Cost of Shift Workers

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India Review, vol. 9, no. 4, OctoberDecember, 2010, pp. 425449Copyright Taylor & Francis Group, LLCISSN 1473-6489 print; 1557-3036 onlineDOI:10.1080/14736489.2010.523618

FIND1473-64891557-3036India Review, Vol. 9, No. 4, Oct 2010: pp. 00India Review

The Cost of Shift Work on EmployeeHealth and Performance: CanOrganizations Afford to Ignore theConsequences?Cost of Shift Work onEmployee Healthand PerformanceIndia Review

NUPUR TUSTIN

IntroductionSince its advent in the 1990s, off-shore outsourcing, or the contract-ing-out of services and manufacturing operations to unaffiliated orga-nizations overseas, has attracted both media and academic attention.1

As an early entrant into the outsourcing industry, India remains thedominant destination for those considering off-shore outsourcing as astrategic business plan, although its success has prompted other coun-tries in Asia, Africa, and East Europe to enter the market.2 Further-

more, the current recession in the United States coupled with the taxbenefits that countries such as China are offering to encourage foreigninvestment by overseas corporations has made off-shore outsourcinga crucial aspect of any strategic business plan to enhance cost savingsand increase efficiency.3 However, high attrition rates in India make itless likely to retain its dominant position in the global outsourcingmarket.4 This study attempted to understand the health hazards asso-ciated with nonstandard work hours called for in the outsourcing

industry and the extent, if any, to which they were responsible for thehigh attrition rates in the Indian market.

The first operation to be outsourced to India was that of customersupport. American customers of such organizations as AmericanExpress found their calls for support directed to agents located inIndia. Although time zone differences between the United States andIndia meant that Indian customer service agents were working throughthe night to provide support to American clients, both academic and

Nupur Tustin is a Doctoral Candidate at the University of Southern California Annenberg


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media attention focused, not on the nonstandard hours of employ-ment, but on accent training. The attention particularly emphasized thelatent imperialism inherent in the accent training that Americanizes

Indians in such jobs, which, in turn, creates an identity crisis.5 Otherresearch emphasized the stress of working in the call center industry.6

Despite the known health hazards of shift work, no attention has beendevoted to documenting the negative health consequences of shiftwork and the impact of employee health on performance, accuracy,and employee satisfaction in this industry.

One aim of this study was to document employees experience ofshift work in organizations within the business process outsourcing

sector where, even though real-time interaction with the overseas cus-tomers of client corporations is not the primary feature of the job,employees work nonstandard hours to cope with work volumes andtight deadlines, as well as to respond to changes in project details thatthe overseas client communicates to the project supervisor. The reasonfor the shift in focus to outsourced processes such as medical transcrip-tion and data conversion is that, although one might argue that workstress for call center employees is as much due to interactions with irate

customers as due to shift work, this argument does not hold for anorganization where employees have no interactions with customers.A more important focus of the study, however, was to discover

whether employees ill-health due to shift work could have a significantimpact on organizations as well by affecting employee turnover. Eventhough India currently remains the dominant offshore location, highattrition rates are a cause for concern, causing organizations to considerother locations such as China and the Philippines. High attrition ratesranked as an important concern for 73 percent of firms experienced inthe outsourcing industry, according to the ORN survey.7 However, tothe extent that attrition rates may be indirectly caused by the adverseaffect of shift work, this is a problem that will be encountered in anyoffshore location when the difference in time zones between the clientslocation and the offshore corporation is eight hours or more.

In-depth interviews did, in fact, indicate that shift work nega-tively affects employee-management relations through its adverseeffect on employee health and performance. Strained employee-

management relations in turn lead to higher attrition rates, and theresulting cost to the corporation of recruiting replacement workers


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Cost of Shift Work on Employee Health and Performance 427

Additionally, this article tries to briefly address the question ofpossible cost-effective solutions management could employ to enableemployees to adjust to night shift work and to ensure that perfor-

mance levels and accuracy are not affected. Although research con-ducted in the United States has documented the links between shiftwork and ill-health, both rotating shifts and graveyard shifts are aninescapable fact of many industries.8 Thus, the purpose of this paper isto posit possible solutions that might be explored in future research toincrease employee satisfaction, promote coping strategies, and, there-fore, improve both performance levels and attrition rates.

BackgroundBusiness process outsourcing (BPO) includes both operations thatentail an interaction with the client, or voice operations, and thosethat do not, non-voice operations. Call centers or customer serviceagencies are an example of the former, while medical transcription isan example of the latter. The BPO industry is part of Indias informa-tion technology (IT) sector, which accounts for about 5 percent of thecountrys gross domestic product. Organizations in the BPO sector

provided employment to about 700,000 Indians and reported reve-nues of $12.5 billion in 2008.9 Since the bulk of the industrys clientsare located in the United States, followed by the United Kingdom,rotating shifts, night shifts, as well as working extended shifts involv-ing over 24 hours of continuous work are the norm.

The follow the sun approach addressed by Aneesh is only possi-ble in the case of corporations that have office locations and teamsworking on a project in different time zones.10 In such cases, teams ineach time zone can work during their daytime hours continuing onthe work done on a project by a team in a different time zone. Whenoperations are outsourced to an organization located in another timezone, however, there is just one team located in one time zone (such asIndia) attempting to provide service to clients in another time zone(such as the United States). The need to conduct quality control meet-ings, to specify project details, and the need to communicate changesin deadline or project specifications necessitate night shift work not

just in call centers, but in companies that provide other services like

medical transcription. In the data conversion and medical transcriptioncompanies that were the focus of this study, shift work also enabled


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Most BPO and IT companies are located in Bangalore, Indias SiliconValley, as well as in the larger metropolitan cities of Delhi, Mumbai,and Chennai. Information technology development in Kolkata in

eastern India, where this study was conducted, has been growing, butat a slower pace. Kolkata is also the least industrialized of Indias fourmetropolitan cities. Its cost of living is lower than that in the othermetropolitan cities and Bangalore, but the city also has fewer employ-ment opportunities, and salary levels tend to be lower.

