EMPLOYEE PERCEPTION OF EMOTIONAL RESILIENCE IN A

HEALTHCARE BPO WORKPLACE

A Thesis

Presented to the Faculty of

Polytechnic University of the Philippines

Sta. Mesa, Manila

In Partial Fulfillment of the Requirements for the Degree in Human

Resource Management

by

Maglipas, Fatima S.
Mabale, Emilyjen S.
Maglalang, Jerickson Russel M.
Manaloto, Alvin G.

2024
 CHAPTER I
THE PROBLEM AND IT’S SETTINGS

I. INTRODUCTION

In the BPO industry, emotional resilience plays a vital role due to the

dynamic and often high-pressure nature of the work environment.

Emotional resiliency refers to someone’s ability to adapt in the face of

adversity, crises, and other significant sources of stress. It is also when a person

can tap into realistic optimism even when dealing with a crisis, where they can

manage external stressors and their own emotions healthily.

Employee perception refers to how employees interpret experiences and

information in the workplace. Perception is subjective, which means each

employee may have a different interpretation of the same situation.

Business Process Outsourcing (BPO) workplace is a setting where a company

outsources business processes to a third-party (external) company. The common

services functions are accounting, payroll, telemarketing, data recording, social

media, and customer service.

BPO (Business Process Outsourcing) employees often face various

challenges in the workplace. These challenges can impact their job satisfaction,

performance, and overall well-being. Common challenges faced by BPO

employees include high workload and targets, irregular shift hours, health and well-

being, limited career growth opportunities and inadequate support system. BPO is

stressful coming to a point where it impacts employees’ emotional well-being.

However, the initial phase in dealing with emotional risk in BPO management is to

identify the sources of emotional risk that influence your staff and clients.

Healthcare BPO in the Philippines includes front and back-office services

like customer help, appointment management, medical coding, billing, and data

handling. These services cater to the needs of Patients, Provider and Facilities.

Contact centers support various channels such as phone, email, web chat, and

social media.

The study aims to understand employee perception of Emotional

Resilience in a Healthcare BPO workplace through Broad-and-Build Theory of

Positive Emotions.

II. THEORETICAL FRAMEWORK

The research process that works like a roadmap for the research study and

helps researchers interpret their findings by providing a structure for organizing

data and developing conclusions is called a theoretical framework.

One theoretical framework that can be used to understand and enhance

emotional resilience is the Broaden-and-Build Theory of Positive Emotions,

proposed by psychologist Barbara Fredrickson. This theory suggests that positive

emotions play an important role in broadening an individual's momentary thought-

action repertoire, which, in turn, can build enduring personal resources.

Based on this theory, experiencing positive emotions such as joy, love, and

gratitude can lead to a broadening of cognitive and behavioral repertoires. This

broadening effect can help individuals develop greater emotional resilience over
time. Positive emotions are thought to undo the lingering effects of negative

emotions, fostering psychological resilience and resource accumulation.

Fredrickson's theory also highlights the idea that the accumulation of

personal resources such as social support, skills, and coping strategies, during

positive emotional experiences can contribute to increased resilience. This

accumulation, eventually, enhances an individual's ability to cope with adversity

and stress.

In reality, individuals can work on developing emotional resilience by

actively cultivating positive emotions, adopting a positive mindset even in the face

of challenges, engaging in activities that bring joy and fulfillment, and building

social connections.

It's important to note that emotional resilience is a complex and multi-

faceted construct, and various theories and models contribute to our

understanding of it.

Resilience, coping skills, and awareness are all enhanced by pleasant

emotions.

Figure 1: Theoretical Framework

III. CONCEPTUAL FRAMEWORK

A conceptual framework is used to understand a research problem and

guide the development and analysis of the research. It is used to provide a clear

and concise understanding of the key concepts, relationships, variables, and

assumptions that underlie a research study. The visual tool used to describe

workflow is called the Input-Process-Output (IPO) Model.

Figure 2: Conceptual Framework

Data were assessed as input from the respondents from the Healthcare

BPO employees on their emotional resilience. The input box specifically reflects

the respondents’ profile such as age, gender, civil status, highest educational

background, and jobs/positions and length of stay with the company. The process

box shows the analysis of data through questionnaires, informal interviews,

presentations, and interpretation. Finally, the output box illustrates the result of the

progression from the input to the process box.

