Presenteeism Is Costing Your Business More Than You Think

Being present isn’t the same thing as being productive. Coming out of COVID, much of the conversation around workforce performance focused on quiet quitting and the cost of employees mentally checking out. Now, as the country faces a growing health crisis, businesses need to pay just as much attention to presenteeism: employees who are unwell, yet still show up.

When it comes to employee health, most leaders focus on absences, but that misses a major part of the problem. Employees who come to work sick, tired, or mentally drained work more slowly, make more mistakes, and communicate less effectively. Last year, presenteeism cost companies over $150 billion [1]. For small and midsized companies, the cost is even higher because one underperforming employee affects the entire operation. Just because someone shows up to work doesn’t mean the business is getting their best.

What Presenteeism Actually Looks Like

People coming to work unable to perform at their usual level is called presenteeism.

The causes vary, but it typically stems from illness, chronic health issues, stress, poor sleep, mental health challenges, or financial pressure.

The real challenge with presenteeism is that it’s extremely difficult for leaders to spot. It doesn’t always look dramatic. It shows up as slower work, missed details, irritability, lower energy, poor communication, or lack of focus. The danger is that it hides in plain sight while the business still pays the cost.

Dealing with presenteeism isn’t any easier than noticing it. Employees come to work when they don’t feel their best because they feel guilty, worry about falling behind, or don’t want to be seen as unreliable. Those are real concerns, but the quality and quantity of work often don’t justify pushing through. It’s also hard for employees to know when to stay home because coming to work unwell is often celebrated by leadership as dedication. The idea of “toughing it out” gets reinforced, and the problem continues.

In Short

Presenteeism shows up as slower work, missed deadlines, irritability, lower energy, poor communication, or lack of focus.

Why Presenteeism Is Becoming a Bigger Issue

In recent years, presenteeism has become a bigger issue than ever before because more employees feel pressure to keep working even when they aren’t healthy enough to perform well. According to Harvard Business Review, from 2018 to 2023, the cost of presenteeism rose by nearly $30 billion [2]. The problem isn’t just that people are getting sick. It’s that financial pressure, rising healthcare costs, burnout, and remote work have made it harder for employees to fully step away, recover, and return at their best. Instead of taking the time they need, many workers stay plugged in and continue producing lower-quality work for longer.

Increased healthcare costs

In recent years, healthcare costs have risen sharply. As a result, it’s more difficult for people to see a doctor as often as they should, and many delay seeking care even when they need it. This keeps people sick for longer and makes health issues harder to resolve. When workers don’t have affordable or convenient access to care, they often continue living their normal lives and going to work while unwell. If healthcare costs continue to increase without leaders offering support, like a preventative health plan, the problem will only continue to worsen.

Burnout is more common

Burnout has been a major topic in the business world over the past few years. Rising workplace demands and economic pressure have created a more anxious work environment. As people lose the energy and drive they once had for their work, presenteeism starts to set in. They still come to the office, answer emails, attend meetings, and complete tasks, but they aren’t contributing at their typical capacity.

Remote work

Many people would probably be surprised to learn that remote work contributes to presenteeism. It blurs the line between work and rest. People who work from home often find it harder to separate their work life from their home life. They have trouble turning the switch off, and many feel like they are always at work. Remote work also makes it easier to keep working when sick because all they do is open their computer. Their output is lower, and they stay sick longer, but they feel like stepping away isn’t a real option.

In Short

Rising economic pressures have made the issue more common, while the increase in remote work has made it more difficult for people to separate work life from home life.

Why Presenteeism Hits SMBs Harder

For SMBs, presenteeism becomes a company-wide operational issue. In large companies, when people don’t show up at their best, the impact is easier to absorb. They have extra layers that fill in the gaps when people are just going through the motions. SMBs don’t have that luxury. They rely on every person pulling their weight each day to compete, and they don’t have the people to absorb reduced performance.

Small teams are a lot like a house of cards. One piece out of place affects the whole structure. One employee operating at 60% slows down projects, customer response times, and internal communication. Their attention to detail drops, quality suffers, and customers start receiving a worse experience.

