Calls for a cure: with flexible schedules and ergonomic accommodations, companies can curb high absenteeism at their call centers.

Call centers are among the nation's fastest growing Industries In 2000, almost one in 20 people in the United States was employed by call centers, and the expectation is that will grow to one in seven this year, according to Fast Company's Web site.

The projected growth makes it all the more important for employers to work with their disability carriers to reduce the high rate of absences and lost productivity due to injuries and illnesses among call center personnel. These centers often experience an absenteeism rote of 30% to 40% on any given day, whereas the absenteeism rate for industry in general averages 5% to 20%, depending upon the particular business, said Dr. Ronald Leopold, vice president and national medical director at MetLife, a provider of disability insurance to individual and institutional customers.

"We're talking about a very significant number here, and it's significant with regard to the day-to-day administration of these centers," he said. "These centers are run by making sure you have enough people answering the phones. So that's a big issue."

Call centers run the gamut, from those that fill orders for clothing and gift baskets to those that handle insurance claims or field consumer complaints.

"Call center positions can be very stressful because so many of the types of calls are not necessarily pleasurable sales calls, but people upset with problems," such as customers objecting to a bill or someone who can't get service, said Joseph Wozniak, chief financial officer of Disability Management Employer Coalition.

"There are lots of difficult, challenging calls to call center staff, and generally they truly do not make a lot of money," he said. "But if you think about it, they're the first-line contact with customers, they are supposed to provide a response, they're supposed to resolve these discrepancies and disputes, most now also cross-sell products and services to retain the client base. So they've got a very complicated job."

Out Sick

The pressure can take a physical and mental toll. "We see huge rates of claims for depression, stress and anxiety," said Leopold. "We're also seeing a lot of more casual, shorter absences, from colds, flu mid upper respiratory infections."

The stress of many call center jobs leaves employees prone to accidents, workplace injuries and musculoskeletal and psychiatric disabilities, which ultimately lead to more absences and disability claims, Leopold said.

Repetitive stress injuries such as carpal tunnel syndrome, a painful progressive condition caused by compression of a key nerve in the wrist, are a factor among call center workers, who may sit at their computers for six or seven hours a day. They may develop these injuries in the hands, arms and neck, said Rebecca A. Shafer, head of workers' compensation consulting at Arthur J. Gallagher & Co. of New York.

"Absenteeism related to carpal tunnel syndrome is a big concern," she said. "Not only do they have to pay the employee who's out of work, but they also have to pay the replacement employee."

Shafer, who assesses corporate workers' compensation practices, recently dealt with a major credit card company that had call center employees with repetitive stress injuries. She tackled the case with a safety expert who studied the ergonomics, or the physical setup of the workplace, while Shafer considered communication, training and employment procedures such as prolonged work periods or lack of task rotation.

In this particular instance, she found the root of the problem was a failure to recognize the onset of these injuries. "Carpal tunnel syndrome is one of the few types of repetitive stress injuries where you actually get a tingling before there's pain," she said. "The trick is to get the employees with the very early signs of repetitive stress injuries."

Among major injuries, carpal tunnel syndrome ranks highest in days away from work, Shafer said. The average days away from work are 30 for repetitive stress injuries, whereas the average for fractures is 29, and amputations, 26.

Solutions

To solve the credit card company's problem, Shafer, who says her cost containment programs can reduce clients' loss costs from 20% to 50%, is establishing a repetitive stress injuries reduction program spearheaded by a task force. The task force will include Shafer, the safety expert, representatives of the company and its carrier, and a doctor who specializes in treating such injuries.

The task force is considering several steps beginning with alerting employees to symptoms so that they understand that tingling is the earliest sign of a problem.

A key part of the communications package will be reminders to employees to take breaks. These might be computer generated messages.

The group also will consider how they can rotate these workers' tasks, even if it means they must leave their computers part of the day, she said. And they will explore the setting up of a break room where employees experiencing the early symptoms can retreat to apply small ice packs to their wrists for five minutes or more. The ice increases blood flow and promotes healing, Shafer added.

The plan also calls for instituting an aggressive return-to-work program. "Many people will tell you that it's impossible to place somebody who's had bilateral carpal tunnel, and is in the post surgical stage, back into the work force in a modified duty program," Shafer said. "So we're looking at some very creative measures we can take." One could involve establishing some sort of controlled task rotation with a week of light duty, then a recheck for symptoms, she said.

Ergonomically Correct

High absenteeism at call centers has spurred Disability Management Employer Coalition, which has 1,200 employer members, to conduct regional seminars and a national conference in August to explore the issue. At the conference, the group will release a report detailing the challenges of this problem and show what some employers have done to address the challenges.