IV. STATEMENT OF THE PROBLEM

The study aims to understand and enhance the emotional resilience of

Healthcare BPO employees.

Specifically, it seeks answers to the following questions.

1. What is the demographic profile of the respondents in terms of?

a. Age

b. Sex

c. Civil Status

d. Highest Educational Background

e. Jobs/Position

f. Length of stay w/ the company

2. How do the employees perceive emotional resilience in a Healthcare BPO

workplace in terms of the following aspects;

a. Impact on Cognitive Flexibility

b. Building Social Connections

c. Resilience and Adversity

 d. Long Term Well-being

e. Employee Engagement

V. SCOPE AND LIMITATIONS OF THE STUDY

The study searched for different understandings from selected respondents

from Healthcare BPO employees to understand emotional resilience.

This research included the profile of the 150 respondents and their

perceptions and assessment of the different aspects of emotional resilience.

The study covers respondents who were in the Healthcare BPO company.

The researchers distributed questionnaires to different BPO Employees through

online and traditional ways.

The findings of this study were limited by the data given by the participants,

which were collected via the researcher's created questionnaire.

VI. SIGNIFICANCE OF THE STUDY

The following parties will find the study's results significant;

Healthcare BPO Employees, who would like to understand and enhance

emotional resilience in a Workplace.

Academics will benefit from this study by using the paper as one of their

references in their investigations to better comprehend and develop an employee's

emotional resilience.
 Other researchers will also benefit by providing them with useful

information and suggestions that will enhance their future research endeavors.

VII. DEFINITION OF TERMS

Business Process Outsourcing (BPO) workplace is a setting where a

company outsources business processes to a third-party (external) company.

Healthcare business process outsourcing refers to the practice where

a healthcare provider outsources its non-core activities to an external party.

Instead of performing the tasks themselves, the healthcare company hires a third-

party firm to handle the work for them. The healthcare BPO sector encompasses

a wide range of activities, including data entry, medical coding and billing, and

medical claims processing services. These services cater to the needs of patients,

providers, and healthcare facilities.

Resilience refers to someone’s ability to adapt in the face of adversity,

crises, and other significant sources of stress.

Employee perception refers to how employees interpret experiences and

information in the workplace.

Positive emotions are emotions that we typically find pleasurable to

experience. It includes happiness, love, joy, gratitude amusement, pride, awe,

serenity, and inspiration.

Cognitive flexibility refers to the ability to shift attentional resources

across perceptual attributes of complex, behaviorally relevant stimuli in response

to changes in environmental contingencies.

 Back office provides important functions that contribute to the success of

the organization. These back-office processes refer to non-client-facing tasks that

keep the business running and provide support for front-end operations.

Operational efficiency is the ability of an organization to reduce waste in

time, effort, and materials as much as possible, while still producing a high-quality

service or product.

Regulatory compliance is the process of complying with applicable laws,

regulations, policies and procedures, standards, and the other rules issued by

governments and regulatory bodies.

Language proficiency relates to a person's ability to produce and

understand a particular language. Proficiency test scores reflect the level at which

a person can communicate in the language that they test in. Your proficiency level

reflects how well you can read, write, and respond in each language.

Social confidence is the ability to feel comfortable interacting with others

in a variety of social situations. This can look like being able to talk to family

members or peers, freely express opinions, and feelings, join in conversations

without feeling self-conscious, and navigate complex social dynamics.

Empathic accuracy is a measure of how accurately one person can infer

the thoughts and feelings of another person.

Cognitive Behavioural Hypnotherapy (CBH) combines Cognitive

Behavioural Therapy (CBT) with hypnosis, to give you the tools to manage and

overcome daily stress and feelings of anxiety, as well as manage some physical

ailments.
 Crisis management is the application of strategies designed to help an

organization deal with a sudden and significant negative event, while maintaining

business continuity.

Employee engagement describes the level of enthusiasm and dedication

a worker feels toward their job. Employee engagement can be critical to a

company's success, given its links to job satisfaction and employee morale.

