Addressing Presenteeism: Looking Beyond “Being at Work”

When businesses work regularly  with occupational health professionals, they are very good at measuring absence. They have policies, trigger points for discussions or interventions and return-to-work plans—and have often built whole systems around it.

But where I notice challenges is recognising and managing situations where someone is at work, but not functioning well – presenteeism, and in practice, it’s often the piece that gets missed as it’s not always obvious.

Presenteeism doesn’t shout and isn’t’ always obvious.  It’s the person who is:

• turning up every day, but struggling to concentrate
• pushing through pain or fatigue just to keep going
• taking much longer to complete tasks than they used to
• quietly stepping back from parts of their role

On paper, they’re “in work” but in reality, they’re often operating well below their usual capacity.

Across the UK, the scale of this is significant. Employees lose far more productivity through working while unwell than through sickness absence, with costs running into the billions each year. [businessqu…rter.co.uk], [psychreg.org]

But beyond the data, what matters most is what we see in practice:

Presenteeism is often the point where things start to unravel—not where they end.

Why it’s becoming more common?

Rarely is it just about someone choosing to work when they perhaps shouldn’t – it’s multi-layered and complex.

It’s a combination of:

• pressure to keep up with workload
• not wanting to let colleagues down
• uncertainty about job security
• workplace cultures that still value visibility
• and increasingly, blurred boundaries with hybrid working

There’s also a strong link with mental health—research consistently shows it plays a major role in reduced productivity at work. [sheffield.ac.uk]. So what looks like “commitment” on the surface is often something much more complex underneath.

Where do usual approaches fall short? A lot of workplace systems still work in fairly binary terms:

• someone is fit for work
• or they’re not

But many people sit somewhere in the middle. They’re in work—but something isn’t working well for them. There are so many factors at play here and if we don’t evaluate this properly, we miss the opportunity to step in early, before things escalate.

Can we looking at presenteeism differently? In occupational therapy terms, presenteeism, at its heart, is about a mismatch:

It’s the gap between what the job demands, and what the person can currently sustain

That’s why it needs more than policy or medical clearance and needs a functional, biopsychosocial approach—which is exactly where occupational therapy comes in.

At Rehab Jigsaw, as occupational therapists, that’s always been our focus:

• understanding the real demands of a role
• understanding the reality of someone’s capacity
• and bridging the gap in a practical, sustainable way

What actually helps: evidence-based approaches in practice

1. Getting specific about the job (job task analysis)

Job roles are often described in broad terms—but people experience them in very specific ways.

When someone is struggling, we break the role down into:

• physical demands
• cognitive load (concentration, decision-making, pace)
• emotional and interpersonal demands
• environmental factors

This helps pinpoint exactly where things are going wrong, so that we can identify what reasonable adjustments would help and why. Without that level of understanding, adjustments can be too generic to be useful.

2. Resetting expectations through functional goal-setting

A pattern we see a lot is people trying to maintain their usual level of output, even when their capacity has reduced – that’s rarely sustainable.

Instead, we focus on:

• realistic, function-based goals, based around education and self-management strategies
• what someone can consistently manage right now
• developing a plan to gradually building back up, where appropriate (grading of activity)

It’s not about reducing expectations long-term— it’s about creating enough stability to move forward.

3. Adjusting the work, not just the person

Presenteeism isn’t just about health—it’s about the interaction between the person and their role.

So alongside individual strategies, we look at:

• workload and pace
• task prioritisation
• flexibility and structure
• environmental factors

Often, relatively small adjustments here can make a big difference—both to performance and how sustainable work feels.

Workload and job design are consistently identified as key drivers of presenteeism, so this piece really matters. [mhfaengland.org]

4. Supporting pacing, fatigue, and cognitive load

For many people, particularly those with chronic conditions, pain, or mental health challenge, the issue isn’t capability in isolation.

It’s consistency over time.

So we introduce strategies around:

• pacing and energy management
• structuring the day or week
• managing cognitive fatigue
• balancing work with recovery

These are often the things that stop short-term struggle becoming long-term absence.

5. Stepping in earlier

One of the biggest opportunities with presenteeism is timing. By the time someone is signed off work, things have often escalated.

Presenteeism gives us a window earlier in that process.

And when organisations act at that point:

• recovery tends to be quicker
• confidence is easier to maintain
• and longer-term absence is often avoidable

There is increasing recognition at a UK policy level that early, work-focused support is key to managing health at work effectively. [gov.uk]

Can we design a different way of measuring “being at work”?

Presenteeism challenges a basic assumption: that being at work means being well enough to do the job.

In reality, there’s a spectrum, and in the middle are people who:

• want to stay in work
• are doing their best
• but need the job to flex slightly to make that possible

That’s the space where the right support can make the biggest difference.

Bringing it back to what matters

At Rehab Jigsaw, our aim is straightforward:

to help people do what matters to them—at home, and at work.

When someone is in work but struggling, that still matters.

Because if we get it right at that point:

• we support the individual’s health and confidence
• we help organisations retain skilled people
• we save businesses time and money
• productivity increases
• and we shift the focus from simply being present… to working well

Final thought

Presenteeism isn’t just about productivity – it’s about function. Once you start looking at it that way, the question changes from:

“Why are they still at work?”

to:

“What’s getting in the way of them working well—and what can we realistically change?”

That’s where the meaningful work sits.

Contact us for a discussion around using occupational therapy to support your business.