This research proposal investigates the impact of dysfunctional turnover on the financial health of the Physician Revenue Group (PRG) in Pakistan, focusing on how toxic work culture and limited career growth contribute to employee exits. The study aims to provide insights into retaining high-performing employees by addressing these factors to improve organizational profitability. The methodology includes a quantitative approach, utilizing surveys to gather data from PRG employees, and aims to uncover the relationship between turnover and financial outcomes.

1. Semester Project
Research Proposal
The impact of dysfunctional turnover on the financial health of an outsourced organization in
Pakistan.
Fahad Farooq 2212004
Sania Younas 9212045
Muhammad Intisar 9212053
Section: BBA-5B-Afternoon
Business Research Method
Submitted to: Dr. Sadia Saeed
At
National University of Modern Languages (NUML)
Islamabad, Pakistan
December 19th
, 2023

2. Table of Contents
1. CHAPTER 1........................................................................................................................................3
1.1. Introduction:................................................................................................................................3
1.2. Rationale of the study:................................................................................................................3
1.3. Theoretical Underpinning:.........................................................................................................4
1.4. Problem Statement: ....................................................................................................................4
1.5. Research Objectives:...................................................................................................................5
1.6. Research Questions:....................................................................................................................5
1.7. Significance of study:..................................................................................................................5
1.8. Practical Significance: ................................................................................................................5
1.9. Proposed Conceptual Model of the Study: ...............................................................................6
2. CHAPTER 2........................................................................................................................................6
2.1. Literature Review:......................................................................................................................6
2.2. Research Gap: .............................................................................................................................7
2.3. Theoretical Framework:.............................................................................................................7
2.4. Conceptual Framework:.............................................................................................................9
2.5. Hypothesis: ..................................................................................................................................9
3. CHAPTER 3......................................................................................................................................10
3.1. Measurement Methodology: ....................................................................................................10
3.2. Population:.................................................................................................................................10
3.3. Sample:.......................................................................................................................................10
3.4. Sampling Technique: ................................................................................................................10
3.5. Data collection:..........................................................................................................................10
3.6. Data Analysis:............................................................................................................................11
3.7. Variables and measurement scale Description:......................................................................11
3.8. Delimitations of the study: .......................................................................................................12
3.9. Research timeline:.....................................................................................................................13
References:.................................................................................................................................................14

3. Topic: The impact of dysfunctional turnover on the financial health of outsourced
organization in Pakistan.
1. CHAPTER 1
1.1. Introduction:
BPO (Business Process Outsourcing) is a term that refers to business model in which
companies outsource some of their operations to third party (external) company. BPO industry
performs the less important operations of large firms (Google) at low cost. It allows outsourcing
firms to reduce their operational cost and increase profit margin. BPO industry is important for
developing countries like Pakistan. The projected revenue generation by BPO industry of Pakistan
in 2023 is almost US$1.00bn. The expected growth rate (CAGR 2023-2028) is 11.65% which will
increase the volume of market up to US$1.78bn. Like every industry turnover is one of the vital
issues in BPO industry. Most of the companies couldn’t last long enough just because of the high
turnover rate. There are two types of turnover (1) Voluntary Turnover and (2) Involuntary
Turnover. Voluntary turnover has further two types (a) Dysfunctional turnover and (b) Functional
turnover. Dysfunctional turnover is when high performing employees leaves the company. The
company’s financial health gets more effected when high performers leave it. Like every other
company dysfunctional turnover is the one of most concerning issue for rapidly growing Medical
Billing company (PRG) Rwp branch. That is why this study is mainly focusing on dysfunctional
turnover and its impact on financial health of the organization. This study will also be addressing
some factors (Toxic work Culture & Less Career Growth) that leads towards dysfunctional
turnover in organization. It will help the organization to retain their high performers by working
on these factors.
This study will find out effect of dysfunctional turnover and its contributing factors on the financial
health of PRG situated in Rawalpindi.
1.2. Rationale of the study:
Dysfunctional turnover has far-reaching consequences for the organization’s financial
health. Understanding the factors like toxic work culture and less career growth is also crucial for
dysfunctional turnover, which ultimately leads towards some sort of impact on financial health of
the organization. does it effects in negative manner?

