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Work, employment and society Copyright © 2008 BSA Publications Ltd® Volume 22(4): 601–613 [DOI: 10.1177/0950017008096738] SAGE Publications Los Angeles, London, New Delhi and Singapore

‘Doing things right’, or ‘doing the right things’? Call centre migrations and dimensions of knowledge ■

Diane van den Broek University of Sydney, Australia

A B S TR AC T

The nature of call centre ‘logics’ and their predominance in routine commercial areas of the economy underscored much of the early research into call centre operations. Recent regulatory, structural and technological developments in advanced economies underscored subsequent migrations of call centres from the private to the public sector (Glucksman, 2004; Taylor and Bain, 2007). Further call centre migrations have also occurred into more skilled occupations in the public sector. Drawing on published and unpublished research on in-bound call centres operating in social work and nursing in the UK and Australia, this discussion analyses the dual migration of call centres from routine commercial operations to professional public sector services. The following discussion recognizes the viability of cost efficient and customer service dualities, however, given shifts into more complex areas of service delivery, pre-existing norms of professional practice became another important driver of call centre labour processes. K EY WO R DS

call centres / knowledge / nursing / social work

Call centre research agendas and debates all centre technologies, including automatic call distribution (ACD) systems and information databases, have emerged in diverse industrial, organizational, temporal and spatial settings. Research analysed a multitude of issues including electronic monitoring, panoptic surveillance and control (Fernie and Metcalf, 1997; Taylor and Bain, 1999), gender and skills (Belt,

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2002), recruitment and selection (Callaghan and Thompson, 2002), trade unionism and union exclusion (Taylor and Bain, 2002; Van den Broek, 2003b), built environment and occupational health and safety (Taylor et al., 2003), churn and workplace stress (Deery et al., 2000), offshoring (Taylor and Bain, 2005), customer relations and identity (Frenkel et al., 1999; Korczynski, 2002), customer market segmentation (Batt and Moynihan, 2001; Houlihan, 2002), teamwork (Mulholland, 2002; Van den Broek et al., 2004), call centre configurations (Glucksman, 2004) and the spatial and temporal implications of call centre operations (Bristow et al., 2000). Several books, and now a global survey, also highlighted the diverse, and not so diverse, conditions under which call centre workers operate (Deery and Kinnie, 2004; Holman et al., 2007; Holtgrewe et al., 2002). While the economic imperatives have been strongly identified in the literature, strategic customer segmentation could also positively influence worker discretion over the labour process (Batt, 2000: 553; Batt and Moynihan, 2001; Shah and Bandi, 2003). Similarly customer satisfaction is an important mediating factor potentially softening the bureaucratic nature of call centre work processes (Korczynski, 2002). Therefore, while heterogeneity remains central to much of the call centre literature, ‘[w]here academic disagreement does exist, it manifests itself largely in the degree [my emphasis] of importance that is attached to either the cost-efficient, or the customer-servicing, logic’ (Bain et al, 2005: 1). The tendency towards a quantity/cost focus has reflected the fact that 75 per cent of the call centres operating in 20 major countries have serviced mass commercial markets (Holman et al., 2007: 2).1 However, recent debates about sectoral difference in previous volumes of this journal (Glucksman, 2004; Taylor and Bain, 2007) have reiterated pervasive drivers of call centres in both private and public areas of employment. For example Bain et al. (2005: 21) identified that the introduction of call centres into police control rooms were motivated as much by well worn desires for greater consistency of services, cost containment and measurable outputs. Questioning assumptions that public sector call centres are less paced, less cost driven and output orientated than their private sector counterparts, Bain et al. (2005) and Houlihan’s (2002) research have shown that numbers also ‘count’ in many public call centre environments. The following discussion extends debates around the tensions between the cost-efficiency and the customer-servicing models of call centres by raising the importance of a priori knowledge and organizational support for workplace learning within the fields of nursing and social work.

