Presenteeism in the workplace and what does presenteeism mean. Whilst looking at presenteeism statistics
This article is about presenteeism in the workplace and includes some in-depth presenteeism statistics. The article has been written by Russell Bowyer. In this article he covers the following topics relating to presenteeism in the workplace:
- What does presenteeism mean?
- Causes of presenteeism in the workplace?
- What are presenteeism costs?
- Let’s take a look at presenteeism mental health.
- Is there a presenteeism culture in your business?
- What are the presenteeism statistics?
- Disadvantages of presenteeism.
- Advantages of presenteeism.
- The Stanford Presenteeism Scale.
- Solutions to prevent presenteeism.
- Other reading to support your organisation in preventing both absenteeism and presenteeism.
1. What does presenteeism mean?
According to the dictionary the definition of presenteeism in the workplace is ‘practice of persistently working longer hours and taking fewer holidays than the terms of one’s employment demand, especially as a result of fear of losing one’s job.‘
Presenteeism is mostly associated with working whilst having an illness. Working whilst sick is likely to cause the loss of productivity, poor health and employees to become exhausted. Presenteeism is also associated with anxiety. This is particularly the case when job security is at threat, but also when there are high levels of workload and stress.
There are some psychological illnesses where integration into the work place will be beneficial to the employee.
A recent study published in the Journal of Occupational Health Psychology unveiled a fascinating, and surprising range of factors found to be contributing to workplace presenteeism.
In this article, employees take on-average four days sick leave per year. Whereas they admitted to being unproductive for an average of 57.50 days per year, which translates into a cost, which is equivalent to three months per annum in lost productivity.
‘Workers reporting long working hours are more likely to have problems with work–life balance and health than workers with standard working hours. Moreover, they are twice as likely to report presenteeism – working when sick – than other workers.’ 6th European Working Conditions Survey. (Eurofound (2016), Sixth European Working Conditions Survey – Overview report, Publications Office of the European Union, Luxembourg.)
Pressure points within an organisation can cause presenteeism
Presenteeism in the workplace is quite complex. It can come from the demands of management within the business or from peer pressure. Alternatively, it can be self-inflicted with many people worried about how they are perceived in the workplace – which can be linked to low self-esteem.
Increased motivation and job satisfaction
Where employees are highly motivated and where they are committed to the organisation, they are more likely to contribute to presenteeism. Staff members with a tendency to be workaholics, are also prone to presenteeism in the workplace too.
Both these employee types are much more likely to come to work when ill, as they enjoy what they do. However, they are probably unaware of the potential for reduced productivity, as a result of working when sick.
Loneliness impacts on productivity in the workplace
Research has shown that loneliness experienced in the UK represents a significant cost to UK employers. In the last ten years, loneliness has become a serious issue, which is affecting the wellbeing and health of staff.
Staff affected by loneliness, that still come to work are likely to be less productive. This will contribute to presenteeism in the workplace for any organisation where they have employees that suffer from loneliness.
Employees who have a fear of losing their job are more likely to come to work when ill
Despite being ill, employees are increasingly still going into work because of fears about their job security. This phenomenon tends to increase during economic downturns. Employees turn up to work, despite their illness, as they are worried that they’ll appear less committed.
Companies trying to do more with less resources
With markets getting ever more competitive, businesses are developing leaner systems and greater efficiency. This development of efficiency is taking its toll on employees, both mentally and physically.
‘In line with existing research we also find that employees with musculoskeletal and other (chronic) health conditions report higher rates of absenteeism and presenteeism than workers without such conditions.’ Health , wellbeing and productivity in the workplace – A Britain’s Healthiest Company summary report.
There has been an increase in presenteeism, as a result of this increased pressure to remain competitive, which is thought to increase productivity, when in fact it has the opposite effect in the workplace.
Badly managed work places can lead to presenteeism
Where there’s no backup plan for tasks completed by an individual, this adds further pressure on that employee. Employees put in this position are reluctant to take time off, for fear that no one else will be able to complete the tasks that they are responsible for.
Additionally, where employees are solely responsible for a particular task, they will be worried about taking time off, for fear of having even more to do when they return to work. This issue is exacerbated where employees are subject to heavy workloads. Heavy workloads puts additional pressure on staff, which will more likely lead to presenteeism.
Alternatively, where other colleagues are responsible for covering the additional work when the member of staff is off sick, this puts additional pressure on the employee who is sick, so they worry about burdening co-workers with their workload.
