The relationships between lost work time and duration of absence spells: proposal for a payroll driven measure of absenteeism.

Absenteeism, when studied by researchers in occupational medicine, human resources, social epidemiology, and labor economics, encompasses several distinct issues: 1) An indirect cost of disease and injury, 2) lost productivity, and 3) an indicator of social disengagement. 1 Although many researchers have focused on health and medical reasons for absenteeism, others have emphasized personal and social factors. Chadwick-Jones2 proposes that the choice to attend work is the result of 1) the individual act of choice between alternative activities, 2) a withdrawal or escape from surveillance, or 3) an individual or group’s resistance to an inflexible system. Goodman3 further classifies absenteeism as either 1) an approach-avoidance behavior (which includes the Steers and Rhodes attendance model4), 2) the result of a decision process, 3) the outcome of an adjustment process, 4) a habit, 5) a consequence of an apparently unrelated event, or 6) a unique phenomenon. More remarkable than these diverse interpretations, is that the measure of absenteeism has also been variably defined, in part, to fit the various needs and objectives of divergent interested parties and researchers, and in part, due to the available sources of information. Consumers of absenteeism research are myriad and include government agencies looking to reduce absenteeism rates by changing wage replacement and social insurance programs; disability carriers looking to maximize profit while still meeting the standard of care of return to work; employers looking to minimize absenteeism by local administrative controls and policies; physicians tasked with determining the timeline for return to work; and labor economists working to optimize economic incentives to encourage attendance. As a result, each of these consumers have measured and predicted absenteeism using their own metrics, each with its own unique definition, numerator, and denominator. Commonly used absenteeism outcomes include hours absent,5–8 days absent2,9–17, and duration of absence spells2,10,13,15,18–21 either as the sole measure of absenteeism or in some combination. The metrics previously used in these studies has been recently and comprehensively reviewed.22,23 In addition to the confusion brought about by competing absenteeism metrics, further difficulty arises due to the often overlooked distinction between absenteeism (defined as time missed from work when one is scheduled to work) and sickness absence. Sickness absence (aka “sick-leave”), a popular term in Europe, has been defined, in research and in practice, as absence from work due to sickness.24 Research on sickness absence has been facilitated by the fact that most national social insurance programs require medical certification to qualify for benefits10,18,25. However, while it is often assumed that absence measured in these registries is due to ill health, researchers have shown poor correlation between actual illness and physician certification of illness for the purposes of obtaining wage replacement.26 Because the majority of administrative rules only allow for approved absence due to illness, most absences will then be reported by the employee as due to sickness. Given the divergent (yet complimentary) research fields in absenteeism, it is our opinion that a standardized measure of absenteeism is needed to help translate findings across disciplines. Moreover, due to the competing definitions currently in use for an “absence day”, “sick-listed period”, “sick-day”, “long-term”, and “short-term absences” etc., it is our belief that a standardized, cross-discipline measure of absenteeism can be accomplished only by using a straightforward and readily calculated measure based solely on hours worked and hours not worked. There are two main objectives of this article: 1) To introduce and demonstrate the calculation of a metric (the Work Lost Rate [WLR]) that can be easily derived from hourly payroll data, and 2) show how the WLR compares to other measures of absenteeism (absence days and duration of absence spell) that are currently in use. We hope that the WLR will be included in all studies that utilize payroll data, not as a replacement of existing measures of absenteeism, but as a standard metric which will facilitate interdisciplinary research and collaboration on absenteeism or sickness absence.