Present but unaccountable: our sick health workforce

Hospitals are full of sick people and not all of them are patients. More and more staff in our hospitals are turning up for work that they are unable to do. They are present, but not working at their best, either due to health problems or other events that are distracting them or both.  It is called presenteeism and is now a bigger problem for the health sector than absenteeism. Up to half the total costs of hospital care can come from workers who are not functioning to their capacity. For example, they often work longer to compensate for the inefficient hours. However, working longer is no solution. Health workers suffering from presenteeism are prone to make more mistakes and are less able to think responsively.

Perceived loss of control over career and work environment are root causes of presenteeism.

Most of us know that we shouldn’t take our coughs and colds to work. On the occasions when we must go to work with an acute health problem, everyone understands that we will be functioning at reduced capacity for a short period of time. Unfortunately, that is not the case with presenteeism. Much of the damaging presenteeism results from long term and largely unrecognized chronic health problems such as rheumatoid arthritis, back pain, depression, obesity and insomnia. Chronic work discrimination, job insecurity and dissatisfaction also compound long term health problems.

Currently, there is little room to manoeuvre around these problems in our largely inflexible health institutions. Trainees are rotated according to service needs and permanent staff are at the behest of the accountants. Perceived loss of control over career and work environment are root causes of presenteeism.

It is time to disrupt our rigid health care so that it can bend not break. For example, we need employers to fit jobs to workers rather than the other way around. Increased flexibility is now essential; not only in career transitions and accessibility to leave, but also in work performance.

We have a wide range of instruments both physiological and psychological to help us assess task difficulty with patients but rarely use them with our workforce. Using signals such as eye movements and pulse rate to differentiate easy from difficult tasks is already operating in other in industries such as IT. In health care, it would be a nice way of integrating what we do for others into what we do for ourselves.

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