Presenteeism and Sustainable Occupational Health in the Workplace

1. Introduction

In the face of the profound impacts of global digitization, aging, and major public health emergencies on work patterns, occupational health in the workplace is of inescapable importance for the achievement of the Sustainable Development Goals. The workplace is not only a place where people earn an economic income, but it is also a key factor in their physical and mental health and social well-being [1,2]. A healthy, safe, and equitable working environment not only prevents the loss of labor due to occupational diseases and injuries but also contributes to a reduction in social inequality gaps [3], thus promoting harmonious social development and stable economic growth. Therefore, occupational health in the workplace is not only a guarantee of personal values and professional development but also an inevitable requirement for the realization of the global Sustainable Development Goals.

However, numerous serious and neglected occupational health issues remain threats to the sustainability of workplaces. Presenteeism has become the norm in businesses around the world due to various health risk factors such as physical illness, occupational exposure, life disorders, and work stress [4,5], especially in the nursing, education, and manufacturing industries. Presenteeism is widely recognized as one of the frequent and high-risk anti-productivity work behaviors in the global occupational health field, and it generally refers to the behavior of an employee who insists on being at work despite experiencing a health problem but exhibits low productivity, reduced motivation, or an inability to be fully engaged in work [6]. Compared to explicit absences such as leave and absenteeism, the productivity loss caused by presenteeism is more serious [7,8], which can have a more severe burden on the health and performance of individual employees, the atmosphere of the team, and the economic cost of the organization [9].

Our Special Issue “Achieving Sustainability in the Workplace: Presenteeism and Occupational Health and Safety” emphasizes a deeper understanding of presenteeism and related occupational health issues in the process of sustainable development in the workplace. Specifically, there are still three questions that need to be clarified about presenteeism in the workplace: (1) How can we understand the essential attributes of presenteeism from a multidimensional perspective? (2) How can we comprehensively and accurately capture and measure presenteeism? and (3) How can we intervene in terms of the negative impact of presenteeism on organizational sustainability?

2. Conceptualization of Presenteeism

Incredibly, in nearly 20 years of occupational health research, there is still no academic consensus on the conceptualization of presenteeism [10]. The concept was first proposed by a British scholar to reflect the organizational phenomenon of the “sickness to work” of a large number of employees in the context of a society with a high rate of unemployment [6]. Early definitions of presenteeism can be divided into two schools of thought, the behaviorist school and the economist school: the behaviorist school, represented by Nordic scholars in the field of occupational health, defines presenteeism as “employees insisting on coming to work when they are experiencing illnesses or other health problems” and focuses on the motivations and incentives for employees to conduct presenteeism [11]; the economist school of thought, represented by North American scholars in the field of economic management, defines presenteeism as “the loss of productivity caused by employees going to work sick” and focuses on the consequences and impacts of presenteeism [12]. Recently, in addition to disease as the dominant causal factor, scholars have found that more occupational health factors, such as stress, burnout, anxiety, and depression [13,14], can increase the intensity of presenteeism. Therefore, the definition of presenteeism has been further expanded to include “the phenomenon of productivity loss due to poor health or other psychosocial factors while employees are at work” [15].

However, current conceptualizations of presenteeism remain superficial, focusing predominantly on the surface-level manifestations of employee behavior, while lacking a comprehensive and systematic definition. This deficiency has resulted in fragmented theoretical frameworks and has plunged managerial practices into a quagmire of subjective assumptions. Presenteeism is not instantaneous or non-occasional, but exists in specific situations or practices. For example, in the face of disease causation of the same severity, defining presenteeism still needs to take into account temporal and spatial factors such as the duration and spread of the disease, rather than making management judgments based on the level of antecedents or consequences alone. This means that presenteeism is a complex multidimensional concept of behavior interacting with context. Unfortunately, although many senior scholars of presenteeism have called for a definition of the multidimensional concept [10,16], there is still a lack of a sound conceptualization, making it difficult to advance relevant theoretical or empirical academic research.

