appeared in the April 2005 issue of Baltimore SmartCEO magazine.