Literature ReviewResearch on the BPO industry in India has been limited, with studies

done primarily on the stress of call center work.11 The psychological andemotional problems individuals face has been well-documented. Emo-tional withdrawal and burnout are caused not just by the way employeesperformance is evaluated, but by the scripted nature of agent-customerinteractions, and employees inability to express anger felt at abusive cus-tomers.12 Typical symptoms include fatigue and a depletion of emotionalresources, a condition common in people who provide care and support.13

The greatest source of stress comes from having to resolve the dichot-

omy between the organizations demand for both efficiency (in terms ofvolume of work) and service (in terms of quality of work) without anyclear guidance about what it is the organization values.14 Although man-agement rhetoric emphasizes the value of service, call center employeesare evaluated in terms of efficiency. The satisfaction of successfullyresolving a customers problem is often overshadowed by the fact thatthe customers expression of appreciation or the complexity of the issueincreases call handling times, resulting in poor performance appraisals.15

While stress may result in minor, but chronic health problems suchas colds, these are not problems specific to working non-standardhours.16 The fact that working non-standard hours does have adversehealth consequences and has been mentioned in prior work on call cen-ters; however, it has not been the primary focus of these studies.17

Thus, the first research question is:

R1: Do employees in the BPO sector face problems with physicalhealth as a result of working night shifts or rotating shifts?

Common problems include impaired sleep, nausea, and gastric


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The stress of call center work and the flat nature of the organiza-tional structure have been shown to be associated with high turnoverrates. Call center work tends to be monotonous, assembly-line

work.19 The relatively flat structure of both call centers and otherBPO organizations provides little opportunity for career growth, afactor contributing to frustration as well as attrition.20 Stigmatized asassembly-line workers and cyber coolies,, call center workers areunlikely to see their jobs as long-term career prospects.21 These fac-tors fuel dissatisfaction leading to high rates of attrition in the BPOindustry.22

A series of research questions follows from these findings:

R2: Do employees in other BPO organizations also find their workmonotonous?

R3: What opportunity for growth is there in other BPO organizations?R4: Are levels of attrition more likely to be due to stress and the flat

work structure or do the ill-effects of shift work also contribute toattrition rates?

Studies suggest that it may be more cost-effective for management toreplace and train new employees than to expend the effort to retainemployees. One study found that management associates a lower costwith frequent turnover than with putting into place programs toencourage employee loyalty.23 The low levels of skill associated withcall center jobs means that organizations can recover almost all oftheir training costs despite an average turnover of eight months.24

Because of these cost-factors, management may be less committed topromoting programs that reduce stress and other health-related prob-lems their employees face. Since employees in the IT sector, as well asin the BPO industry, are not unionized, collective bargaining andnegotiation for better workplace policies are difficult to achieve. Yet,research on shift work and its effect on performance suggest that itmay not be cost-effective for management to ignore the ill effects ofshift work on employees.

Some of the research on shift work indicates that night shift androtating shift work is not just associated with sleep deficits but, also,

with impaired judgment and human error. Studies have documented alist of serious incidents that took place due to human error in the early


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accident, and the Bhopal Union Carbide incident, among others.25 Theseerrors in judgment have been shown to take place in hospitals as well.26

While errors made in BPO organizations that convert documents

from one format to another or develop software may not have suchgrave consequences as the aforementioned ones documented, theymay still result in a significant loss of revenue and reputation for theorganization involved. Errors in the medical transcription industrymay, however, have more serious consequences.

R5: Is management aware of the health problems faced by employeesdue to shift work?

R6: Are management and employees aware of the link between the illeffects of shift work and performance accuracy?

MethodsThe study was conducted in the summer of 2007 in the city of Kolkata,capital of West Bengal, a state in the eastern region of India. Fifty-three employees, including managers, in two BPO organizations wereinterviewed using a semi-structured format. Thirty of the respondents

worked in a data conversion organization specializing in the conver-sion of documents into pdf files and writing xml tags for academicarticles. The other 23 were employed in the largest medical transcrip-tion company in the eastern region. Respondents were mostlybetween 2530 years old.

The city and these organizations were deliberately chosen as salarylevels, as well as work prestige, in such organizations tend to be lowerthan for software engineers and computer specialists in organizationssuch as Oracle or Hewlett Packard. There was less likelihood of longwork hours being perceived as a badge of honor in the organizationschosen.27 A 1977 review cites a number of studies that attest to thecommunitys role in promoting positive attitudes toward shift work.28

Thus, a perception of the prestigious nature of ones job and a sense ofhaving a lucrative career might mitigate to a certain extent the effectsof shift work. However, medical transcription and data conversion donot require the educational investment that software engineering jobsdo and are not as well-paid, making societal perceptions of them more

likely to be similar to those found for call center work.29Each interview lasted about 3545 minutes, taking place in a small


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respondents. Interviewees were given an information sheet describingthe study. The researcher also verbally explained the purpose of thestudy, emphasizing the confidentiality of the material collected.

The general manager in both companies was interviewed first tounderstand the hiring and training process, reasons for attrition, strat-egies used to deal with attrition as well as the hierarchy of the organi-zation. Employees were asked about their reasons for joining thecompany, for being attracted to the BPO industry despite, in somecases, being trained in other professions such as accountancy. Theywere encouraged to describe their job as well as to discuss the positiveand negative aspects of the workplace. In addition, respondents talked

about their experience on the night shift, adjustment problems if any,as well as strategies they used to cope.

ResultsA general description of working conditions at the two organizationsas well as the type of training required prior to employment follows toprovide a context. Next, each research question is answered using thegeneral themes that emerged from the in-depth interviews.

Organizational Structure

Both companies had a large pool of workers in production, a smallergroup of senior employees in charge of monitoring the quality of thework, and a still smaller group of mid-level management. Reflectingthe gender disparity in both the BPO industry and the informationtechnology (IT) sector as a whole, both companies had a small pro-portion of women employees. Women constituted about a fifth of thetotal in the data conversion company and about a third of the total inthe medical transcription company.