Badly managed absenteeism could lead to an increase in presenteeism. A simple back to work interview could help with this. But it’s important to use this carefully, by not putting additional fear or pressure on staff, who may then worry about the back to work interview instead.
Lack of paid sick leave and disciplinary action
Businesses which do not offer pay for sick leave, are probably more likely to suffer from presenteeism.
This could be made worse in the case of where an employee had been the subject of a disciplinary action over sickness.
Additionally, where doctors’ notes for sickness are a requirement, this is likely to put even more pressure on staff members.
Restructuring or down-sizing can lead to presenteeism
Where a business is restructuring or is in the process of down-sizing, this can lead to presenteeism. This is particularly so where redundancies are being made. Employees fear for their job roles, so will be worried about taking time off for sickness, for fear of exposing weakness and losing their job.
Driving down absenteeism can have the effect of increasing presenteeism
There does seem to be a correlation between presenteeism and absenteeism. As businesses drive down absenteeism, presenteeism seems to rise.
However, organisations are in a no-win situation, as by in driving down the presenteeism, they will ultimately drive up absenteeism. But in the interests of employee health, it is more important to discourage presenteeism, and for employees to recover fully from whatever illness they have, before coming back to work.
In the long-term good businesses should be promoting a healthy workplace and focusing on employee well-being. So by the promotion of a healthy workplace , both presenteeism and absenteeism should fall.
Another factor which has been seen to be associated with relatively higher levels of presenteeism is strained relationships at work.
In addition to strained relationships, it has been found that workers who are subject to ‘workplace bullying’ report significantly higher levels of absenteeism and presenteeism than those who are not. This is particularly true where the abuse or bullying is targeted at taking sick days.
Employees personal circumstances will affect presenteeism
The personal circumstances of an employee, and in particular where they have personal financial difficulties, will contribute to presenteeism. This is because employees who are under financial pressure will be afraid to lose their job, and therefore will be under even more pressure to continue working when they shouldn’t.
Another contributor to presenteeism is where families are worried about taking sick days for their own sickness, so instead continue to work. Instead of taking sick days for their own sickness, they are saving these days for when their children are sick instead.
There is research that shows that presenteeism costs more than absenteeism. In fact EHSToday reported in 2016 that presenteeism costs 10 times more than absenteeism. However, unlike the tracking of absenteeism, it is far more difficult to record presenteeism, due to the intangible nature of the phenomenon.
This difficulty is made worse where employees are reluctant to come forward with their problems, and keep things quiet.
Part of the answer to presenteeism costs lies in the low productivity of people who are physically present at work, but who are not contributing as much as they could. This could be for a variety of reasons.
Workers who come to work and are not fully productive costs $1,500 billion per year in America
This is not to say that the whole £1,500 billion relates solely to presenteeism, but as presenteeism is known to reduce productivity, the cost is likely to be significant.
An extrapolation from the research shows that presenteeism costs businesses 10 times more than absenteeism. Employees take on average 4 days off work for sick, but admit to being unproductive for on average 57.5 days per year…the cost associated with absenteeism is $150 billion per annum…therefore the cost for un-productivity is $1,500 billion (or 10-times $150 billion)
Reduced productivity costs UK businesses £15.1 billion per year
In a report published by The Sainsbury Centre for Mental Health on mental health in the workplace, it stated that reduced productivity is costing UK employers £15.1 billion. But unfortunately, there isn’t a split of this figure to show the specific cost associated with presenteeism.
The same report concluded that mental ill health was costing the UK economy some £26 billion per annum too.
Reduced productivity is costing the UK economy an estimated £1,035 for every employee in the country. A linked presenteeism statistic from The Centre for Mental Health.
Due to the nature of the phenomenon, presenteeism is hard to evaluate properly, and any costs will be difficult to calculate accurately.
Research shows that in the UK presenteeism costs twice as much as absenteeism. With increasing employers reporting increases in presenteeism, it is a significant hidden cost to business.
Spending to save on presenteeism in the workplace
Improving productivity by improving employees’ health will take more than relatively low-cost education programs. It may require a certain amount of time and money investment in health and wellbeing programmes.
This investment could include, but is not limited to, paying for new or better medical treatment, to include medication for allergies; counseling for depression and other anxiety problems; programmes to test for and alleviate stress in the workplace.
Human capital – Just as the expense for training is seen by most companies as an investment in a skilled workforce, the cost of medical care and employee wellbeing should be viewed as an investment in a healthy workforce.
