Proactive action is essential in addressing the growing impact of absenteeism and presenteeism on company bottom-lines. The impact will become even more acute in the future, as the shift towards the onset of chronic disease linked to lifestyle during working years drives absenteeism and presenteeism to unprecedented levels. So says Terence Govender, executive head: wellness at Metropolitan Health.
Levels of absenteeism and presenteeism in the workplace impact on employees’ productivity, which in turn has a significant impact on an employer’s bottom-line. Both of these measurements are significantly affected by employee health. Govender believes integrated workplace wellness initiatives that drive greater employee engagement and sustain healthy behaviour change have a critical role to play in reducing levels of absenteeism and presenteeism.
Sharp increases in absenteeism levels
Estimates from Statistics South Africa show that absenteeism costs the SA economy about R16-billion per annum. And it’s a rising trend.
A report by labour specialist Adcorp shows how sharply absence due to sickness in South Africa has increased. In 2001, 0.7% of workers were absent from work due to sickness, whereas in 2011, at a given point in time 3.4% of workers were absent from work due to illness. This represents an increase of nearly 500%.
Absenteeism levels in South Africa are also significantly higher than global levels. Drawing on secondary data research, Metropolitan Health estimates that South Africa’s average absenteeism rate is 10 days a year, whereas the average global absenteeism rate is 2.5 days a year.
The costs associated with absenteeism — an employee’s habitual and intentional absence from work — are more than simply the employee’s salary cost of sick leave. Depending on the nature of the industry, the company may have to bear the cost of bringing in a temporary replacement. Other staff members may become demotivated and morale may dwindle as they are required to ‘carry’ absent employees’ workloads, which in turn fuels presenteeism.
The reasons for habitual and intentional absenteeism are diverse and vary according to industry and sector. However, Metropolitan Health’s experience suggests a shift in the primary drivers of absenteeism over the years towards first substance abuse, followed by chronic disease linked to lifestyle (non-communicable diseases or NCDs), such as hypertension and diabetes.
Govender explains, “We live in a society where excessive smoking, drinking and other addictions have become the norm. This means many people remain oblivious to the fact that they are actually addicted to these harmful substances. Add to this the unhealthy lifestyle choices that have become a way of life for many South Africans, and it’s no surprise that South Africa faces a burgeoning wave of NCDs.”
Rising levels of mental illness should also be of major concern to employers facing absenteeism and presenteeism challenges. About three in 10 people in any given South African workplace experience symptoms of depression at some time. The World Health Organisation has indicated that depression will be the second most disabling health condition in the world by 2020.
Depression and anxiety often lead people to make unhealthy lifestyle choices such as smoking and following poor eating habits, which further fuels obesity, high blood glucose and hypertension — some of the modifiable risk factors that underpin the development of major NCDs.
When the body is at work but the mind is not
While the costs associated with absenteeism eats away at bottom-lines, Govender points out that the impact of presenteeism can be even more severe. Studies have found that the financial impact of presenteeism, which is less visible and more difficult to quantify than absenteeism, can be estimated to be significantly higher than that of normal absenteeism productivity loss.
Presenteeism is a problem because such employees are being physically present at work but not fully engaged. Lack of engagement, largely due to physical or mental distress, drives major losses in productivity.
An Econtech report for Medibank Private on the Economic Modeling of the Cost of Presenteeism in Australia estimates the cost of presenteeism to the Australian economy at $25.7 billion, which is nearly four times the cost of absenteeism.
The main underlying drivers of presenteeism, leading to disengagement and lower productivity, include personal financial difficulties, personal and work stress, work-life imbalance and unhealthy lifestyles which may include bad eating habits, lack of exercise, poor sleeping patterns and substance abuse. Even allergies and asthma have been identified as drivers of presenteeism.
Presenteeism can take various forms. Many employees go to work while ill with conditions such as influenza. Although not well, they fear job security and so pitch up at the workplace, but are largely unproductive once there and they may also infect other employees.
