Hearing loss hazard for call center workers

Noise-induced hearing loss is the second most common occupational disease, reducing the
quality of life for millions of people who suffer from it.

Loud machinery, equipment or vehicles have always been considered the main culprits for
noise-induced hearing loss, but these are - to a great extent - controlled by rules,
regulations and careful monitoring.

For years it was believed that being a call centre operator was a low-risk occupation, but
personal injury claims by call centre workers are increasing. These include repetitive
strain injury, eyesight and posture problems, transient balance disorder, tinnitus and
noise-induced hearing loss.

One of the main causes of hearing damage in a call centre is acoustic shock, which occurs
when a sudden and unexpected burst of high-frequency noise is transmitted through the
operator’s headset.

Dr Setsuo Maeda, a Professor of Human Vibration at Kinki University, Osaka, Japan, has
conducted research to compare the use of conventional headsets with bone-conducting
devices - and to evaluate whether newly available bone-conducting devices reduce the
risk of temporary or permanent hearing loss.

The testing took six days, using a Head and Torso Simulator (HATS), supplied by Brüel &
Kjær. In parallel with the actual workers making calls, the incoming call signal from the
telephone was divided between two headsets. A PULSE data acquisition system, a
monaural headset and a Personal Noise Dose Meter Type 4448 were also used.

“The call centre where we carried out the tests is small and noticeably quieter than the
large, international call centres that employ hundreds of people,” says Dr Maeda. In fact,
the largest call centre in Okinawa employs 3,000 people, making these workplaces
potentially much louder than the test call centre. “My conclusion is that hearing damage
could occur at levels above 90 dB(A),” says Dr Maeda.

Dr Maeda has also conducted laboratory experiments using HATS and PULSE to compare
normal headphones, with bone-conducting headsets, using white noise and found: “bone
conducting devices help to prevent hearing loss.” This has also been confirmed by studies
carried out at the University of Southampton in the United Kingdom.

Hazards of call centre headsets

1 November 2006
Jocelyn Dorrell
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Comments [2]
Noise, Work equipment, Stress/bullying, Noise

What will keep health and safety managers busy in years to come? A lack of physical activity by desk-bound
employees? Thermal discomfort and "multi-factoral risks" where workers face a number of interacting risks?
Jocelyn Dorrell finds that some of the hazards faced by call centre workers come via their headsets.

Last December, the European Agency for Safety and Health at Work's (OSHA's) Risk Observatory published the
best guesses of its panel of 60 health and safety experts in Europe and the US on the emerging risks to EU
workers' health and safety.

Page 1 of 14
Topping their predictions of what would keep health and safety managers busy in years to come were a lack of
physical activity by desk-bound employees, thermal discomfort and "multi-factoral risks" where workers face a
number of interacting risks.

The prime example the report (available at http://osha.eu.int/publications/reports/6805478) gives of workplaces

likely to harbour these multi-factoral risks is call centres. It cites lack of job control and high time pressure, poor
workstation design, background noise and inadequate headsets as factors that can interact to reinforce negative
health effects (see box 1 below).

If call-handling staff are particularly vulnerable to these combined risks, then the issue is one that needs taking
seriously, simply because call (or "contact") centres now account for so many UK jobs. Whatever the publicity
given to some of the big banks and insurers shifting call handling work "offshore" to the sub-continent and the
growth of online services, call centre employment in the UK is still rising and set to rise further in the short term
at least.

Growth forecast

In 2004, business forecasters Datamonitor estimated there were 5,980 contact centres and 435,000 agent
positions. They predicted that by 2008 there would be 7,320 centres and 500,000 agent positions. But the
Department of Trade and Industry's figures suggest that the number of agent positions had already passed the half
million mark as Datamonitor's figures were published.

Ever since the advent of the telephone, businesses have employed people whose jobs included making and
receiving calls to sell products or answer queries, but taking on staff to handle these tasks exclusively and
grouping them together in "centres", from the vast sheds with hundreds of workstations in the finance sector to the
handful of employees in the corner of a local authority housing department, is a phenomenon that took hold only
in the 1990s. The relative newness of the contact centre agent role means we are still learning about the health and
safety issues it throws up for employers. Two that have emerged recently are both delivered via call handlers'
ears.

Stressing a point

The pressures on customer-facing staff are well documented (see HSW December 2005, page 19) and call
handlers face some of the same hazards as employees who deal with customers face-to-face. The HSE's definition
of work-related violence includes verbal abuse and threats as well as physical assault and the former are a day-to-
day reality for staff manning sales and customer care lines.

Persistent verbal abuse can lead to anxiety, stress and absence from work; the HSE estimates that 13 million days
are lost to stress-related absence each year - a problem it is trying to help employers tackle by promoting its stress
management standards (www.hse.gov.uk/stress/standards/index.htm). Stress from customer abuse can be
compounded in call centres by ambitious call targets or key performance indicators (KPIs), a lack of task rotation,
too few breaks and too little job flexibility. Stress also increases handlers' risk of developing voice disorders, and
too few opportunities for making drinks due to heavy workloads can exacerbate the problem.

