Call-centre working practices
Chris Dyer reviews the HSE's advice on health and safety issues in call centres
There are between 900 and 5,000 call centres in the UK - depending on the definition used (see box) - employing between 1% and 1.7% of the working population. In isolation these figures sound small, but call centres already employ more people than coal mining, steel and vehicle production together and the numbers are increasing rapidly: within three years they are expected to employ more than 2% of the working population. Scottish call centres demonstrate the general industry growth: in 1998 it employed 16,000 workers; in 2000, the total is expected to reach 37,000.
Call centres are considered a unique working environment, characterised by: shift systems; electronic performance monitoring; extended, intensive periods of simultaneous computer and telephone use; and high staff turnover. Although covered by Regulations and guidance applicable to offices, the rapid growth of call centres and the significant numbers of people involved have led unions, employers, enforcement authorities and employees to suggest that industry-specific guidance and standards are needed.
In response, the Health and Safety Laboratory (HSL), an HSE agency, carried out a small-scale survey of the industry to examine working practices and factors affecting occupational health. The survey was not intended to be representative of all UK call centres, but aimed to get an in-depth, qualitative insight into the views and experiences of a select group of employees. The HSL survey identified three areas that warranted particular consideration: display screen equipment (DSE) working practices; organisational working practices; and specific health issues.
Based on the HSL's study, the HSE's Local Authority Unit (LAU) recently issued advice to the enforcement authorities - usually local authority inspectors - on the work-related hazards that might be encountered in call centres.1
DSE WORKING PRACTICES
Call handlers rely on a computer to do their job and they can spend up to eight hours a day in front of a computer screen: good DSE working practice is essential.
All six companies visited by the HSL carry out DSE assessments on recruitment and periodically thereafter, but the HSL considers these assessments to have limited validity because "hot-desking" is common in call centres. Call handlers may sit at any workstation - typically there are 10 to 12 - within their team area, different shifts may share the same workstations and call-handling teams can be required to move to different areas within the call centre.
To ensure that call handlers make appropriate adjustments to their workstation, the HSL suggests that a DSE checklist is displayed each time a user logs on and that it must be completed before any work screens can be displayed. This emphasises the importance of the adjustments and provides a paperless record.
Working environment
Call handlers need to be comfortable during the long, unbroken periods they spend at their workstations, so optimal environmental conditions are needed.
The number of people present in a call centre can change dramatically with shifts, depending on the time of day and the day of the week; the HSL says that the environmental conditions control system should adjust to the occupancy level, otherwise temperature and relative humidity may become unacceptable. For example, a high level of computer use during periods of high occupancy can raise the air temperature and dry it. High occupancy levels also mean that air in a call centre needs to be filtered frequently and thoroughly to eliminate germs, volatile organic compounds (VOCs) and dust. Germs and VOCs have the potential to cause sickness absence, the one because they cause colds, the other because they can trigger allergic reactions. VOCs are released by some glues, paints and carpets and are often present in new or refurbished buildings, which is relevant in an industry undergoing such rapid expansion. Dust can irritate the throat and lungs and may contribute to voice loss or trigger asthma. Levels can be controlled by a combination of air filtering and thorough cleaning.
The environmental control system must also be able to cope with changes in the layout of the workstations. Companies with call centres favour hangar-style buildings because the internal layout is flexible and easily reorganised, but this flexibility needs to be taken into account when designing the environmental control system. For example, putting up screens can interrupt airflow and lead to pockets of stagnant air.
In the HSL survey, many of the interviewees said that temperature was a problem: as well as being too hot or cold it was also unpredictable. Mezzanine floors, a feature of hangar-style call centres, were found to cause particular problems. In one case, when air flow was sufficient to cool employees on the mezzanine floor, those on the ground floor near the air inlet vents were too cold.
Some call handlers complained of sore eyes, voice loss and rashes, which can be symptoms of low relative humidity, as can headaches. The HSL researchers suggest employees are made aware of the role that low relative humidity can play in causing dehydration and are encouraged to drink plenty of water or caffeine-free soft drinks; tea and coffee are diuretics and exacerbate the problem.
