Patient safety culture shapes presenteeism and absenteeism: a cross-sectional study among Croatian healthcare workers

Abstract

Healthcare workers have high rates of injuries and illnesses at the workplace, and both their absence from work due to illness (absenteeism) or working ill (presenteeism) can compromise patient safety and the quality of health care delivered. Following this premise, we wanted to determine whether presenteeism and absenteeism were associated with patient safety culture (PSC) and in what way. Our sample consisted of 595 Croatian healthcare workers (150 physicians and 445 nurses) who answered the short-form WHO Health and Work Performance Questionnaire and the Hospital Survey on Patient Safety Culture. The results have confirmed the association with both presenteeism and absenteeism in several PSC dimensions, but not as we expected based on the premise from which we started. Opposite to our expectations, lower job performance (as a measure of presenteeism) was associated with higher PSC instead of lower PSC. Absenteeism, in turn, was associated with lower PSC, just as we expected. These findings suggest that it is the PSC that shapes presenteeist and absenteeist behaviour and not the other way around. High PSC leads to presenteeism, and low PSC to absenteeism. We also believe that the presenteeism questionnaires should be adjusted to health care and better define what lower performance means both quantitatively and qualitatively in a hospital setting. KEY WORDS: nurses; physicians; work performancePresenteeism and absenteeism are rather widespread and present a growing public health concern (1-3). Presenteeism is summarily defined as working ill instead of having taken leave (4) and entails lower performance at work due to health problems (3,5,6). Absenteeism is defined as absence from work (7) due to valid (sick-leave) or less valid reasons (taking a day-off) (8). Both have a very similar negative effect on business, such as expenses and losses in work hours, production, and work morale (9, 10). Presenteeism is often a hidden cost, as workers are physically present, but their performance/productivity is poor (3,11). A large study (12) reported presenteeismrelated production losses of 72 % compared with 28 % of those caused by absenteeism. Other studies also reported higher costs of presenteeism than of absenteeism (13,14).Two longitudinal studies have indicated that presenteeism may increase the risk of future health disorders (15, 16), as it stands in the way of recovery (3, 17). In fact, presenteeism can lead to more sickness absence, as indicated by the positive correlation between the two in several studies (4,18,19).The extent of presenteeism is perhaps best illustrated by a Dutch study (20) reporting that 70 % of the randomly selected participants had claimed to have worked sick at least once a year (20). With physicians, this prevalence soars to 90 % (21-25).In medical profession, presenteeism not only affects the quality of work (3, 11, 26) but puts patients, colleagues, and visitors at the risk of contagion (3,27). In other words, it compromises the very purpose of their work -patient safety. However, pa...

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“…Insight was also provided by the study into the perceived legitimacy of different complaints as a reason for doctors to take sick leave. Findings showed that fatigue, even if extreme, would not be considered legitimate, although its potentially serious effects on job performance Croatia showing that staff in organisations with a stronger safety culture were more, rather than less, likely to work while sick 54 .These findings suggest that safety culture may over-ride the self-care of health professionals which will actually compromise rather than improve patient safety.…”

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