Agents at Lloyds TSB's UK centres are trained in coping with abusive customers at induction. "The advice is try
not to panic or lose your temper, don't take the comments personally and talk to a colleague or your supervisor
after the call if this will help," explains Ann Morrison, health risk manager at the bank. Company policy is that
call handlers may terminate a call if the customer's behaviour does not improve after a warning, says Morrison.
All such calls must be logged with a supervisor and there is the opportunity afterwards to listen to the recording of
the abusive call with a more experienced colleague to help the call handler identify alternative ways of dealing
with similar events in the future.

Morrison says the bank's advice to staff is based on the revised Local Authority Circular LAC94/1, drawn up by
the HSE and Local Authorities Liaison Committee (HELA) (available atwww.hse.gov.uk/lau/lacs/94-1.htm). The
circular includes a series of checklists for local authority inspectors to use when assessing whether any call centre
is a healthy and safe place to work.
Page 2 of 14
"We've also got a healthcare helpline, open to all our staff, which offers confidential counselling and emotional
support if anyone is particularly affected by an abusive phone call or other problem," says Morrison.

Dave Joyce, national health, safety and environment officer at the the Communication Workers' Union (CWU),
which represents call centre staff, says the problem of verbal abuse is getting worse. "People who work in call
centres are sometimes encouraged to try to appease people on the other end of the phone no matter how abusive
they get," Joyce says. He says all employers should follow Lloyds TSB's example in using the HELA guidance as
a starting point: "We would like all centres to match the standards that are set out in 94/1; not just the basic
compliance but also the suggested best practice for the working environment, DSE [display screen equipment],
stress."

Acoustic incidents

In October 2005, the CWU voiced concern about the safety of call centre workers in Aberdeen after staff
complained of bursts of noise in their headsets. Over two days, according to the union, 45 out of 160 workers at
the BT call centre suffered acoustic shock incidents, where sudden, piercing noises came through operators'
headphones. BT carried out a full investigation, acknowledging that from time to time they received reports of
"unexpected and sometimes unexplained sounds". A BT spokeperson said that in the "vast majority of cases" any
side-effects were minor and temporary.

Recent research from Australia and Denmark suggests the BT workers are far from alone. The Acoustic Safety
Programme (ASP) and the National Physical Laboratory (NPL) define an acoustic incident as "a sudden,
unexpected noise event which is perceived as loud, transmitted through a telephone or headset"; and acoustic
shock as "an adverse response to an acoustic incident resulting in alteration of auditory function"
(see www.acousticshock.org).

The new ASP/NPL definitions, which are supported by the CWU and the Department of Trade and Industry,
emphasise that "acoustic shock is not noise-induced hearing loss and occurs at sound pressure levels well below
those which present a risk of immediate hearing damage". Call centre workers using headphones are thought to be
vulnerable because of electrical interference and "sonic spikes", in addition to the more general risks from abusive
callers, whistles and so on.

The symptoms associated with acoustic shock vary, but according to reports can include pain around the ear,
hearing loss, tinnitus (ringing in the ears), sleep loss, noise sensitivity, lethargy, depression and headaches. These
symptoms may be long-term or permanent.

While the HSE is keeping an open mind about the causes of these reported symptoms and has taken a cautious
line on the new research (see box 2), the CWU claims acoustic shock is a "devastating 21st century industrial
injury".

"It's a major issue for us," confirms Joyce. "It ruins call centre workers' lives and it's costing the industry millions
of pounds." According to Joyce, the CWU and the PCS central government workers' union have already handled
more than 700 cases, securing more than £2 million in out-of-court settlements, with awards ranging from several
hundred pounds to more than £100 000. Joyce believes the industry is being too cautious about the problem: "A
lot of people are in denial that it actually exists. But the call centre industry is one of the biggest industries in the
UK today, and workers are at risk of injury every moment they're handling calls. We're campaigning hard for
better recognition of the problem."

Holistic approach

The Customer Contact Association - which has more than 800 corporate members, representing 3,500 senior
practitioners - stresses that while there have been reports of incidents and symptoms that have been described
collectively as acoustic shock, not enough is known yet about the problem. "As there have been no proven cases
as yet among people who work in call centres, our advice is to make sure you are compliant with the Noise at
Work Directive," says a spokesperson for the association.

Page 3 of 14
Tony Jones, marketing manager for contact centres at headset manufacturer Plantronics - the company that
supplied the headset equipment through which Neil Armstrong broadcast from the moon in 1969 - explains that
there are two distinct areas of noise that managers in contact centres and general offices need to consider.

