This document discusses promoting occupational safety and health in call centers. It begins by providing historical context on occupational health pioneers like Ramazzini and Paracelsus. It then discusses common hazards in call centers like ergonomic stresses from prolonged sitting, chemical hazards from cleaning agents, and psychosocial stresses. The document finds call center workers experience high rates of musculoskeletal disorders, eye strain, voice problems, and headaches. It emphasizes prevention through addressing workplace hazards, training, and health promotion programs. Overall, the document promotes a participatory, multi-pronged approach to improving call center worker safety and health.
4. The World of Work then …
"a foul and poisonous dust [that] flies out from
these materials, enters the mouth, then the
throat and lungs, makes the workmen cough
incessantly, and by degrees brings on
asthmatic troubles."
"in whom he
found heaps of
sand that in
running the knife
through the
pulmonary
vesicles he
thought he was
cutting through
some sandy
body."
6. Paracelsus (1493-1541)
Father of Modern Toxicology
Areolus Phillipus
Theophrastus Bombastus
von Hohenheim
"All substances are poisons;
there is none which is not a
poison. The right DOSE
differentiates a poison from
a remedy."
8. Occupational and Work-Related
Diseases and Injuries
• History of exposure to hazardous
workplace factors becomes
indispensable in determining whether
an illness is because of workplace
factors or not.
15. Hazards in the workplace can cause
harm if there is undue exposure such
as through elevated workplace
concentration without proper control
measures.
Important to characterize exposure
16. Work-Related Musculoskeletal
Disorders (WMSDs)
development requires
weeks, months or years of
exposure to ergonomic
risk factors
•Repetitive exertions
•Posture stresses (including static posture)
•Forceful exertions
•Contact stresses
•Job design
•Work organization
•Workstation dimension
18. Diseases of Workers
• Many diseases of occupational cause
are multifactorial,with non-occupational
factors playing a role.
• Personal characteristics, other
environmental and socio-cultural factors
usually play a role as risk factors for
these diseases.
19. Total Health Promotion
• Smoking cessation
• Physical activity
• Nutrition
• Weight reduction
• HIV/AIDS
• Drug Abuse Prevention
• TB Prevention and Control
24. Loss of muscle strength comes
with ageing
• But muscle strength can be
diminished even in young
persons
25. Occupational Safety and Health
is Prevention
• Many occupational conditions are
IRREVERSIBLE
• Occupational conditions are
PREVENTABLE
26. ENSURING WORKER WELL-BEING
• “The choice of a starting age for attention
should be selected as “young” enough
that intervention efforts can be expected to
make a difference during the working life.”
Committee on the Health and Safety Needs of Older Workers National
Research Council and Institute of Medicine
28. Occupational Safety and Health in Call Centers
(Secondary Data)
• Musculoskeletal disorders
– Linked to poorly designed workstations (Hoekstra et.
al. 1995).
– Associated with longer shift duration (Ferreira M and
Saldiva PH, 2002)
– Long uninterrupted hours of work with the computer
– Invariable and sedentary work (Norman K et. al.
2001)
– Low job satisfaction (Most IG, 1999)
29. Occupational Safety and Health in Call Centers
(Secondary Data)
• Voice disorders
– Intensive verbal interaction with clients one of
the contributing factors (Jones K et. al., 2002)
• Eyestrain
– Poor lighting conditions and intensive
computer use (Putnam C et. al., 2000)
30. Occupational Safety and Health in Call Centers
(Secondary Data)
• Problems due to psychosocial and work
organization stressors (Putnam C et. al.,
2000)
– Increased reporting of health disorders
– Negative work attitude (boredom, job
dissatisfaction, anger, etc.)
