Media, Technology and Society

Rescuing efficiency...

In much of the writing of the labour process school, efficiency is generally described as the preserve of Taylorist management practices. To be efficient according to convential manifestations of taylorism entails the measurement of Key Performance Indicators (KPIs) that are designated by management. Efficient work is that which can be rationalized, and subdivided into its component parts so that it can be performed as fast as possible, by people with varying degrees of skill. High skill jobs are reduced as much as possible and those individuals perform only those tasks said to be high skill, while cheaper labour is used to perform more rudimentary tasks.

But for the labour process school, which takes neo-Taylorism to task, how do they view efficiency if not in Taylorist terms? Where does efficiency factor into any proposed quality centered, humanistic workplace?

I believe they take a fuller view of efficiency and take the view that efficiency means that which can be produced as fast as possible, and as cheaply, WHILE maintaining fair wages and working conditions and without compromising the job satisfaction levels of the workers. Accordingly, efficiency is not a narrow criteria, but a broad one, with many objectives which must be fulfilled, not just that of short term measurable productity and profit levels.

I raise this issue of productivity because if Taylorist strategies are countered without providing an alternative vision of efficiency, then it seems unlikely that managers would ever consider them. What manager would ever prioritize job satisfaction and product quality at the utter expense of productivity and measurable performance? To reconsider efficiency as that measure of both productivity (products produced per unit of time), the quality of the product and the good conditions of production is in my view a much better conception of efficiency and workplace economics. It also 'rescues' efficiency from Taylorism, so something can be 'efficient' according to this criteria while "inefficient" according to Taylorism.

Otherwise, labour process theorists come across as too radical and impractical (to my mind). Not only that, but examples can be found of where full view efficiency has been advocated and in fact achieved (i.e. Dofasco Steel Corporation comes to mind).

Contradictions of Control: New Managerial Practices and Canadian Healthcare

According to workplace technologist Robert Howard, managers employ new workplace technologies not to increase productivity and phase out repetitive and menial aspects of workers jobs, but rather to replace or deskill the workers themselves. For Howard, the contradiction here is that reducing or eliminating any dependency on workers’ skills not only reduces their job satisfaction, it also compromises the supposed goals of increased efficiency, productivity and product/service quality. Healthcare researcher Pat Armstrong describes a similar contradiction in her study of government health care reformers and managers’ attempts to transform point of care wards into efficient, cost effective facilities. But what notion of efficiency is being upheld here – efficient in terms of control and cost effectiveness, or efficient in terms of quality care?

Armstrong’s critique of the supposed benefits of rationalizing patient care is supported by Howard’s analysis in key areas. In both circumstances, practices or technological “improvements” are said to assist workers in doing their job, while in actuality undermining their ability to do so. In Howard’s analysis, the agent of reform is not new standards and practices, although these are key, but rather the use of technology as an instrument for labour savings. Howard quotes a memo from AT&T vice president to Bell Systems Managers in which a new telecommunications technology is described as ultimately “[getting] people off the payroll” (Howard, 47).

In Armstrong’s research however, workers are not replaced by any technology, but like other examples in Howard’s analysis, their labour is fragmented where possible and substituted with less-skilled and cheaper labour.(i) This might seem to be a less detrimental alternative to replacing nurses with technology, but according to the nurses involved, the managerial reasons behind it, and the consequent threat to quality service is similar:

“[the practical nurse] didn’t know [of the patients dehydration, previous dosages and bowel conditions and] just went in and removed…a patient’s IV” (Armstrong, 100).

The nurses describe the practical nurses as “just following orders” unable to draw upon the nurses’ extensive training and experience to act as safeguards for patient care - in some cases
despite what doctors orders, or procedure require:

“if a registered nurse thinks you need an IV, you get an IV…if she thinks you need more narcotics she’s going to be on the phone for that” (Armstrong, 100).

In both analyses then, quality suffers as a result of these managerial strategies, regardless of whether workers are replaced with another department of less skilled workers or a new technological system.

In his study, Howard draws upon the illuminating experience of machinist Dave Boggs who was deskilled despite his ability to outperform the programming department and his ambition to use the new technological system to gain more “complex skills” (Howard, 41). While Howard description of technology as a tool for reducing labour overhead while also compromising quality is reflected in Armstrong’s study(ii), his suggestion that workers have the complexity of their work reduced doesn’t seem as immediately apparent with the nurses. For example, the nurses are required to self manage and coordinate themselves in the absence of the (downsized) head nurse position.

However, a closer examination reveals that many of the features of managerial control and ‘contradictions’ outlined in Howard’s work are still seen in Armstrong’s example. Although an increase in responsibilities for individual nurses amounts to more complexity and difficulty, it certainly doesn’t ensure increased job pride or fulfillment.(iii) Quite the opposite, the immense pressure upon nurses to both self manage, and coordinate themselves 24 hours a day while delivering patient care according to a rigid quota of tasks is still a threat to autonomy, job satisfaction and morale (Armstrong, 120).(iv) That said, the nurses in Armstrong’s example didn’t see their work decrease in complexity as did the workers described in Howard’s analysis, but rather they were concerned that “critical skills – registered nursing skills [that are] essential to patient care [were] disappearing in the process of task definition and task transfer” (Armstrong, 103). Some aspects of their job became more complex (coordination, communication), while others became more routine and task oriented, when nurses would rather that they weren’t (bathing, etc).(v)

The most consistent and damning conclusion that can be drawn from these critiques of Taylorist management practices and technology in the workplace is that both threaten the autonomy of workers and their ability to perform the job according to their own standards of quality.(vi) The reduction of work to tasks threatens all work that is not countable or quantifiable, and thus pressures workers to either ignore or rush through aspects of their job that they are not explicitly required to undertake(vii) Although management and health care reformers may say they have patient care in mind, they have ultimately established a system of measurement and standardized benchmarks which rewards nursing practices that are incompatible with quality patient care.
Bibliography

Armstrong, Pat et al. (2000) Heal Thyself: Managing Health Care Reform Ontario, Garmond Press., Canada.

Howard, Robert (1985) “Contradictions of Control” in Brave New Workplace, New York: Penguin Books., US.

Endnotes

i. For example this entails separating “practical” nurse work from registered nurse (RN) work.
ii. Although cheaper, less skilled labour is used in lieu of technology.
iii. For example, there is the example in Armstrong’s case of nurses who were immensely pressured between providing the quality care they felt professionally responsible to provide, and the manager’s unwillingness to pay them for the overtime required to provide this care (Armstrong, 119-120).
iv. As described previously in the context of quality care loss, the efforts of managers to designate some nursing duties as “practical” or only requiring a set amount of time to complete is a threat to nurses autonomy and ability to take pride in their work.
v. Other important but stymied duties include communicating with patients and being able to their own exercise experience and judgment.
vi. For example, most nurses in Armstrong’s study view patient care as more than a set of distinct tasks to be performed and then forgotten about.
vii. For example, Howards example of how industrial machinist Dave Boggs learned how to program the new machine cutting technologies on his own time, but was not rewarded for his enthusiasm to teach himself evidences a disincentive for this positive behaviour. Similarly, Armstrong provides examples of how nurses rushed through their interactions with patients in order to complete tasks to the detriment of establishing valuable patient relationships.