Then there are those employees who overextend themselves and fail to follow a healthy work-life balance. Abnormally long working hours become the norm and they end up stressed and exhausted. Their productivity and the quality of of their work suffers.
One of the most harmful forms is disengagement presenteeism, which is when employees are demotivated or dissatisfied with their job, or certain aspects of the workplace, and do not work at their full capacity. There is also the risk that this lack of motivation and negative behaviour can spread to other employees.
According to Govender, a new form of presenteeism is evolving which can be linked to the affects of social media on employees. Extremely difficult to manage, this form of presenteeism develops from people’s need to be connected. A survey from the United States (US) found that the average person spends 45 minutes to an hour in an eight-hour workday on social media sites. We are only starting to see the tip of what could become a social media iceberg for employers in South Africa.
Some of the costs companies incur as a result of presenteeism include customers who leave due to bad service, an increased risk of workplace injuries, substandard products and tasks that take longer than necessary. Studies also show that a lack of employee engagement leads to higher turnover rates, which in turn reduces productivity.
Absenteeism solutions: measure, and then manage
The starting point for addressing absenteeism is to quantify the size of the problem and understand the specific absenteeism trends and dynamics in a particular workplace. Metropolitan Wellness, the specialist wellness division of Metropolitan Health, offers a programme that addresses absenteeism through a three-step process.
The first step focuses on detecting the main underlying cause of absenteeism. The second step is to treat the root cause, while the final step is to ensure a review process is implemented to avoid future occurances. The programme works by analysing data using sophisticated algorithms.
Proactive wellness management
Employees with high work engagement levels report lower presenteeism-related health conditions, experiencing less discomfort and distraction due to the absence of conditions. Govender believes workplace wellness initiatives have a major role to play in helping to offset the influence that presenteeism-related health conditions have on work engagement levels and supporting sustainable behaviour change across the workplace.
A one-size-fits-all approach never works when it comes to wellness, as each workplace and organisation has specific dynamics and unique needs. The starting point for Metropolitan Wellness is usually a comprehensive workplace situational analysis, followed by a full health risk assessment. Drawing on the outcomes and insights generated in the analysis and assessment phase, a customised wellness solution to address the specific needs of the workplace in question is developed.
The recommended wellness solution may encompass a range of initiatives and interventions, including absenteeism and disability management, employee assistance programmes, health risk assessments and clinical health screening, regular wellness events, occupational health initiatives and voluntary counseling and testing for HIV.
Govender is pleased to note the increasing numbers of South African employers addressing the mental and emotional aspects of wellness through the establishment of Employee Assistance Programmes. These programmes are very effective in addressing many of the issues underlying disengagement presenteeism, such as financial difficulties, personal and work stress and work-life imbalance.
Companies often get their biggest bang for buck from training managers to recognise mental illnesses among staff. Metropolitan Wellness is often called upon to deliver customised management training, peer educator training and incapacity and wellness training for employers who recognise the value of enabling their management in this area.
All stakeholders benefit from integration synergies
Integration and co-ordination between employer wellness initiatives and the company medical scheme not only improves the efficacy of wellness interventions, but also delivers an enhanced return on every healthcare Rand spent.
In an environment in which the focus is shifting from preventative to curative health management, wellness initiatives can be the primary future channel through which medical schemes control loss ratios and improve solvency.
Employers stand to benefit tremendously from the improved productivity that flows from reduced levels of absenteeism and presenteeism, while employees enjoy the many benefits of a healthier lifestyle and improved quality of life.
However, the challenge in unlocking these benefits lies in initiating and supporting sustainable behaviour change across diverse and complex South African workforces.
Govender concludes: “Employees make life and death decisions each day in terms of their lifestyle choices. Integrated wellness initiatives have a key role to play in encouraging and empowering them to make the right choices and taking ‘ownership of their health status’, as they change from being passive recipients of scheme benefits and medical services to active partners and co-producers of their own health.”