Associations Between Supportive Leadership Behavior and the Costs of Absenteeism and Presenteeism: An Epidemiological and Economic Approach

Cost burden of productivity loss due to sickness presenteeism among nurses in South Korea: A cross-sectional study

AIM

This study aimed to estimate the annual cost burden of productivity loss due to sickness presenteeism among hospital nurses in South Korea.

BACKGROUND

Despite nurses being potentially more vulnerable to presenteeism, few studies have analyzed nurses' productivity losses due to sickness presenteeism.

METHODS

This cross-sectional study employed an online survey in January 2023 with 607 nurses working in general/tertiary hospitals in South Korea. The annual cost burden of productivity loss due to sickness presenteeism was calculated based on nurse health conditions, productivity loss, the number of days worked while sick, and income. This study was reported according to the STROBE checklist.

RESULTS

Overall, 93.2% of participants (n = 566) reported at least one health condition, and musculoskeletal diseases were the most prevalent, followed by weariness or fatigue, and sleep-related problems. Approximately 63.9% of participants reported experiencing sickness presenteeism in the preceding four weeks. Those in the severe multimorbidity group exhibited the highest prevalence of sickness presenteeism and productivity loss. The average annual cost of productivity loss due to sickness presenteeism was USD 2,388.26 per nurse and USD 382.11 million at the national level.

DISCUSSION

The cost of sickness presenteeism is high among hospital nurses in South Korea. Nurses with severe multimorbidity engaged in more sickness presenteeism and had higher productivity losses than nurses who were relatively healthy or exhibited moderate multimorbidity.

CONCLUSION

These findings support the need for stakeholders to develop strategies/policies to better address nurses' health conditions, secure better staffing, and reduce sickness presenteeism.

IMPLICATIONS FOR NURSING POLICY

Addressing this issue will not only improve nurse well-being and patient care but also lead to substantial cost savings for healthcare facilities. Additionally, the study findings can inform future cost-effectiveness studies.

The mediating role of psychological safety on humble leadership and presenteeism in Japanese organizations1

BACKGROUND

Presenteeism-induced productivity loss is a global concern. This issue is equally serious in Japan. As a "super-aged society," maintaining and promoting Japanese employees' health is an urgent issue. The combination of these factors makes it imperative to identify the factors that affect presenteeism and clarify the mechanisms driving these factors in Japanese organizations.

OBJECTIVE

Only a few extant studies address presenteeism as a performance variable. Presenteeism can create serious productivity losses in Japan, as it is a "super-aged society." Hence, this study aims to clarify the relationships between humble leadership, psychological safety, and presenteeism in Japanese organizations.

METHODS

We hypothesized that psychological safety mediated the effect of humble leadership on presenteeism. The data of 462 employees from 11 companies were analyzed.

RESULTS

The results supported our hypothesis. Additionally, leader humility, as perceived by the followers, was positively correlated with leaders' own psychological safety in their teams.

CONCLUSIONS

Our findings contribute to the existing literature by highlighting the roles of humble leadership and psychological safety in health and productivity management while accounting for cultural influences. The practical implications of our findings and future directions are also discussed.

Supporting Knowledge Workers’ Health and Well-Being in the Post-Lockdown Era

The specific problem is that knowledge workers experience high levels of stress and burnout in their professional lives, a trend that increased due to the transition to remote work during the COVID-19 pandemic. This integrative literature review addresses this problem by answering the following research questions: (1) How can working in the post-lockdown era allow greater well-being, job satisfaction, and job security to abide?; and (2) How can mental capital be increased in the 21st century to ensure maximum health and positive well-being in the future employment arena and on a global scale? This review contributes to the literature on worker health and wellbeing, hybrid work arrangements, and knowledge workers’ professional experiences. The findings suggest that knowledge workers can only thrive in a hybrid work environment if organizations take an empathetic approach to manage these workers and give them sufficient autonomy and flexibility in determining their work conditions, in addition to ample opportunities for social interaction and professional advancement.