Engaged employees are more likely to be productive and higher performing.

Adversity refers to difficulties or misfortune, often involving challenges,

obstacles, or unfavorable circumstances that one may encounter in life. It can

encompass a wide range of experiences, including hardship, adversity, and

struggle. Adversity can come in various forms, such as personal, professional, or

societal challenges, and individuals often demonstrate resilience and strength in

overcoming adversity.
 CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

A review of the research-related literature, articles, and studies is provided

in this section. It talks about some relevant international and local studies and

literature that provide the research with a crucial grasp of how well the Broad-and-

Build Theory works in terms of how employees perceive their emotional resilience

in a BPO environment. It also addresses a few significant issues and pertinent

topics.

What is BPO?

Business process outsourcing is the process of hiring a third-party service

provider. They perform specific tasks and business operations that are traditionally

done in-house. The BPO agency can be within the local or national range.

However, it can also be offshore outsourcing where the office is anywhere else in

the world. Some of the most commonly outsourced services are back-office tasks,

data analytics, and customer support. Looking into the national context, the

information tech-BPO (IT-BPO) sector is its fastest-growing arm. Currently, it has

sub-sectors that divide the specializations of the workforce into the following

categories: Call centers, Software development, Game development, Engineering

design, Animation, Medical transcription, and Back-office tasks. (Sutana, R. 2021)

The Philippines has become one of the most popular outsourcing

destinations in the world. And it’s easy to see why as this has a direct correlation
with the levels of competencies of its workforce. With a high level of English

language proficiency, a hospitable and courteous culture, and a world-recognized

education system, the country is a hotspot of talent waiting to be tapped. (Talmage-

Rostron, M. 2024)

What is Customer Service?

Customer service holds a paramount role in the success of businesses,

offering a multitude of advantages. Foremost, it serves as a linchpin for customer

retention, ensuring that clients are content with their experiences, thus increasing

the likelihood of repeat purchases and fostering long-term relationships. Moreover,

it cultivates brand loyalty by instilling a sense of value and support in customers,

leading them to choose a particular brand over competitors. Additionally,

exceptional customer service contributes to the establishment of a positive

reputation through positive word-of-mouth recommendations and online reviews

(Tracey, M., 1998) Furthermore, it can drive increased revenue, as satisfied

customers are more inclined to spend more and advocate for the brand. In today's

fiercely competitive market, superior customer service stands as a critical

differentiator, enabling businesses to distinguish themselves. It also serves as a

vital source of feedback for improvement, highlighting areas where products,

services, or overall experiences can be enhanced. Lastly, effective customer

service is essential for crisis management, helping to mitigate negative impacts on

the business during challenging periods. In conclusion, customer service is a

cornerstone of successful businesses, playing a pivotal role in their growth and

sustainability (Leech, P., 1995)

 Customer service in Business Process Outsourcing talks about the

outsourced customer service organizations that focus on providing real-time

customer support via chat, email, phone, social media, and other channels. It

includes using digital tools like co-browsing, chatbots, and live chat for effectively

handling concerns from customers. Positive encounters with employees on a

regular basis increase the possibility that customers will return or refer friends and

family to your business. In addition, 80% percent of customers believe that a

company's customer experience is just as significant as its products or services.

(Patel, 2024)

What is a Healthcare Account in BPO?

In the healthcare sector, Business Process Outsourcing (BPO) for account

services plays a pivotal role in ensuring operational efficiency and maintaining high

standards of patient care. These services are essential for facilitating seamless

interactions between patients and healthcare providers, ultimately enhancing

patient satisfaction. Additionally, account services in BPO help healthcare

organizations comply with complex healthcare regulations and standards,

minimizing the risk of penalties and legal issues. One of the critical aspects of

account services in BPO is the accurate and timely processing of accounts. By

streamlining billing and payment processes, these services help healthcare

providers receive payments promptly, contributing to their financial stability.

