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CARE SETTING:
HOW IT AFFECTS
PRODUCTIVITY COST 1
INTRODUCTION
Nowadays we are experiencing a lot of issues in the workplace. Filling up
these issues with different solutions in order to improve the management of an
organization or institution. Employees are elongated within their capability, going
to work even though not feeling well. Employees who are likely having medical
conditions are less productive in work than those who are physically healthy.
Presenteeism and absenteeism is not easy to measure and a lot or most employers
havent given a lot of time to quantify it. But still many from human resource
department has an interest on this topic on how to gain benefits and as well
solutions to lessen its bad effect to organization or institution.
With this insight gives a suggestion to employers who are concerned of the
productivity of its workforce in the workplace to improve productivity by learning
about presenteeism and absenteeism and taking time to handle such issues. This
would help open our minds how to handle this kind of situations especially to
managers and higher authorities involve with their staffs within their scope of
responsibility.
PRESENTEEISM
In this recovering economy, employers and their workforces are faced with
the daunting prospect of doing more with less in the race to improve productivity.
And employees are stretched to their limits, likely showing up to work when sick.
Employees who are at work with medical conditions are likely to be less
productive than those at work without medical conditions. That is the essential
meaning of presentism.
According to Webster dictionary, Presenteeism is the act of attending work
while sick. A topic that is at times considered its opposite, absenteeism, has
historically received extensive attention in the management sciences.
What is presenteeism and how can a manager combat it? An illness related
condition that negatively affects on-the-job productivity of an employee is called
presenteeism. Presenteeism does not refer to loss of productivity due to employees
extending their tea/lunch breaks, slacking by surfing the internet or emailing
friends, or pretending to be ill to avoid working (Munro, L., 2007).
HISTORY
The study of presenteeism is a relatively new field, but the phenomenon is
not a new problem in the workplace. Presenteeism began to be studied around the
year 2000, while its counterpart, absenteeism, has been studied and quantified for
much longer period. As a result, employers may be more likely to be more aware
and willing to address absenteeism, while reluctant to address presenteeism or
unsure where to begin.
Determining the prevalence of illnesses and medical problems that
undermine job performance in the workforce, calculating the related productivity
loss, and combating that loss in cost-effective ways. This is a new area of study, so
questions remain around a host of issues, including the central one: the exact
degree to which various illnesses reduce productivity. But researchers are
discovering increasingly reliable ways to measure this and are concluding that
presenteeism costs companies billions of dollars a year. Emerging evidence
TYPES OF PRESENTEEISM
Professor Cooper, in an article written in April 2011 for the HRMagazine
(UK) identified four types of presenteeism.
Fully Functioning Presenteeism.
These people are healthy and rarely take sick days. They are engaged,
they are motivated and they contribute fully to their job and to the organization.
Sickness Presenteeism
These are those who turn up to work but whose health is suffering to
greater or lesser degree. Although they are not well, their job-insecurity is such that
they come to work even when they are feeling ill, but they are largely
unproductive.
CAUSES OF PRESENTEEISM
Employer expectations
In today's often "leaner-and-meaner" workplaces, some workers trudge off to
work when sick because they fear one or more of the following: appearing less
committed to their jobs, receiving disciplinary action, or even losing their jobs. A
day or more off can also mean burdening coworkers with job duties, coming back
to a heavy backlog of work responsibilities, or missing work deadlines.
Families and Work Institute, only 39% of low-wage employees are allowed any
paid time off for personal illness. As a result, a number of workers are reporting to
work when ill to avoid loss of pay.
Additionally, many more employers no longer allow employees to accrue
sick days. It's more common today for workers to have a use-it-or-lose-it
arrangement.
Unhealthy lifestyle
An unhealthy lifestyle, for example, smoking, sedentary lifestyle i.e. lack of
exercise, excessive alcohol intake, poor eating habits, and poor sleeping patterns
impact health and wellbeing and workplace productivity. An unhealthy lifestyle
may lead to presenteeism through its impact on an employees health.