4. 1.3. Theoretical Underpinning:
The meaning of dysfunctional turnover has to be understood in negative sense that it is loss
for the organization. As the high performers of the organization leaves job voluntarily. In this
regard, we can consider that the dysfunctional turnover might be bad for the organization and
employees who are part of dysfunctional turnover are causing trouble for financial health.
Dysfunctional turnover can be caused by various factors but here we are taking only two that can
contribute to it; 1(Less Career growth) and 2(Toxic Work Culture). In a competitive industry of
BPO the salaries of high performing employees are not much of a difference, so what can cause
them to leave the organization? It might be Less Career growth in the current organization or Toxic
work culture, these high performers do not like. Well, it could be both. If there is too much toxic
work culture and less career growth in the organization, high performers might leave the
organization. Which can cause financial health issues in the organization.
1.4. Problem Statement:
PRG (Physician Revenue Group) is an offshore outsourced medical billing company. Head
office located in Lahore. It is responsible for providing the medical billing solutions to their clients.
PRG has 5 offices in Lahore, 1 in Rawalpindi and 1 in Gujranwala. Multiple offices are currently
serving in 48 states and 750+ providers within United States. PRG has 1500+ employees combined
in all branches. PRG Rawalpindi branch is facing dysfunctional turnover and it is causing more
financial uncertainty. The turnover is affecting the overall performance and profitability of the
organization. Top Management is highly concerned to the issue and want to solve it. Director
Strategic Management believes less career growth and toxic work culture contributes more in
dysfunctional turnover. Which ultimately causes the great uncertainty in financial health of the
organization.
Prior observations project that toxic work culture and less career growth contributes more in
dysfunctional turnover in PRG. Turnover may not be controlled 100% but it can be reduced by
knowing and improving some factors to retain the high performing employees. Retaining high
performing employees might improve the financial health of the organization. The overall
performance and profitability of company can be improved.

5. 1.5. Research Objectives:
The purpose of this study is:
(1) to know how less career development opportunities and toxic work culture is impacting
dysfunctional turnover in organization?
(2) to measure impact of dysfunctional turnover on financial health.
1.6. Research Questions:
So, the project focuses on the following research Questions:
1. What are the impacts of the factors: less career growth and toxic work culture on the
organization’s dysfunctional turnover?
2. What is the effect of dysfunctional turnover of organization on its financial health? Is it
negative?
1.7. Significance of study:
This research may help managers of the organization to retain the employees, who are
high performer and well paid. It may provide them a way to look at dysfunctional turnover
regarding what employees expect from organization in return for their high performance other than
the high salary. How much important a career growth can be for an employee? What could be
effects of Toxic work culture on employees? What could be the consequences of not improving
both of these factors? This research may be applicable on similar kind of situation in many
organizations.
1.8. Practical Significance:
For PRG this research may be provide an insight of what actually is causing the dysfunctional
turnover, and how it could be improved by enhancing the good work culture and high career growth
chances. This research may provide a ground base data and analysis for the current situation. Policy
makers may consider this research for making new polices for employee retention and better work