31. Occupational Safety and Health in Call Centers
(Secondary Data)
• Concern over potential hearing problems (Patel
J and Broughton K, 2002)
– Exposure to high intensity sound coming from the
headsets
– high sound levels in the room from the simultaneous
talking of the employees
33. Methods
• Case study of 5 call centers
• Purposively selected employees from one (1)
company
– Questionnaire to collect data about personal
circumstances, occupational profile, medical and
psychosocial conditions
– Company profile
• Data will be collected regarding the organization in
terms of size, tasks, type of clients, work
organization, working hours, etc. Information on
incentive system will also be gathered.
34. Results
• 5 call centers
• Varying tasks of operators
– 1 call center with only interactive computer
task (internet online communication)
– 4 call centers both voice and computer
35. Results
A B C D E
Year
Established
1998 2002 2000 1999 1999
Task Intensive
interactive
computer work
(chatting)
Voice and
computer
Voice and
computer
Voice and
computer
Voice and
computer
Nature of
business
Customer
assistance
Telemarketing,
outbound
Telemarketing
(outbound)
and customer
care services
(inbound)
Telemarketing,
mostly
outbound
Telemarketing,
inbound
Gender Equal
proportion of
male and
female
Equal
proportion of
male and
female
70% female 80% female 75% female
Age of
operators
20 - 25 20 - 20 - 35 20 - 25 20 - 25
36. Results
Hazards
Identified
A B C D E
Working
Posture
Rapid and
repetitive
keying,
prolonged
sitting,
static
exertions of
neck, torso,
elbow
freedom of
movement
(sit, stand,
walk about)
Prolonged
sitting,
twisting of
upper body
and neck to
view
monitor
Prolonged
sitting,
twisting of
upper body
and neck to
view
monitor
Prolonged
sitting,
twisting of
upper body
and neck to
view
monitor
37. Results
PARAMETERS Frequency of Extreme Posture Observed
Eye position 39 agents with upward gaze
Upper arm position Raised upper arms and elevated shoulders
in 43 agents
Lower arm position Elbow flexed in 28 agents
Wrist/Hand position Wrist flexed in 4 agents
Wrist extended in 38 agents
Neck position Extremely flexed in 5 agents
Erect position in 50 agents
Trunk position 38 agents leaning forward
Working Posture of Call Center Agents Company E (n=55)
38. Eye symptoms With symptom/s
in the last 7 days
With symptom/s
in the last 6
months
Smarting 22 (29%) 35 (47%)
Gritty 4 (5%) 8 (11%)
Itchiness 13 (17%) 24 (32%)
Eye pain 15 (20%) 25 (33%)
Redness 16 (21%) 29 (39%)
Tearing 10 (13%) 21 (28%)
Dryness 9 (12%) 15 (20%)
Sensitivity to light 15 (20%) 31 (41%)
Frequency of eye symptoms among call center agents (n=73)
39. Frequency of musculoskeletal symptoms among call center agents (n=72)
Musculoskeletal
symptoms
With symptom/s in
the last 7 days
With symptom/s in
the last 6 months
Neck 4 (6%) 36 (50%)
Shoulder 2 (2%) 22 (30%)
Elbow - 2 (2%)
Wrist - 10 (14%)
Upper back 4 (5%) 41 (57%)
Low back 3 (4%) 33 (46%)
Hips or thigh 1 (1%) 11 (15%)
Knee - 5 (7%)
Ankle or feet - 7 (10%)
40. Frequency of hearing and voice disorders among call center agents (n=73)
Hearing and Voice disorders With symptom/s
in the last 7 days
With symptom/s in
the last 6 months
Ear pain - 12 (16%)
Ringing in the ear - 9 (12%)
Need to raise voice when
talking
1 (1%) 15 (20%)
Hoarseness 1 (1%) 35 (48%)
Tiredness or weakness of voice 3 (4%) 53 (73%)
Exerting more effort to talk 2 (2%) 37 (51%)
Cracking of voice 3 (4%) 30 (40%)
Choking sensation 2 (2%) 20 (27%)
Burning sensation in throat - 17 (23%)
Dry throat 1 (1%) 52 (71%)
Complete loss of voice 1 (1%) 4 (5%)
42. Work Elements and associated Risk factors of
voice disorders
Work Environment Job Design/