In one example, a few employers have put sit-and-stand workstations in place. At the push of a button, these workstations will rise so that an employee can stand and work at the desktop. Another push of a button will lower the desk and the employee can sit. The coalition knows of the case of one employee who decided to stop her therapy sessions and close her claim after she was able to stand and work during the day, Wozniak said.

"Our ultimate goal is to try to get a couple of employers to put in some of these improvements and then have someone track the results," Wozniak said, adding that a pilot study probably could begin in 2006.

The coalition's partner in this effort is Liberty Mutual Insurance Co. Michelle Robertson, who leads research on office ergonomics or office work system design at Liberty Mutual Research Institute for Safety, said that years of studies have indicated that high absenteeism stems from a combination of the physical demands as well as the mental demands on these workers.

While risk factors for call center workers and other workers may be similar, the call center employees don't have a sense of control over the design of their jobs the way many other employees do, she indicated.

In addition to working with the coalition, the institute has partnered with other organizations to design office ergonomic interventions, Robertson said. This calls for changing the entire facility, not just the adjustability of the work station and chair, but the lighting, visual line of sight and ambient noise levels.

The research institute couples this with office ergonomics training to help employees understand how to set up their workstations, take rest breaks, get up and stretch, and try to have some sense of control over that physical environment, Robertson said. "We found that those participants in the intervention group with the new office work station design and the office ergonomics training displayed the greatest reduction in upper extremity discomfort," she said.

Currently, Robertson and her staff are conducting a study in a controlled environment to see how the body reacts to various work station configurations and workload levels over a long period of time. They also will look at the effects of training vs. non-training and overall body reaction to stress. "It's hard to do that out in the field," she said. "There are many variables I can't control, such as managers, and how they interact with their employees, but I am able to control that in the laboratory." The experiment is using local people who are trained and then paid to perform real call center jobs in the research institute's laboratory, she said.

"What's important is there's not one single contributing factor--it's multiple contributing factors," Robertson said. "We need to approach it in multiple ways in order for us to really, truly address this so that we can support the workers' needs physically and mentally."

The research by Liberty Mutual Research Institute for Safety is not proprietary and is available to the scientific community, Robertson noted.

Remedies

A number of remedies are available to improve call center working conditions, including:

* Flexible schedules including part-time and expanded hours.

* Review productivity quotas. "The job design might be driving far more burnout than their business can withstand," Leopold said.

* Provide a refuge such as a break room or tranquility room, as well as access to an exercise facility, to allow employees to take time away from their workstations and their headphones.

* Effectively communicate employee assistance programs or work-life programs to help workers cope with their high productivity, high volume, high stress jobs.

Compared with the general working population, a disproportionately high number of younger women staff call centers, Leopold said. Many are working mothers in either a single parent household or a two-income household where the woman needs to work to gain benefits or the husband is unemployed and being a customer service representative serves as the best and most secure position affording them a living, he said.

Clearly, maternity claims can run higher at these businesses where 70% to 95% of the workers tend to be women, Wozniak said. There also can be numerous incidental absences because women tend to be the primary caregivers for children, he noted.

Under California law, larger companies must provide a room where new mothers can breast-feed their infants. Providing this could encourage new mothers to return to work sooner, which would help their companies, Wozniak said. MetLife reports, for example, that the incidence rates for Family and Medical Leave stand-alone claims--those that do not overlap with disability claims--are three times higher among call center operations than MetLife's book of business for Family and Medical Leave claims in non-call centers.

It's not surprising that call centers have been dubbed the sweatshops of the 21st century.

"I believe that the winning strategy for companies is to solve what is a rather complex dilemma and make their call centers places that are successful at keeping people at work and reducing absences," Leopold said.

Key Points

* Call centers often experience an absenteeism rate of 30% to 40% a day.

* The stress of many call center jobs leaves employees prone to accidents, workplace injuries and musculoskeletal and psychiatric disabilities, which lead to more absences and disability claims.

* Caused by multiple factors, absenteeism must be addressed in different ways with the emphasis on prevention.

U.S. Call Center Facts

* The industry standard for call centers is to answer 80% of incoming calls within 30 seconds or less.

* The representative is provided two 15-minute breaks and a lunch break during the usual 10-hour shift.

* Average operator training is 15 days, which is five days below the world's best-practice level of 20.

* Employees typically perform the following tasks simultaneously:

--Validate any and all information;

--Search and read any prior history;

--Enter and document current information;

--Actively listen, solve problems, and sell a product or service in eight minutes or less.

Source: MetLife's The Call Center: Absence, Lost Productivity, and Seven Solutions The guide is available at www.metlifeiseasier.com/disabilityalmanac/archive.asp.

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