Authoritarian leadership and nurse presenteeism: the role of workload and leader identification

BACKGROUND

Nurses' health in the workplace is crucial for ensuring the quality of healthcare. However, presenteeism, the behavior of working in a state of ill health, is widespread in the nursing industry. Considering that the origin of authoritarian leadership and the prevalence of presenteeism are inseparable from Chinese workplace culture, this study aimed to explore the impact and mechanism of authoritarian leadership on presenteeism.

METHODS

A total of 528 nurses were recruited from four grade III level A hospitals in the present survey, which was distributed across 98 nursing teams. Participants were required to complete self-report measures on authoritarian leadership, presenteeism, workload, and leader identification. Description, correlation, and multilevel linear regressions were applied for data analysis.

RESULTS

The present study found that presenteeism was significantly related to participants' demographic characteristics, such as marital status, educational level, technological title, and general health. There was a positive relationship between authoritarian leadership and presenteeism, and workload acted as a mediator in authoritarian leadership and presenteeism. Furthermore, leader identification moderated the relationship between authoritarian leadership and workload. When nurses were under high leader identification, the positive impact of authoritarian leadership on workload was reinforced.

CONCLUSIONS

This study revealed the potential antecedents and mechanisms of nurse presenteeism from the perspective of workplace culture. Results indicated that the excessive authoritarianism of leaders and the heavy workload faced by nurses may be the significant triggers for nurses' presenteeism. The role of leader identification is not always protective, which may heighten the relationship between dark leadership and its outcomes. These observations contribute to enriching research on presenteeism and authoritarian leadership, and provide valuable insights for cultivating healthy working behaviors.

Work-Related Factors Affecting the Occurrence of Presenteeism － Recent Research Trends and Future Directions

Productivity loss due to presenteeism accounts for a large proportion of economic losses caused by workers' health problems. To reduce presenteeism, it is necessary to identify its causes, but, in contrast to the large amount of research on the effects of diseases and lifestyles, there is not enough research on the effects of work-related factors on presenteeism. In this study, those factors include the work environment and the work-related psychological status of workers. The purpose of this review was to identify research trends in presenteeism, defined as work-related productivity loss, and to examine future directions for presenteeism research. We conducted a search with only the keyword "presenteeism" using MEDLINE/PubMed for the last 5 years and extracted 30 relevant articles, most of which were cross-sectional studies. The articles were categorized into the following themes: 1) studies on the associations of various stress models and factors with presenteeism; 2) studies on the mediators and the pathways of association between stress factors and presenteeism; 3) studies on the relationships between organizational factors and presenteeism; and 4) studies on the link between workers' positive and negative psychological status and presenteeism. Our findings showed that, over the last 5 years, the relationship between psychological stress and presenteeism has been extended to include a variety of stress models and stressors. In addition, by putting many models and factors into a single statistical model and adjusting for their interrelationships, important factors have been examined by ensuring that a significant relationship with presenteeism remains. As there is still a lack of longitudinal studies necessary to discuss causality, more research of higher quality is needed.

Understanding the Decision-Making Process Between Presenteeism and Absenteeism

Due to their impact on various stakeholder groups, research on the global phenomena of sickness presenteeism (working despite illness) and sickness absenteeism (absence due to illness) is constantly growing. Most studies focus on identifying factors associated with the attendance behaviors. In contrast, there have been few theoretical approaches to explain the individual decision-making process for or against working while ill. Moreover, their empirical verification is still pending. In the present study, we refer to expectancy theory to theoretically explain how the decision is made. To empirically test the model predictions we applied experimental vignette methodology in an online survey with working adults. The hypotheses were confirmed in that the calculated and predicted decisions significantly matched the intentionally chosen decisions. The results contribute to a better theoretical understanding of the decision-making process and provide starting points for interventions to manage attendance behavior in organizations.