3. Measurement of Presenteeism

Measurement tools for presenteeism mainly originate from Western developed countries and are dominated by direct measures represented by counting and indirect measures represented by reflective scales.

Direct measures generally use a single or small number of independent items to measure the duration or number of presenteeism. The first type of measure focuses on whether or not one goes to work despite being sick and the specific number of days or times they do, with no restrictions on the extent of the health problem and the motivation and consequences of doing so [7]. The second measure restricts the type of illness, assessing the choice to go to work when suffering from a justifiable illness [11]. The third measure emphasizes one’s perception of stress at work in the context of illness [17]. The advantage of the direct measurement method is to calculate the economic costs lost due to presenteeism based on the time and number. The time of presenteeism multiplied by the hourly wage or the annual productivity loss per unit of illness enables the calculation of the cost of presenteeism on productivity.

Indirect measurement methods use reflective scales as the main tool, and numerous measurement scales have been developed for different concepts, groups, and situations. First, the Health and Work Performance Questionnaire (HPQ) measures the amount of time that should be spent working extra hours to compensate for lost productivity due to health impairments [18]. Second, the Stanford Presenteeism Scale-6 (SPS-6), developed by Stanford University, can be used to measure how health problems affect an actor’s ability to do his or her job [19]. Finally, the Work Limitations Questionnaire (WLQ) [20] measures the percentage reduction in the work output of employees with a disease compared to the output of healthy employees, expressed as a productivity loss score. In contrast to direct measures, indirect measures are able to overcome the psychological expectancy effect and common method bias to some extent by allowing subjects to actively assess their health activity and state at work.

However, the design of an existing measurement tools is ensnared in a static and reductionist conceptual trap, failing to adequately capture its dynamic and multifaceted nature, thereby severely constraining research progress due to the lags of these measurement instruments. Both direct and indirect measures, whether unidimensional or multidimensional, treat presenteeism as a reflective concept, i.e., the construct of “presenteeism” exists independently as a common factor and is not combined with different constructs. While technology is getting closer to allowing scholars to analyze and capture more dynamic, long-term data, advances in data analysis must be underpinned by the design of advanced measurement tools [21,22], reminding us that research related to presenteeism still needs to rely on measurement tools that are sufficiently contextualized, complete, and adequate. Particularly, future research should transcend traditional micro-level individual behavior measurements and shift towards an event system perspective, in order to capture the dynamic evolution of presenteeism across time, space, and contexts, thereby more comprehensively elucidating its nature and impact.

4. Intervention of Presenteeism

Despite scholars’ relentless efforts to curb the occurrence of presenteeism through interventions, they have selectively overlooked its far-reaching consequences. This research tendency not only reveals the shortsightedness of the academic field but also leaves organizations passive in addressing the long-term detrimental effects of presenteeism.

Over the past decade, intervention strategies for presenteeism have focused on reducing the occurrence of presenteeism by controlling the causative factors, such as reducing physical and mental health problems such as injuries, illnesses, and anxiety, as well as psychosocial factors such as work stress and burnout [23,24]. However, it is difficult to eradicate presenteeism for a long period of time, and there are still a large number of organizations that are not yet fully aware of the seriousness of presenteeism. There is still a lack of solid empirical evidence to support its possible negative impacts, and no operational coping strategies have been developed yet. Therefore, against the fact that it is difficult to eliminate presenteeism, it is urgent to shift from focusing on answering the question of “how to intervene in occurrences of presenteeism” to working together to solve the key question of “how to deal with the serious consequences of presenteeism”.

5. Current Dilemma and Future Direction

Based on the above discussion, the field of presenteeism research is facing a severe crisis of disconnection between theory and practice: ambiguous conceptualization, lagged measurement, and one-sided interventions have exacerbated the deterioration of occupational health and the constraints on sustainable development in the workplace. Therefore, in this Special Issue “Achieving Sustainability in the Workplace: Presenteeism and Occupational Health and Safety”, we strongly advocate for the application of new theories that deeply integrate modern micro-level behaviors, meso-level events, macro-level organizations, and real-world contexts (such as new technologies and new labor force structures) to future research on occupational health and workplace sustainability triggered by presenteeism. Specially, it is needed to systematically define presenteeism, develop dynamic measurement tools, and prioritize addressing the research gap in consequential interventions.

