Patient safety culture shapes presenteeism and absenteeism: a cross-sectional study among Croatian healthcare workers.

Healthcare workers have high rates of injuries and illnesses at the workplace, and both their absence from work due to illness (absenteeism) or working ill (presenteeism) can compromise patient safety and the quality of health care delivered. Following this premise, we wanted to determine whether presenteeism and absenteeism were associated with patient safety culture (PSC) and in what way. Our sample consisted of 595 Croatian healthcare workers (150 physicians and 445 nurses) who answered the short-form WHO Health and Work Performance Questionnaire and the Hospital Survey on Patient Safety Culture. The results have confirmed the association with both presenteeism and absenteeism in several PSC dimensions, but not as we expected based on the premise from which we started. Opposite to our expectations, lower job performance (as a measure of presenteeism) was associated with higher PSC instead of lower PSC. Absenteeism, in turn, was associated with lower PSC, just as we expected. These findings suggest that it is the PSC that shapes presenteeist and absenteeist behaviour and not the other way around. High PSC leads to presenteeism, and low PSC to absenteeism. We also believe that the presenteeism questionnaires should be adjusted to health care and better define what lower performance means both quantitatively and qualitatively in a hospital setting.