"The first is sudden, loud noises that get referred to variously as acoustic shock, acoustic startle and acoustic
incidents - there isn't really an agreed definition in this area," says Jones. Most telephone systems will limit sound
above 118dB but, he points out, 118dB is still "incredibly loud" and this limit "offers fairly basic protection". It is
known that noise above 118dB can cause hearing damage but there is increasing concern in call centres about
incidents below this level, such as at the BT call centre. "Noises below that level can cause a lot of discomfort -
it's not a nice thing to experience - but fortunately it doesn't happen too often. These things are still the exception."

The second area is the agent's average total exposure to noise over an entire working day, which must be managed
according to the requirements of the new Noise at Work Regulations (see HSW March 2006, page 11). Jones
warns that buyers should be wary of claims that products are "compliant" with the regulations: "Although we
offer products that can help reduce exposure, you really can't say that any product is 'compliant' because the
legislation is about someone's total exposure." Exposure could include noise from co-workers, air-conditioning or
even nearby building works.

"What is really important is that contact centres look at this holistically, and that they look at not just one measure
but a range of different measures," urges Jones. "They could consider sound baffling, the materials within the
contact centre, agent placing, products that control the sound level via the headset; it really is important to look at
the total environment."

Box 1: Multi-factoral risks in call centres

 Prolonged sitting
 Background noise
 Inadequate headsets
 Poor ergonomics
 Low job control
 High time pressure
 High mental and emotional demands
 Musculoskeletal disorders
 Varicose veins
 Nose and throat diseases
 Voice disorders
 Fatigue
 Stress
 Burn-out

Source: OSHA

Box 2: Acoustic shock: the HSE view

The HSE is considering new data on acoustic shock and will consult experts in the UK and other countries to
form an opinion on the emerging evidence. It may issue guidance if it gets substantive evidence.

The executive says it cannot comment on the efficacy of "acoustic shock protection" devices designed to protect
call centre workers. Its current advice to call centres is that they should implement a traceable reporting system
for headset users who may have been exposed to acoustic shock incidents. The reports should include the
following:

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  date and time of the incident
 details of the source of the exposure
 description of the noise
 duration of the exposure
 details of the headset and telephone equipment used
 whether the incident was electronically recorded (a copy should be kept for future reference)
 symptoms experienced by the operator directly related to the acoustic shock incident.

The HSE says call centre agents should be trained to recognise such incidents and how to report them, and
reminds employers of their duty to report certain types of work-related injuries under the Reporting of Injuries,
Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR).

It recommends call centre employers keep up to date with developments in this field through their professional
associations and other representative bodies, as well as through their enforcing authority (usually the local
authority) via the HSE website.

Noise, Work equipment, Stress/bullying, Noise

Comments

It's really good that there | Submitted by admin

It's really good that there are some concerns about the risk that can be brought by in and out in the call centre
company...

 reply

call centre headsets | Submitted by Bob Fadi (not verified)

People working for customer service at time find it very hard to move around the office and even getting up their
seats. The show begins when there is a customer or a client iswith on the line and the representativeand has little
and at times not even little mobility freedom just because of the kind of the headset they are using. What I believe
is that there is always a right tool for the kind of job one does. So for people like these who are looking forward to
give customer service might at times need a wireless headset.
Health concerns

Long hours of work, permanent night shifts, incredibly high work targets, loss of identity are these the
dark clouds that threaten to mar the 'sunshine' call center industry in India? The odd timings and nature
of work roots people to a chair 9 h a day, reading pre-scripted conversations on the phone endlessly -
often to irate customers from across the globe. Where every single second of an employee's time is
recorded, measured and automatically logged onto a computer for praise or censure on a weekly basis.
Where walking down to the water cooler for a drink and a chat with a friend messes up performance
metrics, salaries, and hikes. Where the three acts of listening, watching and talking - all at the same
time - never get a break. This performance monitoring also puts enormous stress on the employees.

India is situated 5 h ahead of UK, 10 h ahead of New York and 13 h ahead of Los Angeles. US and UK
companies can claim overnight response capability because during their night time, it is day time in
India and agents in India can respond to emails during Indian business hours. This is known as follow
the sun model. It is this working at nights that requires adjusting the biological clock and social
practices to a different time, which is turning out to be a major cause for health-related and social
problems.

About 30-40% of the employees working in the call center had complained of eye problems. Soreness,

Page 5 of 14
dryness, blurred vision, light sensitivity, headache, all these put together is labeled as the Computer
vision syndrome. This problem is more acute with the team leaders who need to come in early and go
back late. Digestive disorders are common among employees in the call center. Thirty-four percent of
employees had complaints on this count as revealed by the HR managers.

It was also pointed out that the employees are facing the possibility of losing their voice. The problem
known earlier as 'the teacher syndrome' is now being found in the young workers of call centers. Some
of them may face the acute manifestation of this in the form of permanent loss of voice. In the chronic
form it is characterized by inability to speak (Dysphonia), pain, croakiness of voice, irritating cough,
poor vocal power, inability to modulate and breathing difficulties.