5.1. Conceptualization: Escaping the Unidimensional Definitional Trap

The existing research has fallen into a narrow, unidimensional perspective in defining presenteeism, reducing it to an isolated construct while entirely overlooking its complex nature as an interaction of multiple entities and the contexts. This one-sided understanding not only leads to a misinterpretation of the essence of presenteeism but also results in a severe distortion in the assessment of its consequences. Therefore, there is an urgent need to re-examine the multidimensional attributes and dynamic impacts of presenteeism from an event system perspective.

The conceptualization of presenteeism cannot be defined as a behavior that is inherently positive or negative, which can lead managers to misjudge its motivation and impact [15]. In fact, recent research has identified active and passive motivations for presenteeism [25], and the negative or positive consequences of presenteeism have begun to be debated [26]. Therefore, we discourage that presenteeism always be understood as an employee-level behavior but rather as an event that results from a combination of the actors and contexts. Subsequent research could provide a deeper understanding of the multidimensional attributes of presenteeism that impact entities in terms of intensity, time, and space to avoid serious bias.

5.2. Measurement: Restoring the Dynamic and Systemic Event Context

Existing measurement tools for presenteeism simplistically treat it as an isolated common factor [7,11,17], failing to integrate multi-perspective constructs or adapt to diverse behavioral contexts. This unrealistic approach to measurement not only struggles to accurately reflect the complexity of presenteeism but also places organizations in an inefficient predicament when formulating intervention strategies.

In different cultures and contexts, presenteeism may be more complex, and thus it is difficult to accurately reflect the reality of the situation, adapt to and satisfy different organizational needs, and formulate reasonable and effective incentives or penalties for presenteeism from the perspective of unidimensional behavioral measurements. To this end, presenteeism should be measured in terms of higher-level teams, the organizational climate, and even cultural dimensions, taking into account the contexts of interculturality, digitization, aging, the relationship between individual and team, and the complex organization itself in order to respond to the high demand for occupational health and workplace sustainability.

5.3. Interventions: Facilitating Synergy Among Individuals, Teams, and Technologies

Current interventions for presenteeism remain predominantly focused on superficial “containment” measures, failing to address the underlying causes of the issue and appearing increasingly misaligned with the dual trends of digitalization and aging. This short-sighted theoretical and practical approach not only proves ineffective in controlling the consequences of presenteeism but also exacerbates organizational challenges in occupational health management, pushing them into deeper predicaments.

The existing research mainly focuses on how to reduce the occurrence of presenteeism as the main purpose [27,28,29], ignoring the characteristics of the digital and aging era and the lack of intervention from the consequences as the focus of the coping strategy, which seriously restricts the control of the consequences of presenteeism. To successfully mitigate the consequences of presenteeism, it is essential to leverage the trinity synergy of individual behavior, team collaboration, and digital technology. This approach is not only the key to addressing current challenges but also the core driver for reshaping the paradigm of occupational health management. By achieving precision in individual self-regulation, efficiency in team support and empowerment, and intelligence in technological interventions, a multi-level, dynamic intervention system can be established. This system will fundamentally reverse the erosion of workplace sustainability caused by presenteeism and propel the occupational health field toward a new governance horizon.

6. Conclusions

The promotion of occupational health initiatives is a great issue concerning the realization of the Sustainable Development Goals and clearly defines the responsibility for strengthening occupational health management in the workplace and improving the occupational health literacy of workers. Presenteeism is a complex event system composed of multiple entities such as actors and their teams, digital technologies, and cultural contexts which urgently needs to dynamically and systematically solve the pain points in conceptualization, measurement, and interventions in future research. Occupational health management oriented towards presenteeism reflects the humanistic care for workers, and this direction is in line with the trends of the sustainable development of modern organizations.