Managing to attend

Having a clear attendance management strategy will  help managers and OH staff to deal effectively with the problem
of sickness absence and ensure employees are treated fairly and consistently

To err is human, to forgive divine. However, what is the position when
organisations are faced with high levels of sickness absence?

Managers may consider that the level of non-attendance in their work area is
unacceptably high, but lack the skills or confidence to work towards reducing
it. They may try to "pass the buck", perhaps of the opinion that it
is an occupational health rather than a management problem. It is for this
reason that occupational health nurses may be expected to take a role in
attendance management.

Occupational health nurses can play a valuable part in an attendance
management strategy1. However, they must clarify their role as there is the
potential for conflict between their responsibility to management and their
impartial role as employee advocate. This article explores the roles of
management and the OHN in attendance management.

Sickness absence is absence from work that is attributed to sickness by the
employee and accepted as such by the employer. It is both disruptive and costly
to organisations and impacts on the country’s economy. Indeed, Whitaker asserts
that attendance management remains high on the agenda for governments in the
European Union2.

The costs incurred through non-attendance have implications on work output
and are not confined to those directly related to the financial costs of a sick
pay scheme3.

Sickness absence levels and health and safety

OHNs have a vested interest in attendance management on two counts. Firstly,
in the current climate of downsizing, making a positive contribution to the
reduction of the costs related to absences may justify their continued
existence within their organisation. Secondly, there may well be a relationship
between absence levels and employee health and safety.

Not only may absences be the result of workplace accidents, but accident
levels may be further elevated in areas with high levels of non-attendance,
possibly due to the employment of less experienced and temporary staff covering
reduced staffing levels.

The mismanagement of non-attendance could result in fatigue and stress among
staff covering the workload of their absent colleagues.

Employers have a duty of care under legislation to ensure the health, safety
and welfare of their staff. It is also in their financial interest to reduce
absences due to work-related ill health. OHNs are suitably positioned to work
collaboratively with workers, their representatives and management to improve
worker health. However, OHNs are urged to proceed with caution. Theirs should
be an advisory role; management "own" the problem. It is the
responsibility of managers to grasp the nettle and manage it effectively.

Non-attendance should be dealt with fairly and consistently; compliance with
the requirements of employment and other legislation should be demonstrated.

The findings of Harriss suggest that not all managers appear confident in
managing attendance. Perhaps some do not fully appreciate the variety of
factors underpinning absences1. They may have anxieties about a possible claim
for unfair treatment resulting in their appearance at an industrial tribunal.
Others appear to take an "ostrich stance" burying their head in the
sand in the hope that if ignored long enough the problem will go away.
Unfortunately this is unlikely.

The underpinning causes of high absence levels within an organisation are
complex, but seem to be related to factors about the job, the individual and
the organisation. They are not always directly related to health status, even
though illness may be the reason that the worker gives for non-attendance. For
example workplace stress is currently very topical. Organisations may offer
stress management sessions. Paternalistic organisations may even fund
complementary therapies and ask the OH service to assist in this. Although
employees may perceive these as added benefits, if used in isolation such
measures are open to criticism; if the root causes of organisational stress are
not resolved, such measures can be dismissed as a mere panacea.

A strategic rather than "sticking plaster" approach by management
and the OH service may impact on the organisational factors that precipitate
unacceptable levels of non-attendance.

The roles of management and the OHN

There are several facets to the role of managers in managing attendance. The
foundation of attendance management is knowing the extent of the problem by
maintaining sickness absence statistics and the formulation of a robust policy
communicated to managers and employees. The constituents of such a policy, including
the manager’s responsibilities, are detailed later.

Managers should receive training in dealing with ill health and absence
issues in order that they treat all staff fairly and consistently. This
training should include referral procedures to the OH service and the need to
make reasonable adjustments including a temporary or permanent reduction in
work hours, alterations to work processes, re-training or re-deployment.

Policy development

Many OHNs participate in the formulation of a range of health and safety
policies such as those covering moving and handling, facilitating the
employment of people with a disability, stress, and alcohol and substance

As highlighted above, if the management of attendance is to be undertaken
fairly and consistently an attendance policy is essential and OHNs should be
involved in its formulation as this avoids them being coerced into working
within the requirements of a policy with which they do not agree.