Dual migrations into skilled public sector services: background and method The subsequent material on Australian social workers draws on Van den Broek’s (2003a) study of social workers in the child protection ‘Helpline’ service in the New South Wales Government Department of Community Services


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(DoCS). This research involved five detailed interviews with Helpline caseworkers, all of whom held a degree in social work, social welfare or psychology with the majority of caseworkers holding more than 10 years’ experience in the community health/welfare field. Two interviews were also undertaken with union representatives of the industry and personal observation and analysis of government and non-government inquiries into Helpline’s operations between 2000 and 2002 were undertaken (Van den Broek, 2003a: 239, 240). As such, subsequent events leading to changes which may have occurred in the service since then have not been addressed. Discussion on Australian tele-nursing also draws on Larsen’s (2005) ethnographic study undertaken between 1999 and 2001. Her research involved 20 interviews with trained nurses with telephone triage experience working in Australia’s first medical call centre, Health Direct. Larsen also interviewed representatives from the Health Department of Western Australia who were involved in planning Health Direct and a nurse who assisted in the development of the guidelines used in the triage process. In addition, the present research utilizes unpublished interviews undertaken by the author with nine trained nurses working in a recently established Australian tele-nursing service during 2007. These interviews represent the initiation of further work on various state telehealth systems operating in Australia. Finally data on UK tele-nurses refers to published work, most importantly Gabe et al. (2005); Collin-Jacques and Smith (2005), Smith et al. (2007) and Wise et al. (2007). In drawing these published works together, this discussion recognizes the importance of national, historical and organizational factors which shape call centre labour processes (Collin-Jacques and Smith, 2005). Similarly practitioner identity and career aspirations also influence how work is organized (Gabe et al., 2005). However, potential tensions between quality (as driven by a more demanding and/or valuable consumer profile) and quantity (as driven by the logics of the technologies and managerial control) are also mediated by preexisting worker knowledge and organizational (dis)interest in developing supportive learning environments – a tension articulated here around whether workers were able to ‘do things right’ according to organizational expectations or ‘do the right things’ according to pre-existing occupational codes of practice (Ellstrom, 2001: 428). Important exogenous factors sharpening these tensions between organizational and occupational expectations has involved increasing reform and rationalization in the public provision of social services in health and human services in many advanced economies including Australia and the UK (Hough, 1995; Jones, 2001; Kirkpatrick et al., 2005; Munro, 2004). While nurses and social workers retain a distinct professional and occupational status (Abbott and Meerabeau, 1998), public sector reform has increasingly relied on demonstrated outcomes for quality assurance, with greater focus on organizational and bureaucratic accountabilities (Brannon, 1994; Burton and Van den Broek, forthcoming; Ferguson, 2007; Garrett, 2005; Sapey, 1997). For example when the New South Wales Government Department of Community Services in

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Australia established its call centre ‘Helpline’ in 2000, its aim was to transform the child protection service into a ‘contemporary and professional organization’ (New South Wales Parliament Legislative Council, 2002: 7). Similarly in 1997 the British Government’s White Paper, The New NHS: Modern, Dependable, heralded the restructuring of the NHS around the expressed need for ‘partnership’ and ‘performance’ (Crinson, 1999). Part of this process involved the introduction of 24-hour nursing advice lines and, by 2000, 22 call centres had been established throughout the UK (Gabe et al., 2005). Also in Australia, all state governments have introduced, or are about to introduce, tele-nursing services along the lines of an NHS model with national coverage coordinated by the National Health Call Centre Network Limited (Campbell, 2004; Dearne, 2006).2 Changes to the delivery of services within these professional bureaucracies question the viability of established distinctions between the ‘knowledge’ and the ‘routine’ worker. Over 10 years ago, Frenkel et al. (1995) presented a routine and knowledge work binary, arguing the former (such as customer service representatives in financial and telecommunications industries) merely ‘navigate the various software packages which support their role [and here work is] largely directed by the software’ (1995: 781). At the other end of the spectrum, knowledge workers (such as nurses) drew on theoretical knowledge, intellective skills and creativity which required significant competence to evaluate various aspects of their work. As such the authors make clear distinctions between these two ideal types, with the knowledge and routine worker ‘at opposite ends of the three dimensions of knowledge, creativity and skill’ (1995: 780). Similar ‘ideal types’ are reiterated in ‘symbolic analysts’ employed in ‘professional’ bureaucracies, compared with (the less optimistic) standardized work processes found in ‘machine’ bureaucracies (Blackler, 1995: 1030; Mintzberg, 1979). However, in the case of nurses and social workers often working in call centre bureaucracies, ‘routine’ and ‘knowledge’ dichotomies become considerably slippery. While much of the literature cited earlier highlights how call centre logics lean towards work routinization, as these operations move to more complex areas of service delivery, a priori occupational knowledge assumes added importance. As indicated below, for skilled nurses and social workers the utilization and implementation of call centre technologies were determined by negotiations around pre-existing worker knowledge and managerial support for workplace learning. Given that call centre technologies are often enlisted to rationalize and centralize service interactions, literature has rightly focused on routine areas of employment. However the very skills, knowledge and expertise that call centres aim to rationalize, and to some extent replicate, are important preliminary variables that require further consideration. For example, what are the potential changes (if any) to nursing and social work expertise that are progressively squeezed through the confines of call centre technologies? Also what factors might act to mediate the tensions that develop around this shift of call centres to more skilled areas of work?