Socio-economic Status

The employees at the data conversion organization were primarilylower middle class, commuting to work from the less expensivesuburbs of the city.30 The medical transcription employees, on theother hand, were primarily middle class and were employed in thelargest medical transcription company in the eastern region. Medical

transcription involves transcribing patient records for hospitals andclinics in the United States. The medical transcription company also


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Qualifications

There was a disparity not just in terms of socio-economic statusbetween the employees at the two companies, but also in terms of skill

level required for the job, working conditions, and income. Employeesat the data conversion company required merely an undergraduatedegree and a basic comprehension of English as well as basic computingskills in order to be recruited.31 Those in the medical transcription com-pany needed, in addition to an undergraduate degree, a four-to-sixmonth training course in medical terminology, English comprehension,as well as transcription of audio files, to be considered as potentialemployees. This training is provided at private institutes and costs

approximately Rs. 25,000 for a six-month program.32

Salary and Growth

The starting monthly salary for employees in the medical transcriptioncompany in Kolkata was Rs. 3,500. Thus, only the relatively privilegedcould afford to pay Rs. 25,000 for training for a job in which, at least inthis particular company, they would, after two or three years work,receive a monthly salary of Rs. 10,000. Employees in the data conver-

sion company had a similar starting salary, but unlike employees in themedical transcription company did not receive a shift allowance forworking on the night shift. Starting salaries of Rs. 3,500 are low even byKolkata standards, where the cost of living is relatively lower than incities like Mumbai and Delhi. Employees said they had expected to getat least Rs. 5,0006,000.

There was more opportunity for growth, at least in terms of salaryincrements, in the medical transcription company. Thus, a supervisorwho had been with the data conversion company since the inceptionof its outsourcing operation received a monthly salary of Rs. 11,000 amonth, including incentives. On the other hand, in the medical tran-scription company, a quality analyst (the level below the manageriallevel) who had been with the company from the start received amonthly salary of over Rs. 18,000.

Leave Policy

Employees in the medical transcription company were entitled to paid

leave unlike employees in the data conversion company. Medical tran-scription company employees received two days off after each block


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Employees had six days off per month, were given eight days of sickleave in a year, and could take a 22-day vacation every year.

Employees at the data conversion company, on the other hand,

were treated like day laborers, their salary being deducted for everyday away from work, even when weather conditions or strikes meantthey could not come to work. Although Sundays were supposed to beholidays, they often worked every Sunday.33 While only men were puton the night shift, both men and women had to work extended hours.In the case of men, this often meant working for 36 hours at a stretch,as they covered two or three consecutive shifts during busy periods.

Long commutes meant that employees in the data conversion company

spent a large chunk of time not at work on their commutes. Since employ-ees at the data conversion company were more likely than those in themedical transcription company to live in the suburbs, their daily commuteeach way was often over two hours, spent on public buses and trains. Nei-ther company provided transport to and from work, a facility offered(especially for afternoon and night shift employees) at call centers as well asby multinational corporations that run operations to serve overseas clients.

Initial TrainingBoth companies put new hires on a week of training prior to assigningthem any work. While the training focused on the details of the projectsemployees would be working on, no attempt was made either during thetime of training or during the job interview to familiarize employees withthe health problems commonly encountered on the night shift. Womenwere asked whether their families would consent to their working at night.

Health Problems

Employees at both organizations suffered the ill-effects of night shiftwork, mentioning problems common to shift workers all over theworld: fatigue, impaired sleep, nausea, and gastric issues.34

Respondents cited drowsiness and fatigue on the night shift as wellas disturbed sleep during the day. Employees complained about notbeing able to sleep more than few hours at a stretch. A 31-year oldmedical transcriptionist attributed his disturbed sleep to the fact thathe had to share a room. His 24-year old colleague, who did not have to

share a room, said that despite working having two years experience ofshift work, he still found it difficult to sleep more than two or three


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These problems tended to be worse for employees working on thenight shift for the first time. Yet, the prospect of working on the nightshift continued to be unpleasant even for experienced employees. A

27-year old married employee in the medical transcription companysaid she still faces problems: Four years that Im doing the nightshift, I still feel so depressed when the night shift starts.

Even those who claimed to face no problems at all, saying theyenjoyed working nights, were unwilling to be on the night shift per-manently. One such employee, a 31-year old married man, in themedical transcription company said: I cant do more than five daysof night shift. After five days of night shift, you dont feel like work-

ing. You feel tired. And then in the summer, there is load-shedding[power outages], so you cant sleep during the day. A 26-year oldmale employee also in the medical transcription company said heenjoyed doing night shifts because there was less pressure fromsupervisors, but did not want more than one week of night shift amonth.

Stomach problems and nausea were also common. A 25-year oldemployee in the data conversion company said: I felt weak. I

couldnt eat properly. There was no time to eat, and when you arementally disturbed [as a result of work pressure], eating is a problem.While employees readily admitted to stomach and gastric problems,other than two employees, all said they themselves had not sufferednausea, but referred to colleagues who had: Some people tend tovomit on the night shift (senior quality analyst, male, in the medicaltranscription company for seven years).

Only two women in the medical transcription company specifi-cally mentioned feeling nauseous. One of them a 50-year old, whobegan working five years ago, said the problems she faced were soacute, she had to ask to be let off the night shift:

I was just not able to do night shift. I used to feel sick and nau-seous. I would have a throbbing headache. I wasnt even able toget up from the bed . . . I did it for three or four years, and theproblems didnt get better.

A male respondent also at the medical transcription company alsomentioned feeling unwell: I feel very sick in the morning . . . because

i h d i d f i h hif


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Employee Perceptions of Work and Growth Opportunity

The second and third research questions asked whether employeesperceived their work as routine and monotonous and whether much

opportunity for growth was afforded in the two companies whereemployees were interviewed. Employees in both organizationsemphasized the repetitive nature of their work. This is not Michaellearns to rock, said one employee in the medical transcription com-pany. Some doctors have such voices that just by listening to himyoull get a headache. Employees at the data conversion companyalso emphasized the monotony of the job as well as the pressure ofdoing the same kind of work for hours at a time.

The third research question regarding growth was indirectlyanswered in the description of working conditions and salary providedpreviously. Neither company provided much opportunity for growthin terms of salary increases or promotion to higher designations.

Employees at the data conversion company complained of beingpassed over in a consideration of promotion or salary incrementsdespite receiving positive feedback on the quality of their work. Atthe medical transcription company, employees were aware that the

company needed more people to transcribe medical records than tooversee employees and that, therefore, the possibility of being pro-moted was limited. Respondents from both organizations hoped tomove onto higher-paying jobs in the BPO sector in other cities.

