Nursing Research with Children: Ethical Guidelines

Nursing Research with Children: Ethical Guidelines SUCAN SUTANTO Introduction: Singapore Guideline for Good Clinical Practice (SGGCP) is the primary regulatory document which needs to be observed when conducting trials in Singapore. Last revised in 1999 by Ministry of Health (MOH), the SGCCP regulate conduct of clinical trials in Singapore along with The Medicine (Clinical Trials) Regulations and the Medicine Act. For all research studies involving human subjects or their tissues and organs, MOH made it mandatory that ethics committees are established to provide scientific reviews of their study protocols. The establishment of this committee involved all hospitals, both government and restructured. Thus â€Å"Institutional review boards† (IRB) was born and its guidelines was designed by The Bioethics Advisory Committee (BAC). IRB play a central role as the gateway for ethnics review of â€Å"all Human Biomedical Research carried out under the auspices of its appointing institution† (MOH 2007 p.04). Individual researcher and institutions bear the ultimate ethical responsibility for governing their research. Based on the IRB’s Operational Guidelines (MOH 2007), three fundamental ethical principles; respect for persons, beneficence and justice must be followed in conducting biomedical research involving human. Potentially vulnerable populations must be given special attention. The following sections will examine one of the vulnerable populationchildren. It is primarily challenging for the Ethics committees in assessing pediatric related research as the above principles discussed may conflict with some issues. Vague definitions of principle of equipoise, minimal risk and informed procedures are some contributing factors. The role of ethic committees in evaluation of risk and their impact in pediatric research will be given more focus. Search Strategy PubMed database is primarily used in the search. Combination of keywords are used including of ‘ethics committees’, ‘research’, ‘children’, ‘pediatric’, ‘risk’, ‘ethics’ and ‘assessment’. Children as a population sampling In Singapore, 21 years is the age of majority under the common law. For any individual below the age of 21, Clinical Trial regulation states that parent’s or legal representative’s consent must be obtained for participation in trials. This present an ethical dilemma where the children’s autonomy become their parent or legal guardian, assuming that they have the children’s best interest at heart. The risk-benefit ratio of the research is then left to parents and IRBs to determine. Risk assessment in pediatric research According to U.S. Department of Health and Human Services (HHS) and Pediatric Clinic of North America (Laventhal et al., 2012), there are four definable risk in human research. In Singapore, the risk are less definitive, 2012 BAC guidelines describe only â€Å"research involving minimal risk such as surveys† and â€Å"risks involving more than minimal risks such as those involving invasive procedures† The first level is minimal risk and it can be defined as probability and magnitude of physical or psychological harm that is normally encountered in the daily lives or in the routine medical, dental, or psychological examination of healthy children (HHS 2009). Studies in this category can be carried out even if they do not offer any direct benefit to the child although consent of at least one parent and the child assent is necessary. However this definition is rather vague and carries an inherent issue when applied to pediatric patient such as in the hospital. A survey was conducted on review board chair regarding skin biopsy on newborn and there is actually a split opinion and classification on whether it should be classified as â€Å"minimal risk† (Westra et al., 2011). The second level of risk involves a â€Å"minor increase over minimal risk†. Although there might not be direct benefits to the child, such research might be allowed if it has the potential to yield valuable knowledge. Risks are deemed acceptable if they are comparable to the actual or expected condition of the child, medically or physiologically. In this case, both parents’ consent and child’s assent are required (HHS 2009). The third level of risk is defined as â€Å"greater than minimal or even minor increase over minimal risk† with prospect of direct benefit to the child. Whether the potential benefit justifies the risk must be assessed and determined by IRBs (Laventhal et al., 2012). To determine the risk benefit, IRBs uses component analysis approach. Each intervention or procedure must be evaluated separately. For those components that represent greater than minimal risk, further assessment will be done to determine whether it does or does not hold out the prospect of direct benefit to the enrolled child (Roth-Cline et al., 2011). The component analysis method however has been critiqued as it is standardized to the norm of clinical equipoise to determine the ethical acceptability of protocols. Definitively, clinical equipoise works on the principles of genuine uncertainty on the part of the clinical investigator regarding the comparative therapeutic merits of each treatment arm of a clinical trial and that no one should receive an inferior treatment (Roth-Cline et al., 2011). A dilemma might present itself in trials where data collected is sufficient to doubt the clinical equipoise but not necessarily enough to justify scientific conclusion. An example could be seen in a review of neonatal hypoxic ischemic encephalopathy (HIE) hypothermia treatment trial published by Laventhal et al in 2012. It was shown in a number of trials involving more than 600 infants that cooling HIE infants core temperature might help to elevate their condition. These randomized controlled trials managed to show overall improvement in mortality and disability outcomes although some adverse side effects were reported. However, Laventhal et al., 2012 pointed out that current evidence might not be adequate to determine the safety of this therapy and its efficacy. Therefore, whether to make this treatment mandatory for such patients remain to be decided. In this case, there is a dilemma on whether to allow more of such trials. On one hand, given that much evidence already supports the treatment, it would seem unethical to even deny the controlled subjects from such a beneficial treatment. On the other hand, just because a robust scientific conclusion has not been drawn, is it fair to continue to expose the infants to treatments