Effectiveness of Evidence-Based Telecoaching Delivered Through an Employer-Sponsored Mental Health Benefits Platform

Background: Coaches delivering telemental health services as part of an employer-sponsored benefit may increase access to affordable and effective care. We examined the effectiveness of evidence-based telecoaching delivered via videoconferencing to people requesting mental health services during the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: We analyzed data from 1,228 employees (mean age = 35 ± 8 years; 67.2% female) who utilized telecoaching through the Modern Health benefits platform between March 11, 2020 and March 11, 2021. We used paired samples t tests to examine changes in well-being, burnout, absenteeism, and presenteeism before and after telecoaching and moderated regressions to test whether these changes depended on visit utilization. We analyzed rates of clinical improvement for well-being and reduction from entry in symptoms for burnout. We conducted analyses in the full sample and participants presenting with elevated symptoms at baseline. Results: Participants utilized an average of 2.6 visits. Well-being (p = 0.02) significantly increased, while both presenteeism (p < 0.001) and absenteeism (p < 0.001) significantly decreased at follow-up in our full sample, but represented negligible effect sizes. Burnout was not found to have significantly changed at follow-up in our full sample (p = 0.69). In participants beginning care with elevated depressive-related symptoms, well-being significantly increased (p < 0.001) and 46.3% experienced a clinically relevant improvement. In participants beginning care with elevated levels of burnout, burnout significantly decreased (p < 0.001) and 20.9% experienced a reduction in symptoms from entry. Conclusions: Leveraging videoconferencing, telecoaching had positive effects on mental health and workplace outcomes, even during the COVID-19 pandemic. Evidence-based telecoaching represents a promising option for achieving optimal outcomes in people who need mental health services.

The connection between leader behaviour and employee sickness absence in public administration

Purpose

The purpose of this study is to find the connection between leader behaviour and employee sickness absence in public administration.

Design/methodology/approach

The research data was collected with the help of an online questionnaire. The SPSS statistical programme and structural equation modelling in AMOS were used to analyse the data.

Findings

The research was conducted in public administration institutions, and 3,220 employees from public administration were included in the research sample. The author found a negative one-way relationship between certain types of behaviour and sickness absence. The author defines leader behaviour as a multidimensional construct in which each dimension represents a separate cluster of leader behavioural characteristics. Leaders’ “progressiveness” is the most important dimension, and a one-point increase in “progressiveness” (five-point scale) leads to a reduction of 2.8 days in sickness absence for one employee.

Research limitations/implications

The author focused only on one segment of factors (the behaviour of leaders) that affects sickness absence. To explain the maximum possible measure of the variability in sickness absence, it would be best to include several different influencing factors.

Practical implications

The study represents a structured model of the link between sickness absence and leader behaviour. With the model, it is possible to determine which behavioural forms of leaders influence sickness absence, where leader behaviour is treated as a complex whole, and not as an individual behavioural characteristic.

Originality/value

The study addresses calls for research on the relationship between leader behaviour and employee sickness absence within countries.

The influence of team mindfulness on nurses' presenteeism: A cross-sectional study from the perspective of sensemaking

AIM

This study explores the influence of team mindfulness on nurses' presenteeism. The mediation effect of perceived empathic concern and perceived insider status and the moderating effect of organisational formalization are assessed.

BACKGROUND

Nurses are prone to presenteeism. Few studies have explored the influence of the organisational environment on nurses' presenteeism. Studies that consider organisational, work-related and person-related factors on the decision-making process influencing nurses' presenteeism are scarce.

METHODS

Using a cross-sectional survey, data from 396 nurses were gathered from three time points and multiple regression analyses were used to test each hypothesis.

RESULTS

(a) Team mindfulness reduces nurses' presenteeism. (b) Both perceived empathic concern and perceived insider status mediate the relationship between team mindfulness and nurses' presenteeism. (c) Organisational formalization exerts a positive moderating effect on the relationship between team mindfulness and perceived empathic concern.

CONCLUSIONS

Team mindfulness reduces nurses' presenteeism through affective (perceived empathic concern) and cognitive (perceived insider status) sensemaking paths. Organisational formalization is a situational factor to improve the effectiveness of team mindfulness.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers need to devote themselves to cultivating team mindfulness, building an atmosphere to promote perceived empathic concern and perceived insider status, and promoting a formal organisational structure.