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A priori knowledge and workplace learning: the cases of nursing and social work Professional health workers have always offered some degree of telephone advice both in the UK and in Australia.3 However, recent research has highlighted the acceleration of this trend (Anderson et al., 2006; Burton and Van den Broek, forthcoming; Gabe et al, 2005; Larsen, 2005; Van den Broek, 2003a). While nurses and social workers have a distinct professional and occupational standing relative to each other, both remain highly integrated into state (professional) bureaucracies and both face similar demands for greater accountability and measurable output. As suggested earlier, their distinct spheres of competence and expertise (Abbott and Meerabeau, 1998) have meant they have ‘an occupation rather than having a job or position [thereby calling] on sources of legitimacy for their work performances other than those offered by the employing organization’ (Van Maanen and Barley, 1984: 314). Social workers, dealing in this case with the sensitive areas of child protection, have relied on a ‘unique combination of formal and informal knowledge’ to make complex and in some cases life and death decisions about children at risk (Healy and Meagher, 2004; Van den Broek, 2003a). Two major government investigations into child protection services in the Australian state of New South Wales in 2002 and 2008, after the deaths of several children in this state through neglect, is testimony to the life and death situations these workers face on a daily basis (New South Wales Government, 2008; New South Wales Parliament Legislative Council, 2002). Despite the nature of nursing and social work, it might be expected that call centre technologies could downgrade or substitute many of the interpretative (or tacit) skills identified above with more explicit and routine, codified knowledge associated with high volume models. Nursing and social work call centres take in-bound caller information gathered through checklists of questions and possible responses. Decision support software (including Clinical Assessment System or CAS) requires workers to follow checklists based on software algorithms which ‘pace’ calls and record output. Nurses follow a series of (in the case of one Australian service) 149 guidelines and algorithms, which sequence questions thereby activating protocols about symptoms and dispositions4 with total call time averaging around six to ten minutes (Larsen, 2005: 137). In many respects the software and technology is modelled on the face to face interactions undertaken by these practitioners in more traditional workplace settings. However, given the complexity of their task, telephone assessments could provide numerous challenges to information flow. One Helpline social worker reported how: a ‘woman rang up who had four personalities. It took a while to figure it out. She went into split personalities and was talking about an event that had happened years ago’ (Van den Broek, 2003a: 243). Another felt that, ‘You don’t have all the clues when you are taking reports on the phone. You don’t have the sign language’ (Social Worker 1, 2002).

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Similarly when nurses gain a position in tele-nursing they quickly become aware of the fundamental differences between telephone and ward based nursing. As with social workers, auditory cues are relied upon for nurses to piece together information delivered from callers with a range of communication and language skills (Wahlberg, 2004). One nurse working in a newly established Australian tele-nursing service stated that ‘in this job you learn to sense things in a different way. You can sense hesitancy – your senses have to be more fine tuned’ (Nurse 2, 2007). Nonverbal cues, including ‘degree of breath control, and general conversational tone’ have been important to nurses’ assessments of callers’ emotional states and credibility (Pettinari and Jessop, 2001). For instance if a caller describes the patient as ‘tired’ and ‘lethargic’, this is clinically different to being ‘moribund’ which is a far more serious condition and more visually apparent (Nurse 1, 2007). As such: There is a high level of decision making constantly that wouldn’t be there in a clinical setting. It’s very stressful – recording every word in case it is misinterpreted. This is in the forefront of your mind. In casualty you’re not thinking about those things. You do a visual assessment. You are not conscious of it coming back to bite you. Here you are ‘working blind’ because you are robbed of an important assessment tool. (Nurse 1, 2007)