with possible adverse outcomes? For those randomized into non treatment a rm, would there be any potential direct benefits? Yet, to answer those questions and to find out long term safety and efficacy questions, the only way might be to conduct more trials. Even within the IRB chairmen there are variations and application of assessment of risk- benefit potential. Shah et al in 2004(Shah et al., 2004) randomly surveyed 175 chairmen in United for certain intervention on children relative to the prospect risk and direct benefit. Results were surprising. In one intervention, an allergy skin testing, 23% considers it a minimal risk, close to half consider it minor increase above minimal risk and the rest as more than a minor increase over minimal risk. In the case of direct benefit for participants, 60% of those surveyed consider added psychological counselling as a direct benefit, while another 10% consider participant payment as a direct benefit. These divides in opinion indicates that the integrity of risk and benefits analysis by IRBs can be challenged. The fourth risk level exists for trials where there is no prospect of direct benefit with more than a minor increase over minimal risk for the child. Such studies could be allowed if they have high potential to produce very important knowledge. Such cases are not under approval of IRBs, instead they are referred to an experts panels under the federal government. (Laventhal et al., 2012). In a review by Wendler and Varma in 2006, they examine 9 studies assessed by IRBs which fall into the fourth level. IRBs classified different levels of harm; negligible, minor, moderate, severe and catastrophic harm relative to the normal probability a healthy child may encounter in day to day situation. Wendler and Varma then assess the proposed interventions for each study and then compare with the classification given by IRBS.They argued that eight of the studies could actually be categorized into minimal risk instead of the fourth level of risk. A primary example was the intravenous glucose tolerance test (IVGTT) on healthy children. Known possible harms include nausea, bruising and hypoglycemia. Very minimal adverse events were recorded in thousands of pediatric studies involving IVGTT. Only 1 in 3000 risk of hypoglycemia, it can be resolved with carbohydrates or glucose injection. It is therefore arguable that the IVGTT risk much more minimal in comparison to the 30 in 1000 cha nce of â€Å"minor† harm in average children in their daily routines used as a base of the classification. As such, the review shows that misclassification could occur and valuable research time may be delayed unnecessarily. There is a lack of empirical database on risks of ordinary activities for reference and this might be a contributing factor for the misclassification. It forces the IRB members to rely on their own individuals life experiences to determine the perceptions of risk therefore causing biased. To conclude, pediatric studies have been shown to provide an ethical review challenge. In order to improve the risk analysis and reduce bias, empirical data on the risk of research procedures in pediatric studies as well as database on the risk of daily activities should be collected and better established for reference. There should be standardized guidelines for risk analysis with certain flexibility to account for unique feature of each study (1542 words) References: Bioethics Advisory Committee (2004) Research involving human subjects. Guidelines for IRBs. Singapore: BAC. Available from: http://www.bioethics-singapore.org/index/publications/reports/172-research-involving-human-subjects-guidelines-for-irbs.html [Accessed 28th Jan 2015] Bioethics Advisory Committee (2012) Ethics Guidelines for Human Biomedical Research. Singapore: BAC. Available from: http://www.bioethics-singapore.org/images/uploadfile/32914 PM2012-06-20 BAC Ethics Guidelines (for comments) F.pdf [Accessed 28th Jan 2015] Ministry of Health (2007) Governance Framework for Human Biomedical Research. Available from : https://www.moh.gov.sg/content/dam/moh_web/Publications/Guidelines/Human Biomedical Research/2007/Governance Frwk for HBR_14-12-07_formatted.pdf [accessed 02 March 2015] Department of Health and Human Services (2009). US code of Federal Regulations, USA, FDA, Available from: http://www.hhs.gov/ohrp/archive/humansubjects/guidance/45cfr46.html#46.404 [Accessed 28th Jan 2015] Fernandez, C. (2008) Ethical Issues in health research in children. Paediatr Child Health 13(8) 707-712 LAVENTHAL, N., TARINI, B. A. LANTOS, J. 2012. Ethical issues in neonatal and pediatric clinical trials. Pediatr Clin North Am, 59, 1205-20. Ministry of Health (2007) Operational Guidelines for Institutional Review Boards. Singapore: MOH Available from: https://www.moh.gov.sg/content/dam/moh_web/Publications/Guidelines/Human Biomedical Research/2007/IRB Operational Guidelines_14-12-07_formatted.pdf [Accessed 28th Jan 2015] ROTH-CLINE, M., GERSON, J., BRIGHT, P., LEE, C. S. NELSON, R. M. 2011. Ethical considerations in conducting pediatric research. Handb Exp Pharmacol, 205, 219-44. SHAH, S., WHITTLE, A., WILFOND, B., GENSLER, G. WENDLER, D. 2004. How do institutional review boards apply the federal risk and benefit standards for pediatric research? Jama, 291, 476-82. Westra AE, Wit, JM; Sukhai, RN. And Beaufort ID. (2011) How to best define the concept of minimal risk. The Journal of Pediatrics 159 (3) 496-500 WENDLER, D. VARMA, S. 2006. Minimal risk in pediatric research. J Pediatr, 149, 855-61. Wendler, D. and Glantz L. (2007). A standard for assessing the risks of pediatric research: pro and con. J Pediatr 150, 579-582

“Divergent” by Veronica Roth Essay