Working While Ill Is Not Always Bad-Positive Effects of Presenteeism

Presenteeism-going to work while ill-is a widespread phenomenon worldwide. Previous research has concentrated mainly on its negative effects. This study investigates the positive consequences of presenteeism derived from a comprehensive content model of presenteeism that was developed on the basis of negative effects. In a quantitative online-survey employees (N = 181) rated the degree of experienced or potential positive effects depending on whether they had worked while ill (75%) or not (25%) during the previous year. Results revealed that all postulated positive effects described in the content model were relevant. Most positive effects were rated significantly higher by participants who had shown presenteeism in comparison to those who had not. The positive effects significantly predicted presenteeism propensity (adjusted R ² = 0.20) for participants having shown presenteeism. In addition, an overall rating of positive effects was significantly related to presenteeism, however, to a lesser degree. Overall, the results demonstrate the applicability of the content model to positive effects of presenteeism. They point to the need for further investigation of them and their consideration for the management of presenteeism.

Evaluation of the association between presenteeism and perceived availability of social support among hospital doctors in Zhejiang, China

Background

This study investigated the association between presenteeism and the perceived availability of social support among hospital doctors in China.

Methods

A questionnaire was administered by doctors randomly selected from 13 hospital in Hangzhou China using stratified sampling. Logit model was used for data analysis.

Results

The overall response rate was 88.16%. Among hospital doctors, for each unit increase of the perceived availability of social support, the prevalence of presenteeism was decreased by 8.3% (OR = 0.91, P = 0.000). In particular, if the doctors perceived availability of appraisal support, belonging support and tangible support as sufficient, the act of presenteeism was reduced by 20.2% (OR = 0.806, P = 0.000) 20.4% (OR = 0.803, P = 0.000) and 21.0% (OR = 0.799, P = 0.000) respectively with statistical differences.

Conclusion

In China, appraisal support, belonging support and tangible support, compared to other social support, had a stronger negative correlation with presenteeism among hospital doctors. The benefits of social support in alleviating doctors’ presenteeism warrant further investigation.

Who gains the most from improving working conditions? Health-related absenteeism and presenteeism due to stress at work

Work stress-related productivity losses represent a substantial economic burden. In this study, we estimate the effects of social and task-related stressors and resources at work on health-related productivity losses caused by absenteeism and presenteeism. We also explore the interaction effects between job stressors, job resources and personal resources and estimate the costs of work stress. Work stress is defined as exposure to an unfavorable combination of high job stressors and low job resources. The study is based on a repeated survey assessing work productivity and workplace characteristics among Swiss employees. We use a representative cross-sectional data set and a longitudinal data set and apply both OLS and fixed effects models. We find that an increase in task-related and social job stressors increases health-related productivity losses, whereas an increase in social job resources and personal resources (measured by occupational self-efficacy) reduces these losses. Moreover, we find that job stressors have a stronger effect on health-related productivity losses for employees lacking personal and job resources, and that employees with high levels of job stressors and low personal resources will profit the most from an increase in job resources. Productivity losses due to absenteeism and presenteeism attributable to work stress are estimated at 195 Swiss francs per person and month. Our study has implications for interventions aiming to reduce health absenteeism and presenteeism.

Doctor's presenteeism and its relationship with anxiety and depression: a cross-sectional survey study in China

OBJECTIVES

The impact of presenteeism on doctors' health, quality of patient care and overall performance of health institutions has been reported. The study aimed to investigate the prevalence of presenteeism among doctors, the association between presenteeism and anxiety/depression, and aspects that can help alleviate presenteeism.

DESIGN

A cross-sectional anonymous survey study was conducted between 2017 and 2018.

SETTING

30 hospitals in Hangzhou city, Zhejiang Province, China including 10 category 1 hospitals (20-99 beds), 10 category 2 hospitals (100-499 beds) and 10 category 3 hospitals (> 500 beds) which had the highest population coverage.

PARTICIPANTS

At least 3 doctors from each department in the studied hospitals participated. Each participant received a gift worth around US$5 at completion of the survey.

