If you’re a manager, you want productive employees. Yet you’re probably blind to one of the most serious drains on their productivity – the aches and pains, both physical and emotional, that people bring with them to work. You’re probably also unaware of something even more surprising. The cost of health-related productivity loss may actually exceed the astronomical sums that your company currently spends on employee health care.

I’m reminded of these startling facts as we bid farewell to the flu season and usher in the time of hay fever. Last fall, many employers offered workers subsidized flu shots with the aim of minimizing the cost of people being out sick. Few companies subsidize employee purchases of Claritin and other over-the-counter allergy medications. Why?

They don’t because hay fever, unlike the flu, typically doesn’t prevent people from coming to work. This distinction between ailments that contribute to absenteeism and those that don’t is misleading. It ignores a growing body of research indicating that companies’ greatest health care expense is the decline in on-the-job performance that results from workers’ chronic and often relatively minor health issues.

This phenomenon, known as presenteeism, costs companies way more in lost productivity – 10 times as much, by some estimates – than absenteeism does. (Note that it doesn’t follow, at least from a productivity point of view, that workers should therefore stay at home rather than go to work when they have the sniffles, as numerous articles reporting on the topic have mistakenly asserted.) Furthermore, presenteeism’s costs appear to be significantly higher than companies’ direct spending on employee health care – more than twice the amount, according to an analysis Bank One did of its own medical costs.

All kinds of chronic medical conditions – from diabetes to migraines to back pain – can keep people from doing their best work. They can make it difficult to

• perform certain physical tasks
• concentrate for extended periods
• simply get up to speed at the beginning of the work day.

Depression appears to be the biggest cause of presenteeism, because (as my colleague Diane Coutu recently pointed out in this space) it is so widespread and because it can so profoundly hinder performance if untreated. But studies show that less severe ailments like seasonal allergies – in part because they’re so common – can in the aggregate cost companies millions of dollars in lost productivity.

Several years ago, I wrote an article in Harvard Business Review that introduced the concept of presenteeism to a broad business audience. Since then, researchers have

• improved the tools by which you can measure health-related productivity loss
• calculated the productivity return on certain investments in employee health – say, providing workers with free asthma drugs
• found that changes in employees’ health risk factors – for example, adopting or abandoning an exercise regime – can affect productivity for better or worse.

It’s time for executive hand-wringing about skyrocketing health care costs to be accompanied by an examination of how to reduce this potentially greater indirect cost. Targeted investments in worker health could more than pay for themselves in improved productivity – while offering the not-so-trivial additional benefit of improving employees’ quality of life.

I once saw a quote attributed to Mark Twain (inaccurately, I believe) that went something like this: “Publishers are like the weather. They exist so that people can have something about which to agree to complain.” If publishers ever served that purpose, surely they have been replaced by airlines. They are the universal subject of conversation, more inclusive than sports or movies, less likely to ruin friendships than politics, and less likely to interest HR than sex. Plus, we all have horror stories.

In this respect, April has been the cruelest month. Well, March and April, since Southwest started grounding flights (botched inspections) March 12, British Airways opened (if that is the word) Terminal 5 at Heathrow March 27 (lost luggage, lost staff), and American cancelled its workhorse MD-80 flights for several days starting April 8 (botched inspections). All in all, a great month for Amtrak.

Lord knows I fly enough to know that there’s inherent stochastic hurly-burly (b-school speak for “shit happens”) in air travel. But I never cease to be amazed by the airlines’ surreal attitude toward customer service. On American Airlines’s home page on April 11, the high-water-mark of chaos, the “advisory” at the top connected to a perfectly fine apology; and a day or two later, as normality returned, frequent flyers such as I got an apologetic e-mail. But when the front page of every newspaper in the U.S. shows your passengers stranded and pitiable, surely “FAA Inspections [i.e., not our fault] affect [totally halt] some [as much as 40%] AA travel” is a sentence that should go down in the annals of understatement. And surely the apology should have been on the landing page, not a click in.

British Airways did better, a little. Go there and a pop-up apology greets you. Currently it reads “Since opening London Heathrow's Terminal 5 on March 27, 2008, we have experienced some operational difficulties and we accept that we have not provided the level of service our customers expect.” It was more (and more appropriately) groveling earlier. Click past the “oops,” though, and you’re in an Orwellian opium dream: “At London Heathrow Terminal 5 we’ve created a natural, logical journey that’s so calm, you’ll flow through. It shouldn’t take long to get from Check-in to Departures. Transferring and arriving are just as simple and calm. Spend the time you save enjoying the excellent range of shops, cafes and restaurants. Or simply relax and be wowed by the world class architecture.” You’ll be so tranked out you’ll forget to worry about your bags.