Your decision in life all comes down to you and the path you choose, but just one choice can transform you. Veronica Roth created a strange dystopian world that morally depends on the choices people make in life, because their choices define who they are as people. Her futuristic world is divided into five factions that each represents something different; Abnegation (the selfless), Candor (the honest), Erudite (the intelligent), Amity (the peaceful) and Dauntless (the brave). These five factions were made up to prevent war and bring peace to the world and when they turn sixteen they get the chance to choose to leave their family, to transfer into a new faction or stay with them, but the choice all came down to them. THESIS: In the novel Divergent Veronica Roth examines how the theme of choice leads to bravery, betrayal, and greed. Body Paragraph 1: Topic sentence- Firstly the theme of choice leads to bravery, because of Tris selfish choice to leave abnegation and go into dauntless. Point:  Tris bravery in becoming a part of the dauntless is a foil to her own character, because Tris is a person of action, who has courage and is brave, but Beatrice, is the complete opposite. If Tris never made the choice to leave her faction, she would have never learned to be brave enough to overcome her fears and turn from the underdog into a hero. Bravery is represented in this book as being selfish and foolish, because the characters of the dauntless conception of bravery is acting in ridiculous life threatening situations to prove who is most daring to participate. However, bravery is truly presented as Tris goes through initiation. Not only has her choice to transfer into a different faction show her braveness but it also brought out her inner abnegation and taught her how to be selfless as well: â€Å"I believe in ordinary acts of bravery, in the coura ge that drives one person to stand up for another.† (Roth 207) Analysis: The significance of this quote is to show how Tris resembles bravery itself. Tris showed people that bravery is not just about being strong and committing acts of ruthlessness; it is about standing up for what you believe is right and being the big person in a situation when no one else is. Her choice to be brave and stand up for other people is what made her the hero in the end. Through bravery Tris was able to channel other traits in her from other factions and create a new her. Because of her willingness to be brave she was able to change herself and the way she thought. She was no longer the old Beatrice of abnegation. She turned in to the brave, courageous, strong, smart and selfless Tris of the dauntless. Any obstacle that came in her way she was able to overcome it and beat it and because of the one choice she made to decide to be brave, it made all the difference. Point 2: In addition to the above, Tris is a foil to her own character because if she had never joined the dauntless, she would have never been able to be on her way to saving the world: â€Å"I feel like someone breathed new air in my lungs. I am not abnegation. I am not dauntless. I am Divergent. And I can’t be controlled. (Roth 442) Analysis: The significance of this quote is that it shows how much Tris character changed from when she was in Abnegation to now. Being a part of the dauntless gave Tris the strength, the bravery, and the determination to get out there in the midst of it all as the world is crumbling to stand up for her own kind. If she never made the choice to change factions, she would have never had the chance to completely find herself and who she truly is, make the friends she did, and learn how to face her fears. Conclusion: In conclusion Tris bravery and strength Therefore Victoria Roth shows that through choice leads bravery, because bravery isn’t just something that happens on its own. It is the choice and the act of bravery that only you can decide to commit to and play a factor on your life. Body Paragraph: Topic sentence: Secondly the theme of choice leads to betrayal because of Tris and her brother, Caleb, choice to leave their family Point: Tris and Caleb’s betrayal is an example of pathos. Before Tris and Caleb are chosen to go up and decide on whether they will stay with their old faction or leave, their parents go to congratulate them: â€Å" My father kisses me on the head and clap Caleb on the shoulder grinning. See you soon, he says. Without a trace of doubt† (Roth 40-41) Analysis: The significance of this quote is that it shows how much hurt and betrayal they cause their father, especially, at the time. The one value that is most important about being a part of abnegation is not being selfish and to think about others. In this case Beatrice and Caleb’s choice to leave their family behind was not an act of selfishness, because they only considered themselves and not how their parents would feel. Thinking that his kids would choose to come home and stay with him and their mother, the father made a comment about how he would see them soon before the choosing ceremony started only to know minutes later that neither of his kids is coming home, and one of his kids (Caleb) are going home with the enemy- the erudite. The one choice they made that they thought would benefit them more in life ended up leading to their dishonour and betrayal of not only their family but their ex- faction. Point 2: Another act of betrayal was when one of Tris friends, Al, almost killed her out of jealousy, and insecurity. Al was supposed to be someone Tris thought she could depend on to keep her safe, trust, and ensure her that everything would be â€Å"okay† when the antagonist of the story and his crew would pick on her; but in the end he betrays her: â€Å"The soap smell is familiar. Lemon grass and sage. The same smell around Al’s bunk. A weight drops in my stomach†¦Ã¢â‚¬  â€Å"I suggest you rely on your transfer friends to protect you from now on,† he says â€Å"I thought I was†¦ I feel Al’s hands against my mouth, and a sob jolts my body forward†¦Ã¢â‚¬  â€Å"He wanted you to be the small quiet girl from Abnegation†¦ He hurt you because your strength made him feel week. No other reason† (Roth 278, 295) Analysis: The significance of this quote is that it shows you how one minute you can trust someone and the next they can easily make the choice to betray and  hurt you. Veronica Roth creates pathos for Tris, because Tris knows that she can no longer trust Al again even though they were such good friends. Al’s one choice not only hurt Tris but it also ruined their friendship, and this is one of the ways Veronica Roth shows how your one choice can define who you are as a person. Tris’ strength and ability was what caused Al to be jealous and in the end his jealousy cost him. Conclusion: Therefore, Veronica Roth created a sense of betrayal through the theme of choice, because it is another way of her showing how a specific choice can not only affect you but the other people around you. Body Paragraph 3: Topic Sentence: The theme of choice leads to war as the leader of the Erudite chooses to start a war over her own selfish reason. The factions were divided into five to prevent war and destruction from occurring in the world; but because the people of abnegation are divergent she chooses to take away many people physical and mental control to start a war and take them down: The theme of choice leads to greed because those who have power live in fear of loosing it.

