An occupation that requires workers to spend much of the day making and receiving telephone calls may sound like a relatively safe job. But call centre work has many serious health risks.
According to experts, the mental health effects of these types of jobs can be severe, with workers suffering high rates of stress, depression, anxiety and substance abuse. Call agents must also deal with physical hazards ranging from musculoskeletal disorders to chronic hearing loss.
According to a 2009 study by Toronto-based Morneau Shepell, a provider of employee and family assistance programs, call centre employees report higher levels of mental and physical health issues than those of other industries. It noted 47.6 per cent of employees who quit cited stress as the main reason for leaving.
The industry, the study observed, is marked by high absenteeism, low employee retention and poor customer relations. It also pointed to a number of job characteristics that lead to workplace stress, including stigmatized work, lack of job control, low task variety and high exposure to angry clients.
Genie McDougall of the Canada Employment and Immigration Union (CIEU), which represents agents in various Service Canada departments, agrees many features of call centre work make for an extremely stressful environment.
Severe time pressures are, for example, a fact of life for most call handlers, she says. One reason is “occupancy,” a formula used to measure productivity based on the percentage of time workers spend handling calls versus available time. As a result, most call agents throughout the industry have 10 seconds between calls. In many Service Canada departments, they have five seconds.
“In five seconds, people don’t have a chance to draw breath, take a drink of water, gather their thoughts,” says McDougall, who is national chair of CIEU’s national call centre committee. “And you may have had a rough call. Sometimes, clients are less than congenial.”
Although caller inquiries are often complex, she says, many call agents are required to complete calls in six minutes, six seconds. Calls are also monitored for content and, often, for the agent’s tone, rhythm and lack of hesitation.
“It leads to a lot of stress, both mental and physical, because call centre people are at their seats for long periods of time, sometimes three hours at a stretch, without being able to move around,” she says.
Employees must constantly be watching the clock. Under “dynamic scheduling,” McDougall says, the schedule of breaks and lunches changes day to day. Workers are judged on their “adherence” — that is, how closely they stick to the schedule. In addition to the constant schedule change, they often have to remain on a call when a scheduled break comes up and so deemed “out of adherence.”
These internal workplace pressures, she adds, as well as frequent verbal abuse from callers, contribute to stress and workers’ low morale. In addition, the ability to socialize — a main benefit of being in the workforce — is almost non-existent due to the nature of the work and time constraints.
“You feel as if all you do is come in, you plug in. It’s almost like being a robot. Call centres are being likened to modern-day sweatshops,” she says. “We have more people going out with all kinds of mental stress issues and on long-term disability.”
Call centre workers are also exposed to physical problems. A 2012 study from the United Kingdom, for example, found one in four call agents suffer voice problems, including voice loss, sore throat, hoarseness and breathlessness. It recommended call centres provide basic training in voice control and protection.
Lynn Woodman, director of Voice Power, a Toronto company that provides voice, speech and presentation training, says the main problem for workers required to speak for long periods of time is vocal fatigue.
To work effectively and stay healthy, she explains, the vocal cords need to be flexible, hydrated and supported by a steady stream of air, obtained by deep, abdominal breathing.
“When we don’t have enough breath support, we push the sound through the vocal cords, and it becomes strained and thin. Over time, this has a drying effect on the vocal cords, and they don’t have the flexibility they need,” she says.
When breathing is shallow, Woodman adds, a person uses a narrow portion of the voice’s full range and tone, depriving it of its resonance, which helps the voice carry easily. Call handlers compensate by speaking louder, which requires more energy and effort. In time, she says, incorrect speaking behaviour can lead to vocal nodes, which require a period of rest or, in some cases, surgery.
To keep vocal cords hydrated, Woodman recommends call agents sip water throughout the day and avoid spicy foods and caffeinated drinks. Good posture is essential, too, to reduce strain in the neck and promote relaxed airflow, she says. Staying in the same position for a long time causes tension, so call handlers should try to move around.
“If they can get up, stretch and yawn and get a glass of water at least every 90 minutes, that is definitely going to serve them,” she says.
Spending hours on the phone every day also poses risks to hearing. Even after only a year or two, many call agents show signs of hearing loss, says Sean Lennox, an audiologist with Advanced Hearing Group in Ottawa.
A major cause of damage is headsets, he says. Sets covering both ears shut out more background noise and make hearing easier. But many workers wear sets covering only one ear and so tend to turn up the headset’s volume.
“They usually have more sensory hearing loss in one ear versus the other ear,” he says. “We recommend people have both ears covered, so they don’t turn the volume up as loud.”
A common problem among call centre workers, Lennox says, is acoustic shock disorder (ASD), a syndrome caused by a sudden, loud sound. Often misdiagnosed, ASD may produce some hearing loss, but its main symptoms are an intense fear of loud sounds, depression, anxiety and tinnitus, a phantom sound ranging from a hum to a high-pitched squeal.
For call handlers, whose headset volume may already be turned up, the danger comes when a person on the other end of the call raises their voice.
“The noise is already at an unsafe level, and then they have someone yelling at them on the phone. And a lot of these phones don’t have the capability to limit output, so they’ll hear someone yelling in their ear at over 110 decibels,” he says.
Call centres should conduct regular ambient noise surveys, Lennox says. If the average noise level is above 60 or 70 decibels, they should consider acoustic modifications, such as additional carpeting. Workers should have their hearing tested regularly to detect loss early on.
Call centre workers also face a number of musculoskeletal issues, says Dhananjai Borwankar, technical specialist with the Canadian Centre for Occupational Health and Safety in Hamilton, Ont. Sitting for long periods of time, for example, restricts blood circulation. In a prolonged fixed position, the muscles of the neck, shoulders and trunk become tense, preventing blood from reaching these areas.
“Your body has a decreased ability to transfer oxygen and nutrients to where it needs it most,” he says.
Workers may spend hours leaning to the right or left, Borwankar adds, alternating between hands to hold the phone. Moreover, if the workstation is poorly organized, they may have to stretch to get documents placed beyond their reach.
Repeatedly stretching the body to its extreme range of motion, or holding an awkward position for a long time, increases the risk of injury to that part of the body, he says.
The dimensions of the workstation, especially in relation to the worker’s height, are key ergonomic considerations. Working at a table that is too high or low can injure the shoulders and wrists. Borwankar advises companies bring in an ergonomic specialist to review workstations and match them to the workers.
“(They need) someone who will look at the workstation — not just at new chairs but also at the type of work that’s being done and how it’s organized — and look at putting all those elements together to try to minimize ergonomic concerns,” he says.
As the Morneau Shepell study emphasizes, it’s important for call centres to promote good physical and mental health, in both workers and supervisors. It recommends managers increase worker control and variety, provide opportunities for a wider use of skills, and judge work output — not the person or hours.