Measured to death

May 11, 2014

Workshop Talks

by Htun Lin

A nurse on a hospital ward challenged her manager when he assigned her another new patient, saying it was not safe for her existing patients—she had not even had time to tend to the previous new admissions. Her manager countered that, according to the metrics, she was due for another assignment.

The manager explained to the distressed nurse that all her colleagues were overwhelmed too. The ER is monitored by computer tracking systems to move patients to wards within a certain amount of time.

Inevitably, the nurse realized she had to relent despite her objections, as the manager pointedly demanded: “Are you refusing to accept this assignment?” That was a threat of disciplinary action for insubordination.

Reliance on metrics in healthcare has become a new Taylorism, or management by time study. Everything in the hospital workplace is now tracked by sophisticated computer programs, down to every last pill, gauze and penny, and down to every last motion. This vast pool of information becomes Big Data. Big Data, generated by computer tracking devices, has become the foreman of the new healthcare assembly line in the “affordability” era.

 We tend to think of the NSA, Google and Facebook first when we think of Big Data. But a new use for Big Data has emerged: to cut costs. The Affordable Care Act’s (ACA) mission included eliminating waste, fraud and abuse in Medicare, as well as ending discrimination based on pre-existing conditions.

 The HMO industry transformed the concept of “affordability” to their own version of cost-control. Whereas before ACA they blocked access for those with pre-existing conditions, now they restrict access to all.

According to a recent report from the McKinsey Global Institute, “the U.S. healthcare system could save $300 billion a year ($1,000 per American) through better integration and analysis of the data produced by everything from clinical trials to health insurance transactions to smart running shoes.” Those savings have to be spent on an army of foremen and overseers to monitor computer data.


As one rank-and-file caregiver put it, “For every worker, there is an undisclosed cadre of supervisors, consultants and monitors to measure and track every minute of our work.” But they’re not in touch with the concrete reality on the shop floor.

Traditional medical research utilized concrete epidemiological data to determine specific causes of disease, such as those collected and studied by the Centers for Disease Control. HMOs’ interpretation of data is an analysis to cut cost. They seek at every turn to eliminate live human beings, to replace them with machines.

Medical researchers have developed a useful tool called the “Checklist,” checking for a very concrete set of criteria. For example, before surgery, asking the patient to identify the correct limb to be operated on, and checking and double-checking all tasks to ensure accuracy and precision.

HMOs have created their own checklist. At the top of that list they put cost control, usurping the decisions of caregivers at each step. Admonishing caregivers with extensive professional training, as if they were children, to perform something as basic and essential as hand washing, is a sign that something is terribly amiss. It has become increasingly difficult for health workers to perform tasks to their full professional capacity when they are constantly treated like robots.


Hospitals are also beset by the proliferation of antibiotic-resistant super-bugs. When mechanical thinking dominates the shop floor, no amount of edicts issued from the digital ivory tower of HMO Big Data can deny the inevitability of mistakes and accidents. Real quality of patient care is not possible.

For health workers to adequately support their patients, they have to be supported. Caregivers cannot give quality care when they don’t feel that care themselves.

Big Data has the power to measure everything and analyze anything. It indulges the fetish of hi-tech and numbers as pure quantity. It knows the cost of everything. It understands the value of nothing, nor the meaning of anything. Only human beings can transcend that kind of alienation, because we were the ones who created it.

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