When employees come to work when they are not mentally present due to an illness, extreme family/life pressures or stress, they are not giving themselves adequate time to get better.
In addition, whilst at work when they have an illness, performance will likely deteriorate. The mental health impact on staff is significant and can have bad long-term effects.
So what presenteeism mental health issues should be considered?
Sleeping problems caused by presenteeism
Sleeping problems are another health concern for employees. Sleep deprivation can potential affect both safety and workers’ performance. A lack of sleep over a prolonged period of time can result in sickness absence and lead to presenteeism in the workplace. However, in extreme cases, this can lead to mental and physical health issues for the staff.
Low morale, combined with an unpleasant workplace atmosphere, will quickly lead to a demotivate workforce. If one employee comes to work sick, this sets the example for others. If any of the staff are disinterested and/or demotivated, then their potentially ‘bad-attitude’ will likely spread to others…not to mention the actual illness they may also be spreading to fellow workers.
Low morale and demotivation is not good for mental health. This can lead to depression and anxiety in the workplace too, which if not addressed, will lead to presenteeism in the workplace too.
Where a presenteeism culture exists within your organisation, it’s time to look to the reasons why. Many organisations assume that if sickness rates are low, employees are generally healthy. However, this could be belying the real truth.
Using sickness levels within your organisation as a measure in isolation, can create a false positive. Sickness levels may be low, but only because employees are working when sick, meaning that presenteeism is high.
So despite low absenteeism rates, with high presenteeism, productivity rates will be low. This in turn could be costing the business much more than if it were to encouraging staff to recover properly from their illnesses in the first place.
The Stanford Presenteeism Scale, which measures presenteeism in the workplace, will instead help to uncover the truth about the presenteeism culture. Identifying the level of presenteeism will allow the hidden costs associated with it to be revealed.
Where a presenteeism culture exists within in your business, it is time to look into how to improve the overall health and wellbeing of your staff, which has been proved to reduce presenteeism.
Whilst researching this subject, there were a few statistics which I came across. Some of the statistics are directly associated with presenteeism, whilst others are linked to presenteeism. Some of these presenteeism statistics are as follows:
Direct presenteeism statistics
- Companies that report an increase in presenteeism are nearly 2-times as likely to report an increase in stress related absence, as those that hadn’t (64% versus 35%). (1)
- 72% of the 1,000 employers surveyed, report they have observed presenteeism. (6)
- 29% of the 1,000 employers surveyed, say they’ve seen an increase in presenteeism in the last 12 months. (6)
- In 2016 48% of the 1,000 businesses surveyed, are actively discouraging presenteeism in the workplace (2015: 31%). (6)
- 54% of the 1,000 businesses surveyed with less than 250 employees, have taken action to reducing presenteeism. (7)
- 41% of the 1,000 businesses surveyed with between 250-500 employees, have taken action to reducing presenteeism. (7)
- 35% of the 1,000 businesses surveyed with between 1,000+ employees, have taken action to reducing presenteeism. (7)
- 37% of the 1,000 businesses surveyed with between 250-500 employees, have taken action to reducing presenteeism. (7)
- 40% of staff have confirmed that in the past 12 months they were working when sick. (8)
- 55% of employees associated with presenteeism are working 48 hours or more per week. (9)
- Workers are 2-Times more likely to go to work when they are sick (presenteeism) when they work long hours. (9)
- 85% of 18-24 year olds are stating that presenteeism exists in their workplace. This is compared with 66% of those employees who are over 54. (10)
- 42% of employees say that their respect for colleagues would be diminished if they spent fewer hours in the office. Peer pressure is thought to lead to presenteeism. (10)
- 50% of senior managers said they would be less inclined to recommend someone for promotion if the individual spent less time in the office. Management pressure on staff is thought to lead to presenteeism. (10)
- 82% of office workers are reporting a culture of presenteeism in creative industries, which is compared to 58% in technology. (10)
- 52 percent or organizations with “poor/fair” morale reported presenteeism was a problem. (12)
Statistics linked to presenteeism
- 89% of workers who turned up at work with an illness admit that they are less productive. (1)
- Costs associated with loneliness and reduced output and productivity are estimated to be £665 million. (2)
- At any one time, one worker in six will be experiencing depression, anxiety or problems relating to stress. (3)
- The total cost to UK employers of problems associated with mental health, which includes depression, anxiety and stress, are estimated to be £26 billion. (3)
- Two in Five (Nearly 40%) of U.S. workers missed work due to depression – Reporting an average of 10 days per annum missed days work. (4)