BOSS stands for burnout stress syndrome

The BOSS syndrome is seen very commonly among young people working in call centers. The
symptoms of this syndrome include chronic fatigue, insomnia and complete alteration of 24-hour
biological rhythm of the body are routine cause for sickness absenteeism. Chronic levels of stress
affect the heart, endocrine system and also lead to sleep disorders.[5] Although most such cases do
not require treatment or medication, they need guidance on physical and mental coordination to cope
with a job that requires hyper-alert efficiency. There is a concern regarding the noise hazard especially
of the Acoustic shock, which is due to sudden high frequency noise, which is very damaging to the ear
and can also cause permanent deafness. There are also complaints regarding muskuloskeletal
disorders, we need to wonder whether they outsource body pain along with work. The call center
processes are designed to fit the technology and not the workers.

Little documentation is available as yet on these health problems but there are three clear issues
emerging from the nature of call center work, the first is on the issue of identity, and the second issue is
the isolation faced by call center employees. Given the intense contact between team members on a
shift, there is bound to be some development of inter-personal relationships. When the shift changes,
there is a sudden break-up of relations. There is a period of total isolation both within the work
environment and without - since family lives get disrupted and contacts between family members break-
up. The third issue is related to the stress levels of employees put to work on night shifts and given high
targets - this may force some towards drug abuse of some sort like pep-up pills and other drugs to keep
them going - especially when youngsters have money to indulge - this is a very genuine apprehension.

Staffing troubles

One prediction is that by 2008, India will employ two million people as call center operators. The only
obstacle to runaway growth may be finding enough high-standard recruits with good enough English to
meet demand. Today, most top executives acknowledge that a steady turnover of staff is an inevitable
aspect of the industry. The reasons for this could be boredom with the job, seeking better prospects or
a change, better monetary benefits lack of career opportunities especially when it comes to vertical
growth which is very minimum, or even the failure of the call center to effectively train employees to
stay at the job. Because the work is so repetitive, most employees leave within 2 years. Ambitious
youngsters, out to make a fast buck, hop skip and jump across BPO companies, making staff turnover
the single largest issue for business leaders and boardrooms.[6],[7]

Turnover rates as high as 30% have created a major problem for the call center as they have to
compete with each other for a slice of the business cake. And some have found a unique way to meet
their growth numbers by turning to the "been-there-done-that 40 plus" generation. The greying of the
BPO sector began a few months ago and is a newly emerging trend in India.[8]

There are fears about the social impact when within a couple of years the first crop of young 19-20-
year-old employees slogs it out and inevitably suffers burnout. They are less responsible people, their
maturity level is low, and thinking power towards planning their career is also low. Recognition is not so
high for those who work for call center in our society for various reasons. Some time they themselves
hinder to introduce to the society that they are employed in a call center. As a result of work pressure to
Page 6 of 14
meet the target day and day out and competition among the group they get frustrated and quit these
jobs. Because of minimum qualification, they cannot compete with out side world and they are blank
when are out of this job. They have given up on higher studies for the seemingly lucrative call center
job. Where do they go from here?

Legal support

The picture that emerges is the absence of any notion of work protections and guidelines. In an industry
being touted as the magic wand that will ward off unemployment, no one wants to discuss establishing
an equitable and gender-safe work culture.

In countries like the UK and Australia,where the call center industryis a lot older, there is a great deal of
understanding on what this unique workplace entails and what needs to be done about it. In the UK, the
government intervened a while ago with a local authority circular called "Advice Regarding Call Center
Working Practices." The circular not only list in detail the stress factors and ailments peculiar to this
industry, but also has various benchmarks and measures on how to deal with them. In Australia, some
call center companies have signed onto a call center charter that includes, among other things, a
minimum standards code of the workplace.

As of now, no understanding of the problem exists in India, leave alone a minimum standards code.
Some call center and BPO companies in the country have got together under the aegis of Nasscom to
address common areas of concern - but so far these have largely centered on deciding how not to
poach on each other's employees and what to do with the Shops and Establishments Act. Employee
stress - and its impact on the bottomline through high attrition rates - is not even on the horizon of
concerns. Although the fundamental elements of a call handler's job are the same as a typical
computer-based office job, the close combination of these elements results in a unique job often of an
intensive nature, hence the need for appraisal of dangers that are lurking in the corners of well
furnished BPO offices.

Recommendations

•There is a need for more explicit, detailed and relevant regulations, guidance specific to this industry.

•Health risk assessments both pre-employment and periodic for employees should be conducted
especially eye and audiometry tests.

• Call handlers should be provided with information on the risks identified in the risk assessment and
how these risks can be controlled.

• Length and frequency of breaks should be adequate.

•Need for full time counsellors to strike a balance between physical and mental rhythm to syncronise
body clock.

• Establishment of welfare committee where in employees are an important part where they can voice
their concerns.

•Ergonomic assessments of work station for 24 hours occupancy should be done.

