Absence Management in Healthcare: A Strategic Perspective

The Problem: High Absenteeism in a Healthcare Setting

In any organizational setting, the relevance of human resources cannot be overstated. It follows that for an organization to accomplish its objectives and fulfill its mandate, it should maintain a skilled, committed, and effective workforce. There are a wide range of personnel-related factors that affect the effective delivery of services in healthcare institutions. One such factor is personnel absenteeism. The problem identified in the selected Federally Qualified Health Center (FQHC) relates to a high rate of absenteeism — with the facility having to grapple with, among other things, unscheduled absences of staff. This effectively gets in the way of effective service delivery and results in longer patient wait times, a higher-than-desired rate of patient readmissions, and loss of revenue. The need to rein in the high rate of absenteeism at the facility has therefore been identified as a priority.

The causes of the high absenteeism rate were identified through the development and dissemination of an employee absenteeism questionnaire. Specifically, the questionnaire sought to establish the reasons employees cite for failing to report to their workstations for periods deemed beyond the acceptable time span. The key cause of personnel absenteeism was identified as low employee morale. Other, less prominent reasons cited included sickness and family commitments.

To determine the absence rate at the facility, the following formula was used:

Employee absenteeism rate (%) = (Number of days absent / Total working days) × 100

Data from the most recent quarter — specifically the months of July, August, and September — was utilized. During this period, the facility was found to have an absenteeism rate of 18%. For the facility to continue delivering effectively on its mandate, the employee absenteeism rate must be reduced. This is especially important given that the current rate is substantially higher than the industry average. Available data from the U.S. Bureau of Labor Statistics (BLS) indicates that as of 2022, the absence rate among healthcare practitioners and technical occupations in full-time wage and salary workers stood at 4.1% (BLS, 2023). With a reduction in employee absence rates, the facility is likely to witness positive outcomes including decreased patient wait times, a lower rate of patient readmissions, and increased revenue.

One of the steps to successful change identified by Kotter and Whitehead (2010) is increasing urgency. According to the authors, this involves the identification of a significant opportunity by a large number of people, who then become highly motivated to pursue it. In the present scenario, the goal is to get the process moving by initiating dialogue about the current state of affairs and the need to institute measures aimed at reducing absenteeism. This helps ensure that all those involved take ownership of the process and possess intrinsic motivation to see the change through. According to Boyatzis, Smith, and Oosten (2019), research indicates that one way of ensuring that change is lasting is by ensuring that it is both intentional and internally motivated.

Towards this end, the facility's key stakeholders will be provided with data gathered from the computation of the employee absenteeism rate and the employee absenteeism questionnaires. The impact of such a high absenteeism rate will then be highlighted, with specific reference to its effects on patient wait times, readmission rates, and revenue. Scenarios will be developed to illustrate what could happen in the future if the problem is not addressed, as well as the benefits the facility stands to gain if it is. There is also a need to ensure that the interests of all key stakeholders are understood, with the intention of demonstrating how those interests will be advanced or curtailed by the chosen course of action. Interests mapping is of great relevance in bringing key stakeholders on board and has been identified by Lax and Sebenius (2007) as a tool of effective negotiation. In their words, "since your counterparts will say yes for their reasons, not yours, you need the maximum insight possible into how well their interests would be met by a deal versus their best no-deal option" (Lax and Sebenius, 2007, p. 3).

Available evidence confirms that employee absenteeism has a negative impact on healthcare organizations. As Cole and Kelly (2020) point out, workers left to cover for absent colleagues often end up overworked, resulting in burnout and, ultimately, decreased employee morale. In their study on workload and burnout among healthcare workers, Portoghese, Galletta, Coppola, Finco, and Campagna (2014) found that "burnout among health care workers is associated with high turnover rates and absenteeism due to sickness, relative ineffectiveness in the workplace, as well as low job satisfaction" (p. 153). Unscheduled absenteeism at the facility therefore gets in the way of effective service delivery and results in revenue loss, high staff turnover, and low morale. There is urgent need to address the problem.