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Finding the balance: A healthy attitude to work

Suzy Phillips on why presenteeism is more costly to organisations than absenteeism

New evidence from The Centre for Mental Health, the CIPD and Towers Perrin has revealed that 'presenteeism' costs up to seven times more than absence for organisations in the UK. It seems that more than 25% of staff, continue to work through illness instead of taking time off to recover. This will not only have a huge impact on the individual and their families but think of the effect on their colleagues.
When people are suffering from stress or other illnesses it is generally the case that they are not functioning as well as they would normally. Experience and evidence has shown that stress and illness impacts on an employee’s performance and efficiency as well as their colleague and client relationships. We have all no doubt witnessed or heard about a person who continues to struggle into work at the detriment of themselves and others. Their anxiety permeates and soon the office environment becomes a stressful place to be in. Evidence has revealed that public sector workers are at a greater risk of work- related stress than private sector workers, with mental health issues accounting for 4.6 million days lost in the public sector alone in 2010/11. 

Some recent examples from research:

  • Black and Frost for the DWP in 2011, revealed that 26% of staff are working despite long-term physical and/or mental health challenges (3)
  • The CIPD reported 53% of employees with poor mental health say they continue to go to work and 41% say they sometimes do. These employees report this impacts on their: concentration; learning; ability to make decisions; patience; ability to deliver multiple or complex tasks; and increases the likelihood of getting into conflict with colleague
  • 43% of employers underestimate the prevalence of mental illness in the workplace, and 72% of employers do not have a stress management or mental health policy.

So with all this evidence of the damaging effects of ‘presenteeism’ and lack of attention to wellbeing, what can be done to improve the situation in the workplace? Here is a story about what happened to a man who we will call John and what he and his employers then did: 

John was 42 and worked in the City as a senior manager in a large global investment organisation. He was married with two adolescent children and commuted in from Kent each day – a journey of about an hour and a half. He worked on average a 50-hour week and generally took work home at evenings and weekends. In his 20s, John had been a keen footballer and went to the gym three times a week. He was fit then and of average weight. He gave up football in his 30s and gradually the gym sessions went to once a week and then in his 40s, very occasionally.

John’s working life involved regular lunch and evening meetings with clients, trips around their UK offices, and occasional international travel which required him to stay away. He began to eat richer food and when in a hurry, fast food. His alcohol consumption increased and most evenings he drank a bottle of wine and even more at weekends. John began to put on weight and developed a bit of a paunch. At times when hurrying for his train he found himself getting breathless and perspiring a lot.

John's wife noticed a change in him. He seemed more distracted and increasingly involved in his work whilst at home. She began to resent his job but whenever she mentioned it to him, he would often reply that he was just finishing something which then went on for another hour. He would also get irritable with her and tell her how important it was for the company and if she wanted to have that next holiday then he needed to earn the money for it. Their relationship began to deteriorate and John increasingly buried himself in his work. He worried about his position in the company, feeling he was no longer one of the ‘bright young things’ with future promotion opportunities. John's colleagues began to notice how tired and short-tempered he was becoming at work. He was easily irritated when a new member of staff asked questions about their key project. He acted in a defensive way in meetings when the finance director asked him for certain figures and projections, and he was making quite a few errors. His friend Dave was concerned and kept asking John if he was ok, to which John tended to say he was fine, just busy. When Dave used to ask him to come out with the others for their usual Friday evening drinking session, John would either go and drink too much, or refuse saying he had too much on.

John’s wife was worrying about his state of health. John seemed out of breath a lot, was sleeping badly and had put on a lot of weight. One Sunday, John went to meet an old friend, Pete, to watch a football match and on the way began to feel dizzy. He started sweating profusely and began to clutch his heart. Pete was very concerned and wanted to take him to hospital but John steadied himself and said he just felt a bit faint and needed a drink.

It all came to a head the following week when John's boss asked to see him in his office. He pointed out to John several errors in his last report and mentioned that he was concerned about him. He felt it was unlike John not be "on the ball" and there had been talk around the office about his drinking. John became agitated, denying anything was wrong, saying there was a lot on his plate at the moment but once the contract they were working on was over, it would be fine. His boss said ok but he couldn't go on making mistakes as it was being noticed by the board. 

John went back to his office feeling dizzy again and felt an increasingly familiar pain in his heart which he ignored. Two days later his boss came to see him about an incident. He said there had been a complaint and he was concerned about John's performance and behaviour which was just not acceptable. He asked for the report he was waiting for. John suddenly felt tears brimming into his eyes, he found himself getting increasingly hot and flustered, and he finally broke down saying he couldn't cope and didn't feel well. His boss was taken by surprise and sat down with John, giving him a glass of water. They had a long chat which resulted in John being referred to Occupational Health and given some time of work.

Our story pauses here as we think of what might happen next. From experience in HR management and working as a consultant in many different types of organisations, a range of actions could now follow: 

John goes to Occupational Health who identify he is under pressure and recommends he takes a fortnight off work and sees his GP. John takes the time off and goes to see his GP but doesn’t explain the full extent of his problems or follows very much of the GPs advice. He returns to work, telling Occupational Health he is feeling a lot better and just needed a bit of space. Gradually John returns to his old ways and things become more serious health and work wise.


John goes to Occupational Health, who after a long meeting, book an appointment that week for John to speak to a specialist advisor they contract with, to talk about his issues and seek support with his life style. They ask John to contact his GP straight away about the pains he is having and his other health issues and book to see him again in a week’s time. They recommend to HR that John is given time of work and to see what the GP recommends as the way forward. The HR department refer to their Health and Wellbeing policy which supports the Occupational Health Adviser’s recommendations. HR then implement their health and wellbeing strategy, offering John a range of different options:

Attendance on a training programme or short interventions about diet, alcohol usage, weight, exercise, meditation/mindfulness and other ways of achieving a healthier work life balance; Reference to on-line support and leaflets on the above topics for John to read and complete short questionnaires on-line, leading to recommendations for actions; One-to-one meetings with an executive coach to enable John to explore his issues and find some options to achieve a healthier way of living and managing at work; A review of his work commitments and working style with his boss, discussing ways to help John return to work (if this was what he wanted).

After following most of option two and after a month off, John returned to work initially part-time and gradually increased this to full-time working. He cut out his international travel commitments, which were given to a colleague who was looking for the opportunity to experience this. John attended a gym twice a week and continued to enjoy football outings with his friend Pete alongside his son and daughter. After 6 months, John returned to nearly his former weight having changed his diet and taking more walks with his wife and dog during evenings and weekends. He altered the way he worked, having attended a course on effective time management, prioritisation and delegation. He only occasionally took work home. John continues to see his executive coach once a month, which he finds invaluable to keep him on track and to remember what is important to him in his life.

Organisations globally are recognising the importance of health and wellbeing policies and practice. Unilever’s health promotion programme in 12 months showed “significantly reduced health risks, reduced absenteeism, and improved workplace performance”. The cost of the intervention to the company was £70 per employee; these costs were more than outweighed by improvements in absenteeism and work performance. Royal Sun Alliance’s risk assessment and stress management programme indicated a 3:1 return on their investment. London Underground’s stress reduction programme for all 13,000 employees saw a reduction in absenteeism costs of around £705k in the first two years and improved productivity and positive healthy lifestyle change were also observed. 

It is time employees and employers work together to promote wellbeing for all staff. We know it makes sense.

Author: Suzy Phillips, senior partner, the8group


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