•Need for more detailed study to collect data from larger number of employees working in a broader
range of sectors spread over a wider geographic area, so that the research findings will be useful to
provide initial advice to this industry

Background: Call centre workers in BPO face unique occupational hazards - mental, physical and
psychosocial. Material & Method: A sample 100 call centre workers of both sexes and from two cities
Pune and Mumbai were surveyed by both qualitative and quantitative methods for the above health
Page 7 of 14
problems. Results: A high proportion of workers faced sleep disturbances and associated mental
stress and anxiety. Sleep disturbance and anxiety was significantly more in international call centres
compared to domestic. There was also disturbance in circadian rhythms due to night shift. Physical
problems such as musculoskeletal disorders, obesity, eye, and hearing problems were also present.
Psychosocial problems included disruption in family life, use of tobacco and alcohol, and faulty eating
habits. Conclusion: Better personal management, health education and more research is indicated to
study the health problems in this emerging occupation.

Keywords: Call centre, Health hazards, BPO

How to cite this article:

Bhuyar P, Banerjee A, Pandve H, Padmnabhan P, Patil A, Duggirala S, Rajan S, Chaudhury S. Mental,
physical and social health problems of call centre workers. Ind Psychiatry J 2008;17:21-5

How to cite this URL:

Bhuyar P, Banerjee A, Pandve H, Padmnabhan P, Patil A, Duggirala S, Rajan S, Chaudhury S. Mental,
physical and social health problems of call centre workers. Ind Psychiatry J [serial online] 2008
[cited 2016 Feb 9];17:21-5. Available
from: http://www.industrialpsychiatry.org/text.asp?2008/17/1/21/63059

With rapidly changing workplaces, unique occupational health hazards are emerging. Traditional
industrial health concerns were related more in the physical health domain. Emerging new occupations
particularly in Information Technology (IT) and IT enabled Services (ITES), pose a host of new health
challenges particularly those related to mental and social health.

BPO (Business Process Outsourcing) has been the latest mantra in India today. For many employed in
the call center sector, "the daily experience is of repetitive, intensive and stressful work, which
frequently results in employee "burnout". Call centers are established to create an environment in which
work can be standardized to create relatively uniform and repetitious activities so as to achieve
economies of scale and consistent quality of customer service. This weakens employee autonomy and
enhances the potential for management control. Loss of control is generally understood to be an
important indicator of work related stress. Besides, the stress, the working hours of call centers may
cause sleep disturbances and disturbances in biological rhythm. Physical health also may adversely
affected because of irregular and sedentary working hours and unhealthy lifestyles. Job pressure at call
centers also may adversely affect social health. Though India with China is in the forefront of ITES
industry, occupational health research in this new industry is lagging. The present study was
undertaken upon samples of call centre workers in Pune (Domestic BPO) and Mumbai (International
BPO). The purpose was to carry out a pilot study of the mental, physical and social health dimensions
among this new class of industrial workers.

Material and Methods

The study was carried out at two sites Pune and Mumbai. It included a domestic BPO call centre
located at Pune and an international call centre at Mumbai. 50 call centre employees of both sexes
were randomly selected from each site giving a total study population of 100. Besides a handful of call
centre workers from Pune were contacted for qualitative inputs by focus group interviews.

Both qualitative and quantitative research methods were used. Qualitative data were collected by focus
group interviews of a group of 8 BPO employees by one of the senior investigators using open ended
interview method. Quantitative data was collected on a pre-tested structured instrument by two medical
interns one located at Pune and the other at Mumbai by face to face interview technique. No scale for
anxiety or mental stress has been used. All conditions recorded were self reported or perceived.
Page 8 of 14
Data entry and statistical analysis. Data was entered on Microsoft Excel spreadsheet and analyzed
using EpiInfo 2002. Chi Sq and ODDs Ratio with 95% Confidence Intervals were used to explore
associations between two main predictors such as gender and type of call centre (whether domestic or
international) and some outcomes of interest.

Results

A. Qualitative findings

Themes elicited from Focus Group Discussions.

a. Reasons for joining BPO. Some of the reasons for joining the BPO were: to earn money while
waiting for a better job, good work environment, peer pressure, good benefits, and attractive life
style.
b. Reasons for leaving BPO (attrition). Some of the reasons for attrition are: stagnation in career
graph, to pursue higher education, getting better salary elsewhere, disruption in family and
personal life, conflicts with peers and superiors in the office, stress and strain of work.

B. Quantitative findings

Age, Sex, Education and marital status.. The average age of the respondents working in the
international BPOs was 26.32 (SD = 3.66). The mean age of those working in domestic call centres
was 25.18 (SD = 3.09). Out of the 100 workers 49 were females and 51 males. Majority 96% were
graduates and only 4% had completed only school education. 60% of the call centre workers were
married.

Self reported mental health problems. The main self reported mental health problems were related to
sleep disturbances, anxiety, mental stress and disturbance in biological rhythms. Sleep disturbances
was reported by 8% of the domestic call centre workers and 50% of the international call centre
workers. This difference was statistically significant. [Table 1]. There was no association of gender and
sleep disturbance.