Operating in this non-visual environment could extend nurses’ and social workers’ expertise (see Gabe et al., 2005 for a discussion of CAS as a knowledge enhancing tool for nurses), however, both nurses and social workers describe how ACD and CAS systems could result in task fragmentation, pacing and increased monitoring, some of which included the practice of ‘mystery shopping’ which again would be difficult in a traditional ward setting (Gabe et al., 2005; Wise et al., 2007). Such pacing and monitoring of calls highlight tensions over (im)balances between potentially divergent occupational norms and professional codes of practice on the one hand, with organizational expectations about output on the other. Regarding output targets, tensions are illustrated in one social worker’s comment: You get the feeling that we are being pushed further and further down the road of a call centre – but we’re not a telecommunications firm selling mobile phones. (Van den Broek, 2003a: 244)

Similarly one Australian tele-nurse recently reflected that: I can understand it in the tax department where you need extra guidelines, but nurses have a ‘code of conduct’ – when you are a nurse you know how to talk to people. I’m not here to collect data. (Nurse 5, 2007)

While such task fragmentation was reminiscent of high volume call centre work (which could also be resisted), workers negotiated around pre-existing occupational training and professional practice. More than routine customer service representatives, nurses and social workers argued around the need for autonomy to spend time to probe and clarify the gravity and the context of each call. While organizational routines were often not conducive to nurses lingering with


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callers, nurses and social workers could negotiate to retain some autonomy to under-ride and over-ride algorithms and to deviate from prescribed and predetermined questions (Gabe et al., 2005; Larsen, 2005; Van den Broek, 2003a). As discussed earlier, discretion over time allocation and task autonomy have often been important proxies differentiating routine from knowledge work. It’s been argued that knowledge workers ‘construct, rather than simply adopt, roles prescribed by management’, with routine workers merely following software scripts (Frenkel et al., 1995: 786). However, subjective factors including occupational standing as well as managerial support for, and worker interest in, situational and workplace learning (Lave and Wenger, 1991) act on, and shape, the way objective features including technologies and software are utilized. On the issue of workplace learning, Ellstrom identified several alternative modes of learning, adaptive and developmental learning. The former involved workers merely reproducing tasks, ‘resulting in routinized (automated) actions performed without much conscious attention and control’ (Ellstrom, 2001: 423), while the latter involved workers being able to: diagnose a perhaps unclear and puzzling problem … [I]ndividuals within an organization … question established definitions of problems or objectives and … act to transform institutional ideologies, routines, structures or practices. (Ellstrom, 2001: 423)

Recent research into care work (Ellstrom et al., 2008) highlighted various subjective factors which influenced adaptive or developmental learning including client demands, work context, worker qualifications, management support for learning and the learning readiness of workers themselves. However, because organizational returns for worker reflection may conflict with more immediate performance outcomes, organizations often ‘get caught’ in reproductive or adaptive modes of learning. Here workers would be more likely to follow software scripts and checklists, which encourage them to merely ‘do things right’ according to organizational needs, rather than doing ‘the right thing’ in an occupational or creative sense (Ellstrom, 2001: 428). The levels of autonomy which might emerge for nurses and social workers varied according to immediate supervisors’ attitudes to workplace learning. For example one social worker stated: We have 13 team leaders and each one of them has a different approach … I know that if I go to one particular team leader I will get the Level One but if I go to the other one I won’t. It depends who is on the shift at the time. Some are open to discussion others are not. (Social Worker 2, 2002)

Demands for autonomous decision making depended on demographics and worker interest in adapting technologies (Ellstrom, 2001: 431). Several studies suggest that some nurses and social workers transition into call centre employment as a ‘stop gap’ measure or desire to extend their working lives rather than extending opportunities to increase existing expertise (Gabe et al., 2005; Van den Broek, 2003a). Therefore any ‘bending [of] the norms’ (Callaghan and Thompson, 2001: 16) depended on professional expectations about career progression.

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While contingent on various factors identified earlier, nurses and social workers did have varying capacities to modify checklists, by over- and underriding the technologies they worked with. Given the complexity of their task, these workers therefore commanded or demanded autonomy to navigate around technologies and software packages according to their own specific professional backgrounds and expertise.