Institute for Health and Productivity Studies and the health-information firm
Medstat, on-the-job losses are possibly as high as 60 percent of the total cost of
worker illness, exceeding the costs of absenteeism and medical and disability
benefits. Allergies, headaches, arthritis, asthma and mental-health ailments such as
depression cause the greatest on-the-job productivity losses.
All in all, this means that from about one-fifth to three-fifth of the total
dollars attributable to common health conditions faced by employers appear to be
the result of on-the-job productivity losses, says Ron Goetzel, director of IHPS. In
fact, the expense of these losses is in most cases higher than medical costs.
Employers need to weigh the costs of good medical care against the potential for
on-the-job productivity losses, which we see are substantial in many cases.
EMPLOYERS SOLUTION
Paid Time off (PTO) programs are increasingly being offered by employers.
In these programs, all time off is combined into a single bank of days. Employees
have the flexibility to take these days in a way that will meet their individual
needs.
Paying for employee flu shots or providing an onsite flu clinic is a definite
cost-effective measure employers can take. Reducing the number of employees
who contract and spread the flu is a win-win scenario for all: increased
productivity and workplace morale, and a healthier bottom line.
drawing out the key themes to develop a model (see Figure 1) for use in further
analysis.
A UK mixed method study by Grinyer and Singleton (2000) compared two
public sector offices, one with higher long-term sickness than the other.
Organizations were matched on key criteria such as size, employee prole and
location, and employees were interviewed regarding two specic organizational
factors related to the non-use of sick leave: obligation to colleagues (an internal
pressure) and fear of reaching trigger points (an external pressure). Work
attendance was greater in those who felt strongly committed to serving others
(clients or patients) or felt their absence would have negative consequences for
themselves, colleagues or a third party. Organizational policies introduced to
reduce casual sickness, such as increased monitoring of short-term sick leave,
made staff fearful of being absent, which then left them feeling stressed and
resentful. Policies were viewed as penalizing the genuinely sick, as staff feared
reaching a trigger point which would result in disciplinary action.
Surprise staff with activities that are all about them. Reward them. Let
them know you value them and appreciate their hard work
Evaluate, and if necessary change your management style. How you
engage, lead, manage and communicate with your employees and
contractors will influence their level of engagement and commitment to
the workplace and their level of productivity
ABSENTEEISM
Employees presence at work place during the scheduled time is highly
essential for the smooth running of the production process in particular and the
HISTORY
If we look back the history, there is only a small written history of
absenteeism in business literature, apparently because until the 20th century
businesses had a clear rule, "No work: no pay." Then labour unions forced the
companies into agreements to allow employees to take time off from work for
illness or vacations and the practice of offering paid "sick days" become
widespread. These practices still vary among companies and union contracts and
normally there is an average of four to ten sick days per year is standard.
Companies have realized that human absence management policies are cost
effective; even many companies were unwilling to off paid leave to their
employees. In fact, there is an estimate in the current studies regarding absenteeism
that those company who have effective employee absence strategies can reduce
their overall payroll costs by atleast 10 percent.
TYPES OF ABSENTEEISM
Human Resources professionals suggest that there are two types of
absenteeism. First, it is important to distinguish between the two major types of
absences which, under the law, must be dealt with in different ways:
Further, if the
CAUSES OF ABSENTEEISM
The causes of non-culpable absenteeism are generally not a big concern.
Because employees inform managers ahead of time they won't be able to work, the
impact isn't a serious as with the unanticipated, culpable absenteeism.
The causes of culpable absenteeism are important, as it can provide
managers with important feedback, either about a single employee or about
workplace morale.
People miss work for a variety of reasons, many of which are legitimate and
others less so. Some of the common causes of absenteeism include (but are not
limited to):
coworkers and/or bosses are more likely to call in sick to avoid the situation
order to stay home and take care of a child/elder when normal arrangements
have fallen through (for example, a sick caregiver or a snow day at school)
or if a child/elder is sick.
coworkers and/or the company are more likely to miss work simply because
they have no motivation to go.
commonly reported reasons for missing work (though not always the actual
reason). Not surprisingly, each year during the cold and flu season, there is a
dramatic spike in absenteeism rates for both full-time and part-time
employees.