Attrition in Bpo

Abstract The broad objective of this research is to identify the root causes of attrition and retention in BPOs, analyzing the level of employee motivation, satisfaction and involvement, generate a model for maximizing sustenance of employees in the organization and come up with concrete recommendations, which will eventually be valuable to the organizations to retain their employees for a long term. 1. Objective It is clear from the review of BPO research that solutions are required to some specific problems of practical importance in the field of escalating attrition and retention in BPOs. The broad objective f this paper is to identify the root causes of attrition and retention in BPOs, analyzing the level of employee motivation, satisfaction and involvement, generate a model for maximizing sustenance of employees in the organization and come up with concrete recommendations, which will eventually be valuable to the organizations to retain their employees for a long term. The spec ific objectives of this paper are:  · To identify and rank the factors of attrition in BPOs based on accumulative literature review and secondary data.  · To develop a regression model for escalating the stay of employees in BPOs nd give recommendations for the same.  · To assess the existing level of employee motivation and validate the model by studying the impact of recommendations on a small patch. 2. Introduction The last decade saw an upheaval in the growth and development of the Indian economy, which was accompanied by the revolution in the technological front and a radical change in the way businesses were done. Instead of being the jack-ofall- trades, the smart organizations have now redefined the way of working and now aim at being the master of their core business. Outsourcing the non-core processes in order to concentrate on the ore ones is how the companies prefer to work now. BPO has become the obvious strategic choice of the phenomenal lifestyles seem to flash t he mind in a jiffy. That’s just the start. One reads it again, contemplates over it, dives into the unveiled afflictions, and gives it a second thought and companies looking at the visible profits of cost reduction while improving the quality of service, increasing shareholder value etc. With the whirlpool of opportunities the Indian Business Process Outsourcing sector seems to be on a happy ride. It has emerged rapidly, and its exports have grown from $565 million in 2000 to about $7. 3 illion in 2005. With the boat steaming ahead in the global markets, India has already become the most privileged destination. Hence such an eternal inventory of opportunities simply showcases a phenomenon, which is no less than the renaissance for our Indian markets. Attrition in BPOs has terrible effects on the organization. The high attrition costs increases the costs to the organization considerably. They have to combat the amount of disruption due to unplanned exits. The more the people l eave an organization, the more it is a drain on the company’s resources like recruitment expenses, training and orientation resources and the time.The high attrition rate also affects the productivity of the organization. Therefore, it is extremely important to curb attrition not only for an individual firm but also for the industry as a whole. Many researchers have worked enormously on the IT & BPO sector, citing its challenges, issues, and ATTRITION AND RETENTION OF EMPLOYEES IN BPO SECTOR Ankita Srivastava [email  protected] com SKS Group of Institution,Mathura Yogesh Tiwari [email  protected] com SKS Group of Institution,Mathura Hradesh Kumar hradesh. [email  protected] com SKS Group of Institution,Mathura Ankita Srivastava et al,Int. J. Comp. Tech.Appl,Vol 2 (6), 3056-3065 IJCTA | NOV-DEC 2011 Available [email  protected] ijcta. com 3056 ISSN:2229-6093 opportunities in and around employee performance, employee satisfaction, employee turnover etc. 3. Literature Re view Grossman and Helpman’s (2005: 135) statement, â€Å"We live in an age of outsourcing,† clearly designates that outsourcing has now become an acknowledged, accepted and established business strategy. One of the most familiar forms of outsourcing is business process outsourcing BPO, i. e. , transferring the operational ownership of one or more of the firm’s business processes to an external supplier that, in turn, administers the rocesses according to some predefined metrics (Ghosh and Scott, 2005; Stone, 2004). BPO or Business Process Outsourcing thus refers to the rearrangement of entire business functions to some other service providers, primarily in low cost locations. The service provider may be either selfowned or a third party. This relocation or transferring of business processes to an external provider is essentially to accomplish increased shareholder value. Some of the general services provided by the BPOs are Receivables and Payables, Inventory Ma nagement, Order Processing, Cash flow Analysis, Reconciliation, Data Entry, PayrollProcessing, QuickBooks Accounting, Financial Statement Preparation and Accounting Services. Some of the web based services include live online sales and order entry, E-commerce transaction support, Live online enquiry handling, Web Design/Development. Reduced international trade barriers and improved telecommunication and IT capability over the past decade has led to a situation where organizations across the world are increasingly interlinked with each other. This has resulted in intense global competition, challenging business managers across the world to find ways to reduce the cost of conducting business and accessing lobal resources in meeting the need of global markets. In such a context, the reorganization of business models to leverage benefits of outsourcing and focus on core competencies has become a key strategy pursued by large corporations across the world. BPO service-providers are expec ted to provide a wide spectrum of benefits to their customers, ranging from having greater expertise in the outsourced processes, lower costs achieved through economies of scale, scalability and the ability to absorb cyclicality of loads.  · Demand-Supply Equations According to market analysis firm Gartner, the global outsourcing market in 2000 was pproximately $119 bn and will touch $234 bn by the end of 2005. The market is expected to grow to about $310 bn by the end of 2008. Contribution from the North American continent stands at about 59% of the total market, with Europe contributing about 27% and Asia-Pac region (including Japan) contributing the remaining portion of the market. In terms of vertical contribution, the financial services industry contributes approximately 17% of the total market size, followed by the Telecom sector (16%), Consumer Goods and Services (15%), Manufacturing (9%) and the rest by the Information Technology sector. Global BPO Market by IndustryFigure : 1 The BPO market can be broadly broken down into three areas of functional operations: i. Business administration (falling under G&A expense costs) ii. Supply chain management (COGS), and iii. Sales, marketing and customer care (Selling and marketing costs) India has emerged as one of the bright stars in the global Business Process Outsourcing market and has maintained its global competitiveness by offering the best combination of cost, quality and scalability. The growth rates of the Indian BPO-ITES industry have been 59%, 45. 