The policy should define what constitutes sickness absence and state the
procedure employees should follow for reporting absences. It should also
indicate how attendance is managed. It is usual to distinguish between
long-term and short-term absence and an OH referral may be required as a result
of either of these patterns of non-attendance.

A period of long-term absence of say six weeks may be the result of major
surgery. It is important to assess whether the employee is indeed fit enough to
resume the requirements of his or her post. The employee’s general practitioner
may have indicated to the patient that a good recovery has been made but
without appreciating the patient’s job requirements. The OHN is able to make
recommendations regarding fitness, or otherwise, to return to work.

Repeated short-term absences are the most disruptive as making suitable
arrangements for cover poses difficulties. Advice from the OHN may be sought
regarding possible underlying health issues leading to this pattern of
non-attendance. Although this is not part of a disciplinary process itself, if
no serious health problems have been identified the manager may then decide to
initiate disciplinary action. No matter what the absence pattern the manager
has an important part to play. This includes undertaking return to work interviews
(RTWIs) and, if considered appropriate, then making a written referral to the
OH service. The manager must explain why a referral is necessary and gain the
employee’s consent to this. The employee cannot be forced to attend such an
appointment and has the right to withhold consent. However, without OH input
the manager is unaware of the work implications of the employee’s health
status. Managers have to manage their staff and they can still initiate further
disciplinary action with or without OH advice.

RTWIs should be detailed in the attendance policy. These meetings offer the
opportunity for both parties to discuss any problems that may be affecting work
performance or attendance. It should demonstrate to employees the manager’s
concern about their welfare. Furthermore it indicates to staff members that
their attendance at work is important and that their absence has been noted.
This may influence their decision to withdraw from work in the future.

Data collection

The compilation of accurate data is the first step in promoting attendance
and is key to successful attendance management. If the extent of non-attendance
within a workplace is unknown it cannot be managed successfully.

Buchan suggests that interventions can only be effective if they follow the
collection of appropriate sickness absence data4. Accurate record keeping is
essential in identifying attendance patterns. These records should indicate the
frequency and duration of spells of absence in a given time period, usually the
financial year.

Managers find it helpful to see how periods of absence relate to days of the
working week – particularly if absences repeatedly seem to fall either side of
a weekend or on days that precede, or follow, annual leave.

Triggers for management action

Repeated short-term absences should trigger further management intervention.
Silcox notes that 61 per cent of organisations utilise a trigger system based
on length or number of spells of absence or a combination of both. The use of
triggers facilitates the review of an individual’s attendance record and may
result in a referral to the OH service5. Although the use of triggers is
common, an Industrial Relations Services study suggests that there is no
preferred system6.

Organisations may choose to initiate interventions following a stated number
of episodes in a given time period. Alternatively they may use an index such as
the Bradford Factor (BF). The BF is a simple formula indicating the
significance of a worker’s absence pattern and facilitates the recognition of
repeated short-term absences. The BF is calculated by multiplying the number of
days lost from work by the square of the number of episodes of non-attendance.

The following scenario illustrates how the BF can be used: A manager has two
employees who have both been absent from work for 20 days within a period of
three months. The first employee has been absent for 20 consecutive working
days as the result of a hospital admission. The Bradford Factor for this person
would be 20 days multiplied by the square of one episode, i.e. 20 x 12 = 20.

The second employee had absences totalling 20 working days on five occasions
within the same three-month period. The BF for this person would be 20 x 52=
500. This highlights the significance of the absences of the second employee.
Management may choose to initiate action based on the use of this factor.

OHNs should not be directly involved in any disciplinary processes as this
would lead to an ethical conflict. Their role is advisory and supportive rather
than policing; this should be made clear to both line managers and the referred
employee. OHNs are able to assess any underlying health problems linked to the
employee’s absences. They are then in a position to give impartial advice to
both employee and employer.

The advice to these parties may serve different purposes. The employee may
appreciate advice on how he or she can deal with a health problem. The advice
given to management will usually explain the implications of the employee’s
health status in relation to the job requirements and performance at work
without breaching client confidentiality.

Absences may be work related. Reduced morale, perhaps the result of poor
working conditions or an aggressive management style, could be reflected in
elevated absence levels. Concerns regarding working conditions require a
further risk assessment, perhaps resulting in modifications to work processes
or control measures.

It is appropriate that the OHN is asked for an opinion on the health of
employees with a tendency to repeated short-term absences as well as those who
have had a long-term absence. These may or may not be work related.