Partial shifts Arriving late, leaving early and taking longer breaks
form the bulk of the cause and provide a legitimate explanation for much of its
occurrence. Many of these factors are prevalent in society and are open to
interventions in the public arena as well as the workplace. For example the
workplace can be a vehicle for the amplification of public health messages dealing
with cigarette smoking, drug and alcohol use, diabetes and influenza for mutual
benefit.
Thus illness related leave might be unfairly considered unavoidable from a
workplace or medical perspective. Various estimates have indicated that disease
accounts for 50-75% of work absences, colds and flus are most likely to account
for short absences of 1-2 days.
Motivation
Employee absenteeism costs employers an average of $2,500 a day in
expenses, according to Benefits.org. While employees get sick and need time off,
other factors contribute to absenteeism including low morale, boredom, poor
management and stress. To limit the time employees take off from work,
businesses should develop an attendance policy as well as create an environment
that is conducive to work, supports employees and fosters morale. Work attendance
motivation is subject to the compound and dynamic between the importance and
value of work and non-work alternatives.
Motivation is easier said than done, but it can be accomplished by enhancing
the intrinsic motivation employees receive from their job by making production
goals more realistic, increasing desirable job responsibilities, and improving
working conditions. An employer can also increase extrinsic motivation by
implementing a type of recognition or reward program.
Distance from work
Distance from work also appears to influence likelihood of sickness absence
because of distance or transport difficulties, which may be magnified by illness or
by presenting additional barriers or disincentives. Generally a minority of workers
account for the majority of leave taken. Some 30% of employees accounted for
70% of leave taken in a study of Telecom employees. The authors felt that this was
attributable to a sizeable minority of chronically ill employees who take long
absence spells. In a model involving a measure of avoidable absence just over
25% of workers accounted for all the avoidable leave taken. Past absence history
is moderately predictive of future absences, with absence frequency rather than
duration being the key indicator. Most studies seem to review absence history
CONSEQUENCES OF ABSENTEEISM
Companies expect employees to use some sick days from time to time. Life
happens, and family issues, injuries and sickness will interfere with the work
schedule of a company's employees.
However, excessive absences can quickly become costly for employers.
Even a single sick day may reduce productivity, but when absenteeism becomes an
extensive problem, the effects may negatively affect the morale, productivity and
finances of a company. (Burgess, Joy, 2013)
workers
staff morale and employee service may suffer
Financial Costs
payment of overtime may result
cost of self-insured income protection plans must be borne plus the wage
sick children; care for adult relatives; or the performance of important personal
business
For calculating the rate of absenteeism we require the number of people scheduled
to work and number of people actually present.
Absenteeism can be find out of absence rate method
Rate of absenteeism = No. of man days lost
100
absenteeism %
93 X 100
2000
Try developing a mission statement and a set of values for your business
which will help to create a unified working environment.
Offering incentives for staff members who have shown good attendance and
performance levels will help with absenteeism. Offering extra holidays or
rewards for exceptional attendance records can help to motivate and engage
employees. The HR department can help set up these kinds of incentives and
rewards for your employees.
Remember to communicate with your workforce. Nowadays, with so much
reliance on technology, it can be easy to forget about face-to-face
communication, but your employees welfare depends on it. Make sure you
show your employees that you care about their wellbeing and happiness at
work. Show them you appreciate their time and dedication and are available
to talk through any problems they may be having.
Being organized is critical when it comes to trying to manage absenteeism.
Employees need to know that they work for an organized and wellstructured company with the correct, legal procedures in place. They want to
know they are being treated fairly and in the same way as everyone else.
Managers and HR teams should ensure that they implement effective
procedures and continually uphold them.