Reflections and directions: knowledge variants of call centre work While call centres have dominated routine, commercial areas of the economy, there has been considerable expansion of call centre operations into the delivery of professional public services. This article has analysed how these technologies might (re)shape skills, knowledge and professional practice within the fields of nursing and social work. In particular it has argued that while call centre technologies have the potential to control the pace and codify and routinize knowledge, ‘it is not technology that is the catastrophe, but its imbrications within the relations that embrace it’ (Garrett, 2005: 531). Here the technological infrastructure combines with bureaucratic forms of managerial control to modify social relations at work (Callaghan and Thompson, 2002). As nurses and social workers related above, pre-existing professional experience shaped organizational practices including their ability to influence the utilization of technologies, time allocation and task autonomy in particular worksites. The rationale for introducing standardizing (call centre) technologies is often associated with budget cuts and staff shortages. As such, retaining professional practice may be problematic in a context of public sector reform (Burton and Van den Broek, forthcoming). However while technologies, which rationalize and centralize service interactions, remain an important feature of the labour process in telephone based nursing and social work, the very skills, knowledge and expertise that call centre operations aim to rationalize and to some extent replicate, are also central. Call centre labour processes of both nurses and social workers discussed here could tend toward standardization, which could undermine opportunities for professionalization (Gabe et al., 2005; Larsen, 2005; Van den Broek, 2003a). As such, this could be yet another variant on the mass production call centre model (Bain et al., 2005; Batt and Moynihan, 2001). However unlike in high volume routinized call centres, preexisting professional practice allowed for varying degrees of autonomy to under-ride and over-ride algorithms and to deviate from prescribed questions. Similarly, due to the complex, and often sensitive, nature of the services provided, including tasks such as spontaneous problem-solving and counselling, nursing and social work knowledge could only be codified up to a certain level. As such, there were strong counter tendencies leaning away from quantity driven routinization towards retention of practitioner knowledge. This will be a tendency which may or may not become more apparent as call centers


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penetrate further onto skilled professional areas of service delivery, depending on the occupational and organizational context which emerges. Analogous to the sides of a Rubix cube, it could be argued that the pre-existing knowledge and expertise of workers pulled in one direction, but pulling in the other direction was the tension between organizational control mechanisms and learning protocols within particular worksites. Mediating factors also involved nurses’ and social workers’ occupational expectations and demographic variables which shaped practitioners’ interest in modifying potentially rigid institutional routines. As such, negotiable relationships between standardizing call centre technologies and occupational and a priori knowledge make ‘ideal types’ far from being at ‘opposite ends’ of the knowledge/skill spectrum. Indeed to remain viable, distinctions between routine workers, focused on quantity and cost, and knowledge workers, focused on quality and customers, require some consideration of how technologies are mediated by managerial support for workplace learning as well as the durability of a priori knowledge and professional practice.

Acknowledgement Sincere thanks to the editor and the two anonymous referees of WES for their detailed comments on earlier drafts of this article. Also thanks to participants of the 26th International Labour Process Conference for their helpful feedback on the issues discussed here.

Notes 1

2

3 4

Within Australia 31 per cent of total call sector seats are in (mostly outsourced) public sector call centres, while in the UK the number of public sector call centres grew from 13 in 1989 to 133 in 2002 (callcentres.net, 2007; National Audit Office, 2002). While Queensland’s tele-nursing service remains in house, services in all other states are outsourced by their respective Health Departments, as will be the national service established later in 2008. In the case of Swedish nurses, telephone triage systems have been in place since the 1930s (Wahlberg, 2004). Level 1 represents the need to alert an ambulance while level 5 assesses home care as sufficient.

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Van den Broek

Diane van den Broek Diane van den Broek is a senior lecturer at Work and Organizational Studies at the University of Sydney. Her research covers various aspects of call centre labour processes as well as aesthetic labour within Australian retail. Her current research focuses on tele-nursing as well as knowledge management and the influence of tertiary institutions on student employability. Address: Work & Organizational Studies, Faculty of Economics & Business, Institute Building, University of Sydney, Sydney 2006, Australia. Email: [email protected] Date submitted October 2007 Date accepted July 2008

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