Attrition

An important finding of the study was with respect to the fourthresearch question regarding attrition. Attrition rates in the data con-version company averaged 25 percent a month, while that in themedical transcription company averaged approximately 7 percent amonth.35 These rates appear to be higher than the industrial average,which at 22.5 percent a year, is also fairly high.36 Managers in bothcompanies expressed concern about high attrition and the cost to thecompany. High attrition is a source of concern to the IT sector and toNASSCOM, the trade body representing the sector, as a summit orga-nized on the issue in June 2008 attests.37

Although employees worried about being able to cope with the ill-

effects of shift work as they aged, the adverse health effects of rotatingand night shifts were not a direct cause of attrition. A 27-year old


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two years he had worked on shifts, he was not sure whether he wouldbe able to take the pressure after five years. A 33-year old marriedemployee said his ability to cope with the stress of work would deter-

mine whether he would remain in medical transcription five yearslater. An employee in the data conversion company echoed this view:

If the shifts continue to rotate, after a certain age, I may not beable to take that kind of pressure . . . If you look around on thefloor, youll see that the average age of people here is between 25and 30. So, their energy level is fairly high and they can cope. Idoubt whether they will be able to do it when they are older.

Attrition was caused, for the most part, by the conjunction of poorworking conditions and a sense that adequate compensation was notreceived for enduring night shift work and long work hours. A seniormanager at the medical transcription company, who had previouslybeen a physician, recognized that inadequate compensation coupledwith long working hours was responsible for dissatisfaction:

[in the medical profession] there was a sense that there will be apayoff . . . night shifts and day shifts do not matter to [doctors] . . .doctors know the more they work, the more handsomely theywill get paid. So, that financial motivation is there for us. For thesepeople [medical transcriptionists] financial motivation is there . . .but it cannot be as high as that of a doctor.

This idea of inadequate compensation was reiterated by employeesin the data conversion company. One employee said: With the inputI am giving, I am not getting that much of output . . . I get very littletime to spend with my daughter. . .because we have to work on Sun-days as well. A 25-year old male employee who had been with thedata conversion company for a little over a year also mentioned theextended work timings: When I joined, I soon learned that time isnot a factor in this company. You have to finish the work at any cost.I have often had to do continuous day and night shifts, which affectedmy health. But I had to consider the money.

In the medical transcription company, the effect of long workinghours on family life38 and management demands, especially on the


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lower volume of work achieved, that caused dissatisfaction and attri-tion. A 50-year old senior medical transcriptionist complained thatmanagement pressure to stay beyond the 10-hour shift was stressful:

The supervisors just dont understand that I have a home [to takecare of]. Her 27-year old colleague said: You dont get much time tospend with your family. We dont get the opportunity to participatein the festivals because its a 24/7 job, so Sunday is never a holiday . . .In a family, most of the people not in this industry have their holidayson a Sunday . . . Ive done night shifts on Durga pujas. 39 Althoughthis respondents husband works in the same company, she too isaffected by sudden changes in shift timings: Yesterday, he was having

a holiday, and he was called for night shift. So, I went home [afterworking on the day shift], and I couldnt meet him.

Management Awareness of Health Problems

Managers and supervisors in both companies were aware of the healthproblems employees faced due both to long working hours and nightshift work, but were unaware that employees could be taught copingstrategies based on an awareness of circadian rhythms.40 Management

also felt that the demands from overseas client to meet delivery timesmeant that employees health took a secondary consideration. Aproject coordinator in the data processing organization mentionedsome of these problems in the context of challenges he faces as some-one entrusted with the task of ensuring delivery deadlines are met forprojects the company undertakes:

Sometimes we need to work beyond capacity . . . in order toachieve the clients goal, we have to [produce more than isrequired] . . . Sometimes people in the night shift people get tiredand exhausted . . . its a common thing. But we have to make him[individual team members] understand that we have to gear up,otherwise we wont be meeting the schedule. Sometimes, he mayget indisposed, so thats one of the most problematic areas becauseon night shifts, there are some medicines over here. But theres nodoctor over here.

A senior manager at the medical transcription company reiteratedthese health problems, highlighting the nature of problems employees


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Its mostly the biological clock that upsets them. They are in thenight shift, and then again when they go to the day shift, they feelvery sick. They cant digest their food. They cant sleep. Like they

do the night shift, and when they go home, they say we cant sleepin the daytime. There is a lot of disturbance. You know our Indianhomes, there are so many disturbances.41 Many people do nothave a personal room of their own that they can you know closedoors and windows and sleep.

Like her counterpart at the data processing company, this seniormanager, who left the medical profession to join medical transcription,

also emphasized the importance of ensuring that employees meet thestringent delivery schedules and quality demands of U.S.-based clients:

If I am managing this company from a managers standpoint, Ihave got very limited choices. If I look at them from the doctorspoint of view, then I cant get the work out [of them] . . . As ahuman being, I can feel that the work they are doing is veryfatiguing . . . But it has to be done because the clients expect it to

be done . . . In order to earn the revenue, we have to do a standardvolume of work everyday. Otherwise, we will not be able to earnour salaries.

Management Awareness of Effect of Shift Work on Performance

The last research question asked whether management was aware ofthe association between shift work and performance accuracy.42

Although managers interviewed at both companies were unaware thatperformance levels during the night shift might be impaired as a resultof fatigue and other health problems employees suffered, employeeswere aware that their performance, and hence the incentives theyearned, suffered on the night shift.

Despite the lower volume of work at night, the strain of night shiftwork had an adverse effect on accuracy. A 29-year old at the medicaltranscription company who had been an employee of the company fortwo years said: For me [dealing with night shifts] is not at all easy,even now . . . like its a dread . . . its very difficult for me . . . We have

to achieve our targets, and when we fail to achieve it, we get to hearabout it from our seniors. Achieving the target meant not only


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accuracy. A senior medical transcriptionist explained that he hadnoticed a drop of at 1520 percent in his accuracy level when workingon the night shift.

Since, achieving targets in terms of accuracy as well as volume ofwork factor into the incentives people get, an ability to achieve thetarget can make a substantial dent in an employees salary. A 38-yearold medical transcriptionist who had joined the company four monthsback said he often failed to achieve his targets. An employee at thedata conversion company said his need to take frequent breaks duringthe night shift affected both the volume of work he achieved as well asthe incentives he earned.