As I said, I get it that things go wrong. Badly wrong. All the time. I get it that security is a pain, profits are nonexistent, systems are complex, fixes take time. I’m not stupid. So why do airlines behave as if they think I am?

If it’s accepted wisdom that businesses should revisit their strategies and organizational structures and processes on a regular basis to ensure that they are still relevant, doesn’t it make sense to periodically take stock of how you’re spending your time? Given the current economic climate, there’s no better occasion than now to step back and make sure you’re maximizing your value to your organization.

I got this idea while observing a program at General Electric’s famous management-training center in Crotonville, New York. Its purpose was to get managers better focused on pursuing innovation and growth, two of CEO Jeff Immelt’s top priorities.

I went through the program with the senior managers of the Power Generation business. With their work lives already overstretched by the old priorities, these “turbine heads” (as they are affectionately known within GE) had an epiphany: Something had to go. Then they proceeded to discuss which responsibilities they should delegate to others and which meetings could either be conducted more efficiently or killed.

Of course, you’d be an idiot not to rethink your job if you boss changes your priorities. But why wait? Drawing from the Crotonville experience, I’ve come up with some basic steps for carrying out this task:

Compare your calendar with the priorities. Label the purpose of every regular or recurring activity on your quarterly calendar and highlight those activities that are connected with your top five priorities. This simple exercise will reveal where you’re squandering your time.

Be ruthless. Instead of persuading yourself why you can’t give up the time you’ve been devoting to underperforming operations or overly demanding customers that seem important even if they aren’t connected to a strategic priority, start with the attitude that you simply cannot deal with them anymore. In some cases, you’ll realize that you’ve been treating the symptoms of the disease and should finally cure the disease. In others, you’ll discover that the task will provide a growth opportunity for someone else.

Ask your team to do the same. Then discuss together how jobs could be recast and how the group as a whole could better spend its time. Make it clear that everything can be challenged—down to the PowerPoint slides presented regularly at meetings. Do you really need 20? If you could only have, say, two, which ones would they be?

Make time for your people and yourself. When you’re rebuilding your calendar, be sure to include quality time for your team to get together to brainstorm about the strategy, the organization, and new opportunities. Last but not least, absolutely include time to pursue personal priorities that will help you grow and make you more valuable to your organization.

More on Productivity:
Beware the Busy Manager
Manage Your Energy, Not Your Time
Overloaded Circuits: Why Smart People Underperform
Are You Spending Your Time the Right Way?

With the current recession and inevitable downsizing, more and more business people are being forced to strike it out on their own. For some, this will be the opportunity to become a consultant, a teacher, or to write the great American novel. Inevitably there will be challenges. But whatever your post-corporate career holds for you, this much is certain: Your greatest challenge will be finding health insurance coverage without the corporate umbrella to protect you.

Take the case of my brother who was 55 and a former CEO when he took early retirement. To his great chagrin he discovered the he couldn’t find health insurance. A millionaire several times over, Mike had the money to pay whatever premiums a health insurance company might ask. The problem: he had preexisting conditions – diabetes and high blood pressure. No one in the state of New Hampshire would touch him.

I cannot emphasize strongly enough how much you must investigate health care coverage before you take a step into the great unknown. If you see the writing on the wall, start immediately to investigate your options. At no time has this been so important than it is now that some health care companies are implementing new policies requiring insured people to pay a percentage of very expensive drugs rather than the $10 or $15 traditional co-pay, according to a recent article in the New York Times (by Gina Kolata, April 14, 2008 ). The result is that consumers can pay thousands of dollars per month for a single life-saving drug.

The insurance companies covering blue chip corporations, such as Harvard University, are not yet following the pay-by-percentage policy. However without some radical shift in this country’s health care policy, it’s inevitable that even the premier insurance companies will force such requirements on consumers in the future. And if you’re setting out now to be an entrepreneur, the problem is immediate. There are no perfect options, but here’re a few places you can start looking for help.

• ehealthinsurance.com seems to offer pretty good coverage, but it’s not offered in every state.

• Local Chambers of Commerce provide insurance to members.

• Artists, writers, photographers, and so on can often receive insurance through The Freelancers Union.

