Companies that pressure employees to work when they’re sick may be losing more than they gain. A new study says such “presenteeism” — working when you’re sick and related behaviors — costs employers a lot of money in lost productivity and through behaviors like theft and deciding to quit to find a job that lets you stay home when you’re ill.

The University of South Florida study is published in the Journal of Occupational and Organizational Psychology.

The researchers said that missing work — absenteeism — may hurt productivity. But “going to work while sick — or presenteeism — costs even more.” A Harvard Business Review article noted estimates on presenteeism puts the national cost at $150 billion.

The researchers introduced a new tool called the “Presenteeism Pressure Scale” to measure the expectation by companies that workers would work even if they didn’t feel well. The scale assigns scores of 1-7 to statements like “People who use sick or mental health days are looked down on in my organization,” “I know people in my organization will understand if I need to take a sick day,” or “It is uncommon for employees to take sick or mental health days in my organization,” among others. Eleven statements were included in the final scale.

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“Employees often go to work while sick because they feel pressure from their workplace. In a study of 764 workers, many said they worked while unwell not solely due to personal motivations but because their organization made it seem normal or expected. This shows how much workplace rules and culture can influence attendance behavior,” background material on the study reported.

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But workers who feel pressured to work when they are unwell may resent it and view their employment negatively, “interpreting it as a lack of care for employee well-being,” per the research. And that lowers personal satisfaction and commitment to the job — “backed by data from over 800 workers from a diverse set of industries.”

Among the results is an increased chance that employees want to quit.

Popular Science reported on lead researcher Claire Smith’s assertion that “‘the characteristics of individual workers (e.g., need for social approval) and the nature of their jobs (e.g., high-performance standards) cannot entirely be blamed for the sizable and growing issue that is presenteeism.’ Instead, both organizations and researchers must consider the pressure the social context of the workplace exerts on workers to engage in unhealthy, unproductive presenteeism behaviors.” Smith is a University of South Florida assistant professor of psychology.

It’s a problem Smith said employers should try to fix by creating standards for “flexible, personalized policies” that allow employees to decide when they need to stay home because they’re sick.

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