DiscussionThe primary contribution of this study was to extend research doneon the BPO industry to organizations other than call centers and todocument employees experience of shift work in situations wherework stress and ill health are more likely to be caused by shift workrather than by stressful interactions with angry clients overseas.Despite health problems and impaired performance, employees were

not reluctant to work shifts. However, the negative impact of shift workon both health and performance did strain employee-management rela-tions. Employee dissatisfaction was fueled by the perception thatmanagement did not fully comprehend the way night and rotatingshift work affected both physical health and performance. Dissatisfac-tion, in turn, resulted in higher attrition rates. Although attrition wasa cause of concern to management, very little attempt appeared tohave been made to resolve employee dissatisfaction and to facilitateemployees ability to cope with night shift work. The key findings aresummarized in the following discussion.

First, while both men and women feel the ill-effects of night shiftwork, women appeared to suffer more acutely than men. Not onlywere women more likely to complain of health problems, managersin the medical transcription company where women were assignedto night shift work also noticed that women seemed to suffer more.This finding is both significant and disturbing in light of recentstudies suggesting a link between night shift work, exposure to light

during the night, and breast cancer.43 Research also indicates thatolder people might be prone to the ill-effects of shift work than


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Second, despite these health problems, employees were neitheraverse to working night shifts nor were they opposed to working inthe BPO sector. Employees referred to the lucrative opportunities

that a booming BPO industry presented. Although all, but seniormanagers, admitted to searching for other, better opportunities, thesetended to be in the same industry. Even those, who initially enteredthe BPO industry merely because they needed a job, said they wantedto stay on. There was also an understanding of the fact that BPO andIT jobs require working in shifts. This was a key finding, as an impor-tant goal of this project was to find out whether knowing the healthconsequences of working night shifts would deter people from joining

companies.Moreover, unlike Wallace and colleagues findings indicating that

high attrition is not a concern to managers, this study indicated thatmanagement at these companies and that the IT sector in general areconcerned about high attrition rates.45 A combination of factors,including shift work, contributes to attrition and suggests that explor-ing strategies to alleviate the ill effects of shift work on both healthand performance might serve to improve employee-management rela-

tions and lower attrition rates. Findings from this study suggest thatshift work mediates through employee health and performance toaffect employee-management relations and attrition. Specifically, shiftwork affects employee health, which, in turn, affects performance.Impaired performance is a source of strain in employee-managementrelationship, which causes attrition.

Third, no information was provided to employees about the short-term health consequences of shift work, although educating the work-force is one of the first steps recommended to facilitate adjustment.46

Neither managers nor employees were aware of the long-term conse-quences of shift work, in particular the association with cancer. Giventhat night shift work is considered a risk factor for breast and colorec-tal cancer, it is especially important for those who work nights to beaware of their risk and to adopt preventive health measures such asregular screenings.47

Finally, while managers seemed to be unaware of the effect thatnight shift work can have on performance, employees indicated that

concentrating on their work and being accurate was more difficult onthe night shift. Although more research needs to be done on the cost


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study indicate they are important enough for management to considerstrategies to minimize the adverse health effects of night shift work.Furthermore, the results indicated that high attrition rates are specific

to the outsourcing industry rather than to India, suggesting that shift-ing operations to other offshore locations would not be an adequatesolution.

Strategies for Coping With Shift WorkInterviewees responses, as well as prior research, indicate certainbasic strategies that employers could adopt to facilitate shift workersadjustment to night and rotating shifts. The respondents for this study

said they were unaware of the effect of shift work on physical healthprior to working in an organization requiring shift work. Bothemployees and management appeared to be unaware of the linkbetween shift work and cancer or of the use of the principles of circa-dian rhythms to adjust to shift work.48 Understanding that circadianrhythms can be adjusted can help determine how shifts should berotated and the amount of light needed in the workplace to ensureemployees are alert during work hours and are able to sleep for an

uninterrupted period afterward.49

Information

Although instituting a policy of not allowing women and older peopleto work on the night shift might be perceived as unfair since employ-ees who work on shifts other than the day shift receive a daily allow-ance, it is extremely important that potential employees be madeaware of both the short-term and long-term consequences of shiftwork in order to make an informed decision about whether they wishto work on the night shift or not. Thus, while the women interviewedin the data conversion company said they had no desire to work onthe night shift, a female supervisor at the data conversion companywas convinced that the companys policy of not assigning women tothe night shift had hampered her career and growth.

Information provided should describe both the ill effects of nightshift work and discuss coping strategies. Organizations in the BPOsector, including the ones in this study, typically enroll new hires in a

week or two of training prior to assigning them on projects. Thistraining for the most part focuses on details of the work, but could


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442 India Review

health consequences of night shift work and provide them with cop-ing strategies. Providing a brochure with information or having otheremployees who have successfully adjusted to shift work discuss their

strategies would be helpful and, yet, not costly.Respondents in this study were in favor of being informed about

the adverse health effects of night shift work. I think those who wantto work here [in the BPO industry] need to know what its about, andshould be given the information before being brought into work,said one data conversion employee. His colleague reiterated this view:It was only after doing night shifts that I realized what kind of prob-lems people face. Yes, if we told about the problems earlier, it would

have been better. We would have been mentally prepared to face thenight shift.

The idea of being mentally prepared is as important as respondentswho said they had adjusted to night shift and rotating shift work men-tioned the importance of having a positive attitude toward shift work.A 38-year old medical transcriptionist who joined six months backmentioned the importance of a cognitive reappraisal of the situation:Ive never seen midnight in Kolkata. If you look at in that view, you

find yourself in a better position. A quality analyst in the same com-pany reiterated this point of view: Since Ive come to do a job . . . Ishould overcome difficulties to see my career gets better. Otheremployees also attributed their successful adjustment to having a pos-itive, optimistic attitude.

Circadian Adjustment

Both recent and past research on shift work emphasizes understand-ing circadian rhythms and the amount of time it can take to adjust toany Change.50 Thus, studies suggest that individuals take between fourto six weeks to adjust to any change and, therefore, recommend atleast four consecutive weeks of night shift. However, since individualsoften revert to their normal schedule on their days off, they may notfully adjust to the night shift even when assigned to an extendedperiod of night shift.51 Burgess recommends three days of day shiftfollowed by three days of afternoon shift and then three days of nightshift with three days off after the night shift.52 Kuhn also found that

physicians preferred working two to three days of night shift.53While changing shifts at three-day intervals may not be feasible,


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adjustment can be helpful in determining shift intervals and how torotate them. Thus, delaying sleep rather than advancing it seems to bea better strategy, and in keeping with this principle, following a period

of day shift with a period of afternoon shift and then a period of nightshift is an importation rotation strategy.54 In the data conversion com-pany, although shifts rotated on a weekly basis, work pressure andpressure from management often resulted in employees working adouble or even a triple shift. Having two to three days off after aperiod of night shift is also important, although not adhered to inmany BPO organizations.