Moreover, outsourcing non-core functions such as billing and accounts receivable

management allows healthcare providers to focus on delivering quality patient

care, which is their primary mission. Account services in BPO are instrumental in

improving the overall efficiency and effectiveness of healthcare operations. By

outsourcing these services, healthcare organizations can optimize their resources,

enhance patient satisfaction, and ensure compliance with regulatory requirements,

ultimately leading to improved healthcare outcomes. (Candelario, C.M.C, 2024)

Business process outsourcing (BPO) in the healthcare industry describes

how healthcare organizations use outsourcing businesses to handle their

complicated and non-core tasks. Medical companies work with an outsourcing

provider to help them carry out their tasks more effectively and more efficiently

than performing them internally. Delegating their work also enables them to lower

expenses, boost productivity, and provide higher-quality healthcare services.

(Estrellado, 2024).

Institutions use the following methods to outsource BPO services for

healthcare. Avoiding costly mistakes. - avoiding expensive errors. When managing

some services internally, mistakes are often committed. Healthcare BPO reduces

these mistakes by outsourcing these tasks to highly qualified people with years of

training. Regulatory compliance. - Medical businesses should also abide by

compliance standards that protect patient welfare and information. Compliance

can be enhanced by outsourcing to BPO companies, which will handle the related

paperwork and procedures. Focus on patient care. Having BPO services for

healthcare releases you of an added responsibility of handling difficult and time-

consuming obligations, allowing you to focus more on delivering more effective

patient care—as the phrase goes, "No company can stand alone." (Estrellado,

2024)
What is Employee Perception?

Employee perception refers to how employees interpret information and

experiences in the workplace. Perception is subjective, meaning that each

employee may have a different interpretation of the same work situation.

Understanding how your employees differ is essential for employers to create a

positive work environment and improve job satisfaction and employee

engagement across the board. (Austin P. 2023)

Resilience

The term "personal resilience" defines how well you manage challenging

situations in your life. It is frequently defined as having the potential to "bounce

back" and continue without having a hard time when faced with adversity. It

includes being able to control your thoughts and emotions effectively and seeing

difficult circumstances as opportunities rather than risks to yourself. (Burton-

Hughes, L. 2023)

Emotional Resilience has three building blocks – these are the pillars on

which we can build resilience or work on improving it. Also referred to as the three

dimensions of emotional resilience, the three elements include; 1. The Physical

Elements - involving physical strength, energy, good health, and vitality. 2. The

Mental or Psychological Elements - Including aspects like adjustability, attention

and focus, self-esteem, self-confidence, emotional awareness and regulation, self-

expression, thinking, and reasoning abilities. 3. The Social Elements - Including

interpersonal relationships (work, partner, kids, parents, friends, community, etc),

group conformity, likeability, communication, and cooperation. (McCraty & Childre,

2010)

Research states that emotional resilience is a skill that is taught and

learned but for it to improve it should be practiced in everyday life. Emotional

resilience is considered an important quality for professionals since this could

indicate individuals who can positively adapt to stressful situations, manage

emotional demands, enhance professional growth, improve well-being, and foster

effective coping strategies (Stephens, 2013).

Resilience is not about the ability to endure; it is about the ability to

replenish or restore your energy. Resilience in the workplace is mostly dependent

on putting out your best effort each day and then taking a break to recover so you

can keep going. Not only is physical resilience a component of resilience, but

mental, emotional, and spiritual resilience as well. Since facing difficulties is a

necessary element of being human, recovery is necessary for every aspect of the

human experience. Resilience is an important skill, and building resilience at work

is an excellent way to start enhancing your capacity to overcome obstacles. The

supply of energy you can use at any given time is related to everything we do in

business. Developing a self-care routine based on recovery is one of the best

strategies to increase resilience. Recharging your body is essential to developing

resilience, whether this means performing a 20-minute meditation or reducing your

activities to take an afternoon rest. (Markel, 2023). Building resilience is a very

personal procedure that requires action, patience, and self-reflection. Managers

and team leaders, however, may help in a person's development by giving them

the appropriate resources and instruction. Senior-level support for resilience

fosters organizational resilience as well, establishing resilience as a workplace

culture. This reassures employees and motivates them to set aside time for

personal growth. (Burton-Hughes, L 2023).