6. culture for all human resources. This research may lead them towards better financial health
outcomes by retaining high performing employees in the organization.
1.9. Proposed Conceptual Model of the Study:
In this research we have one independent variable (Dysfunctional turnover) and what
change it is causing in depending variable (Financial health), how two moderator variables (Toxic
work culture and Less Career growth) affect the relationship between independent and dependent
variable?
2. CHAPTER 2
2.1. Literature Review:
Employee turnover can be good and bad for the organization (Dalton et al, 1981). It has
been estimated in various studies that losing an efficient employee cost up to five times his salary
(Giri, D.M.S. and Mrs. Y. Gayatri. 2018). Employee turnover occurs if either the organization asks
the employee to leave the organization or the employee itself leaves the organization. It can be
considered as involuntary and voluntary employee turnover respectively (Wallace, J., and Gaylor,
K. P. 2012). Further voluntary employee turnover is categorized into dysfunctional and functional
employee turnover (Dalton et al., 1981). On the basis of the type of separation from the
organization, voluntary employee turnover is categorized as Dysfunctional or functional employee
turnover (Wallace, J., and Gaylor, K. P. 2012). Dysfunctional employee turnover occurs when
employee wants to leave the organization but the organization wants to retain the employee and
functional employee turnover occurs when an employee leaves the organization but the
organization is not concerned about the employee exit (Dalton et al, 1981).
A toxic workplace is one where bad behavior is rampant and goes unchecked because employees
and leaders are afraid to speak up (Christine Porath and Christine Pearson, 2009). Toxicity in the
workplace refers to dysfunctional interpersonal processes that harm an organization and its people
(Mitch Kusy and Elizabeth Holloway, 2009). A toxic work environment is one in which negativity
spreads, and the workplace becomes a breeding ground for chronic complaining, gossiping, and
overall dissatisfaction (Gary Chapman and Paul White, 2014).

7. Limited opportunities for advancement within an organization (Hall, D. T, 1976). Stagnant career
paths and lack of development opportunities (Allen, D. G., & Meyer, J. P, 1996). Perceptual lack
of career advancement opportunities and limited opportunities to learn new skills (Bretz, R. D., &
Tompson, D. R, 1999). Feelings of undervaluation, boredom, and loss of motivation due to lack
of career growth opportunities (Brockner, J., Greenberg, J., & Wiesenfeld, B, 2004). Perceived
lack of career development opportunities as a major predictor of employee turnover (Saks, A. M.,
Robertson, P. J., & Lomax, W. A, 2006).
2.2. Research Gap:
As per literature review, we have doubts that toxic work culture and less career growth
might be the factors affecting the dysfunctional turnover. Might be, Managers of PRG have not
looked at the situation from this angle and have flaws in career growth program and better culture
assurance policy. While researching we might encounter these two factors causing more
dysfunctional turnover which leads towards negative impact on financial health of organization.
2.3. Theoretical Framework:
Key concepts:
Dysfunctional turnover: It is the type of voluntary turnover. Dysfunctional turnover occurs when
high performers of the organization leave the job. This type of turnover effects organization the
most.
Less Career Growth: It is the situation when employees do not see potential growth in their
career. They have nothing more to learn and the job gets boring. No new role and no more
responsibilities in the same organization makes them feel like useless. They do not feel motivated
while performing the same task again and again over the years.
Toxic work culture: The work culture in which employees’ attitude and behavior is not good.
Employees do not feel comfortable with in the organization and its effects the overall productivity.
They feel like they are not treated well in any of the ways.
Financial health: The revenue generated by the firm. How much the firms earn with in the given
time period.

8. Background:
Dysfunctional Turnover:
Gary S. Becker, (1964) says “Lost knowledge and skills require time and resources to replace,
impacting output and efficiency”. Oliver E. Williamson, (1985) says “New employees require
training and time to become productive, impacting output and revenue generation”. Denise M.
Rousseau, (1995) says “Disgruntled employees may provide poor customer service, leading to lost
business”.
In this research we are considering Oliver E. Williamson’s theory as it is most relevant to study’s
aim. Williamson’s theory justifies it relevance to dysfunctional turnover impacting revenue
generation.
Toxic work culture:
George Homans, (1958) says “Feeling undervalued and disrespected in a toxic environment
decreases employee commitment, increasing the likelihood of seeking opportunities elsewhere”.
Patrick M. Wright and Michael A. Hitt, (1997) says “High-performing employees are more likely
to leave toxic environments, taking their valuable skills and knowledge with them”. Chris Argyris
and Donald A. Schön (1978) says “A toxic culture may drive out diverse perspectives and creative
individuals, hindering innovation and adaptability”.
In current study we are considering Patrick M. Wright’s and Michael A. Hitt’s theory. Theory
clearly mentions high performer turnover get influenced by toxic environment of the organization.
Less Career Growth:
Gary S. Becker (1964) says “High-performing and ambitious individuals are more likely to seek
opportunities elsewhere if they see no path for advancement within the organization”. Denise M.
Rousseau (1995) says “Dissatisfied employees are more likely to seek opportunities elsewhere that
offer better prospects for advancement and growth”. George Homans (1958) says “Feeling
undervalued and lacking future prospects within the organization can motivate employees to seek
opportunities elsewhere”.