Although lighting was not raised as an issue during the study, most people prefer to be in an environment with some natural light, even if windows are covered by blinds to reduce glare. Lighting requirements may be influenced by whether or not call handlers have to consult and complete paperwork in addition to operating DSE and by whether it is a night or a day shift.
Workstation requirements
The companies in the study were aware of the importance of appropriate workstation equipment; two had tried a range of desks and chairs before deciding on which ones to use. They were also willing to buy specialist equipment, such as orthopaedic chairs and ergonomic keyboards, but this was usually to reduce the effects of musculoskeletal disorders (MSDs) that had already occurred rather than to prevent them from occurring in the first place.
The main workstation problems experienced by call handlers were to do with space: some desks were not big enough to allow 21" screen monitors to be positioned the correct distance from the user; on desks that faced each other the monitors had to be staggered.
The lack of secure storage for personal items also caused problems. The stated practice is that each desk should have all the necessary reference and stationery materials for the task, but many call handlers prefer to carry their own because they make their own notes in the reference materials and the desk sets of stationery are often incomplete. Storage space is rarely provided and the boxes used to carry these materials can become trip hazards when left by a workstation.
Daily work routines
Some call handlers interviewed by the HSL said their job was monotonous and that the limited variety made them dissatisfied. Call handlers are generally organised into teams, each team specialising in a particular topic. For most call handlers, moving to a new team is the only chance for change. Even within the task of handling the call there is little opportunity for variation as conversations are scripted.
Nor do call handlers have much control over their work. Automatic call distribution systems control the frequency and number of calls handlers take: as soon as the administration associated with a call is finished, another call is automatically relayed to the handler.
This combination of limited variety and low control are characteristics of poor job design, and such jobs may be inherently stressful. Managers interviewed in the study recognised that the call handlers' job was monotonous and that handlers may take sick leave as an escape. Line managers are concerned about absence rates, keep records of the causes of sickness absence and interview individuals with poor attendance records.
Managers also realise that sick leave can result from MSDs caused by repetitive tasks. When a call handler is suffering from an MSD, it is common practice for their task to be changed to make it more varied. The HSL concludes that companies have not taken on board the reduction in the risks of ill health that could be achieved by improving job design before ill-health occurs.
Variety could be introduced by allowing call handlers to answer a range of calls rather than being restricted to one particular product, although the HSL acknowledges that multiskilling can give rise to its own problems. Some call handlers complained that it was sometimes difficult to switch from a detailed conversation on one topic to a detailed conversation on a different topic with the next caller and they were also concerned that they were not "up to speed" on topics that they did not cover regularly. A balance needs to be struck, with call handlers dealing with perhaps two or three related topics.
The HSL suggests that job design would be improved further if call handlers were allowed more respite from handling calls. Breaks from facing customers could be achieved if call handlers undertook data processing at their work station; and carrying out basic administrative tasks, such as compiling information packs, gives them the opportunity to stretch and move around. Some companies provide an antidote to the limited control over the pace of handling calls by allowing handlers to coach new recruits, organise team events or contribute to projects such as developing new products or responding to internet enquiries.
In addition to variety, some of these tasks offer job enrichment, which is another important element in good job design and a determinant of job satisfaction.
Job redesign benefits
The HSL says that improving the job design of call handling would require a fundamental reorganisation of the business, but that this could have a potentially huge impact on the balance sheet through reduced sickness absence and turnover, increased productivity and improved staff morale. If companies are unwilling to redesign the job of call handling, the HSL suggests that they should ensure that both management and call handlers understand the importance of, and arrangements for, taking breaks. The HSL says that companies may not appreciate the extent to which adequate breaks can help to reduce problems with productivity and absence (see box above): with more frequent breaks, call handlers may be better able to cope with the poor design of their jobs without taking sick leave or resigning.
The companies visited said that targets for the amount of time spent dealing with customers allowed call handlers to have adequate scheduled breaks, use the toilet, get drinks and to take a break after dealing with a difficult call. But the interviews with call handlers suggested that they were not clear as to when they were scheduled to take breaks, and that they felt under pressure to be on the telephone as much as possible in order to meet their targets.