- 50% of U.S. workers reported challenges relating to thinking on the job, resulting in reduced productivity. (4)
- The cost to employers in America associated with depression is an estimated at $100 billion annually. (4)
- The cost to employers in America directly relating to employee absences and lost productivity, is an estimated $44 billion annually. (4)
- 64% of a surveyed group in the U.S. reported cognitive related challenges – As a result presenteeism has been found to exacerbate these challenges. (4)
- 58% of employees in the U.S. who suffered from depression do not tell their employers of their disease. (4)
- 49% of employees in the U.S. didn’t tell their employer, as they felt that if they did it would put their job at risk. (4)
- 73 per cent of employees surveyed, have at least one form of work-related stress. (5)
- 50% of employees surveyed, said stress was due to unrealistic time pressure and demands. (5)
- 30 per cent of staff said not being consulted about change in the workplace increased stress. (5)
- A survey of 1,000 employers, 35% said their organisation has a well-being strategy or programme in place. (6)
- 46% of the 1,000 employers surveyed, reported that their organisation has increased its focus on well-being over the last 12 months. (6)
- 63% of the 1,000 employers surveyed, said they want their organisation to be a great place to work in. (6)
- 74% of organisations offer some sort of health promotion benefit to employees. (7)
- 28% of employers made significant changes to enhance the physical working environment to promote well-being. (7)
- Workers who work long hours are nearly 4-times more likely than other workers to report a good fit between working hours and social commitments. (9)
- 52% of employers in the US pay sick leave. (11)
Apart from the obvious reduced productivity levels seen as a result of presenteeism, there is a wider health issue too. This is due to the added hazard of cross-infection to the other members of staff, where the member of staff has a contagious illness.
Health and safely dangers in the workplace
A serious hazard exists where staff are suffering from fatigued, but still operate machinery. This can become a health and safety concern for the staff and for the business as a whole.
‘The economic costs of ill-health and its impact on work are measurable. But the human costs are often hidden and privately borne.’ Dame Carol Black – Black Review (2008)
Research has shown that where employees continue to work whilst ill, they will be less productive. This will have a ‘hidden cost’ effect on any business. Calculating the cost of reduced productivity, as a result of presenteeism, is an extremely difficult task to perform.
Research shows that a significant proportion of employees who are being subject to unrealistic time pressures, will cause of a loss of productivity.
Long-term health problems
In addition to real-time reduced productivity, employees are at the risk of future health problems from being present at work whilst ill. Their bodies are not having the chance to heal properly. There is increased stress, which in turn causes other related issues and associated health problems.
‘Mental-health problems are also found to cause significant productivity loss, especially in the form of presenteeism.’ Health , wellbeing and productivity in the workplace – A Britain’s Healthiest Company summary report.
Health and safety concerns
Where staff operate machinery in the workplace, there is an increased health and safely risk associated with presenteeism. Operating machinery whilst fatigued can be dangerous, be it operating machinery in a factory, operating a forklift or driving a company vehicle. Company vehicles include cars, vans and of course lorriestoo.
Companies need to consider including a presenteeism section within their employers handbook. This will not only help to cover for claims against potential workplace accidents, but also it will show that you are a ‘good employer’.
Lower profits and a reduced business value
Presenteeism represents a cost to organisations, sometimes significantly hitting the bottom line. This reduction in profits will have a knock-on effect to the value of the business. This is especially true where the ‘profits-multiple’ is use to calculate business value.
A further impact of the effects of presenteeism in the workplace is in a possible reduction in customer service levels. This will ultimately have a wider implication to the business as a whole, and consequently on value of it in the event of a sale.
With such a negative phenomenon, which is associated with costing businesses billions around the world, looking at the advantages of presenteeism seems strange. However, there is at least one advantage where presenteeism is a good for employees.
With presenteeism in the workplace, there’s only one advantage that I can find. Where an employee has a psychological illnesses, and where integration into the work place will be beneficial to them, this is the only time where presenteeism works in the favour of the staff member. Where the employee benefits from this arrangement, ultimately the organisation will benefit too.
This will require the employee to come forward to admit they have the psychological illness in the first place, before this arrangement will work.
Where companies encourage their staff to be honest in the workplace, employees are more likely to come forward in these types of circumstance. whereas, if an employee is worried about losing their job by coming forward, they will not do so.