9. In the following research we are considering Denise M. Rousseau’s theory because it suits the aim
of this study. We want to see if less career growth influences the relationship between
Dysfunctional turnover and financial health of this specific organization.
2.4. Conceptual Framework:
2.5. Hypothesis:
H1= Dysfunctional turnover negatively affect the financial health.
H2= Toxic work culture moderates the relationship of dysfunctional turnover and financial
health such that: higher toxic work culture strengthens the relationship between dysfunctional
turnover and financial health.
H3 = Less career growth moderates the relationship between dysfunctional turnover and
financial health such that: higher the less career growth strengthens the relationship between
dysfunctional turnover and financial health.
Dysfunc�onal
turnover
Financial Health
Less career
Growth
Toxic work
culture

10. 3. CHAPTER 3
3.1. Measurement Methodology:
This research can be considered as explanatory research as we are conducting it for the
specific organization. In this research we are trying to overcome a certain situation of an
organization. This research will be focusing on variable’s effect on each other and predicting the
impact one variable on other. We are using Quantitative data for this research purpose.
3.2. Population:
Population of this research is employees of PRG Rwp branch. We will conduct this research
on employees and try to get desired data from the population. Total population size will be 800.
N = 800
3.3. Sample:
The sample size of this research is 300.
n = 300
3.4. Sampling Technique:
Probability sampling Technique will be used in this research. We are going to use stratified
random sampling, a type of probability sampling so that every employee in population will have
equal chance of being selected. There will be two strata, 1st
for current employees and 2nd
for
former employees.
3.5. Data collection:
Given research is going to use blend of primary data collection method for Moderating
variables (Toxic work culture & Less career growth) and secondary data collection method,
for independent variable (Dysfunctional turnover) and dependent variable (Financial health).
We are going to use questionnaire for the collection of primary data. In the current situation a
precise and well-formed questionnaire will be used. A close-ended questionnaire with
multiple choices is best for the research. As it takes less time and cost. It would be distributed
among sample. For secondary data we are going to use organizational data from HR
department and Finance Department.

11. 3.6. Data Analysis:
We will use multiple moderated regression data analysis technique for this study. As we
have 1 independent variable, 1 dependent variable and 2 moderators. The significant coefficient
will show the either to reject or accept the hypothesis.
3.7. Variables and measurement scale Description:
For independent variable (Dysfunctional turnover) and dependent variable (Financial
health) organizational data will be used. In this research will use ordinal scale for measuring our
Moderating variables. In ordinal scale we are going to use a specific technique known as 5-point
Likert scale. It will provide better answer to the opinion-based statement of question.
The Questionnaire will be distributed online to former employees and by hand to current
employees of organization.
Operationalization of Moderating Variables:
Less Career growth:
Engagement work engagement of employee in current designation.
Career Satisfaction employee’s satisfaction with his current role.
Aspirations employee’s hopes or goals he wants to achieve.
Job Security employee’s feeling about job security.
Toxic Work culture:
Prevalence existence of toxic work culture.
Experience Has employee encountered toxicity.
Impact toxicity impact on employee.
Consequences employee wants to leave the organization