Investing in workforce management systems can really help with your
businesses organization. Hardware that can track an employees whereabouts
Marital status:
Age:
Younger employees are absent more frequently than older employees but the
latter are absent for longer periods of time.
Gender
Women are absent more frequently than men. Women are more likely to
report poor health status and chronic conditions (Paringer 1983: 124-125;
Mastekaasa & Olsen 1998: 203). Women and men have typically different wages
and different roles in the home. The importance of the gender wage gap for
absenteeism is an open question as it involves both income and substitution effects.
Substance abuse
Drug use, abuse, or addiction among employees and their family members
can cause expensive problems for business and industry, ranging from lost
Sickness
Poor health is often considered to be the most important cause of
absenteeism. Some illnesses or injuries are so serious that going to work is hardly a
choice. Other health problems are possible to combine with work, but with greater
or smaller levels of inconvenience. Health does not only seem to be associated
with age but also with sex.
Characteristics of the manager
The costs of absenteeism are particularly high where worker productivity is
interdependent, that means where work is performed in teams (Heywood & Jirjahn
2004). The historical literature is often emphasizing how managers used
punishments to maintain discipline. Those who failed to show up could get wage
reductions or even be fired. But managers had also other means. One way, was to
select workers according to perceived group characteristics or, which became
widely spread during the twentieth century, to use medical expertise to screen
workers before hiring. Furthermore, as respected members of society, owners and
Job Satisfaction.
Have a plan
If and when the times comes that you must take steps to address excessive
absenteeism, have a plan and a process for doing so that is applied consistently at a
pre-determined threshold. Make sure that the employee is aware of resources
available to them to assist them in improving their attendance, like counselling or
work-life services through your organizations EAP, or the availability of a
flextime program. Make a plan of action and a time frame for improvement, and
follow up on the employees progress.
Similarly, have a plan in place for how your organization will deal with noncompliance to the absence policy, with the associated disciplinary action. Include
information about the consequences of non-compliance in your attendance policy,
so that everyones expectations are managed.
The greater the extent to which individuals identify their goals with the goals
of the organization and care what happens to it, the greater their motivation
to be regular in attendance.
The more people find their jobs meaningful to them, the greater their
motivation to be regular in attendance.
As employees workload increases due to the absence of a co-worker, peer
pressure is exerted on the absent co-worker to attend work on a regular
basis.
The more people like working for the organization the higher their
motivation to attend regularly. Recognition of good employee attendance
helps improve attendance.
Employees will have a lower absence ratio if they feel free to discuss their
on-the-job problems with their immediate supervisor.
Employees with a low absence ratio have attitudes of confidence and "team"
spirit.
Low absence ratio employees are found to be more satisfied with their
opportunity for promotion and upgrading.
Certification
This seeks to enhance the changes in medical certification (particularly the
introduction of the fit note) made following the 2008 Black Review. For longerterm absences (four weeks or more), or difficult cases, employers and doctors
guidance to ensure that judgements about fitness to work move away from only
Both light touch discussions and more structured interviews represent good
practice in terms of supporting the employee to attend work and identify any
actions needed to achieve this. Advice and support can be gained from your
Faculty HR Team contact. In cases where disability related absences are identified
managers should liaise with HR before determining next steps.
The below information is for guidance purposes only and aims to support
managers in undertaking such discussions/interviews. It is, however, recognized
that the manager will need to determine how best to structure each such
discussion/interview to best reflect the given circumstances of the case.
issues):
2.
Ensure you undertake action points you are responsible for and let the
employee know.
Be available to talk to/meet with the employee, should they have any
NURSING TURNOVER
Nurse absenteeism is a growing management concern. It can contribute to
understaffed units, staffing instability, and other factors that could have a negative
impact on patient care. The impacts of absenteeism on the quality of nursing care
have rarely been studied.
argued that the single greatest way for healthcare organizations to improve their
performance is to simply increase the levels of their nursing staff. But such a
strategy can never work unless organizations can effectively reduce and manage
nursing turnover.
Two approaches have been used to diagnose the causes of nursing turnover.