Organization
Individual/
Psychosocial Factors
a. High intensity of
background noise
b. Poor room acoustic
c. Low temperature and
humidity
d. Poor workplace air
causing irritation
a. Prolonged heavy use
of voice
b. Fast paced work
brought about by
automated call routing
or dialing system
c. Repetitive reading
from long scripts
d. Lack of or inadequate
breaks
a. Habit of speaking
loudly
b. Smoking
c. Frequent intake of
caffeinated beverages
d. Infrequent hydration
e. Infections involving
the throat
f. Intake of throat
drying medications
43. Work Elements and associated Risk
factors of hearing disorders
Work Environment Job Design/
Organization
Individual/
Psychosocial
Factors
a. High intensity
background noise
b. Noise from
headsets
c. Poor room
acoustic
a. Long duration of
work
b. Infrequent breaks
c. Inadequate
number of
headsets
a. Poor hygiene
b. Lack of training
on proper
maintenance of
headsets
44. Work Elements and associated Risk factors of visual fatigue
Visual
Display
Work Environment Work
Position
Job Design/
Organization
Individual/
Psychosocial
Factors
poor image
quality, flicker,
character size
(too small or
too big)
a. poor illumination,
excessive contrast in visual
field, glare, reflections
b. high vertical position of
the display which may
lead to dryness
c. inappropriate viewing
distance between worker
and screen, keyboard,
document
d. dry air (relative humidity
<40%)
e. air movement >0.5 m/sec
upward gaze
direction
a. long duration of
work , esp. if
without breaks
b. high degree of
concentration
required
c. fast pace of
work
d. repetitive and
invariable task
a. uncorrected visual
deficiencies
b. inadequate
training on VDT
operation
45. Work Elements and associated Risk factors of work-
related musculoskeletal disorder
Physical Work
Environment
Workstation
Design
Work Posture Job Design/
Organization
Individual/
Psychosocial
Factors
Contributing to
improper
posture
a. inadequate
lighting
b. presence of
glare and
reflections on
the screen
a. chair without
proper lumbar
support
b. not height
adjustable
chair and
keyboard
c. too high or
too low
position of
monitor or
keyboard
d. inadequate
workspace
a. static posture
b. repetitive
keying or
mouse
manipulation
c. non-neutral
posture
(head or body
twisted to one
side; wrist
flexed or
extended;
elevated
shoulders)
a. long duration
of work , esp.
if without
breaks
b. high degree
of
concentration
required
c. fast pace of
work
d. invariable,
repetitive task
e. high
performance
quotas
a. uncorrected
visual
deficiencies
b. inadequate
training on
computer
operation
c. lack of job
control
d. low job
satisfaction
46. Health, Safety and
Social Issues
Risk Factors Associated with Night Work
Sleep disorders • Continued poor quality sleep
Gastrointestinal
disorders
a. Digestive function reduced at night.
b. Intake of coffee and other drinks containing caffeine
c. Increased incidence of smoking to keep awake at night
d. No access to proper meals at night because canteens are closed at
night
e. irregular meal times and snack
Errors and Accidents a. Decreased alertness corresponding to trough of circadian rhythm
b. Sleep debt
c. Cumulative fatigue
Substance abuse a. Alcohol used to overcome fatigue and sleep debt
b. Amphetamines and caffeine used to keep awake at night
Physical attack • Walking very late at night or very early in the morning because public
transport may not be available at these times
Disruption in the
pattern of social
practices
a. Exclusion from events and activities involving the family, friends or
community
b. Lack of contact with partners, children and friends
c. Inability to pursue education, sports etc.
