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"Presenteeism is a measure of productivity. It can be gauged in a number of ways," says Margie Weiss, PhD, CEO and community health advocate at the Weiss Health Group, a Neenah, WI-based consulting company that works with companies and communities on health and wellness.
The most frequently used metrics, says Weiss, are absenteeism statistics and Health Risk Assessment (HRA) responses. "One of the best mechanisms for occupational health care providers is a data dashboard that can be updated on a regular basis," says Weiss.
Dashboard components should be linked back to HRA results, health care costs, Employee Assistance Program use rates and Occupational Safety and Health Administration (OSHA)-recordable data, says Weiss.
Weiss says that confounding variables are a challenge when it comes to measuring presenteeism. For instance, an absenteeism rate could be the result of policy changes, effective employee health programs, or cleaner indoor air, she says.
"A great example is a decrease in smokers in the workplace, which could be due to 'no smoking' policies, support services such as counseling, or public policy changes," adds Weiss.
Another challenge, says Weiss, is the fact that HRA presenteeism statistics are the result of self-reported information. "One example of more quantitative testing would be biometric screening, such as blood pressure, percentage of body fat, and nicotine levels," notes Weiss.
A drop in absenteeism may coincide with the implementation of a new wellness program, but how do you know if the two events are linked? "It is sometimes hard to ascertain whether a new policy, health and wellness initiative or facility renovation results in increased productivity, less absenteeism or improved scores on HRA reports," says Weiss.
For this reason, it is important that occupational health care providers use a "triangulated approach" to measuring and reporting presenteeism.
Quantitative statistics, such as sick days, days worked and OSHA–reported absences, must be evaluated in conjunction with more subjective data, she explains, such as responses to items on HRA questionnaires.
"These metrics must also be tied to other financial metrics which measure business activity, such as sales or production revenues," says Weiss.
No objective metrics
Many types of employment have no objective ways to assess employee performance and productivity, says Diane Lack, RN, MS, CCM, cardiology case manager at the University of Michigan Health System's Cardiovascular Center in Ann Arbor.
"Self-reported measurements, especially with short recall periods of one or two weeks, can be vital sources of information in health promotion programs," says Lack. These provide high validity and reliability for measuring health risk as well as planning, implementing, and assessing interventions, she notes.
Lack says that an integrated approach to health and productivity improvements is the best strategy to decrease presenteeism.
However, she notes that research indicates that the complex nature of presenteeism, and uncertainties that still surround its measurements, warrant caution while translating measurements into monetary value.1
"There is no consensus regarding how best to measure, quantify, and evaluate productivity costs," Lack explains. "Inordinate emphasis on projected cost analysis should be discouraged, while standardization of presenteeism measurements should be encouraged."
1. Cyr A, Hagan S. Letters to the editor: Measurement and quantification of presenteeism. Jrl Occ Env Med. 2007;49: 1299-1301.