That impacts every part of the business and makes it harder for others to do their jobs. In customer-facing roles, a drop in patience or focus makes customers feel rushed or dismissed. A customer may stop working with the company altogether because the person they interacted with shouldn’t have been working in the first place.

There is also the risk of spreading sickness to others in the office. Most SMBs are able to overcome one person delivering subpar performance, but not several. If sickness spreads, the problems multiply. Projects don’t just slow down; they stop. Internal communication breaks down, and people lose visibility into what’s happening. This forces the employees who are operating at full capacity to take on even more, increasing stress and making the original problem worse.

During the pandemic, people gained a real understanding of staying home when sick. However, as time has moved on, old habits are creeping back in. Recently, employers have been pushing hard to get their workforces back in the office, putting even more pressure on their teams to come in no matter what.

To be successful, SMBs depend on an outsized impact from their workforce. Presenteeism makes that harder because it doesn’t just affect one person’s work. It spreads through the organization. If leaders don’t take steps to reduce presenteeism, the company pays the price in productivity, quality, customer experience, and team stability.

In Short

SMBs are hit harder because they rely on an outsized impact from their teams. When one person is operating below their usual level, it impacts the entire organization.

What Leaders Can Do

For an organization to overcome presenteeism, change has to come from the top down. This isn’t the kind of issue that blows over on its own. Leaders need to take active steps to help their workforce stay healthy and perform at their best.

Offer preventative health support

Leadership needs to take proactive steps to make healthcare easier to access. A preventative health plan helps employees get care earlier instead of waiting until a small issue becomes a major absence. These plans provide easier access to primary care, urgent care, virtual doctors, prescriptions, and routine support. All of that helps employees address health problems before they disrupt the business. When leaders take care of workers, workers are better positioned to take care of the business.

Make it ok to stay home sick

Leadership sets the standard, and employees shouldn’t feel like staying home when sick is a sign of weakness or lack of commitment. Leaders should communicate clearly that protecting the team matters more than pushing through illness. Presenteeism has a much larger impact than many leaders realize. Leaders need to make one thing clear: taking time off beats pushing through sick and dragging down performance.

Watch for signs of presenteeism

While it’s difficult to spot, leaders need to look for signs of presenteeism. They should pay attention to sudden drops in quality, focus, energy, responsiveness, or communication. Those signs often point to someone who is struggling but still trying to show up. By noticing the signs early, leaders are able to step in before the issue affects the entire organization.

Cross-train where possible

Even with better health support, people will still get sick. However, leaders should take steps to make it easier for employees to take the time away they need. In SMBs, one of the major reasons people “play through the pain” is because they are the only one in the company who knows how to do the job. They feel like staying home will create problems for everyone else. Cross-training key responsibilities reduces that pressure. People know they have backup, so they aren’t as nervous about taking care of themselves. SMBs should also consider adding a vetted “bench” of experts for key areas that can’t go unattended. For roles like engineers or customer support, it can be incredibly valuable to have a trusted source to turn to when someone has to miss time.

In Short

By making it easier for employees to get care and training people to be able to step in for each other, SMB leaders can make a real difference.

Showing Up Should Not Come at the Cost of Performance

Presenteeism is easy to overlook because the employee is still showing up. But showing up isn’t the same thing as performing well.

When employees come to work sick, exhausted, or mentally drained, the business pays for it through slower work, more mistakes, weaker communication, and poor customer experiences. For SMBs, that cost hits harder because every person plays an important role in keeping the business moving.

Leaders can’t eliminate every illness or personal challenge, but they can reduce the pressure employees feel to work through them. By offering preventative health support, making it ok to stay home sick, watching for warning signs, and cross-training key responsibilities, SMB leaders protect both their people and their business. Presenteeism isn’t a sign of dedication. It’s a warning sign that employees don’t have the support, coverage, or confidence they need to step away and get healthy.

Take the first step towards tackling presenteeism right now. Download this whitepaper and learn how a preventative health plan can save you the money lost to presenteeism.