Eyes and eyesight
Intensive use of DSE can cause temporary effects on vision, but any permanent eyesight deterioration is usually attributable to the normal ageing effect. The HSL says that there is no convincing scientific evidence to support the widely held belief that DSE use can lead to long-term eyesight damage. Nevertheless, a number of interviewees said they believed their eyesight had deteriorated due to intensive DSE use.
No interviewee had been offered an eyesight test and eye examination during their induction training, and nobody said their company encouraged regular eye tests. The HSL believes that this is an important omission because these procedures provide baseline data for future reference and identify individuals whose uncorrected eyesight deficiencies may result in a higher than average risk of eyesight problems and headaches from DSE use.
The rate of blinking drops when a DSE is used and the reduced lubrication can lead to tired and sore eyes and headaches. Rest breaks or changes in work activity allow the eyes to recover. The HSL recommends that the importance of maintaining a normal blink rate and that techniques for doing this be explained to call handlers.
Although all the companies in the study introduced DSE health and safety during induction training, the HSL found that the call handlers it spoke to did not really understand that poor DSE working practices can damage physical and mental health. The study also found that training could be improved if call handlers were shown simple exercises to be performed at the workstation to reduce muscular tension, which can lead to headaches and eventually to MSDs.
ORGANISATIONAL WORKING PRACTICES
Call centres are unlike most other office environments in that they usually operate shift systems. The HSL points out that particular attention needs to be paid to first aid and security if adequate cover is to be maintained, especially as some call centres operate 24 hours a day, 365 days a year.
Extended hours can also mean that there is inadequate provision of refreshments for those not on a day shift. None of the call centres visited by the HSL had canteen facilities available throughout the night. Headaches and migraines can be triggered by too little food; and night-shift workers may be at particular risk because of the irregular and unsocial hours worked.
Monitoring
Call handlers are subject to quantitative and qualitative electronic performance monitoring (EPM). Data is collected on a minute-by-minute basis, giving details of the percentage of a specified period that a call handler is on the telephone, the average duration of a call, and the time spent in post-call administration. For each statistic, call handlers are required to achieve set targets.
The individual results are collated to give statistics for teams and the call centre as a whole. The longer callers have to wait before speaking to a call handler, the greater the chance that they will ring off and take their custom elsewhere. Companies monitor the average length of time a caller has to wait and the abandonment rate. The HSL found that an almost universal feature of call centres is an overhead display showing the number of calls waiting and the longest time waited.
Team leaders carry out qualitative monitoring of call handlers by monitoring recorded and real-time calls. This is done to check that call handlers give the correct information, follow the script closely, listen to the caller, use their knowledge of the products effectively and exploit sales opportunities.
The results of the qualitative and quantitative monitoring are fed back to the call handlers and are used as the basis for training, improving customer service and determining performance-related pay. Despite suggestions that this intense monitoring causes unacceptable stress, none of the call handlers interviewed by the HSL said EPM was a stressor, although the study acknowledges that there has been little research carried out in the workplace on the effects of close EPM on employee physical and mental health and wellbeing.
SPECIFIC HEALTH ISSUES
The main cause of long-term sickness absence and legal cases in the call centres visited by the HSL are MSDs, with risk factors associated with the working environment, workstations and work routines. The HSL found that companies were keenly aware of the causes of MSDs, such as DSE and organisational working practices (see above), and their consequences, but that most tend to follow only fairly basic procedures for reducing risks and react to, rather than prevent, serious cases.
Stress
Call handlers interviewed described their job overall as monotonous rather than stressful, although a number of individual components of the job were highlighted as stressful (see box at left). But while self-reported stress was low, the physical and behavioural manifestations of stress, such as headaches and migraines and high absence and turnover rates, were common.
Most of the team leaders and call-centre managers interviewed accepted that call handling was stressful and were aware of the effects that this had on employee health and productivity. But they thought that little could be done to improve the nature of the job so as to reduce stress at source. Most of the companies involved in the study had a reactive approach to stress. A range of services were offered, including employee assistance programmes, counselling, fitness classes and social events. Some of the health professionals thought that variable shift patterns, which made childcare and domestic arrangements more difficult, were the main source of stress.