Anxiety was reported by overall 55% of the workers. This was significantly higher in international call
centre compared to domestic call centre[Table 2]. Though women reported higher prevalence of
anxiety (53.1%) as compared to men (37.3%), this was short of statistical significance[Table 3].

Women reported statistically significantly more perceived mental stress compared to men [Table 4].

However, there was no association between perceived mental stress and type of call centre (domestic
or international).

Overall 21% reported disturbance in biological rhythm. This was significantly more in international call
centre workers compared to domestic workers [Table 5]. There was no association of gender and
disturbance of biorhythm.

Physical health problems. These were mostly in form of musculoskeletal disorders, digestive
disorders, eye, voice and hearing problems. Besides there were certain consequences of sedentary
lifestyle such as various grades of overweight/obesity.

Proportion of workers reporting various musculoskeletal problems were as follows:

Page 9 of 14
  Backache: 58.6%
 Pain hand/wrists: 17.3%
 Shoulder pain: 6.9%
 Other sites: 3.4%
 Nil: 13.8%

Digestive problems: Only 29% did not report any digestive disturbances. Others reported various
digestive disturbances such as hyperacidity, bloating, flatulence and constipation.

The most common eye problem was dryness (26.9%). Headache due to eye strain was also common
(15.4%). Over 75% had varying degrees of throat problems sometime or the other affecting their voice
such as hoarseness, irritating cough, inability to modulate voice and breathing difficulties. Hearing
problems was reported by 24% of the respondents. Over 22% were having obesity grade 1 (BMI
between 25 and 29.99) and 2% were grossly obese (BMI >30),

Psychosocial problems: The various psychosocial problems were in the form of disruptive family
relations, poor recreation opportunity, vices such as alcohol and tobacco use, and faulty eating habits.

Very bad family relations was reported by only 6% of the call centre workers. 28% reported average
domestic bliss, while 19% had very good family support. 60% reported that their off days/holidays did
not coincide with that of spouse/other family members adversely affecting quality of family life. Off duty
36% preferred to relax and rest, while 16% went out for "de-stressing." Others reported various hobbies
such as gardening, music, books, and so on. 26% (mostly males) reported use of tobacco/alcohol. 34%
were found to have unhealthy eating habits in form of fast and junk foods.

Discussion

Symptoms and health problems caused or aggravated by work are common (Martimo et al 2007).
Other investigators have also employed the methods of self assessed health status of employees as
used in the present study in industrial health research (Martimo et al 2007, Collins et al 2005). In
emerging occupations such as offshoring which is just the tip of the iceberg in how globalization can
transform industries (Farell 2004), for preliminary and rapid assessments of health hazards self
reported stress and ill health can provide "quick and dirty" data on the basis of which more refined
studies can be planned.

Disturbed sleep as reported by 29% of the workers in the present study is a sign of fatigue and
occupational burn out (Ekstedt et al 2006, Akerstedt, et al, 2007). Occupational burnout is
characterized by impaired sleep. Ekstedt et al (2006) suggested that impaired sleep may play a role in
the development of exhaustion in burnout. Burnout patients may show pronounced sleepiness and
mental fatigue at most times of the day for weekdays without reduction during weekends. Drake et al
(2004), demonstrated that individuals with shift work sleep disorder are at risk for significant behavioral
and health related morbidity. They further suggested that prevalence of shift work sleep disorder is
approximately 10% of the night and rotating shift work population.

21% of the respondents in the present study mentioned disturbance in biological rhythms. Most people
experience regular shifts in alertness, mood and energy throughout the day. Many of such fluctuations
occur over the course of a single day and are therefore known as circadian rhythms. Research findings
indicate that such shifts are related to changes in underlying bodily processes (Moore-Ede, Sulzman &
Fuller, 1982). In occupations such as BPO industry where individuals must work at times when they
would normally be sleeping this biological clock may be deranged. The resetting of the biological clock
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is draining, both physically and psychologically (Czeisler, Moore-Ede, & Coleman, 1982). These effects,
in turn, have been linked to poorer on-the-job performance, increased industrial and traffic accidents,
and adverse effects on health (Lidell, 1982, Meijmann, van der Meer, & van Dormolen, 1993). In view of
these findings, efforts have been made to develop procedures for minimizing such disruptions. One
approach involves keeping employees on the same shift for several weeks rather than for a short
duration (Czeisler, Moore-Ede, & Coleman, 1982). This schedule give individuals more opportunity to
reset their biological clocks than do weekly changes in shift. Another procedure is to expose people
who must stay awake at night to bright light just before they would normally go to sleep; this resets their
circadian rhythm, so they have an easier time staying awake - and alert (Houpt, Boulos, & Moore-Ede,
1996).