• AARP, if you’re over 50, offers health insurance policies, but members are expected to pay thousands of dollars for the drugs they need.

Getting health insurance if you’re young and healthy is easy, but most people exiting corporations during downsizing are employees in their 40s and 50s. It’s a dangerous world for this cohort. My brother’s solution? He was drafted to run for selectman in New Hampshire and won by a landslide. A nice perk of the job: health insurance. But then my brother’s a true entrepreneur. With a little chutzpah and imagination – and luck – you can be, too.

So what’s been your experience in finding health insurance? What resources can you share? Are you satisfied with your policy, if you have been able to find one? What kind of coverage does your policy provide? How much do you pay? Since so much is at stake, please share what you have learned.

In an era marked by generally lower service standards in all kinds of industries, I had a singular encounter last week with a genuine service missionary named John (see Frances X. Frei’s HBR article,“The Four Things a Service Business Must Get Right”).

John is a furnace guy. He works for the oil company that delivers nearly $4/gallon heating oil to my house. He was there to do annual maintenance on my 25-year-old boiler. He arrived around 2:40 and stayed until 4, doing quite a bit more for my furnace than other guys had in other years. By the time he left, the unit was humming.

While he worked he told me that even though he’s employed by an oil company, he and his colleagues also service gas systems. “When something goes wrong with a gas furnace, the gas company tells you to call a plumber.” John’s company can sometimes win converts by coming to the rescue. He also said he’d just come from the house of an 80-plus-year-old customer with an ailing wife. The customer needed a new furnace but didn’t have the money for it.

“It breaks your heart,” said John. “Hell, if I thought he could just afford to pay for the parts I’d go over there myself on the weekend and put it together for him.”

The final wrinkle to this story is that John’s company went through a period of strict emphasis on service metrics. Management decreed that maintenance visits should be completed in a specified amount of time, regardless of the needs of the boiler in question. John looks back on this as a dark period in the company’s history, from which it—and he—are still recovering. But like a good primary care physician with a patient, he clearly relished being able to give my furnace as much time as he believed it needed.

So the question is this: Is someone like John a hero or a liability? Now liberated from metrics, is he squandering a scarce company resource—his time? Or is he building customer loyalty by the boiler?

“It’s possible to be too feminist!” my teenage son announced at the dinner table the other night. “How so?” I asked. “People can just go over the top, that’s all,” he said.
“He’s right,” said my husband.

I’m sorry to report that my daughter and I looked at each other and rolled our eyes. But I recovered my equilibrium and dug a little deeper into what my son meant. It turned out that he’s bothered by girls who talk as if women are superior to men – who stereotype men in mean-spirited ways.

“I agree, that’s not okay,” I said. “But it’s not feminism. Those girls are being sexist in the other direction. Feminism is about making sure girls and women have the same opportunities that men do – and vice versa.”

The exchange got me thinking about how biases affect our behavior at work. Despite my rather simplistic statement at the dinner table, I’m perfectly aware that bias is anything but simple or straightforward. The truth is that most of us have biases that we’d rather not admit to. HBR published a fascinating article a couple of years back -- How (Un)Ethical Are You? -- which encouraged readers to take the Implicit Association Tests (implicit.harvard.edu). Taking the test persuaded me that what we think we believe isn’t always what we unconsciously believe. Most people who take the test favor young people, rich people, and white people over older, poorer, darker people, for example. And people have biases in favor of their own social, racial, and gender groups that come into play during hiring, assignment, and promotion decisions.

I recently had to confront a bias in myself that I hadn’t really been aware of. I was reading an article we’re going to publish in the fall which looks at what Gulf countries are doing with the massive amounts of cash they’ve built up. They’re investing in their own infrastructure and also investing heavily in Northern Africa, China, India, and the rest of Asia. Something about the article made me uneasy. It didn’t take me long to realize I was uncomfortable because North America and Western Europe were barely mentioned. I guess that at some primitive, implicit, indefensible level, I still think that the United States and Western Europe are the center of the universe, and I get worried when that’s not the case.

I immediately went next door to my colleague Anand Raman, who’s Indian, and confessed. “I just realized you guys are taking over,” I said, mostly joking. “It was weird to feel invisible.” Anand laughed. “We’re not taking over,” he said. “But we might achieve parity.”

Have you had surprising moments of clarity at work, when you realized you were more biased than you’d thought? Any suggestions for managing bias?