3% and 44. 4% in years 2002-03, 03-04 and 04- 05 with revenues of over $3. billion in FY 2003- 04 and expected to touch $5. 7 bn in FY 2004-05. Ankita Srivastava et al,Int. J. Comp. Tech. Appl,Vol 2 (6), 3056-3065 IJCTA | NOV-DEC 2011 Available [email  protected] ijcta. com 3057 ISSN:2229-6093  · BPO in India Currently the sector employs approximately 2,45,100 people and another 94,500 jobs are expected to be added in the current financial year. There a re over 400 ITES-BPO companies operating in the Indian market, including captive units (of both MNCs and Indian companies) and third-party services providers. In terms of markets, the US continues to be the main consumer of India’s ITES-BPO ervices (with a 66% share of the market), followed by Western Europe (including the UK), which accounted for 20% of export revenues. In terms of functional service offerings, Customer Care and Support services contributed approximately 34% of the industry’s revenues with the other leading service lines including Finance (with a contribution of 22%), Administration (13%) and Content Development (19%). The global financial services vertical remained the largest user of Indian ITESBPO services, followed by telecom, healthcare and airline segments. Captive units continued to dominate the ITESBPO industry, accounting for ver 65 percent of the value of the work off shored to India. 4. Research Methodology The methodology deployed for this survey consisted of primary research, with insights being captured through questionnaires and face -to- face discussions with senior management of participant organizations. Inputs from potential customers to this industry have also been collated, with respect to their key concerns while considering outsourcing to India. The analysis was further supplemented by PwC knowledge-bases and published data to validate trends and best practices, emerging from primary sources. Our analysis and findings are ased on consensus findings from the survey and are supported by quantitative and qualitative inputs from the respondents. The data presented in this report is based on information received from the respondents and has been collated to represent an industry trend. The general intent of this descriptive study was threefold. Therefore a systematic and organized methodology was obtained for the research study. A survey design was used to obtain the required information. The population for thi s study comprised of employees working in various BPOs in the National Capital Region. A sample size of 250 was chosen for this study. Simple andom sampling technique was used to gather data from the respondents, because of which respondents diverged from every age group, gender, organization, marital status etc. but were restricted only to low and middle level employees, where the attrition is highest. The questionnaire was intricately designed to tap the demographic variables including age, education, gender, marital status, and tenure of the respondents. It also gathered information about the factors responsible for attrition, the factors that can be employed to retain the employees in a BPO, their overall level of satisfaction, motivation, involvement and life nterest and work compatibility. Main data collection began in the month of July 2011. Statistical Package for the Social Sciences (SPSS) version 17. 0 was religiously used for the statistical analyses.  · Primary Data An alysis A questionnaire was intricately designed to tap the factors responsible for attrition, the factors that are expected to be present in a specific job for retention. The instrument was divided into 4 parts. The first part gathered information about the personal profile of the respondents which included their age, gender, education, marital status, and tenure. Part II consisted of questions about their easons for change or probable change in their jobs. Part III aimed at knowing what according to the respondents is important for their sustenance in an organization. And last of all, Part IV was about their overall perception of the work which included their level of satisfaction, level of motivation, level of involvement and level of life interest and work compatibility.  · Secondary Data Analysis In order to gain a deeper understanding about the phenomenon of high attrition, and identification of the factors behind it, a lot of literature on BPO, particularly what got publishe d during 2004 and 2005 was studied in detail.Major causal factors for high attrition in Indian BPO industry identified in this study were based on qualitative research using secondary data. These were compared with causal factors for attrition identified through personal interview with a number of BPO employees in the Ankita Srivastava et al,Int. J. Comp. Tech. Appl,Vol 2 (6), 3056-3065 IJCTA | NOV-DEC 2011 Available [email  protected] ijcta. com 3058 ISSN:2229-6093 NCR. There was a close similarity between the two results, authenticating the qualitative research on causal agents for attrition identified in this study. The study ranked low perceived value and onotonous work as number one factor attrition. Rank two was shared by high salary expectation and unusual working hours. Next factor was disillusioned employees; rank four was shared by stress and burnout, pressure to perform on metrics, and lack of motivation. Finally rank five was jointly shared by lack of security and soci al interaction. Causal Agents / Factors Score (on 1) (Rank) Higher Salary Expectation 0. 7 (Rank-II) Lack of Security 0. 3 (Rank-V) Lack of Social Interaction 0. 3 (Rank-V) Monotonous Work 0. 8 (Rank-I) Unusual Working Hours 0. 7 (Rank-II) Pressure to perform on Metrics 0. 5 (Rank-IV) Low Perceived Value 0. (Rank-I) Disillusioned Employees 0. 6 (Rank-III) Stress and Burnout 0. 5 (Rank-IV) Lack of Motivation 0. 5 (Rank-IV) Table 1: Summary of ranks from secondary study 5. Growth of BPO industry  · Company Owned Units Pioneered BPO in India Company owned units such as American Express, General Electric (GE), Citibank, and AOL etc. triggered the trend of outsourcing back office operations and call centre services to India. Since then several banks, insurance companies, airlines and manufacturing companies have set up back office service centers in India.  · Venture Funded New Companies Over the last few years, a number of xperienced professionals have set up start-up operations in India. Generally such start-ups have been funded by venture capital funds.  · Leading IT Services Companies enter BPO Given the magnitude of such opportunity, natural synergies with the software services business and the ability to leverage their high-end physical infrastructure and management bandwidth, most large IT services companies have ventured into ITES. Consolidation of the market with the smaller players merging with each other/ larger companies for economies of scale  · Domain / Industry Specialized BPO’s Niche players in industry verticals or specific usiness processes have setup BPO businesses. Many of these players have had vast experience in the domestic market and are now offering offshore BPO services Generalized large BPO players are now focusing on â€Å"verticalizing† their competencies and structures Industry Structure MNC subsidiar ies Internatio nal BPO Companie s Diversifi ed IT Compan ies GE Convergys Daksh Infosys (Progeon) British Airways Sitel Brigade Wipro (Spectrami nd) eServe, HSBC, Scope, AmEx eFunds Talisma Tech Mahindra Hewlett Packard —- Hero HCL Table: 2 Ankita Srivastava et al,Int. J. Comp. Tech. Appl,Vol 2 (6), 3056-3065 IJCTA | NOV-DEC 2011Available [email  protected] ijcta. com 3059 ISSN:2229-6093  · Size and Growth of BPO in India Figure: 2 The growth in the BPO sector of India in 2004 was mainly due to the demands from the two segments – BFSI and telecommunications. There were low telecom costs for the leased lines and 400 companies were part of the BPO sector of India. The companies that were involved included third parties, Indian companies and MNC. Growth of BPO sector in India has been truly impressive in recent years, but things can get even better, according to market analysts. India stands out already as a market leader as far as BPOs are oncerned and so India also attracts huge foreign investments which are extremely essential since the Indian economy is expected to have an un precedented growth in the years to come. Growth of BPO Sector in India during the first half of 2007 was showing a moderate trend of growth which is registered at 14%. Five years ago, the growth in this sector was quite low due to less contracts but the situation is worse now. However, the growth of the BPO sector is expected to improve. The BPO and KPO sectors in India have been showing some positive signs with demands from western countries increasing manifold due to the vailability of cost-effective labour in India, which is highly skilled and also fluent in English. The BPOs in India are focused on increasing the growth through change in pricing techniques. Pricing in a BPO is supposed to be based on the value added to the business. So a remarkable change is in store as the BPOs in India work towards their full potential. Of course, the big boom in the BPO industry in 2003 had generated a lot of employment opportunities and continues even today. Nevertheless, Indian BPO sector i s facing competition from countries like Philippines, Mexico, Malaysia, China, and Canada. The xpected growth of this sector in 2003 was 25%. Nations like the United States and Europe are showing great interest in increasing their investments in the Indian BPO sector. India has an edge over other countries as we consider the following:  · Tech savvy professionals  · Cost effectiveness  · Superior competency  · Business risk mitigation  · 24 hour service  · Economy of scale The trends in growth of the BPO sector in India are as follows:  · 2003 – USD 2. 8 billion  · 2004 – USD 3. 9 billion  · 2005 – USD 5. 7 billion According to studies conducted by NASSCOM and leading business Intelligence Company, McKinsey & Co. he Indian IT/BPO segment is expected to employ over 1. 1 million Indians by the year 2008. Market research shows that in terms of job creation, the ITES-BPO industry is growing at over 50 percent. In the financial year 2003-2004, ITESB PO companies were the largest recruiters in the IT/ITES sector, adding a total of about 70,000 jobs. An estimated 70,000 new Jobs expected in 2005 in the field pf ITES. Plus there will be additional hiring to replace industry attrition that is around 25%. On the other hand BPO and outsourcing services would generate around 1, 25,000 new Jobs in 2005. McKinsey & Co. predicts global market or IT-enabled services to be over $140 billion by 2008. In that the opportunity for India will be around $ 17 Billion. Ankita Srivastava et al,Int. J. Comp. Tech. Appl,Vol 2 (6), 3056-3065 IJCTA | NOV-DEC 2011 Available [email  protected] ijcta. com 3060 ISSN:2229-6093 Figure: 3 Supplier-Side Assessment  · Domestic Indian BPO Industry has seen a spurt in the recent years growing at a 33 %CAGR.  · The Domestic Indian BPO industry grew from a USD 660 Million to a USD 1. 18 Billion industry.  · EBITA margins for domestic BPO stood at a double digit Percent figure  · Billing rates are less com pared to offshore segment – Most Indian BPOs (especially all centers) are engaged throughout the night hours (for offshore clients), leaving the facility empty for the day. 1. This enabled them to be leveraged during the day for domestic markets in India Demand Side Assessment  · Financial, banking, and telecom companies are leading the domestic BPO wave: 1. BFSI sector companies – UK’s largest banking firm 2. Telecom majors- almost all major mobile & landline telephony provider 6. Factors responsible for attrition and retention of employees in BPO Hackman & Oldham (1976) proposed the Job Characteristics Model, which is widely used as a framework to study how particular ob characteristics impact on job outcomes, including job satisfaction. The model states that there are five core job characteristics (skill variety, task identity, task significance, autonomy, and feedback) which impact three critical psychological states (experienced meaningfulness, experience d responsibility for outcomes, and knowledge of the actual results), in turn influencing work outcomes (job satisfaction, absenteeism, work motivation, etc). The basic hypothesis of this research that employee motivation, employee satisfaction, employee involvement, and life interest and work compatibility lead to rolonged sustenance is an extension of this model with minor modifications in it. It is proposed that the Job Characteristics model is modified by redefining job dimensions as growth prospects, accountability, sense of accomplishment, self-esteem, job security, interpersonal relationships, working conditions, by extending organizational outcomes as satisfied, motivated, involved and retained employees. Figure 1 is the modified Hackman and Oldham’s Job Characteristics model which has been taken as the base to study the research questions pertaining to this research. The new model is also designed to be of use as a management tool and must herefore be simple and flexi ble enough to be of use to the management of an organization. Typical management questions would involve the likely motivational impact of job redesign, such as increasing employees’ level of control and responsibility over their work behaviour or introducing a scheme whereby employees participate in certain management decisions. The model should therefore allow managers to manipulate a host of job characteristics and investigate the likely effects upon the motivation, performance and sustenance of the workforce. This study aimed at exploring the dimensions of attrition and retention.Based on our ground work; initial survey and personal interviews held with the BPO employees, it was found that factors that contribute to attrition are quite different from the factors that contribute to retention. Ankita Srivastava et al,Int. J. Comp. Tech. Appl,Vol 2 (6), 3056-3065 IJCTA | NOV-DEC 2011 Available [email  protected] ijcta. com 3061 ISSN:2229-6093 Figure:4 Modified version of H ackman and Oldham’s Job Characteristics Model Based on the Hackman and Oldham’s Job Characteristics Model and the modifications made to it, a