An automatic client review by the OH service is advisable following a period
of long-term sickness absence, of say three weeks’ duration, or following a
reportable workplace accident. This offers the opportunity to decide whether
the person is now fit enough to carry out the requirements of the job or
whether a return to work programme should be negotiated with both the client
and the manager. This is appropriate whether the absence was the result of
physical or mental illness.

The use of the term recovery programme is used in some organisations to
stress the positive aspects of such an initiative.

OHNs have the specialist clinical knowledge and skills to devise and
initiate a phased recovery programme and this should be an important aspect of
their role.

Assessment of fitness

A competent assessment of fitness to return to work involves consideration
of the extent of fitness or degree of impairment and the employee’s job
demands. It requires an appreciation of the work processes and materials. The
fitness to work (FTW) model proposed by Murugiah, Thornbory and Harriss7
(Figure 1) may prove useful in considering whether an employee with a
significant health deficit is fit to return to work on restricted or
unrestricted duties. This model provides a framework to match a person’s
attributes with specific work requirements, as well as a framework for the documentation
of the decision-making process. This model may prove invaluable to OHNs during
their consultations with employees. There may be an added benefit to the OHN if
management decide to terminate the employment of the member of staff on the
grounds of non-attendance. If this individual feels he or she has a case for
unfair dismissal the OHN may have to justify to an industrial tribunal any
recommendations made to management.

The OHN can make effective links with a range of practitioners, such as doctors,
disability advisers, ergonomists, and physical and occupational therapists in
order to give the best possible advice to both worker and manager. Although
employees may be fit to undertake work of some description, a multitude of
factors, not least continuing health problems, may preclude them from returning
to their previous post. Redeployment may be possible and should be

Termination of employment

Unfortunately the occasion may arise when a manager has no option but to
terminate the employment of a staff member who may be either a frequent
non-attender or have a significant health problem leading to long-term absence.

An industrial tribunal may find dismissal on the grounds of non-attendance
appropriate, provided that the individual concerned has been treated fairly and
that the organisation has demonstrated compliance with both company policies
and the requirements of employment legislation.

Dismissal would be considered fair under the following circumstances:

– If an employee has an unacceptable level of repeated short-term absences
and has been issued with formal warnings that failure to improve will result in
dismissal. The employer must demonstrate that employment was terminated on the
grounds of conduct, capability or some other substantial reason

– If the employee’s ill-health results in an incapacity to return to his or
her job, despite reasonable adjustments having been made, dismissal on the
grounds of incapacity may be considered fair. The employer must demonstrate
compliance with the requirements of the Disability Discrimination Act 1995

Employees with a long-standing health problem resulting in their incapacity
to carry out the requirements of their post should be dealt with sensitively.

Issuing warnings would be too harsh under these circumstances – payment in
lieu of notice is a more appropriate route to take. If the employee is a member
of a company pension scheme retirement on the grounds of ill health should be


Although managers and OHNs have different roles they both have the potential
to reduce non-attendance. Managers should assess the extent of the problem by
keeping accurate records; if they are aware of the extent of the problem they
are then more likely to be able to manage it. They may decide to pursue a
disciplinary route if an employee consistently has an unacceptable level of
non-attendance. However they would be ill advised to do this without first
having fully investigated the facts.

The OHN can advise on work-related health conditions, workplace hazards and
control measures. They may facilitate a return to work following an employee’s
period of sickness absence by recommending adaptations to the work tasks,
process or environment in order to match worker capabilities. This is to everyone’s


1. Harriss A (2001) Attending to sickness absence. The experience of OH
nursing degree students. Occupational Health Review, 92: 24-27.

2. Whitaker S (2001) The Management of Sickness Absence. Occupational & Environmental
Medicine, 58 (6): 420-424.

3. Harriss A (2001) Sick of absenteeism. Occupational Health, 53(10): 14-16.

4. Buchan J (1994) Attendance management. Nursing Management, 1: 18-19.

5. Silcox S (1999) Sickness absence survey. Occupational Health Review, 77:

6. Industrial Relations Services (1994) Industrial Relations Review and
Report 569 October.

7. Murugiah S, Thornbory G, Harriss A (2002) Assessment of fitness.
Occupational Health, 54 (4): 26-29.

Anne Harriss is Programme Director, Occupational Health Nursing, RCN
Development Centre, South Bank University

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