Presenteeism and the Hidden Cost of Showing Up Unwell

There’s a behaviour that’s still quietly celebrated in leadership culture, often without being named. The leader who never stops. The founder who shows up regardless. The senior figure who pushes through illness, exhaustion, or emotional strain because it feels responsible to do so.

It’s usually framed as commitment, resilience, or dedication.

But there’s growing evidence that it’s doing far more harm than good.

That behaviour is presenteeism.

Presenteeism is defined as going to work despite feeling unwell or dealing with issues that would normally justify stepping back. People are present, but they’re operating at reduced capacity, cognitively, emotionally, and physically. In leadership roles, where judgement, decision-making, and emotional regulation matter most, that reduction has consequences far beyond the individual.

According to a 2020 study by the Chartered Institute of Personnel and Development, 89% of respondents had witnessed presenteeism in their organisation, while 73% had seen “leaveism”, people using annual leave to work rather than recover. Despite this, only 32% of organisations were actively taking steps to discourage these behaviours.

Presenteeism at leadership level doesn’t stay contained. It sets the tone.

TL;DR – Leadership Summary

Presenteeism in leaders often looks like commitment, but it quietly erodes decision-making, judgement, and performance. When senior leaders push through illness or exhaustion, they normalise unsustainable behaviour and create cultures that rely on sacrifice rather than capacity. Leadership wellbeing isn’t a personal issue, it’s a performance issue, and when leaders take responsibility for their own wellbeing, the impact flows through the entire organisation.

Low Absence Isn’t Proof of Healthy Leadership

Absence levels are the lowest they’ve been in two decades. On paper, that looks positive. In reality, it tells us very little about how leaders are actually functioning.

Leaders rarely step away when they’re struggling. More often, they continue to show up, carrying responsibility, pressure, and decision fatigue, while quietly operating below their best.

Leadership presenteeism often shows up as:

• Slower or more reactive decision-making
• Reduced strategic thinking and creativity
• Emotional fatigue, irritability, or withdrawal
• Leaders becoming bottlenecks because they won’t step back
• Teams hesitating to rest because senior figures never do

This isn’t about effort. It’s about capacity.

Presenteeism doesn’t remove risk, it delays it, until it appears later as burnout, fractured relationships, or long-term absence.

Why Leadership Behaviour Matters More Than Any Policy

Many organisations now have wellbeing strategies. HR and L&D teams are working hard to move the conversation forward. But there’s still a gap between intention and impact.

Only a quarter of managers believe they can spot early warning signs of mental ill health, and fewer feel confident having sensitive conversations at senior levels. Despite years of discussion, there’s been little shift in whether wellbeing has genuinely reached senior leadership agendas.

The reason is simple.

Wellbeing doesn’t become embedded through policy alone. It becomes embedded through behaviour.

If senior leaders consistently work through illness, exhaustion, or stress, the unspoken message is clear, regardless of what’s written in a handbook.

This is why leadership wellbeing needs to be treated as a strategic issue, not a personal one.

Selfish Leadership Reframes Presenteeism Entirely

Selfish Leadership isn’t about stepping away from responsibility. It’s about understanding that leadership effectiveness depends on wellbeing, not sacrifice.

When leaders push through regardless of how they’re functioning, they often believe they’re being dependable. In reality, they may be reinforcing systems that rely on overextension rather than sustainability.

Selfish Thinking encourages more responsible questions:

• What example does my behaviour set when I never rest?
• Am I modelling resilience, or self-neglect dressed up as commitment?
• Have we built a system that copes when I step back, or one that depends on me constantly pushing through?

These are the kinds of reflections that often surface in leadership wellbeing workshops, where leaders have space to step back and examine the patterns they’ve normalised, not as a judgement, but as a leadership development conversation.

Leaders who never stop unintentionally teach others that stopping is unsafe. Leaders who manage their energy deliberately create cultures where performance is sustainable.

Presenteeism Is a Leadership System Issue

Most leaders don’t practise presenteeism because they want to. They do it because they feel responsible, because they don’t want to let people down, because the business feels fragile without them, or because there’s an unspoken expectation that senior figures should be immune to limits.

Those beliefs don’t arise in isolation. They’re signals from the system.

A leadership wellbeing approach rooted in Selfish Thinking recognises that:

• Rest is not a failure of leadership
• Recovery underpins decision quality
• Sustainable performance requires leaders to manage capacity, not ignore it

This is often where leadership mentoring becomes valuable, not to fix individuals, but to give leaders a confidential space to untangle responsibility from self-sacrifice and build ways of leading that don’t rely on constant personal cost.

Why This Matters for HR and Leadership Teams

For HR and L&D teams, presenteeism is difficult to challenge because it looks like commitment. But unwell leaders don’t lead well, and cultures built on constant sacrifice eventually pay the price.

A top-down approach to wellbeing recognises a simple truth, when leaders are supported to manage their wellbeing, make better decisions, and rest appropriately, the impact flows through the organisation without needing to be forced.

A Final Reflection

If organisations want healthier teams, they need healthier leadership. That starts with recognising that presenteeism at the top quietly undermines everything beneath it.

Selfish Leadership doesn’t ask leaders to step away from responsibility. It asks them to take it seriously enough to protect their capacity to lead well.

Sometimes the most responsible thing a leader can do is pause, reflect, and change the example they’re setting.