In the present study an appreciable number also reported musculoskeletal problems such as backache
and pain in upper limbs and hand. Risk factors for upper-extremity musculoskeletal disorders include
biomechanical factors (force, repetition, posture and psychosocial factors (job stress) as stated by
Morse et al (2007). Menzel (2007), also has brought out the role of psychosocial factors (job strain,
social support at work, and job dissatisfaction) in musculoskeletal disorders. He suggested measures
for reducing the incidence of musculoskeletal disorders and addressing psychosocial risk factors to
prevent delayed recovery. William et al (2007), have carried out a systematic review of psychometric
evaluation of health related work outcome measures for musculoskeletal disorders.

To tackle other problems such as hearing, eyesight, and obesity, periodic health examinations should
help in early diagnosis and remedial measures. Hygiene measures such as resting the eyes every few
minutes and lubricating eye drops may prevent dryness of eyes. Health education about prevention and
control of obesity and other lifestyle disorders can be offered at the workplace. Promotion of healthy
food habits can be facilitated by providing subsidized canteens as has been done by many IT
industries.

The authors concede that this is an exploratory study only. More refined studies with need for scale
development for stress in the emerging occupations in IT and ITES are indicated.

Lastly it is desirable to employ HR Professionals with knowledge of Human Psychology in BPO

units/call centers. The services offered by professionals may not be felt in the initial stages. Companies
like Tata, L&T, MICO and few others have employed professionals in their factories. The professionals
can do wonders in BPO sectors as well. People are the backbone of BPO industry and it is certain that
professional HR or Human Resource Psychologist can make inroad in this emerging organization and
facilitate the growth of organization in an immense way.[14]

NIOSH Releases Materials on Call Center Noise Hazards

NIOSH research shows that workers at call and dispatch centers may face several hazards, including acoustic
trauma from a sudden spike in noise levels and background noise from an incoming call.

 Oct 16, 2011

Workers at call and dispatch centers may suffer health risks associated with high noise levels from their headsets.
The National Institute for Occupational Safety and Health (NIOSH) has developed recommendations for
prevention.

Millions of workers at call and dispatch centers in the United States use headsets during most of their workday.
They mainly include dispatchers, medical transcriptionists, air traffic control specialists, customer service
representatives, switchboard operators, reservationists, and bill collectors. Many work in high-pressure, stressful
environments with noisy surroundings and poor ergonomic conditions. Although these other factors can pose
additional health risks to workers, the scope of this document is limited to providing recommendations for
reducing noise hazards.

NIOSH research shows that workers at call and dispatch centers may face several hazards:
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  Acoustic trauma from a sudden spike in noise levels (e.g., from feedback into the headsets or a sudden
change in volume),
 background noise from the incoming call, and
 background noise and other stressors in the workplace.

Background noise in the workplace (radios played by other workers, conversations, noise from heating and air
conditioning systems) or from the callers’ locations may cause workers to turn up the headset volume, resulting in
sudden increase in noise levels transmitted into their ears. Some communication systems may experience
feedback or interference that could cause spikes or squeals from the headset. Some workers complain of
fluctuations in noise levels in the headset or having little control over headset volume.

The NIOSH recommended exposure limit (REL) for occupational noise exposures is 85 decibels. Exposures at or
above this level are considered hazardous.

NIOSH has conducted several Health Hazard Evaluations (HHE) on workers who wear headsets for most of the
workday, including FAA air traffic control specialists, emergency call center operators, and police station
dispatchers. NIOSH has also conducted evaluations at several locations where medical transcriptionists work and
at one fire department where emergency dispatchers work. Researchers interviewed workers, measured workers’
noise exposures, conducted area noise measurements, and measured sound levels from headsets using an artificial
head fixture.

With the medical transcriptionists, the sound levels of the transcription recordings often varied even within a
single dictation, forcing the transcriptionists to manually adjust the volume higher or lower. In some instances, the
transcriptionists adjusted the volume to a higher or maximum setting to hear a low or quiet dictation, then the
dictation levels or background noise spiked suddenly and was transmitted into their ears at those maximum levels.
Researchers found that sound levels and high-frequency tones played at maximum volume resulted in equivalent
sound levels under the headsets that were 4-18 dBA higher than the NIOSH recommended limit of 85 dBA.
Thirteen of 21 transcriptionists (62 percent) interviewed reported having problems with the fluctuation in sound
levels from the transcription communication equipment and headsets.

As for the 911 fire department dispatchers, background noise in the work area did not exceed the NIOSH REL
(The median value of overall full-shift noise levels was 60 dBA). However, noise from loud alarms, visitors, and
other distractions did cause the dispatchers to increase the volume on their headsets to mask the noisy
environment. Although an examination of actual 911 recordings played through the headsets produced peak levels
as high as 100 dB SPL at maximum volume, a review of the dispatchers’ audiograms showed no evidence of
noise-induced hearing loss. How¬ever, repeated and prolonged exposure to such levels can cause hearing loss and
ringing in the ear.