A research study conducted in 2012 by Grant and Kinman found that

resilient employees are those who have developed reflective skills, flexible coping

styles, effective work-life balance, social confidence, and a strong social support

network. Moreover, workers who demonstrate “accurate empathy” build

compassionate relationships with others without becoming emotionally overloaded

and distressed (Grant & Kinman, 2014). People who are resilient and able to

navigate the highs and lows of life can cope well with stress and can work to the

best of their abilities despite the pressure. How can surgeons and other healthcare

professionals become more resilient emotionally, not only to facilitate work but to

thrive at it? Emotional resilience not only protects our mental and physical well-

being but also helps to prevent cognitive errors and enables us to care for our

patients safely and effectively (Murden et al., 2018).

In the busy and sometimes stressful world of business, being able to handle

tough situations and bounce back is super important. This is what we call emotional

resilience. It's not just about getting through tough times at work, but also about

learning from them and coming out stronger.

Emotional resilience isn't something you're born with – it's something you

can develop over time. One way to do this is through a method called Cognitive

Behavioral Hypnotherapy (CBH), which I specialize in. CBH combines strategies

for changing how you think and act with the relaxing power of hypnotherapy.

So, what does being emotionally resilient look like at work? It could mean

staying calm when deadlines are looming, being able to adapt when plans change
suddenly, or staying committed to growing, even when things don't go as planned.

Through CBH, people can learn to recognize these qualities in themselves and

work on building them up.

Why Resilience Is Critical in the Modern Contact Center

In today's world of computers and the internet, if your computer system

stops working, it can really hurt your business. It affects your customers, your

workers, your reputation, and your money. Big and medium-sized companies say

that just one hour of computer trouble can cost them more than $300,000 because

they lose business, work slows down, and they must spend money to fix things.

The pandemic showed businesses how important it is to plan ahead for

emergencies. But surprisingly, in a study done in 2020, more than half of the

companies around the world had no plans for dealing with a big emergency like

COVID-19. Some companies didn't even have basic plans for keeping their

business going during tough times.

It's super important to make sure your contact center is ready to keep

working, manage your employees, and fix any tech problems that come up. But

because of the pandemic, many companies are now focusing on something called

"business resilience" instead of just "business continuity."

But actually, you need both. So, what's the difference between business

continuity and resilience? Business continuity means being able to keep providing

your products and services even when things go wrong. Resilience, though, is

more about not just surviving a problem, but also getting stronger because of it.

It's like bouncing back from tough times and becoming even better than before.
 Let's look at resilience during the pandemic, like when companies had to

switch to working from home. Contact centers had to deal with lots of challenges,

but they didn't just keep going—they got better. They started using new tools,

changed how they manage things, and even made their work setups more flexible.

This means they're not just surviving, they're growing and getting stronger, so they

can handle future problems better.

Broad-and-Build Theory

The broaden-and-build theory suggests that experiencing positive

emotions helps people expand their immediate, momentary thoughts to help

strengthen their psychological, social, cognitive, and physical resources. In other

words, positive emotions help increase awareness, boost coping ability, and

improve resilience. (Arlin C. 2023)

The broaden-and-build theory also suggests that positive emotions

improve the ability to bounce back in the face of obstacles giving you tools to

manage difficult situations. You're able to improve psychological resilience by

giving you more tools to manage negative emotions. When you feel more positive,

you are also able to see yourself as "wise." This enables you to operate from your

"wise" mind rather than reacting out of negative emotion. (Arlin C. 2023)

Synthesis of the Reviewed Literature and Studies

This review presents a range of literature, articles, theory, principles, and

various studies. The aforementioned evidence showed the correlation between

positive emotions and enhanced emotional awareness, coping abilities, and

resilience in the BPO industry.

According to the study, the Philippines is a prime location for outsourcing

because of its workforce with strong English skills, friendly culture, and an effective

education system.

Business Process Outsourcing (BPO) for account services is crucial in the

healthcare sector, ensuring operational efficiency and patient care standards.

These services facilitate smooth interactions between patients and providers,

boosting patient satisfaction. BPO account services also aid in compliance with

complex healthcare regulations, reducing the risk of penalties. Timely and accurate

processing of accounts is essential, as it helps healthcare providers receive

payments promptly and maintain financial stability. Outsourcing non-core functions

like billing allows providers to focus on delivering quality care, enhancing overall

efficiency and effectiveness in healthcare operations.