Social and Peer SupportAlthough the literature on social support has established the bufferingeffect of social support on stress, and its effect on psychological aswell as physical well-being, using social support as a strategy to com-bat the ill-effects of night and rotating shift work, has not been men-tioned in any of the literature on call centers or on shift work.55 Bothmanagement support and peer support, in the form of support fromcolleagues, are especially important.

As the findings regarding attrition indicate, dissatisfaction and thedecision to leave are caused not so much by the monotony of thework, limited opportunities, or night shift alone, but by a combina-tion of these factors and a sense that the investment of time employeesmake to the organization is not adequately compensated. Managersinability to make an association between the health effects of nightshift work and impaired performance in terms of accuracy and volumeof work achieved also causes employee stress.

Employees in the medical transcription company perceived unduepressure from management and an inability to understand the effectsof fatigue and impaired sleep as well as other effects such as nausea onthe quality of employees work. Expressing understanding for thesephysical effects of night shift work can be especially helpful as somesupervisors in the data conversion company appeared to realize.56

Supervisors willingness to take on some of the workload when workvolumes are high is also helpful. Employees in the data conversioncompany were not as resentful as expected of having to work long

hours because supervisors worked equally long hours.The literature on social support as well as peer support groups for


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444 India Review

with stressful situations.57 The experiential knowledge peers provide100

makes peer support extremely valuable in combating health condi-tions. Respondents in this study mentioned, discovering through their

own experience, the usefulness of several coping strategies that havebeen mentioned in the literature on shift work.58 These include sleep-ing in intervals and taking naps if sleeping a solid eight hours at astretch was not an option; eating a light meal at regular intervals; anddrinking plenty of water instead of caffeine.

The medical transcription companys policy of allowing two daysoff after a period of night shift came, in fact, from the employees, sug-gesting the usefulness of experiential knowledge and peer support in

developing coping strategies to combat the ill-effects of night shiftwork. Support from a fellow-worker can be useful in lowering self-reported health problems and mitigating workplace problems and hasbeen demonstrated in some studies.59

Future Directions of ResearchWhile findings from the study suggested a link between night shiftwork, ill-health, and impaired performance, it relied on employees

perceptions of their work. These were based on incentives earned onthe night shift versus other shifts and, thus, were unlikely to be inaccu-rate. However, this was not a quantitative study, and thus the linkbetween the effect of night shift work on employees health and per-formance and the resulting impact on the companys revenue could notbe conclusively established. More quantitative work is recommendedto establish this link in order that organizations might be convincedthat the health problems that employees face as a result of their worktimings and conditions are not just personal problems to be dealt withat the individual level. The adverse health consequences that employeesface could adversely affect their organization as well, making it cost-effective to resolve these problems rather than ignoring them.

Moreover, the precise role played by shift work, low pay, andopportunities for promotion in contributing to attrition rates needs tobe more systematically explored. The model suggested by the study(Figure 1) is that shift work mediates through employee health andperformance to affect employee-management relations. Impaired per-

formance can cause an actual or threatened loss of reputation as well ascontracts for the organization due to poor productivity and quality levels.


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put pressure on employees to perform, causing strained relations andemployee dissatisfaction, and ultimately attrition. Both the time andthe cost of rehiring and retraining new employees to replace thosewho have left can add significantly to the organizations cost of pro-duction, as well as its ability to deliver on its promises to the client.However, quantitative studies are needed to test this model.

The coping strategies discussed in the paper should be cost-effective

to implement. However, more research may be needed to see howwell they adapt to the Indian context. The labor policies implicit inboth the problem highlighted and the solutions described could formthe basis of general labor policies applicable to the IT sector so thatworking conditions are more uniform across organizations.

NOTES

1. The Bureau of Economic Analysis (BEA) distinguishes between outsourcing, contract-ing out operations to unaffiliated organizations, off-shoring, shifting operations to over-

seas locations, and off-shore outsourcing, a subset of both outsourcing and off-shoring,when operations are contracted to unaffiliated organizations overseas. The terms tend tobe used interchangeably however See Off-Shoring: How Big is It? http://www

FIGURE 1

PROPOSED MODEL OF THE IMPACT OF SHIFT WORK ON ORGANIZATIONS

Shift Work

Organizational Concern Over Potential Loss of Reputation/Contracts

Organization Responds by Having Management Put Pressure on Employees

Strained Employee-Management Relations Employee Dissatisfaction

Higher Attrition

Cost of Rehiring and Retraining + Loss of Productivity

Poor Employee Health Impaired Employee Performance


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2. A.T. Kearney, Geography of Off-Shoring is Shifting, According to A.T. Kearney Study,(May 18, 2009), http://www.atkearney.com/index.php/news-media/geography-of-offshoring-is-shifting.html; PricewaterhouseCoopers, Expansion Seen for GlobalOutsourcing Market: Competition Seen from New Market Entrants, PWC Survey Finds,

(January 7, 2010), http://www.pwc.com/en_SK/sk/tlacove-spravy/assets/2010/2010-01-07_Global-Outsourcing-Survey_EN.pdf; and Duke University Offshoring ResearchNetwork, Offshoring Reaches the C-Suite, (Duke University Offshoring ResearchNetwork Survey Report, 20072008).

3. PricewaterhouseCoopers, Expansion Seen; PricewaterhouseCoopers, Is the Global Out-sourcing Business in for a No-holds-barred Competition? (2009), http://www.pwc.com/fi_FI/fi/julkaisut/tiedostot/Global_Outsourcing_Survey2009.pdf; Duke UniversityOffshoring Research Network, Offshoring Reaches.

4. Duke University Offshoring Research Network, Offshoring Reaches.5. R.C. Datta, Worker and Work A Case Study of an International Call Centre in

India, Paper presented at the 22nd International Labour Process Conference, Univer-sity of Amsterdam, 57 April (2004); Kiran Mirchandani, Practices of Global Capital:

Gaps, Cracks and Ironies in Transnational Call Centres in India, Global Networks: AJournal of Transnational Affairs, Vol. 4, No. 4 (2004), pp. 35574; Winifred R. Poster,Whos on the Line? Indian Call Center Agents Pose as Americans for U.S.-OutsourcedFirms, Industrial Relations, Vol. 46, No. 2, (2007), pp. 271304; Raka Shome, Think-ing Through Diaspora: Call Centers, India, and a New Politics of Hybridity, Interna-tional Journal of Cultural Studies, Vol. 9, No. 1 (2006), pp. 10524.

