We compare sickness absence policies in the Netherlands, Denmark and Ireland, examining whether and how the institutional logic of ‘activation’ that is paramount in Europe is understood and given shape in each country. They differ in their support for the underlying ideas of ‘activation’, and especially vary in the design of their governance systems, as can be seen in the allocation of responsibilities, the description of return-to-work routines and the use of regulative instruments. We contribute to institutional theory by demonstrating the important but often neglected role of national governance systems in the macro–micro linkage between institutional logics and organizational and individual behaviour. Since sickness absence is a major cause of workforce inactivity, the practical relevance of this study is the comparative reflection on recent policy developments to improve sickness absence management.