clearer and more lucid pictorial framework of the model is given in Figure 5 and 6. Figure 5 learly illustrates the basic constructs of the attrition model: personal characteristics, negative job characteristics (job dimensions), and the final resultant as attrition. Figure 6 illustrates constructs of retention model i. e. personal characteristics, intrinsic job dimensions and the resulting level of satisfaction, motivation and involvement (work outcomes) and the final result i. e. retained employees (organizational outcomes). Figure: 5 Basic models for attrition Figure 5 clearly suggests the personal characteristics as age, education, gender, marital status and tenure along with the negative characteristics of a BPO job i. . monotonous nature of job, lack of motivation, poor mentoring, power and politics, dissatisfaction with co lleagues, low career growth, lack of skill variety, irregular working hours, achievement not recognized etc. These two collectively result in the attrition of employees. The question is how much do these factors actually contribute to attrition. Similarly figure 6 describes the personal characteristics and core job dimensions which are intrinsic in nature and how do they contribute to retention of employees. Figure: 6 Basic model for retention of employee 7. Result and Analysis  · Regression Model for retentionThe dependent variable was sustenance in an organization, and the independent variables were personal characteristics viz. age, gender, education, marital status, and retention factors viz. motivation factors, extrinsic factors, involvement factors, and life interest and job compatibility factors. All these eight factors were put in the model as independent variables and willingness to continue in the organization was put as the dependent variable. Intrinsic motivation facto rs, employee involvement factors, age and education are the main determinants of retention. The value of multiple R is 0. 60 and the value of r square is 0. 6 in the equation. It states that 36% of the retention in a BPO is explained by these factors. An employee’s sustenance in an organization can be rightfully explained by these factors. Ankita Srivastava et al,Int. J. Comp. Tech. Appl,Vol 2 (6), 3056-3065 IJCTA | NOV-DEC 2011 Available [email  protected] ijcta. com 3062 ISSN:2229-6093 Equation: 1 Y= 1. 78 + 0. 47X 1 + 0. 15X 2 – 0. 13X 3 – 0. 11X 4 Where, Y = Stay in the organization X1 = Intrinsic Motivation Factors X2 = Involvement Factors X3 = Age X4 = Education After forming the regression model, value for each respondent’s willingness to stay in the organization was calculated.These predicted values were then compared to the actual values as given by the respondents. There was a strong correlation between the actual and predicted values. The cor relation came out to be 0. 659** which was significant at 0. 01 level. Thus, on the basis of the regression model it can be concluded that intrinsic motivation factors; and involvement factors are quite instrumental in retaining the employees in an organization and at the same time, age and education negatively contribute to the sustenance of the employees in the organization. Employee involvement is a proven tool to motivate and retain mployees and according to the result here, it can be constructive in the Indian BPOs too. In the West, there has been ongoing interest in getting workers more involved in various processes, such as decision-making and information sharing. Employee participation adds to employees’ growth needs and sense of achievement through a healthier deployment of their dexterity and potential. Employee participation in planning and decision making and in articulating new policies also acts an important tool to improve employee motivation. Finding ways to i ntrinsically motivate employees to improve effectiveness and performance can have ong lasting impact on their sustenance too. Based on the two dimensions i. e. motivation and involvement which, according to the regression model, significantly contribute to the sustenance of an employee in the organization, employees can be broadly classified into four broad categories. There are people who are woefully inadequate in both dimensions i. e. neither are they involved in the work, nor are they motivated to perform. We may call such people as ‘detached’ who leave the organization for no rhyme or reason, hence extremely difficult to be retained. Next comes the ‘disgruntled’ who get involved in the iven assignment but lack aspiring motivation. Such people are moderately to highly difficult to be retained as they lack in the basic intrinsic motivation. The other two segments comprise of ‘strugglers’ and ‘stars’ who are at the higher end of the motivation continuum. The former may be relatively lower in their involvement as compared with the latter. ‘Strugglers’ lack involvements but have a high degree of intrinsic motivation, because of which they struggle hard to work. It is moderately difficult to retain them. The ease and art lies in fulfilling their involvement needs by expanding their responsibilities, empowering them, aking them involved in decision making etc. ‘Stars’ are highly motivated and highly involved in the work, and thus they are the easiest to be retained. ‘Disgruntled’ and ‘strugglers’ are the focus segments, which a company would not want to lose. They need to be enhanced, protected, valued and retained by pulling away all the nonretentive forces and kicking the retentive forces into high gear. DISGRUNTLED Highly involved but demotivated employees Moderately to highly difficult to retain STARS Highly involved and highly motivated employees Easy to retain DETACHED Uninvolved and demotivated employees Highly Difficult to retainSTRUGGLERS Uninvolved but highly motivated employees Moderately difficult to retain LOW HIGH Table: 3 Intrinsic Motivations Involvement vis-a-vis Intrinsic Motivation: Effect on employee retention  · Model Validation For the final validation of the regression model, a small patch test was done on a sample of 50 employees in Intelnet Private Ltd. Few concrete recommendations were made to the process manager of this BPO and he was asked to stringently apply these recommendations. The employees chosen for this study were the ones who had said they would leave the organization if they were offered work with the same pay elsewhere.Data which was collected, after three months of implementation, was analyzed statistically. The response scores were put in the regression equation as derived from the fourth objective and the resultant willingness to stay in the organization was calculated. The comparison with the ir original scores clearly revealed that there was an escalation HIGH LOW Ankita Srivastava et al,Int. J. Comp. Tech. Appl,Vol 2 (6), 3056-3065 IJCTA | NOV-DEC 2011 Available [email  protected] ijcta. com 3063 ISSN:2229-6093 in the scores. Also, the predicted scores and the actual scores of the willingness to continue in the organization was put under correlation.Finally, employees were classified under four broad categories based on their level of involvement and motivation viz. detached, disgruntled, strugglers and stars. 