6. Stephen Deery, Rick Iverson, and Janet Walsh, Work Relationships in Telephone CallCentres: Understanding Emotional Exhaustion and Employee Withdrawal,Journal ofManagement Studies, Vol. 39, No. 4 (2002), pp. 47196; Sujata Gothoskar, Telework-ing and Gender, Economic and Political Weekly, Vol. 35, No. 26 (June 2000), pp. 229398;Govind Kelkar, Girija Shrestha, and N. Veena, IT Industry and Womens Agency:Explorations in Bangalore, and Delhi, India, Gender, Technology and Development,

Vol. 6, No. 1 (2002), pp. 6384; Philip Taylor, Chris Baldry, Peter Bain, and VaughanEllis, A Unique Working Environment: Health, Sickness and Absence in UK CallCentres, Work, Employment & Society, Vol. 17, No. 3 (2003), pp. 43558; Philip Taylorand Peter Bain, An Assembly Line in the Head: Work and Employee Relations in theCall Centre, Industrial Relations Journal, Vol. 30, No. 2 (1999), pp. 10117.

7. Duke University Offshoring Research Network, Offshoring Reaches.8. Paula A. Burgess, Optimal Shift Duration and Sequence: Recommended Approach for

Short-term Emergency Response Activations for Public Health and Emergency Man-agement,American Journal of Public Health, Vol. 97 (Supplement 1, 2007), pp. S88-91;Scott Davis, Dana K. Mirick, and Richard G. Stevens, Night Shift Work, Light atNight, and Risk of Breast Cancer, Journal of the National Cancer Institute, Vol. 93,No. 20 (2001), pp. 155762; Paul A. Shulte, Gregory R. Wagner, Alec Ostry, Laura A.

Blanciforti et al., Work, Obesity, and Occupational Safety and Health, AmericanJournal of Public Health, Vol. 97, No. 3 (2007), pp. 42836.

9. Indian IT-BPO Industry 2009: NASSCOM Analysis, NASSCOM (February 2009),http//:www.nasscom.in/upload/5216/IT_Industry_Factsheet-Mar_2009.pdf

10. A. Aneesh, Virtual Migration: The Programming of Globalization (Durham: DukeUniversity Press, 2006).

11. Deery et al., Work Relationships; Gothoskar, Teleworking and Gender; Kelkaret al., IT Industry and Womens Agency; Taylor et al., A Unique Working Environ-ment; Taylor, An Assembly Line

12. Datta, Worker and Work; Deery et al., Work Relationships; Taylor et al., AUnique Working Environment.

13. Deery et al., Work Relationships.

14. Catriona M. Wallace, Geoff Eagleson, and Robert Waldersee, The Sacrificial HR Strat-egy in Call Centers, International Journal of Service Industry Management, Vol. 11,No 2 (2000) pp 17484


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15. Datta, Worker and Work; Deery et al., Work Relationships; Mirchandani, Prac-tices of Global Capital; Taylor et al., A Unique Working Environment.

16. Philip Taylor and Peter Bain, India Calling to the Far Away Towns: The Call CentreLabour Process and Globalization, Work, Employment & Society, Vol. 19, No. 2

(2005), pp. 26182.17. S. Chakraborty, Indian Call Centers Not a Bed of Roses; Booming Nascent Industry

is Plagued by a High Turnover Rate, India Currents, San Jose Vol. 17, No. 6 (September2003), pp. 20; Datta, Worker and Work; Dinesh C. Sharma, India: BPOs: Not SoSunny for Women Here, Womens Feature Service, New Delhi (May 30, 2005); Taylorand Bain, India Calling to the Far Away Towns.

18. Datta, Worker and Work; Randall B. Dunham, Shift Work: A Review and Theoreti-cal Analysis, The Academy of Management Review, Vol. 2, No. 4 (1997), pp. 62434;Nancy P. Gordon, Paul D. Cleary, Claire E. Parker, and Charles A. Czeisler, ThePrevalence and Health Impact of Shift Work, American Journal of Public Health, Vol.76, No. 10 (1986), 122528; Taylor and Bain, India Calling.

19. Taylor and Bain, An Assembly Line.

20. Deery et al., Work Relationships.21. Datta, Worker and Work.22. Datta, Worker and Work; Deery et al., Work Relationships; Taylor and Bain,

India Calling.23. Wallace et al., The Sacrificial HR Strategy.24. Datta, Worker and Work.25. Burgess, Optimal Shift Duration; Stella Chatzitheochari and Sara Arber, Lack of

Sleep, Work and the Long Hours Culture: Evidence from the UK Time Use Survey,Work, Employment & Society, Vol. 23, No. 1 (2009), pp. 3048.

26. Diane R.Gold, Suzanne Rogacz, Naomi Bock, T.D. Tosteson, et al., Rotating ShiftWork, Sleep, and Accidents Related to Sleepiness in Hospital Nurses,American Jour-nal of Public Health, Vol. 82, No. 7 (1992), pp. 101114.

27. Eric Darier, Time to be Lazy, Work, the Environment and Subjectivities, Time andSociety, Vol. 7, No. 2/3 (1998), pp. 26777; Jonathan Gershuny, Busyness as the Badgeof Honour for the New Superordinate Working Class, Social Research, Vol. 72, No. 2(2005), pp. 287314.

28. Dunham, Shift Work.29. Taylor and Bain, An Assembly.30. The general manager at each organization referred to employees as either lower middle

class or middle class, terms commonly used to refer to socio-economic status inIndia. Family income, parents employment, place of education (whether at a prestigiousinstitution or a less-reputed institution), as well as place of residence combine togetherto form an impression of individuals class status. Unlike in the United States, wealthierIndians tend to live in city centers rather than in the suburbs.

31. These include creating a file or opening a Word document.32. The dollar is equivalent to about Rs. 47. Data from http//:www.x-rates.com.33. Kolkata has torrential rains during the monsoons, which result in waterlogged streets,

bringing life to a standstill. As a city in a communist state, Kolkata is also subject to fre-quent strikes called by political parties. It is unsafe to venture out at such times.