Continued support for the staff from employers, by utilising programmes like the Thrive Programme, will be beneficial to both staff and the organisation. Whilst the cost of programmes like the Thrive programme can be high, the costs associated with doing nothing will be much higher.
In the Stanford Presenteeism Scale, presenteeism is scored. In order to score a business using the Stanford Presenteeism Scale (SPS-6), a series of questions are asked of the employee, which include the following:
- Because of my ‘health problem’, the stresses of my job were much harder to handle.
- Despite having my ‘health problem’, I was able to finish hard tasks in my work.
- My ‘health problem’ distracted me from taking pleasure in my work.
- I felt hopeless about finishing certain work tasks, due to my ‘health problem’.
- At work, I was able to focus on achieving my goals despite my ‘health problem’.
- Despite having my ‘health problem’, I felt energetic enough to complete all my work.
The above questions are from The Stanford Presenteesim Scale (SPS-6; 2001 version), which is jointly owned by Merck & Co., Inc., and Stanford University School of Medicine.
Employees will score their answer on a range from strongly disagree through to strongly agree. For questions #2, 5, and 6 strongly disagreeing scores a one, whereas strongly agreeing scores a five, with somewhat agreeing = 2; uncertain = 3; somewhat agree = 4. For questions #1, 3 and 4 these scores are reversed.
Scores on the Stanford Presenteeism Scale SPS-6 can range from six through to 30. The lower the Stanford Presenteeism Scale score, the lower the level of presenteeism in the business. Conversely, the higher the Stanford Presenteeism Scale SPS-6 score, the higher the level of presenteeism.
The Endicott Work Productivity Scale (EWPS)
‘The Endicott Work Productivity Scale (EWPS) is a brief self-report questionnaire designed to enable investigators to obtain a sensitive measure of work productivity. The total score is based on the degree to which behaviours and subjective feelings or attitudes that are likely to reduce productivity and efficiency in work activities characterize the subject during the week before evaluation. The total score was found to be reliable and valid within a group of depressed outpatients and a group of non-patients in the community. The EWPS score is related to, but not redundant with, measures of overall severity of illness and severity of depression in these samples. The EWPS shows considerable promise as an easily used, brief, and sensitive measure for assessing the effects on work performance of various disorders and the efficacy of different therapeutic interventions.‘ Source is PubMed.
Whilst the real cost of presenteeism is difficult to measure properly, both in terms of cost and reduced productivity, it is something that organisations should be taking seriously. There are a number of solutions to reduce presenteeism, and research has shown that companies are now taking action.
Organisations need to work towards eliminating unnecessary absenteeism, whilst at the same time not increasing negative presenteeism.
Recognising the problem of presenteeism is the first step to the solution
The first step to solving any problem is often times recognising the problem in the first place. Many employees probably still haven’t heard of the term presenteeism, so are unlikely to know whether their business suffers from it or not. So by understanding the problem and by making the managers in the business aware of it, is a step in the right direction.
Business owners need to be made aware of how presenteeism is affecting their bottom line through reduced productivity. When they do, they are much more likely to face the problem and take action.
Develop a workplace policy on presenteeism and inform the staff
Once the problem has been identified, incorporating a policy on presenteeism into the staff handbook would be a good next step. As a part of developing the policy on presenteeism, it’s important for staff to know where they stand on coming to work whilst sick.
Educating them also on the dangers of coming to work when sick, not just from a health and safely aspect, but also from the infection of others view point, is important. The policy and explanation to the staff should include guidelines on when it’s okay to come back to work, but also when it’s not okay.
Where there is direct contact between staff and the public, the education of staff of when it’s okay to come to work when sick, is also important. This would be particularly true in the case of a hospital, where infection is more closely controlled. This is also crucial in the restaurant or food industry. Businesses don’t want to be responsible for infecting customers who eat at their restaurants or other food establishments, directly as a result of food contamination due to a sick employee.
It would be good to introduce a workplace policy whereby employees could be disciplined in certain situations when they come to work ill. This could also lead to dismissal of workers, whereby they’ve infected co-workers and/or clients or patients of the organisation through their illness.
The role of line managers in reducing presenteeism is crucial
Studies have shown that support in the workplace from line managers is important. Having supervisor support has been shown to mitigate the negative impact of presenteeism. However, line managers will need training in how to manage both absenteeism and presenteeism, in order to avoid creating a secondary problem for management staff and the associated pressure and stress.