The first is to identify why nurses choose to work in different jobs and then
determine if those needs are being met. In other words, are employers supporting
the employment value proposition that led nurses to originally accept a job offer.
The second approach is to identify things that occur after nurses are hired that lead
them to quit jobs even though the jobs may have met their initial job expectations.
This approach focuses on identifying specific events or conditions that lead nurses
to conclude that their current job no longer matches their personal career goals
and/or job needs.
Research suggests that the primary factors that influence nurses choice of
employers are work schedules, career development opportunities, and commuting
distance. However the relative importance of these factors varies widely across
nurses. Nursing, like many other professional hourly jobs, attracts individuals with
an extremely wide range of career interest and goals. Some nurses place a premium
on job schedules that do not interfere with their commitments outside of work.
Others look for jobs that give them opportunities to develop their professional
skills and capabilities.
FACTORS DRIVING NURSING TURNOVER
Feeling overworked; not being able to manage workload
Lack of role clarity and low sense of control over job performance
Not feeling respected and valued for contributions and capabilities
Poor communication with management around critical issues affecting
work
Not receiving recognition or rewards for accomplishments Lack of
career opportunities and support for career development
Lack of trust and effective collaboration with coworkers
Work schedule does not match job needs or expectations
Work is too physically
The factors identified, which leads nurses to quit jobs are often considerably
different from the factors that led them to accept the jobs in the first place. Issues
that have been identified as primary factors in nurses decision to quit their jobs.
The issue at the top of the list, feeling overworked is largely a result of low
staffing levels which is itself primarily caused by nursing turnover (the vicious
cycle of ever increasing nursing turnover discussed earlier). In fact, one study of
601 registered nurses found that 43% of nurses would actually prefer increased
staffing levels over increased wages or scheduling.
Most of the issues are directly related to the behavior of nursing managers. It
is often said that employees dont quit companies, they quit managers, and it
appears that this is the case for nursing as well. Studies have found that longer
tenured nurse managers tend to have lower levels of turnover than less experienced
manager. This suggests that more experienced nursing managers may be more
effective at creating work environments that support the unique needs of nurses.
These managers are more likely to have developed effective techniques for clearly
defining nurses job expectations, managing their workloads, and recognizing and
rewarding nurses for their accomplishments. Experienced nursing managers may
also have developed unique skills to help nurses cope with the highly stressful and
emotionally exhausting aspects of their work.
NURSE ABSENTEEISM AND STAFFING STRATEGIES FOR
HOSPITAL INPATIENT UNITS
Inpatient units are often organized by nursing skills required to provide care.
A typical classification of inpatient units includes the following tiers: intensive care
(ICU), step-down, and medical/surgical. Multiple units may exist within a tier,
each with a somewhat different specialization. For example, different ICUs may
take care of a common pool of patients and in addition have a few beds that are
reserved for subpopulations such as cardiac and vascular, surgical, trauma, and
pediatric patients. Nurses whose skills are adequate for assignment to a particular
type of unit may be assigned to any one of the multiple units of that type, which is
then called their home unit. When nurses take care of a special subpopulation of
patients within their home unit, they undertake training that is specific to the needs
of that patient group. Hospitals also provide periodic learning opportunities to
nurses to keep their skills up to date.
Some hospitals create a pool of nurses, referred to as the float pool, who
may be assigned to different units depending on short-term variation in nursing
heuristics for use by nurse managers. The structural properties we establish provide
insights for developing staffing strategies in environments where work is
performed by groups or teams of employees.
The savings are of the order of 3-4% of overtime costs, which may be
considered small by some. It is important to document or note that our approach
reduces variance in rate of attendance and its approach makes it easy-toimplement. Nurse managers dont need to exert much effort to realize the benefit
of reduced cost and reduced day-to-day variability in the number of additional
nurses they will need to find to meet the requirements in each duty shift. The
proposed strategies utilize information that is easy to track from historical datanurses absentee rates and inpatient units demand distributions. The former may be
estimated from nurses attendance records whereas the latter may be estimated
from census data and documentation and tare nurse-patient ratios in duty shift.