47. Implications of the Study
• Knowledge gained to be used to improve
working conditions
– In existing and prospective new call centers
– Address the OSH problems at an early stage
• Policy/Program Implications
– needs of women, mothers, young workers
– policies concerning work shifts, esp. prolonged
night work
– adequate, on-site medical and health
promotion facilities
48. Implications of the Study
• Recognition of complex nature of safety and
health issues in call centers
– Interaction of psychosocial factors with other work
factors
– Unique work organization because of electronic
monitoring
– High performance standards
– Issues on job security
• Compensation implications
– Recognition of problems of workers in call centers
• Associated with air quality, ambient noise, noise from
headset, human-computer interaction, shift work, etc.
49. Approach in Ensuring
Well-Being of Workers
• Looking at regulatory
requirements
• Relevant laws,
standards, issuances
and guidelines
– Enforcement
– Implementation
– Inspection
– Evaluation
• Looking at developmental
strategies
• Information
• Education
• Training
• Campaigns
• Good practices
• Successful cases
• Competitions
• Demonstrations
• Interventions
50. Participatory approach
Participation and involvement from
stakeholders
• Coordinated intervention
• Learning from
– specifications/guidelines,
– scientific data
– best practice
The Occupational Safety and Health Center, through its technical divisions, has embarked on a research project that will look into the occupational safety and health conditions in call centers in the Philippines. This project addresses a relatively recent phenomenon in the work environment that employs thousands of Filipino young workers.
A search of secondary data or published reports yielded only a few studies concerning occupational safety and health conditions in call centers. Among the identified health problems in call center employees were pains in the neck/shoulder, wrist and back areas. These problems were associated with poor workstation design such as computer monitors placed above eye level, work surfaces that were too high, non-adjustable chair. Other factors mentioned that contribute to the development of muscle and joint pains were long uninterrupted hours of work with the computer, invariable and sedentary work and low job satisfaction.
Another health issue that affect call center operators is the risk of having voice problems. Telemarketers are twice more likely to have voice problems compared to the general population as shown by the study of Jones. Symptoms noted were dry itchy throat, hoarseness, frequent clearing of throat. One of the factors identified to contribute to the problem is the high demand on the vocal system because of the interactive nature of the task of call center operators. Workers also reported eye strain associated with the physical environment such as poor lighting conditions and uninterrupted use of computers.
The major psychosocial and work organization stressors identified by participants include Very little job security fearing that their call centre might close suddenly Dealing with rude clients Unrealistic performance quotas assessed in terms call rates, call times, sales quotas; constant electronic performance monitoring; random taping of phone conversations. Work Schedules that interfere with family and social life. Very early or late shifts created transportation problems and concerns for safety Performing simplified, highly fragmented repetitive, fast paced workloads The interaction of psychosocial factors and other work factors have been related to injury and other health issues in the workplace
Call center workers have been documented to have occasional exposure to higher noise levels is possible, for example from fax tones, holding tones, and high pitched tones from mobile telephones. High sound levels in the room may also occur from the simultaneous talking of the employees. Though it is recognized that in general the levels of noise transmitted through the headsets or levels present in the call centers are incapable of damaging the ear directly, a large number of workers studied were concerned that their hearing was being damaged as a result of exposure to noise at work.
The Occupational Safety and Health Center, through its technical divisions, has embarked on a research project that will look into the occupational safety and health conditions in call centers in the Philippines. This project addresses a relatively recent phenomenon in the work environment that employs thousands of Filipino young workers.
A cross-sectional study is being planned in 5 call centers covering various nature and complexity of tasks. About 50 employees from each company selected by purposive sampling will be asked to answer a questionnaire. Data about personal circumstances, occupational profile, medical and psychosocial conditions will be collected. Data that will be collected by interviewing the management of the company will include the following: History of the company, nature of the business, size, type of clients, tasks of workers, etc. Incentives and benefits as well as performance monitoring scheme implemented in the company Policy on work schedules such as rest and breaks, overtime, and shift rotation Components of occupational safety and health program
Five call centers were visited. The operators of these call centers perform a wide array of tasks. The employees in one call center are engaged in internet real-time or online communication or chatting for the duration of the work shift. The task involves intensive interactive computer work. There is no verbal interaction with the customers. The employees of the other 4 call center visited have direct interaction with customers both inbound and outbound via telephone. The computers are used to process transactions (retrieve and/or input information).