12. Questionnaire example:
Please indicate your level of agreement with the following statements using the following scale:
1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly Agree
i. There is a lot of gossip and negativity in my workplace. ( )
ii. Communication within my company is open and transparent. ( )
iii. I feel comfortable expressing my opinions and concerns at work. ( )
iv. I witness bullying or harassment in my workplace. ( )
v. My workload is manageable and I have a good work-life balance. ( )
vi. I trust my manager to act fairly and ethically. ( )
vii. I feel unchallenged and bored due to the lack of career growth opportunities at your
company. ()
viii. Lack of career growth opportunities at your current job affects your overall motivation to
work. ()
ix. How much do you agree that limited career growth impacts your engagement and
productivity at work. ()
x. extent do you agree that limited career growth has negatively impacted your overall career
aspirations. ()
xi. How much has limited career growth impacted your desire to pursue new learning and
development opportunities. ()
xii. does the lack of career growth make you feel anxious or uncertain about your future career
prospects. ()
xiii. does the lack of career growth make you feel insecure in your current job position. ()
3.8. Delimitations of the study:
This study will use quantitative data method approach. The study will use questionnaire
and organizational data as a main data collection method and will use Multiple Moderating
Regression technique to analyze the data. The research will exclude other methods, designs and
tools that are not suitable for this research.

13. 3.9. Research timeline:
Phase Start Date End Date Deliverables
Literature Review Jan 1, 2024 Feb 28, 2024 Annotated bibliography, Theoretical framework document
Methodology Development Mar 1, 2024 Mar 31, 2024 Research design document, Data collection protocols
Data Collection Apr 1, 2024 Jun 30, 2024 Survey data, questionnaire data
Data Analysis Jul 1, 2024 Aug 31, 2024 Analyzed datasets, Preliminary results report
Results Interpretation Sep 1, 2024 Oct 31, 2024 Draft research report, Discussion of findings
Dissemination Nov 1, 2024 Dec 31, 2024 Conference presentation, Research paper submission

14. References:
[1]. Rizwan Raheem Ahmed1, Safdar Hussain Javed2, BUSINESS PROCESS OUTSOURCING:
A CASE STUDY ON PAKISTAN’S OUTBOUND CALL CENTERS.
[2]. Gupta, V. (2013). An analysis of attrition: retention strategy for IT/BPO industry. International
Journal of Advance Research in Computer Science and Management Studies, 1(7).
[3]. Dan R. Dalton, William D. Todor and David M. Krackhardt, Turnover Overstated: The
Functional Taxonomy, , Vol. 7, No. 1 (Jan., 1982).
[4]. Preeti Dwivedi, Dr. Vijit Chaturvedi and Dr. J.K. Vashis, Improving Dysfunctional Employee
Turnover, January 2019
[5]. Wallace, J., & Gaylor, K. P. (2012). A study of the dysfunctional and functional aspects of
voluntary employee turnover.
[6]. Christine Pearson and Christine Porath, The Cost of Bad Behavior, How Incivility Is
Damaging Your Business and What to Do About It, July 9, 2009.
[7]. Dr. Mitchell Kusy and Dr. Elizabeth Holloway, Toxic workplace! managing toxic
personalities and their systems of power, 2009
[8]. Gary Chapman, Paul White, Five Languages of Appreciation in the Workplace Paperback –
January 1, 2011,
[9]. Douglas T. Hall, Careers in Organizations, January 1, 1976
[10]. Allen, N. and Meyer, J. (1996) Affective, Continuance and Normative Commitment to the
Organization: An Examination of Construct Validity. Journal of Vocational Behavior, 49, 252-276.
[11]. Jeffrey H. Greenhaus and Gary N. Powell, When Work and Family Are Allies: A Theory of
Work-Family Enrichment, Vol. 31, No. 1 (Jan., 1999).
[12]. Joel Brockner, Batia M. Wiesenfeld, How, When and Why Does Outcome Favorability
Interact with Procedural Fairness, 2004.