Overall, the NIOSH evaluations did not reveal hearing loss problems among call center operators and dispatchers
that can be directly attributed to noise exposures from their headsets or the surrounding environment. However,
most workers interviewed reported various symptoms often associated with prolonged exposure to high noise
levels. Symptoms included ringing in their ears, headaches, irritability, increased tension, and fatigue.

NIOSH recommends that workers and employers at call centers take the following steps to protect against hearing
damage and other adverse health effects:

Workers

 Notify your supervisor and take protective action if you experience tinnitus (ringing in the ears), a dulled
sense of hearing, or a fullness in the ears after a work shift or exposure to noise (that was not present
before the exposure or work shift). This indicates an overexposure that, if repeated, will likely cause
permanent effects.
 Do not set the volume control above the middle point. The lower the better.

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  Ask to try different headsets with improved protection or noise-cancelling features.
 Clean and maintain your headset periodically. Replace them when you notice damage or decreased
performance.
 Take advantage of breaks (in quiet areas) whenever possible.

Employers

 Consider supplying communication systems with noise-limiting features.

 Install noise controls to reduce background noise levels in the work environment, such as barriers
between workstations or sound-absorbing materials on hard surfaces in the room.
 Provide workers with a variety of communication headsets that offer adjustable volume controls, noise-
limiting or cancelling features, and improved comfort and protection from ambient noise.
 Establish a regular training program and educate workers about the proper use of headsets,
communication equipment, and maintaining a quiet workplace environment.
 Evaluate workplace exposure for noise levels above the NIOSH REL of 85 dBA and establish a hearing
conservation program for exposed workers, including yearly hearing tests.
Background

In 2003, a study was conducted to add to the knowledge available on issues relating to occupational safety and
health in contact center work. General Guidelines on OSH are set by the Occupational Safety and Health
Standards (OSHS) which cover practically all workplaces in the formal sector but the peculiarity of certain
hazards and risks in Contact Centers needed addressing.

In addition to susceptibility to health problems from computer use, contact center workers have to deal with work
organization and psychosocial factors such as fear of not being able to meet performance quotas, anxiety over
constant electronic monitoring of performance, predominant night work to coincide with regular working hours in
Northern America or Europe, disruption in social or domestic life and safety concerns because of night work.

This rapidly expanding industry also has to deal with concerns of women especially working mothers as well as
with work issues of young workers. It also relates to the aspirations of young workers in terms of career
opportunities and training.

Based on the previous case study carried out by the Occupational Safety and Health Center of the Department of
Labor and Employment, specific case study focusing on psychosocial concerns was carried out from Y 2006 to
2007.

Objectives

The main objective of the study was to look into the occupational safety and health conditions in selected contact
centers in the Philippines . Specifically, it aimed at:

 Ascertaining the psychosocial concerns of workers and their ergonomic conditions

 Documenting any occupational safety and health programs being implemented, in particular psychosocial
programs
 Studying the relationship between exposures to ergonomic and physical hazards and stress experienced by
workers
Methods

These included a survey of ten selected contact centers using focus group discussions, individual
interviews of workers, of key informants and management of respondent establishments as well as the following:.

 History of the company, nature of the business, size, type of clients, tasks of workers, etc.
 Elements of their occupational safety and health program
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  Health and safety audit checklist
 Checklist on the computer workstation, with emphasis on the characteristics of the computer and
peripherals, furniture (table, chair, etc.), and workstation layout.
 The noise, air velocity, temperature, and relative humidity in the vicinity of the selected employee’s
workstation were also measured. Evaluation of the indoor air quality was done in the room where the
selected employee is assigned.
 The odd work schedule is a peculiarity in contact centers in the Philippines . This is characterized by
predominantly night work to coincide with the regular business hours of the clients in Northern America
or Europe . Nightwork, thus, becomes an important occupational safety and health issue. Prolonged
nocturnal work forces the worker to invert the "activity-rest" cycle and has been documented to have
negative impact on the health and well-being of the workers. Health effects may include sleep disorders,
eating disturbances and gastrointestinal disorders, mental problems and cardiovascular disturbances.
The present study was able to determine job-related psychosocial stress factors, working conditions in contact
centers often have high workload, excessive supervision and monitoring, job insecurity, and unpredictable work
schedules have been found to be quite stressful. The possible association of psychosocial stress factors with
somatic symptoms of musculoskeletal disorders had been noted by many studies. An increased awareness or
perception of symptoms may lead to increased reporting of physical symptoms..

Contact centers usually employ young workers often in their first jobs. Many might hesitate to complain against
tasks that might place them in peril or press for better conditions at work. In effect, the symptoms solicited from
the subjects of the study may be an underestimate of the true state of their health..

Recommendations

The study make recommendations which have impact on policies and programs for the contact centers, as well as
the integration of major psychosocial concerns in the existing technical guidelines on health and safety for
workers in contact centers, in training and in information dissemination programs.

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