INEFFECTIVE ROUTINIZATION
Factor 4 ( 0.6954) comprises reasons for absenteeism that are classified
under ineffective routinization because they deal with the daily operational
activities in the workplace. A lot of reasons for absenteeism in place of work are
connected with the unit routine. According to Johnson and Indvik (1997),
monotonous jobs with no room for creativity can lead to a low morale and the
absenteeism of nursing staff. Kass et al. (2001) stated that those repetitive tasks
that under-utilized ones ability lead to feelings of boredom and fatigue, which
result in absenteeism of nurses in the workplace. The individuals scope is
systematically underutilize, and one may find the job boring and this may lead to
absenteeism. No significant responses to items in factor 4 were identified.
The sub professional nurses were more inclined than the professional nurses to
indicate that nurses are absent from work because they have to do a job that
requires more skills than they have in the present.
Allgood et al. (2000), stated that autonomy contributes more to absenteeism
among nurses with lower educational qualifications than those with higher
qualifications. The findings indicated that the sub professional nurses are more in
agreement with this statement than the professional nurses.
Role ambiguity
The role ambiguity factor, its significant differences on the extent to which
role ambiguity contributes towards absenteeism were identified. Nurses younger
than 40 years were significantly more inclined than nurses who are 40 years and
above older to indicate that absenteeism is due to having to work fluctuating shifts
and to perform duties without a job description.
Nurses who experience role conflict in their workplace shows inadequate
work commitment and have high rates of absenteeism. The findings indicate that
younger nurses are more in agreement with these views than nurses above 40 years
older. About the factors ineffective routinisation and the effect of workload in the
CONCLUSION
Presenteeism is intertwined with loss of productivity due to real health
problems of employees, such as allergies, rheumatoid arthritis, chronic back pain,
and so on. These health problems are not severe hence the employees report for
duty but their productivity will be below par. Presenteeism is a complex issue and
its impact in the workplace is only just beginning to be recognized. It is an
emerging issue, though it has remained hidden and undetected for a long time. It is
difficult to identify and measure and in view of the magnitude of its economic
impact on business and employee health and safety, presenteeism is an issue that
all managers will need to address at some point in their career.
enough researches that gives evidence that presenteeism is a real phenomenon and
costs more than absenteeism, health care and pharmaceutical benefits combined.
Employers need to take more care to their employees about their health and
presenteeism and know how to recognize each effort of the staff to be present.
Nurse Managers should have the control and support to enhance the practice
environment to productive one without having hindrances in the workplace and
balance the capacity of each staff. The above review contains different views on
various aspects on characteristics of nurse, manager, and work and organizations.
Although numerous researches have been implied on contributing factors about
absenteeism, still it is a growing problem now a days in the organizations. In order
to lessen it, it is important to understand its causes and become evident.
Traditional health management programs are usually implemented to this
end and standards workplace possibilities program demonstrates an effective
alternative. By providing an extent solutions to these problem, health resources,
productivity, and credibility of each worker can be quickly improve to those at
work with medical conditions and struggling with presenteeism.
REFERENCES
Websites/books
Black Business Leaders. (2004). Health and Productivity: Presenteeism
Costs Big Bucks. Retrieved from
http://www.tnj.com/archives/2004/september/health-and-productivity
Employee Absenteeism and Attendance in the Workplace | HR Topics
for human resources. (n.d.). Retrieved August 3, 2015, from
http://topics.hrhero.com/absenteeism-and-attendance/
http://www.benefits.org/optimize/risk-sharing/attendance-management?
showall=&start=2
http://onlinelibrary.wiley.com/doi/10.1111/0033-3352.00173/abstract
Jos dos Reisa, R.,Silveirab, A.M., De Freitas La Roccaa, P., Bonillac, I.,
Ginc, A., Martin, M., (n.d.). Factors related to sickness absenteeism
among nursing personnel. aHospital das Clnicas da Universidade