The Creepy, Intrusive Ways You're Being Spied on at Work
Continued from previous page
Meanwhile, on another floor, hospital emergency departments worry about admitting too many patients or admitting patients who aren’t sick enough. Because only so many beds are available, it’s better for them to be occupied by the sickest patients so that care can go to the neediest and hospitals can generate the most revenue. It’s a tough balance: if hospitals have empty beds they make less money, but if all their beds are full, they may have to divert needy patients to other hospitals (or have them waiting on stretchers in hallways), which is not good. So physicians in emergency departments are subjected to routine performance monitoring and pressure to admit fewer patients. One hospital administrator explained:
We monitor all the activity of all our docs. We give them reports every month on their acuity, their time to disposition, the number of tests per doctor per diagnosis, their efficiency in terms of what we pay through the department, and that’s all recorded. And your abilities, your bonuses, all that information is used as a 360[-degree] view of you as an emergency physician in the department. But if you’re admitting twenty-two percent or twenty-three percent, twenty-four percent, then . . . you should be more tight with your admissions because you’re actually losing [the hospital] money. . . . the chairman would say, “You know, the last couple months you’ve been admitting a lot more percentiles. Just try to bring it down a little bit.”
Perhaps because of their high professional status, physicians are probably more often given incentives to admit fewer patients rather than punished for admitting too many. Still, performance monitoring can serve as public shaming, because monthly reports typically include names alongside performance scores.
Another hospital surveillance system relies on RFID tags worn by the staff. Under the Tayloristic name “workflow management,” administrators use these tags to track the movements and locations of staff in real time. The ostensible goal is to reduce redundant movements, minimize inventory, and “rationalize” hospitals so they are as efficient as possible. While all that sounds smart and practical, surveillance is always about control, so the people under its gaze seldom see it in such a positive light.
What ends up happening is that hospital administrators can’t help but discipline workers whose locations are being tracked. In one case a hospital was just piloting a workflow management system and asked staff to wear RFID-embedded badges. An administrator saw that two orderlies, people who transport patients, were hanging out at a loading dock, so he called them on their walkie-talkies and asked where they were. When they both lied about their locations, the administrator stormed down to the loading dock and fired them on the spot. The intended purpose of the system was to improve efficiency, and workers were never told they’d be spied on, but once the system was in place it was automatically transformed into a disciplinary surveillance technology.
Although various tracking and performance-monitoring systems in hospitals may improve some measures of productivity, they may also produce unintended consequences that burden workers and their patients. If their primary goals are to increase throughput and save (or make) money, then the health care mission of these organizations may suffer. Then again, many people and communities may suffer if hospitals go out of business, so the problems are much deeper and more complex than simply saying no to workplace surveillance and yes to care and compassion. Nonetheless, many hospital staff find tracking systems unreasonably invasive and feel they diminish autonomy and trust in the workplace. Some nurses even intentionally smash RFID tags and sabotage the systems. It stands to reason that authentically involving workers in decision making and organizing workplaces to provide incentives instead of punishments would boost morale and combat arbitrary abuses of power.
The “Eyes in the Sky” at Casinos
One of our students was a blackjack dealer at a casino. She described the elaborate rituals she had to perform for the invisible security staff watching her through cameras mounted above her table. She had to ensure that her hand of cards was never lifted more than forty-five degrees off the table; she had to position the deck at a precise angle to the edge of the table; she couldn’t touch her cards or the deck unnecessarily, because it might be construed as a signal to a player; when she accepted tips, she had to tap the chips against the table and immediately place them in her tip container; and when she let the table, she had to
clap her hands together and turn them palm up for the cameras to see. Any deviation from protocol would automatically trigger an inspection from security that could result in disciplinary action.