PRIMARY AND SECONDARY OUTCOME MEASURES

The prevalence of presenteeism and its relationship with anxiety or depression were evaluated as the primary outcomes. Secondary outcomes included the prevalence of abnormal cases of anxiety and depression.

RESULTS

The survey was completed by 1153/1309 hospital doctors (response rate 88.1%). Presenteeism was reported by 66.4% of participants. Using the Hospital Anxiety and Depression Scale, 68.8% and 72.3% of participants had abnormal cases of anxiety and depression, respectively. Logistic regression analysis showed that participants with abnormal cases of anxiety, borderline cases of depression or abnormal cases of depression were more likely to practice presenteeism (all p<0.05). Other significant work-related contributing factors included: time working at the current hospital, management duty, monthly salary and ease of replacement (all p<0.05).

CONCLUSION

Presenteeism was prevalent among doctors in China and the association of presenteeism with abnormal cases of anxiety or depression was significant. Considering the modifiable work-related contributing factors, appropriate measures at the healthcare institutions to support doctors' mental health, help them develop and reinforce management skills, and ensure appropriate manpower are important to alleviate presenteeism behaviour.

Millennials: sickness presenteeism and its correlates: a cross-sectional online survey

OBJECTIVE

Sickness presenteeism (SP) is a well-documented phenomenon in the current workforce. However, little is known about the SP of future employees (Millennials). We investigated rate and propensity of presenteeism and health-related and work-related correlates in university students to obtain information about the relevance of SP in the future workforce. Sickness presenteeism (SP) refers to going towork while ill.¹ DESIGN AND SETTING: We administered a cross-sectional online survey in August 2018 involving self-assessments of health-related and work-related behaviour. As planned, we analysed rates, instances and propensities of presenteeism and absenteeism. The target population was Millennial university students.

RESULTS

749 German university students, average age 24.7±3.6 years, 49.5% women, mean academic progress 4.5±2.7 semesters, <1% without work experience, 15.4±10.3 mean weekly working hours. Presenteeism rates in the complete sample were 64% at school and 60.4% at work. For the subsample of participants who reported sickness, presenteeism rates were 87.9% at school and 87% at work. Presenteeism propensity among them was 0.67±0.34 at school and 0.68±0.35 at work. SP at school and at work was significantly correlated with subjective health (r=0.29, p=0.000 and r=0.25, p=0.000) and locus of control (r=-0.20, p=0.000 and r=-0.26, p=0.000). Age and sex adjusted multiple regression analysis showed that subjective health explained 9.7% of the variance in SP at school (B=0.049, p=0.000) and 8.1% of the variance in SP at work (B=0.037, p=0.000).

CONCLUSIONS

The SP rates of the future workforce were in line with previous research on older employees, whereas the presenteeism propensities we found here were higher. Across all analyses, subjective health proved to be associated with presenteeism. Thus, the relevance of SP will remain constant or might even increase with regard to the future workforce. Programmes offering health education should be implemented to sensitise this generation as early as possible.

Quality of leadership and presenteeism in health professions education and research: a test of a recovery-based process model with cognitive irritation and impaired sleep as mediators

Presenteeism (PRES) includes working while feeling ill and constrained in performance. Compared with absence from work, PRES generates significantly higher cost estimates. Health problems and PRES are related to leadership quality. Hence, research on corporate health management needs to explore why leadership problems (LP) correspond to more frequent PRES.This study tests recovery after work as an underlying process with cognitive irritation (COGIRR) and sleep problems (SP) as simultaneous mediators and explores three mediation pathways (path one: LP→COGIRR→PRES; path two: LP→SP→PRES; and path three: LP→COGIRR→SP→PRES). Out of 293 employees of a university's school of health professions in German-speaking Switzerland, 211 completed a questionnaire. LP and PRES were found to be positively related (r(211) = .22, p < .01). The tests of mediation yielded no significant results for path one and two, but the third mediation path LP→COGIRR→SP→PRES was positive and differed significantly from zero (B = 0.83, CI95 = 0.33 to 1.69). According to our results, a recovery-based mediation model fits the empirical self-report data best. These results suggest that occupational health interventions should improve leadership quality to promote recovery after work in order to increase health and productivity by reduced PRES.

