Workplace technologies help hospital management control health
professionals in five ways:
1. Surveillance
Your employer has to know what you’re doing in order to control you.
Because managers can’t watch everything you do, hospitals adopt surveillance technologies.
Surveillance is one of the primary functions of electronic medical records (EMRs), the computerized version of patients’ paper records. Computers keep track not only of data entered, but also of exactly when each entry is made. This allows management to monitor work processes closely, analyze them, and force RNs to change them and work faster.
2. Division
Employees are easily controlled when they see themselves as individuals distinct from other employees. They’re much stronger and harder to control when they feel solidarity with their coworkers and act collectively. Hospital management knows this and uses technologies to divide RNs.
3. Routinization
Hospital management wants to control health professionals so it can routinize work processes
• By simplifying them and fragmenting them into tasks, and
• By standardizing the tasks.
Management would like you to think that “standardizing” work processes means raising quality standards, but it doesn’t. “Standardizing” really means making work processes uniform, or forcing everyone to do them in exactly the same way. Making work processes simpler and more uniform allows management to speed up and intensify work. This is how routinization
increases technical efficiency.
4. Deskilling
Skill and Judgment
Routinization leads to the deskilling of work processes and health professionals. Skill is the ability, drawn from education and experience, to do something expertly. It can also be defined as the effective exercise of professional judgment in non-routine situations.
How Skill is Related to control
Highly skilled employees are harder to control than less-skilled employees. The most highly skilled employees are considered professionals. Professionals have significant responsibility and have conventionally had the freedom to design their own work processes in the ways that suit them best. They don’t need someone else to manage their time. A health professional’s judgment in deciding how to get work done should be respected by hospital management.
Automation
When work processes are sufficiently routinized, they can be automated. You can probably think of medical technologies that help health professionals do things they couldn’t otherwise do. Such a technology benefits professionals and patients because it’s skill-enhancing. But technologies that automate work are usually deskilling or skill-degrading because they’re designed to serve management by tightening its control of employees.
Much health information technology is skill-degrading. As the work of health professionals becomes increasingly automated, they lose the ability to do their jobs without HIT. To make matters worse, they’re expected to keep pace with machines. They serve the machines rather than doing the more gratifying work of patient care, and ultimately they’re compensated less well.
5. Displacement
Employers would prefer not to have to control employees. It’s too much trouble. Machines are technically efficient, and they don’t join labor unions. From an employer’s point of view, the ideal workplace would be one where machines did all the work. Of course, in all industries, there are still many jobs performed by people rather than machines, but employers automate whatever processes they can. For health professionals, as for other employees, losing skills is a stage on the way to being replaced by machines.