34. Datta, Worker and Work; Dunham, Shift Work; Gordon et al., The Prevalenceand Health Impact.

35. A Business Standardarticle published in August, 2007 estimates that attrition rates in thenon-voice sector range between 2030 percent. While the report does not specifywhether these are monthly or annual rates, the figures presumably refer to annual rates.http//:www.nasscom.in/Nasscom/templates/NormalPage.aspx?id=51998

36. A September 2008 report refers to a survey released by the Hay Group, according to

which attrition rates in the BPO sector are the highest in the country. While the reportdoes not specify whether these are monthly or annual rates, presumably these are thelatter http://www business-standard com/india/storypage php?autono=45711&tp=on


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448 India Review

38. These results are in keeping with Pressers findings regarding the disruptive effect ofshift life on family life 56,57.

39. An important festival in West Bengal, equivalent to Thanksgiving or Christmas.40. Harriet B. Presser, Nonstandard Work Schedules and Marital Instability,Journal of Mar-

riage and Family, Vol. 62, No. 1 (Feb. 2000), pp. 93110; Harriet B. Presser, Working in a 24/7Economy: Challenges for American Families (New York: Russell Sage Foundation, 2003).

41. People often have to share a room. Even when this is not the case, maid servants comingin to clean the room, and newspaper boys and milkmen who make deliveries early in themorning make sleeping during the day difficult.

42. Burgess, Optimal Shift Duration; Dunham, Shift Work.43. Chatzitheochari and Arber, Lack of Sleep; Gold et al., Rotating Shift Work; Davis

et al., Night Shift Work.44. Johnni Hansen, Increased Breast Cancer Risk Among Women Who Work Predomi-

nantly at Night, Epidemiology, Vol. 12 (2001), pp. 7477; Eero Pukkala, AnssiAuvinen, and Gunilla Wahlberg, Incidence of Cancer Among Finnish Airline CabinAttendants, 196792, BMJ311 (1995), pp. 64952.

45. Torbjorn T. Akerstedt, Psychological and Psychophysiological Effects of Shift Work,Scandinavian Journal of Work, Environment & Health, Vol. 16 (Supplement 1, 1990),pp. 6773.

46. Burgess, Optimal Shift Duration.47. Wallace et al., The Sacrificial HR Strategy; Burgess, Optimal Shift Duration; Davis

et al., Night Shift Work; Hansen, Increased Breast Cancer Risk.48. Pukkala et al., Incidence of Cancer; Eva S. Schernhammer, Francine Laden, Frank

E. Speizer, Walter C. Willet, et al., Night- Shift Work and Risk of Colorectal Cancer inthe Nurses Health Study, Journal of the National Cancer Institute, Vol. 95, No. 11(June 2003), pp. 82528.

49. Burgess, Optimal Shift Duration; Gloria Kuhn, Circadian Rhythm, Shift Work, andEmergency Medicine,Annals of Emergency Medicine, Vol. 37, No. 1 (2001), pp. 8898;

Gloria Kuhn, Circadian Rhythm, Shift Work, and Emergency Medicine, Annals ofEmergency Medicine, Vol. 37, No. 1 (2001), pp. 8898.

50. Burgess, Optimal Shift Duration; Mark R. Smith, Louis F. Fogg, and Charmane I.Eastman, Practical Interventions to Promote Circadian Adaptation to PermanentNight Shift Work: Study 4, Journal of Biological Rhythms, Vol. 24, No. 2 (2009),pp. 16172; Burgess, Optimal Shift Duration; Dunham, Shift Work.

51. Gordon et al., The Prevalence and Health; Kuhn, Circadian Rhythm.52. Burgess, Optimal Shift Duration.53. Dunham, Shift Work.54. Burgess, Optimal Shift Duration; Kuhn, Circadian Rhythm.55. Miko Harma, Hakola Tarja, Kandolin Irja, Sallinen. Mikael, et al., A Controlled Inter-

vention Study on the Effects of a Very Rapidly Forward Rotating Shift System on Sleep-

Wakefulness and Well-being Among Young and Elderly Shift Workers, InternationalJournal of Psychophysiology, Vol. 59 (2006), pp. 7079; Sheldon Cohen, Social Rela-tionship and Health,American Psychologist (2006), pp. 67684.

56. Refer to a supervisors quote regarding supervisor support to employees in the sub-section on management awareness of health problems.

57. Benjamin H. Gottlieb, Marshaling Social Support: The State of the Art in Research andPractice, in B.H. Gottlieb (ed.), Marshaling Social Support: Formats, Processes, andEffects (London: Sage, 1988); Lis Adamsen, From Victim to Agent: The Clinical andSocial Significance of Self-Help Group Participation for People with Life-ThreateningDiseases, Scandinavian Journal of Caring, Vol. 16 (2002), pp. 22431; H. SharonCampbell, Marie R. Phaneuf, and Karen Deane, Cancer Peer Support Programs - DoThey Work? Patient Education and Counseling, Vol. 55 (2004), 315; Sheldon Cohen,

Social Relationship and Health.58. Thomasina Borkman, Experiential Knowledge: A New Concept for the Analysis of

Self-help Groups Social Service Review Vol 50 (1976) pp 44556; Burgess Optimal


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59.Rebecca Smith-Coggins, Mark R. Rosekind, Kenneth R. Buccino, David F. Dinges et al.,Rotating Shift Work Schedules: Can We Enhance Physician Adaptation to NightShifts? Academic Emergency Medicine, Vol. 4, No. 10 (1997), pp. 95161; Ulla Peterson,Gunnar Bergstrom, Mats Samuelsson, Maries Asberg, and Ake Nygren, Reflecting Peer

Support Groups in the Prevention of Stress and Burnout: Randomized Controlled Trial,Journal of Advanced Nursing, Vol. 63, No. 5 (2008), pp. 50616; I.J. Hetty van Emmerik,Martin C. Euwema, and Arnold.B. Bakker, Threats of Workplace Violence and theBuffering Effects of Social Support, Group & Organization Management, Vol. 32, No. 2(2007), pp. 15275; Erik L. Werner, Even Laerum, Marjon E.A. Wormgoor, Erik Lindh,et al., Peer Support in an Occupational Setting Preventing LBP-related Sick Leave,Occupational Medicine, Vol. 57 (2007), 16.


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Cost of Shift Workers

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