How much work can you get done when your co-worker is coughing, sniffling and sneezing right next to you? In addition to worrying about your teammate's well-being, it is hard not to wonder if they are contagious, whether you will be sick next, and how all of this is going to impact the project on which you two are working.

Conversely, everybody feels better if sick employees stay home. Here are four ways to create a culture that diminishes presenteeism.

Presenteeism is not being a hero

Back in the day, employees were considered heroes when they showed up clutching Dayquil and Kleenex, and sniffled and coughed through the workday. However, a workplace culture that views this behavior as dedication or strong work ethic reflects poorly on the leadership and negatively impacts productivity.

Presenteeism is, in the words of journalist and commentator Joe Queenan, "when sick employees drag their forlorn carcasses into the office and waste everyone else’s time by hacking their way through their working day on an empty tank."

According to the 2015 GCC Virgin Pulse study, presenteeism is estimated to cost businesses nearly 10 times as much money as absenteeism. Understanding the significance of that impact is the first step in avoiding presenteeism.

The second step to avoiding presenteeism is to create a culture that allows for calling in sick. As noted in a Harvard Business Review article, while it is clear when employees call out sick, it is not always clear when employees show up to work and suffer in silence — even when they have access to time off.

And while there is a growing trend of local governments to mandating sick time for even part-time employees, it is not a given that everyone has access to time off. Ensure that your organization provides for time-off options that are widely available and easy to access.

Third, create support systems that allow for remote or other work options. Technology can usually help accommodate exempt employees working from home. Flex or make-up time options can be alternatives for non-exempt employees or those working in jobs that must be done on-site.

Fourth, set the example. With the tools in place to allow employees to take time off or to work from home, leaders must be seen using those tools and encouraging managers to lead by example as well.

We need to make it a point to send employees home with well wishes and stay home ourselves when we are contagious. No one will take advantage of the resources provided if it is not seen as safe and encouraged to do so.

The bottom line is, presenteeism is real and expensive, yet it can be minimized or avoided by creating a culture that recognizes the cost and provides alternatives to coming to work sick.