The HSL concludes that more research is needed before any firm conclusions can be drawn about the sources of stress for call handlers and ameliorating factors.
Hearing
In research commissioned by the Royal National Institute for Deaf People and the TUC, some call handlers reported that they were subjected to acute intense noises and prolonged high levels of sound through their headsets, which led to tinnitus and dulled hearing. Some said these effects were shortlived, others said they were permanent. During the HSL study no call handlers reported intolerable noise or impaired hearing, but the study concluded that this was also an area requiring further research.
On the basis of the HSE's rule-of-thumb measure for acceptable background noise levels - two people two metres apart are able to hold a conversation without raising their voices - none of the call centres had unacceptably high background noise levels. Background noise is important because call handlers generally adjust their headset volume to be 10dB(A) louder. Noise-cancelling microphones filter out background noise, such as the voices of other call handlers, so that only the caller's and handler's voices are heard through the earpiece. This allows the call handlers to keep their voices low and helps to reduce noise exposure.
Call handlers also need to be trained to position the microphone for optimal performance, otherwise they may have to talk more loudly and increase their headset volumes in order to hear themselves.
The HSL says that handlers should be given a choice of headsets with one or two earpieces. It is essential that the volume can be adjusted, and the risk of hearing impairment can be reduced by using a noise limiter that prevents extremely loud noises from reaching the earpiece. Headsets should be fully adjustable to ensure a comfortable fit. The intensive use of headsets increases the risk of ear irritation and infection; the HSL says that call handlers should be given the training, time and materials needed to keep headsets clean.
Hearing tests may be appropriate at induction to provide a baseline data for reference and to check that call handlers do not have a hearing impairment that may be exacerbated by intensive telephone use.
Voice loss
The HSE's health directorate has been contacted by an ear, nose and throat surgeon who is concerned by the number of cases of voice loss - dysphonia - presented by call handlers, and further research has been proposed in this area. Dysphonia can include not just the inability to speak, but also pain, tension, croakiness, coughs, inability to modulate, poor or no vocal power and breathing difficulties.
None of the call handlers interviewed by the HSL said that voice loss was a significant problem, although some mentioned it when prompted. Call handlers could be at higher risk of voice loss than other office workers because their job requires them to speak on the telephone for extended periods without regular breaks. Breaking scripts into shorter sections so that handlers have micro-breaks while callers respond to their questions may be beneficial. The HSL says that call handlers should be made aware of the risk of dysphonia so that they can recognise the symptoms and be trained to take preventive action, such as stretching to relieve tension in the neck and shoulders.
A lack of information
During its research, the HSL reviewed the academic literature, but found that there was little rigorous research concerned with the psychosocial or health and safety perspectives of call centres. Coverage in press articles was found to have a negative bias, with call centres described as modern-day sweatshops. This lack of reliable information, combined with the findings of the HSL survey, has persuaded the HSE's Local Authority Unit (LAU) of the need for further research.
As HSB went to press, research was getting under way (see box at left). This study will examine a range of call centres in different locations and industry sectors, and of different sizes and maturity, in order to measure the potential physical and psychological health risks associated with working practices. It will explore measures that may be taken to reduce risks and will review the application of existing guidance and Regulations, such as the Health and Safety (Display Screen Equipment) Regulations 1992, to see if guidance can be produced aimed specifically at call centres.
Announcing the research Brian Etheridge, head of the LAU, said: "The call-centre industry is a relatively new, and rapidly expanding, one. It is important that we are able to give appropriate guidance and advice to the industry and the enforcing authorities."
What constitutes a "call centre" is a matter of debate as there is no universally agreed definition. The HSL considers that:
VALUE OF BREAKS
STRESSFUL ELEMENTS IN CALL HANDLING
HSL CALL-CENTRE RESEARCH
The questionnaire is likely to cover:
DSE working practices, including -
Organisational working practices, including -
Specific health issues, including -
1"Initial advice regarding call centre working practices", HELA Circular 94/1, November 1999, LAU, HSE, Rose Court, 2 Southwark Bridge, London SE1 9HS, tel: 020 7717 6442, fax: 020 7717 6418.
