Absenteeism is an issue that has grown in importance over the past few years; however, little has been done to explore the impact of presenteeism on individual and organisational performance and well‐being. This article is based on interviews collected in nine case study organisations in the UK. Two sector organisations (one private and one public) were studied to examine absence management and a conceptual model of presenteeism, with further illustration provided using data from the other seven case studies. This enabled a pattern of presenteeism to emerge, along with the contextual and individual factors which impact on it. In addition to previous research, we found that presenteeism is a complex ‘problem’ and that it is not a single one‐dimensional construct, but is continually being shaped by individual and organisational factors. In addition, we found that performance and well‐being are more closely related to the organisational reaction to presenteeism and absenteeism, rather than the act itself.

Critical care outreach services have had a positive impact on the delivery and organization of hospital care. In attempting to share critical care skills, however, these services can experience a tension between the aims of service delivery and education - a tension which is partly resolved by sharing skills in the clinical and organizational context of direct patient care.

Purpose -Many studies look at the effects of human resource (HR) initiatives. Yet very few consider why organisations adopt them in the first place. Health and wellbeing interventions offer a critical case because they offer apparent benefits for all. Assessing the process of engagement reveals variations in managerial commitment, which has implications for studies of "effects". This paper seeks to address these issues. Design/methodology/approach -The study offered a free health intervention to organisations; this was separate from the research study, which aimed to assess the effects. A total of 86 organisations were approached, of which 53 indicated some interest in involvement. After further withdrawals and selection against criteria of size and sector, nine remained. The paper assesses the degree of engagement with the study, looking in detail at three organisations. The methods utilised included structured telephone interviews, qualitative interviews and observation. Findings -The organisations underwent a rigorous selection procedure to ensure their full commitment to the study. On this basis it is expected that the participating organisations would be highly engaged. However, it became clear that there were considerable variations in how they engaged. This reflected the favourability of the organisational context, but also the enthusiasm and commitment of key actors. Originality/value -Engaged organisations were a highly self-selected group. Studies of effects of interventions may thus be systematically biased. The interventions studies here were also shaped by how they were put into practice; they were not fixed things whose effects could be understood independently of their implementation. The study was also able to make predictions of the subsequent effects of the interventions based on the process of implementation. The results of a follow-up study to test these predictions will be reported in a further paper.

This article analyses nursing expertise with a particular focus at the level of clinical and organizational practice. Through an examination of a specialist team of hospital nurses, and drawing on the concept of a community of practice, the article provides a critique of discussions of nursing expertise which can be overly normative, individualistic or divorced from practice. The theoretical background to our analysis is the division of labour in health care; the case study on which this analysis is based is a particular health policy: the introduction of critical care outreach services. The empirical portions of the article are based on a qualitative study of eight such services in England. In the first part of the analysis we elaborate on three ways in which 'expertise' can be deployed in practice: teaching and training; consultancy and advice; and practical clinical action. Each of these is shown to be related to the development of a community of practice. In the second part of the analysis we examine in more detail the impact of outreach nurses on the division of labour in health care and on traditional occupational hierarchies. A general implication of our findings is that expertise has fundamentally social characteristics which need to be acknowledged in academic and policy discourse.