8. Conclusion The regression model for the retention of employees in a BPO explains two important factors i. e. intrinsic motivation factors and involvement factors. This result is robustly analogous with all the prevalent and established theories of motivation viz. Herzberg’s theory, Maslow’s theory, Alderfer’s Theory, McClellend’s Theory. According to all these theories, the higher order needs revolve around self esteem, or selfact ualization in one way or the other.According to Maslow’s theory, the higher-level needs are selfesteem and self-actualization. Only when one need is satisfied, another higher-level need emerges and motivates the person to do something to satisfy it. A satisfied need is no longer a motivator. Only the next level of needs in the hierarchy will act as motivators. Once a level of needs has been satisfied they no longer act as motivators and the individual then directs attention towards the next level of needs in the hierarchy. Herzberg draws a parallel with Maslow’s theory but with a subtle difference. According to his theory, motivator factors are actors that are intrinsic to the job, such as the content of the work itself and the availability of opportunities for responsibility, advancement and recognition for achievement. The motivator factors, which Herzberg described as â€Å"complex factors leading to this sense of personal growth and selfactualization†, would then be able to act on that employee and increase job satisfaction and productivity. Thus, according to this theory, in order to motivate workers towards higher productivity, it is important to ensure that the motivators are utilized to arouse the instinct of the employees. Herzberg’s motivator and hygiene actors can be mapped onto Maslow’s hierarchy of needs with the motivator factors corresponding to the higher order needs of ego and self-actualization. Next, according to Alderfer’s ERG theory, growth needs involve the intrinsic desire for personal development and include the intrinsic element of Maslow’s esteem category as well as self-actualization needs. Finally according to McClellend’s theory, people with a high achievement need have a compelling drive to succeed. They strive for personal achievement rather than rewards and have a desire to do something better or more efficiently than it has een done before. They seek situations where they can attain personal responsibility for finding solutions to problems, where they can receive rapid feedback on their performance so they can tell easily whether they are improving or not, and where they can set moderately challenging goals. 9. Recommendations Organizations should have a proactive retention strategy which helps in reducing employee turnover. Retention plan strategies should be different for different level of employees, because their roles are different; their needs are different; what motivates them are different and what makes hem leave are also different. Based on the study it has been seen that dimensions of satisfaction and motivate are significantly different for employees on the basis of age, gender, marital status and education. Then, the regression model revealed that intrinsic motivation and involvement factors, as well as age and education level contribute to the sustenance of employees in the organization. Thus based on the findings, it can be said if the employees are motivated and involved in the work they can be retained. The ease of retention would depend on their degree of motivation and involvement. It is desirable to lan employee retention strategy by an organization, which should cover following aspects:  · Reciprocity is the key. Employees are investors in the company and expect a return on investment. The return can be in the form of recognition, empowerment and authority.  · Retention must be part of the organization’s DNA. Successful organizations have woven retention and engagement deeply into their structure.  · Loyalty is never given. Loyalty must be earned; even satisfied employees sometimes leave. Therefore, develop sense of loyalty among the employees.  · Organizations must be seen as employers of choice. One has to compete on ompensation and benefits, but win on culture, learning and development.  · Stars include more than just the top 10% – – or 1%! Stars are people at any level who sustain in the organization and bring value to it. Ankita Srivastava et al,Int. J. Comp. Tech. Appl,Vol 2 (6), 3056-3065 IJCTA | NOV-DEC 2011 Available [email  protected] ijcta. com 3064 ISSN:2229-6093  · Each generation of employees has different reasons for staying. For the first time in modern history, there are varied generations working side-by-side in most companies of this industry. Generational differences continue to pose new challenges to today’s employers.Thus, retaining them needs a generation-centric approach.  · Mentor widely and in both directions. Build learning relationships in all directions and hold all partners responsible for the success.  · Train intelligently. Provide on-going retention training in manageable bites – make it a continuous effort and find ways to size the retention plan to the specific demographics of the organization.  · Create a development culture. â€Å"Career development is the right thing for the organization (ide ntifying and developing future leaders), the right thing for the employee (creating a development environment), and a key retention omponent. †  · Recognize managers who keep employees. Meaningful recognition remains a potent energizer for employees and managers alike. 10. References 1. Vohra, Kushal, Systems Approach to Retention of Critical Employees. Available at SSRN: http://ssrn. com/abstract=662442 2. Tapper, David. â€Å"Worldwide and U. S. IT Outsourcing Services 2004–2008 Forecast: A Potential Perfect Storm. † Market Analysis (April 2004): IDC, Document 31089 . 3. Witt, L. A. , Martha C. Andrews, and Dawn S. Carlson. â€Å"When Conscientiousness Isn’t Enough: Emotional Exhaustion and Performance among Call Center Customer Service Representatives. †Journal of Management 30 (February 2004): 149–60. 4. Walletwatch. â€Å"Call Centre Attrition Puts HR Managers to Test. † (April 2003). www. samachar. com/biz/fullstory. ht ml; (Ac cessed on May 8, 2010). 5. Rediff. com â€Å"What Indian BPO Industry Needs. †(2005a). us. rediff. com/money/200 5/apr/23bpo. htm; (Accessed on May 1, 2010). ———. â€Å"1000 Jobs Offshored . 6. Ravichandaran, Ram. â€Å"BPO, ITES Sectors to Hot Up in 2005, Says NASSCOM Report. † Financial Express (March 9, 2005): 2 7. Ramchandran, Kumar and Sudhir Voleti. â€Å"Business Process Outsourcing (BPO): Emerging Scenario and Strategic Options for IT-enabled Services. Vikalpa 29 (January–March 2004): 49–62. 8. Prakash, S. and Chowdhury, R. (2004). â€Å"Managing attrition in BPO†, In search of Excellence, Cool Avenues, http://www. coolavenues. com/know/hr/s_1 .php. Last accessed on: February 06, 2010. 9. Pande, Bhanu â€Å"Sun, Survey Can’t Deter the Call of Duty. † Economic Times Online (July 29, 2005). (Accessed on May 8, 2010). 10. Neale, Helen. â€Å"Offshore BPO Delivery. † NelsonHall BPO and Outsourcing Sub scription Service: Nelson-Hall, 2004 . Ankita Srivastava et al,Int. J. Comp. Tech. Appl,Vol 2 (6), 3056-3065 IJCTA | NOV-DEC 2011 Available [email  protected] ijcta. com 3065 ISSN:2229-6093

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