‘Workers who have experienced a substantial restructuring or reorganisation at their workplace are more likely to report presenteeism, sickness absence, greater work intensity and being exposed to adverse social behaviour than other workers.’ 6th European Working Conditions Survey. (Eurofound (2016), Sixth European Working Conditions Survey – Overview report, Publications Office of the European Union, Luxembourg.)
Make changes to disciplinary procedures which involve an absence due to sickness
Whilst it may be appropriate to discipline employees in certain circumstances involving time off for sickness, with the aim to controlling absenteeism, this may unknowingly encourage presenteeism instead. Counter productive HR policies need to be reviewed for the benefit of the business as a whole.
Return to work programmes and support
When staff have been off sick for a period of absence, it is important to have some form of ‘back to work’ routine. Provide the facility of a back to work interview, which should include an assessment of their current capability to work now.
Staff will feel supported, plus the organisation will have a better understanding of the reasons for the illness of their staff. Better monitoring of staff sickness under a return to work programme will lead to better management of staff wellbeing.
By paying attention to and by raising awareness about how to better support employees with ill health, can be positioned as a ’employment value proposition.’
Offering paid sick leave
Where employees are struggling financially, they are more likely to come to work when sick where paid sick leave is not offered. This would be particularly true for long-term sickness, where in the UK minimal government sick pay is offered, where employees cannot afford not to work when sick.
Healthy Families Act demonstrates that if workers in the U.S. had just seven paid sick days per year, the U.S. national economy would experience a net savings of $8.2 billion per year due to reduced turnover, higher productivity, and reduction in the spread of contagion in the workplace.
Employers are placed in a difficult situation, as there are employees who take advantage of paid sick leave. The question is, do you as a company offer paid sick leave for the majority of honest people, to discourage presenteeism? Or do you not provide for paid sick leave, thus leaving your business open to the risk of higher presenteeism and reduced productivity?
Boost morale in your organisation
According to a CCH survey, morale has a significant impact on the incidence of presenteeism. Interestingly, they showed that companies with low morale had more employees turning up to work when ill.
However, I would ask the question…is this employees having a low morale because they see the need to turn up to work when they are ill…with the low morale being a result of presenteeism instead.
Take an active involvement in preventing employee sickness
Employers that actively help employees to prevent illness will likely help the reduction of both absenteeism and presenteeism.
Offering a flu vaccination programme for example, would be a good starting point. Flu is not only debilitating for employees, but it is also highly contagious. Preventing this decease before it starts is the best approach and, although the vaccination program will cost, it is more likely to be a lower costs than the cost of absenteeism caused by a flu epidemic in the first place.
The Black Review (2008)
A report written by Dame Carol Black and published by the UK government identifies challenges in improving health, work and wellbeing and sets out recommendations for reform. This document is 115 pages long and can be found here: Black Review (2008).
Whilst this review in itself does not focus on presenteeism, it does discuss workplace health and wellbeing. A quote from this document ‘A shift in attitudes is necessary to ensure that employers and employees recognise not only the importance of preventing ill-health, but also the key role the workplace can play in promoting health and well-being.’
Sainsbury Centre for Mental Health, 2007 (Now Centre for Mental Health)
Also The Sainsbury Centre for Mental Health – Policy Paper 8 looks at ‘Mental Health at Work: Developing the business case.’ The report sites that mental health problems among their staff is estimated at nearly £26 billion each year. This £26 billion cost is split £2.4 billion for staff turnover; £8.4 billion for sickness absence; and a massive £15.1 billion reduced productivity.
Research evidence for this post on presenteeism in the workplace is as follows:
- ERS Research & Consultancy – Health at Work: Economic Evidence Report 2016.
- New Economics Foundation – Cost of loneliness to UK employees.
- Centre for Mental Health – Employment: the economic case.
- Employers Health Coalition – Survey of US Workers The Impact of Depression at Work Audit (IDeA).
- Vitality – Findings; Workplace Health Interventions.
- CIPD – Line Managers under-prepared by employers to manage absence.
- CIPD – Annual Survey Report – Absence Management 2016.
- European Working Conditions Survey (EWCS) of 40,000 respondents in 34 countries.
- 6th European Working Conditions Survey. Eurofound (2016), Sixth European Working Conditions Survey – Overview report, Publications Office of the European Union, Luxembourg.
- A culture of presenteeism is damaging productivity in UK offices – HR Review.
- Families and Work Institute – Paid Time Off, Vacation, Sick Days and Short-term Care Giving in the United States.
- CCH survey. CCH 2007 Unscheduled Absence Survey.
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