By Kay Needle, Early Intervention and Rehabilitation Expert at Generali UK Employee Benefits
Evolution in thinking about presenteeism – the fact that there are different types and not all are bad for people or business – could arguably be applied to absence management. Changes in working practices have ensured that absence is no longer black and white; absent or not absent. There’s a middle ground and we don’t always have to be feeling 100% fit and well to be working. This brings potential implications for absence management policy and practice, including the type of early intervention and rehabilitation support extended to employees.
In our latest Wellbeing360 podcast episode I discuss this, together with Dr Julie Denning, Managing Director & Chartered Health Psychologist at Working To Wellbeing, one of our early intervention partners. Julie is also Chair of the Vocational Rehabilitation Association.
We ask and explore: should modern working practices lead to a more flexible approach to absence and recovery? Is there a risk that such an approach might lead to an increase in the type of presenteeism that’s not good for people and business; namely, working while too unwell? And what can employers do to support employees at different stages of the Health Continuum?
In this article, we include some of the highlights from that podcast.
Presenteeism: learned behaviour from school days?
Kay: Do you think working while unwell might be driven by underlying, learned behaviour that perhaps goes right back to our childhood and school days? You know, you take a day off sick and your parents guilt you for it, because they’ve got to take a day off work to be home with you.
Julie: Just the other morning, incidentally, my son was saying that his recent time off school for sickness impacted his absence rate; it’s no longer 100%. I don’t remember even having that kind of thought process when I was that age.
Kay: Yes, UK schools have to provide statistics on absence to a national government database. The classroom environment is effectively a model for a professional environment. So, if we’re learning in the classroom that absence is not OK, that’s what we’re carrying through to our professional lives. This could potentially be fuelling that working while unwell presenteeism.
New ways of working, sickness absence and behaviours
Kay: Hybrid working seems to be driving a shift in learned behaviours. When we have our weekly team catch-up and look at who’s going to be in the office over the coming week, people will sometimes join the call who are clearly unwell and say they’re planning to come in. The rest of the team is now saying, “Please don’t! You seem unwell and we don’t want to catch it!”. Then the person is relieved and feels OK to stay home. We’ve moved to a place where we know we don’t want to spread illness in a team, but we’ve yet to shift to a place where people can confidently say: “I’m not well, so I’m not coming in”. We seem to need others to facilitate that for us. So, we’ve still got a way to go, but there has been a mindset shift.
Julie: And that brings us to ‘types’ of illness too. There’s the infectious stuff that you can see and hear. But what about those with a long-term condition, where the symptoms might be hidden. Then what kind of conversation are you having. In situations where there aren’t the social cues to say “please stay at home” how do we help that section of the population?
This is where Vocational Rehabilitation support proves invaluable, either through utilising our expertise to train line managers in how to best help and / or supporting individuals with long-term conditions to return to and stay in work; whether on a remote or in-person basis. It’s often the case that people with long-term conditions are well enough to work, but perhaps not 100% well. Some may never feel 100% well, but that doesn’t mean they can never work.
The Health Continuum and healthy behaviour
Julie: This is where encouraging healthy behaviours comes in. This is about permissions, nudging, social norms and conformity. So, for example, if a line manager was actively putting lunch in their diary, everyone seeing their diary – and their associated behaviour at lunch time – would see there’s permission to do the same.
Kay: It’s going back to what we said earlier, are we ever feeling 100%. It varies throughout the day and from day to day. So, having an adequate lunch break could make the difference between, say, a 50% day and an 80% day.
Julie: Probably. There’s definitely evidence that going for a walk during the day makes you more productive. And having lunch means you’re refuelling – our bodies need it to sustain the day. This links into the idea of a Health Continuum; how are we proactively maintaining living a healthy lifestyle. The continuum goes from one end of the spectrum, which is healthy, sustained wellbeing, to the other end, which is death and premature death.
This isn’t necessarily about providing treatment. That might get you to that middle ground – symptom neutral – but, actually, we want to shift people across the continuum to get them into the space of good health and then optimum health. This is about maintaining and improving health and wellbeing as opposed to yo-yo’ing between poor health / good health states.
Kay: It’s interesting isn’t it, because neutral isn’t a bad place to start. A lot of us exist in neutral; no significant illness, maybe go to the gym when you’ve got time, drink more water or eat more vegetables when you can remember. In other words, you’ve built in some healthy behaviours but they’re not yet part of your day to day life.
Julie: The trouble is, this is about doing something that doesn’t have a clear and immediate outcome. And as human beings, we like to have a cause and effect. Before we get to the stage of automatic behaviour – the kind of behaviour that we then sustain for a long period of time - there needs to be a process of just checking in with yourself and noticing that, say, drinking more water, is actually helping. Or noticing that, as a result of exercising, you can climb the stairs without getting out of breath, or lift things more easily and not feel creaky when you get up from your chair. Or, through eating more healthily, you have a sharper focus.
When you’re trying to shift a behaviour, you have to notice that cause and effect for yourself. Otherwise, it might just pass you by.
Kay: From an employer perspective, we can determine whether the interventions needed to improve where employees sit on that health continuum are working, by measuring reduced absence rates. There’s also a lot employers can do around health screening, know your numbers, e.g. measuring visceral fat levels. These are all things that employers could arrange – and with the help of group income protection providers like us - to help their employees understand where they currently sit on the Health Continuum.
Julie: And when considering wellbeing interventions to try to shift employees from good to optimum, it’s important to not be ‘all-encompassing’. Otherwise, you’re missing the individual differences. It’s important to not assume you know what employees want. Instead, it should be about equipping employees to do what they need to do, within the overall spirit of wanting to support them to get to a good and optimum health space.
Kay: The Health Continuum picks up very nicely what we said at the start, about avoid black and white approaches. It’s about appreciating there are stages in between. That there’s a neutral place, and we don’t always have to be feeling 100% to perform well at work.
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