From the following article, the perception of an individual in the workplace

is subjective and varies depending on their location. Employers must comprehend

the differences to foster a positive work environment, enhance job satisfaction, and

increase employee engagement.

Personal resilience refers to effectively managing challenging situations in

life, bouncing back from adversity, controlling thoughts and emotions, and viewing

difficulties as opportunities for growth.

The build-and-broadening theory proposes that positive emotions can

enhance mental, social, cognitive, and physical capabilities by expanding thoughts

and awareness. According to this theory, positive emotions can enhance coping
and resilience by helping individuals cope with challenges and negative feelings

while operating in a smarter mindset.

 CHAPTER III

RESEARCH METHODOLOGY

This chapter covers the researcher's entire strategy, including research

methods and techniques, selecting a research object, determining sample size,

validating the instrument, and implementing data analysis systems. Using

statistical tools is necessary to process the data in the study.

Method of Research

A descriptive research approach will be used in this study. This quantitative

research design is applied when the goal is to identify characteristics, frequencies,

trends, and categories. In the descriptive research method, necessary information

is collected using a survey questionnaire, which is then analyzed and interpreted.

Population, Sample size and Sampling Technique

The study group is based at Health Care Company in Ortigas. Cochran's

calculation provides the respondents' sample size. The formula is below;

N is the population size (200)

n is the new
 Table 1

132 Respondents

Description of the Respondents

The respondents of our study are the selected BPO Employees of the CSR

division of Healthcare BPO in Ortigas. The company is a top offshore provider of

healthcare outsourcing services. They focus on medical billing, coding, accounts

receivable management, and other healthcare-related services. The expected

profile of respondents from this organization varied in terms of age, gender, marital

status, level of education, job/positions, and length of employment in the

organization. This qualification ensures that the participants understand the nature

of the questionnaire, which facilitates the completion of the survey items.

Research Instrument

The questionnaire is intended to be used as the main collection tool for this

study. Two primary components of the questionnaire are the respondent's profile

and the survey profile. Demographic data encompasses respondents' profiles such

as age, sex, civil status, highest educational level, jobs/position, and duration of

stay in the organization. The survey will explore the employees' perceived

emotional resilience in a BPO workplace in terms of the following aspects; Impact

on Cognitive Flexibility, Building Social connections, Resilience and Adversity,

Long-Term Well-being, and Employee Engagement.

The questions were prepared in a Likert scale format. The choices

represent the degree of effectiveness each respondent perceive of the given

question. To interpret the total responses of all respondents to each question, a

weighted average was calculated by using the scale below.

Table 2

Weighted Mean Scale for Interpretation

Mean Mean Range Interpretation

4.21 - 5.00 5 Strongly Agree

3.41 - 4.20 4 Agree

2.61 - 3.40 3 Somewhat Agree

1.81 - 2.60 2 Disagree

1.00 - 1.80 1 Strongly Disagree

 To verify the questionnaire's validity and reliability for the study, the

researcher tested it on 43 non-participating respondents last May 22, 2024. They

were then asked for feedback to enhance the instrument's accuracy.

A Likert survey is the response type chosen, enabling participants to

respond to the survey with ease. In addition, with this research tool, the researcher

was able to effectively apply a quantitative approach using statistics to interpret

the data.

Data Gathering Procedure

The researcher has confirmed that the Healthcare BPO in Ortigas has 200

employees in the CSR division at their Ortigas City location. The study will use

both online and traditional paper surveys to gather information from respondents.

Online surveys will be sent to 100 participants from April 1, 2024, to April 30, 2024.

Traditional paper surveys will be distributed to 50 participants, from May 1, 2024,

to May 31, 2024. Once all completed surveys are collected, the responses will be

compiled and tabulated.

Statistical Treatment of Data

I. Frequency and percentage are the statistical methods employed. The

profile of the respondents is determined by examining their frequency and

percentage distribution. The formula is stated below;

 Table 3

100 is constant.

II. The weighted mean average in quantitative research is a method used to

calculate the average value of a set of data, where each data point is assigned, a

weight based on its importance or relevance.