With flu season in full bloom, it is not comforting that the people most likely to treat patients are the most likely to go to work sick themselves.
The phenomenon is known as “presenteeism.” Employees are there, but not doing much because they do not feel well or are distracted. Researchers calculate costs associated with lack of productivity in the workplace are at least two to three times greater than direct healthcare expenses.
As many as 80 percent of physicians go to work despite their own ailments, disregarding well-established links between patient illnesses such as the flu and bacterial infections to sick healthcare workers. Nearly 70 percent of medical residents also said they went to work despite flu-like symptoms, often fearing that they somehow seem less dedicated to their craft in the eyes of their superiors.
Despite improvement in recent years, the flu vaccination rate among healthcare workers remains less than 75 percent. However, it is not optional at some healthcare organizations. Baylor and Methodist systems employees are required to get a flu shot or face termination.
Other healthcare workers are just as unlikely to stay home because they feel they are indispensable or their absence will unduly tax coworkers. That especially is the case in small clinical practices.
The highest rates of presenteeism generally are in healthcare and education, where employees work with vulnerable populations. Working with pain and illness in medicine can be considered a badge of honor and professionalism, despite the risk of contagion and potential compromise to patient safety.
Nurses are especially afflicted. About 3 out of 4 nurses say they work with some level of pain, and about 1 out of 5 report symptoms of depression. Nurses who reported a high level of presenteeism were more likely to admit to higher rates of medication errors and a greater number of patient falls.
Texas Health Resources chief clinical officer Daniel Varga, MD, said healthcare workers are service-oriented people whose training often includes taking care of patients all night.
“This is part and parcel to their [professional] DNA,” he said.
THR’s company wellness initiatives attempt to address presenteeism, Varga said, incorporating financial and spiritual health as well as traditional risk factors and chronic conditions. He said THR attempts clinically to ensure patient safety does not depend on the performance of one person.
“A lot of [presenteeism] is inevitable despite pre-emptive intervention,” he said. “You are going to be a lot fresher at the beginning of a surgery than at the end.”
Varga noted the 2011 stricter national regulations that reduced the continuous-duty hours of first-year resident physicians from 30 to 16 hours to encourage more sleep and less fatigue as an attempt to address presenteeism.
Becky Hall, vice president of health and wellness at Baylor, said the system surveys its employees at least every two years about their engagement because they are more likely to remain with the organization and be more productive.
Hall also said the system spots trends in individual departments in health assessment questionnaires on presenteeism issues, such as back pain and stress. It deploys health coaches and educators to those departments to address the identified health issue. She said Baylor also uses its hospital chaplains to counsel employees who are going through divorce or other personal issues that can affect productivity.
Rosemarie Aznavorian, vice president and chief nursing officer at THR Central Staffing, said the two biggest presenteeism challenges for nurses are: working when they are sick, and fatigue. She said THR centrally monitors nurse work schedules at all of its facilities closely to allow adequate sleep and avoid excessive 12-hour work shifts. THR maintains a pool of more than 400 supplemental nurses to draw on in case of an outbreak in illness or special circumstances. For example, she said the supplemental nursing force was deployed to Cleburne in May 2013 after the town was ravaged by tornadoes to allow full-time THR nurses to deal with personal issues.
Cheryl Flynn, senior vice president and chief human resources officer of Methodist Health System, said Methodist also uses a supplemental labor pool during illness outbreaks such as the recent spike in flu cases.
Steve Jacob is founding editor of D Healthcare Daily and author of the book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at [email protected]