Call Centers as Natural Experiments for PHI

Operating call centers is an essential function for a wide range of organizations, though the function is all too often outsourced, even off-shored to other organizations. One advantage to making and keeping it an internal function is the opportunity such centers offer as natural experiment possibilities with respect to virtually all elements of planned and adopted PHI strategies and initiatives.

Call centers tend to employ lower-paid personnel, though some specialized function centers, including those in the PHI business, itself, often employ highly-paid professionals, such as nurse coaches for disease management initiatives. But turnover in such centers may be high, given the nature of the work, but that means that the importance and value of promoting both the health and engagement/loyalty of call center staff will be that much greater.

By applying PHI strategies and initiatives to call center staff, perhaps using call centers for pilot testing of basic policies and procedures, along with other efforts aimed at improving employee performance and value, employers and insurers can learn a lot about how well PHI elements work. Perhaps most valuable is the opportunity call centers offer for testing whatever method will be used for measuring productivity and performance.

It has long been a general practice in validating the various methods available for estimating productivity and performance levels through self-report surveys to compare such estimates to actual measured performance in call centers. One such validation, for example, found that self-reported productivity impairment due to health problems was 2.5 times greater than actual measured output. [G. Pransky, et al. “Performance Decrements Resulting from Illness in the Workplace” JOEM 47:1 Jan 2005 34-40]

Because of the normally high turnover and absence rates in call centers, due to the pressures of the work, such centers also are logical locations for pilot testing of efforts aimed at reducing both. [K. Carson “Tested Methods for Reducing Absenteeism in the Call Center” CustomerManagementIQ.com Mar 16, 2010] While health, and particularly problems related to stress, are likely to be major sources of impairment, there may be other causes of absence and turnover that need to be addressed, and these can be tested as well.

Because pay-for-performance (P4P) systems are often used with call center staff, such centers also represent logical testing grounds for such systems. In addition to testing the effects of P4P on call center staff performance, such systems also tend to promote “internal marketing” efforts by call center staff to encourage or demand back-office support improvements. [B. Hall, E. Lazear, et al. “Performance Pay at Safelite Auto Glass” Harvard Business School Dec 6, 2001 (Case Studies 9-800-291 & 292)]

Call centers may or may not, however, be good places for gauging the “multiplier” effect. This is the impact that the absence of particular employees with particular job skills and responsibilities, have on the performance of others. This effect has been measured at greater than 10x the individual’s lost performance, in the case of construction engineers, at 1.85x for medical assistants, but virtually nothing for easily replaceable short-order cooks, for example. [T. Parry “Capturing the Elusive: How Absence Impacts Lost Productivity” IBI Research Insights Aug 2006 (www.ibiweb.org)]

While it seems likely that the absence of one staff member in a call center could impact the performance of those on the job, the actual impact would likely vary according to the number of other agents available to take up the slack, whether “floaters” could fill in, and whether the call center is used mainly to handle incoming vs. outgoing calls. In any case, it would likely not be the best model for all other employees in the organization.

Whether call centers are the best model for testing PHI interventions, or even the accuracy of productivity and performance impairment estimates is not yet known. But at least the general applicability and impact of PHI can be tested therein for employers who are unsure of the results they might get from PHI investments. As more experience with call center validations of measurement and interventions emerge, we should gain a better idea of the value of such natural experiments.