The next few slides will show the results of the preliminary survey. The companies visited have operated between less than a year to 5 years. All of the companies cater primarily to clients in the US. As mentioned earlier, the tasks performed by the operators differed in terms of extensiveness of computer use and vocal load. The tasks of the operators in 4 companies involve talking on the telephone and computer use. On the other, the task of operators in one company only involve computer use. The nature of the business also varied. All except for 1 are engaged in telemarketing. Predominantly female workforce was noted in 3 companies. The other 2 boasts of equal proportion of male and female. All the call centers visited employ young workers.
Static posture from prolonged sitting, postural fixation when viewing the computer monitor and repetitive movements are common occurrences in computer-based tasks. And these we saw in 4 out 5 companies visited. In the long run, these working posture may lead to muscle and joint pains. Interestingly, in one company, the operators were allowed to assume different body postures and positions. They can walk about because they use wireless headsets and because of minimal human-computer interaction.
Postures of 55 agents were directly observed and evaluated using the Rapid Upper Limb Assessment checklist. Noted predominant postures are as follows (Table 9). The agents had upward gaze. When working with monitor height settings above eye level (seen in 39 out of 55 workstations), Twisting of the head and the trunk to either side in all agents was brought about by monitors placed either to the left or to the right of the agents. The upper arms and shoulders were elevated in 43 agents because of the relatively high keyboard height. Also, 28 agents assumed extremely flexed elbows. The agents assumed awkward and sustained reaching position when using the mouse. Because of inadequate workspace, the mouse were positioned relatively distant to the agents, Non-neutral* wrist position was noted in 42 out of 55 agents during keyboard use. 38 of them had extended wrists while another 4 had flexed wrists. Only 11 agents had neutral wrist positions. Forward leaning posture was noted in 38 agents. The other 17 were seen to assume backward leaning position.
A self-administered questionnaire was given to the 75 participants a week before the actual survey. Three agents returned the symptom survey for the musculoskeletal disorders unanswered; 2 agents did not answer the eye, hearing and voice symptom survey. Of the 72 who completely answered the forms, 5 females and 4 male agents reported no symptom referable to the eyes, ears, voice and musculoskeletal system. At least 1 symptom was reported by 63 agents. The distribution of complaints according to the affected organ systems is given in the following slides. The recent symptoms (experienced in the last 7 days) commonly noted by the respondents involved the eyes. Four to 22% of the surveyed agents reported having any one of the 8 eye strain symptoms - smarting and eye redness being manifested most frequently. Higher incidences were seen in the past 6 months.
Among the musculoskeletal disorders reported by the subjects, the highest frequencies were seen for the upper back, neck and lower back, in descending order. Around 4 agents were unable to perform their usual work during the last 7 days because of pains in the mentioned areas.
None of the agents surveyed complained of recent symptoms of hearing disorders. However, in the past 6 months, the complaints of ear pain and ringing in the ear were reported. Of the 73 agents, up to 53 (73%) responded to have at least one symptom of voice disorder in the last 6 months. Those who have voice disorder symptoms in the last 7 days also complained that their work was adversely affected.
The Occupational Safety and Health Center is supporting the development of the call center industry and we believe that through this study Knowledge will be gained to improve working conditions In existing and prospective new call centers Address the OSH problems at an early stage to avoid an upsurge of safety and health-related issues From our findings, we will be able to assist in the formulation of policy and programs that will address the needs of women include working mothers and young workers Health and safety issues concerning work shifts, esp. prolonged night work And the need for adequate, on-site medical and health promotion facilities
Occupational safety and health concerns of non-industrial workers are often times overlooked. Through this project, the complex nature of health issues in call centers as an example of non-industrial workplace is presented. The health problems of workers in call centers associated with air quality, ambient noise, noise from headset, human-computer interaction, shift work are brought into light and may aid in clarifying issues in compensation.