Work-Related Intervention Needs and Potential Occupational Outcomes among Medical Assistants: A Cross-Sectional Study

Medical assistants' (MAs) working conditions have been characterized as precarious, and workplace-related intervention needs have been identified. However, strategies to change the MAs adverse working conditions are mostly seen on an individual level, including leaving the employer or even the profession. Since such intentions are antecedents of actual turnover, we aimed to quantify the potential link of reported unmet intervention needs with unfavorable occupational outcomes. Data were collected by means of a nationwide survey among medical assistants (n = 994) in Germany (September 2016-April 2017). The three subscales working conditions, reward from the supervisor, and task-related independence were derived from a 12-item instrument regarding work-related interventions needs (the independent variables). We used subscale-specific z-scores and a total needs z-score. The four outcome variables (i.e., intention to leave the employer, intention to leave the MA profession, choosing MA profession again, and recommending MA profession to young people) were dichotomized, and logistic regression analyses were performed and limited to MAs in employment (n = 887). We found that increasing needs according to the categorized total needs score were associated with increasing odds of all occupational outcomes. Needs pertaining to working conditions and reward from the supervisor were the strongest determinants of MAs' consideration of leaving their employer or profession (Odds ratios: 1.55-2.61). In summary, our study identified unmet work-related intervention needs that are associated with unfavorable occupational outcomes. In light of staffing shortage in health care, the identified needs should be addressed to ensure that sufficient recruitment of junior staff in the profession of medical assistants remains feasible and that experienced staff is retained.

Desired improvements of working conditions among medical assistants in Germany: a cross-sectional study

Background

In outpatient care in Germany, medical assistants (MAs) are the contact persons for patients' concerns and their working conditions are relevant to their own health and the provided quality of care. MAs working conditions have been described as precarious leading to high levels of work stress. Consequently, we aimed to examine MAs' needs for work-related improvements.

Methods

We surveyed 887 employed MAs between September 2016 and April 2017. A 20-item questionnaire measured desired improvements. To measure correlations between variables we computed a matrix of tetrachoric correlations for binary variables and performed an exploratory factor analysis. We ran ordinal logistic regression models employing 11 independent variables to examine determinants of needs.

Results

A total of 97.3% of the participants expressed any need and, on average, 10.27 needs were reported. Most frequently, needs were expressed related to a higher salary (87.0%), less documentation (76.0%) and more recognition from society (75.4%). Exploratory factor analysis suggested three dimensions of needs for work-related improvements (i.e. working conditions, reward from the supervisor and task-related independence). Ordinal logistic regression models only identified determinants for the outcome variable task-related independence, which was more frequent in those with longer work experience or in a leadership position.

Conclusions

The high prevalence of desired workplace-related improvements among MAs highlights the relevance of modifying their working conditions. The fact that we found only few determinants signals that there are no specific high-risk subgroups, but interventions to improve MAs' working conditions should target the entire MA population.

Associations of ambivalent leadership with distress and cortisol secretion

Ambivalent social ties, i.e., whereby a relationship is evaluated simultaneously in positive and negative terms, are a potential source of distress and can perturb health-relevant biological functions. Social interactions at the workplace, in particular with supervisors, are often described in ambivalent terms, but the psychological and psychobiological impact of such interactions has received little scientific attention. The current study examined associations between ambivalent attitudes towards one's supervisor, perceived distress (general and work-related), and diurnal dynamics of the stress hormone cortisol. 613 employees evaluated their supervisor in terms of positive and negative behaviors, which was combined into an ambivalent index. Higher ambivalence was associated with higher perceived distress and work-related stress (p < .001), and with a larger cortisol awakening response and higher day-time secretion post-awakening (p < .01). The present study is the first to identify ambivalence towards supervisors as a predictor of employee distress and stress-related endocrine dysregulation. In consequence, focusing solely on positive or negative leader behavior may insufficiently capture the true complexity of workplace interactions and attempts to compensate negative behaviors with positive are unlikely to reduce distress-but quite the opposite-by increasing ambivalence.