Medical practice too standardised?

[MeSci]

This NEJM article looks at 'Taylorism' (I never knew that it was called this or that there was someone specific we could blame!): the standardisation of work, which has now permeated healthcare.

I recall when we had 'time and motion' studies every so often in my first job (in the 70s) - we had to keep a record of everything we did, and it was a bore. It was supposed to provide information on how much 'traffic' there was at given times (it was a telephone exchange.) so as to determine how many staff were needed.

I was shocked to find that my last job (80s-90s - civil service) did this ALL THE TIME. We spent so much time recording what we had done that it clearly reduced the amount of time available to actually DO the work. It seemed to be based on the assumption that, if we didn't account for every minute of our time, we could not be trusted to do enough work to justify our salaries.

I'm pleased to see this issue being discussed. I wonder whether it is possible to change things now...

 

[Chrisb]

this is something that has needed saying for some time. The worrying thing is that the outcomes seem entirely predictable. Yet come as a complete surprise to some.

 

[MeSci]

this is something that has needed saying for some time. The worrying thing is that the outcomes seem entirely predictable. Yet come as a complete surprise to some.

One area where it is having terrible effects is in home-based social care, with care workers being expected to carry out multiple personal care tasks in very little time, for frail, often-confused elderly people.

I can tell you that the result of the time/numbers-focused civil service culture was a very high level of error. It was seen as more important to do things quickly than correctly. My previously-good handwriting turned into a scrawl as I rushed through jobs under pressure.

When I proposed a widespread check of files, to make sure that we had people's names, addresses, NI numbers, dates of birth, etc., correct, having found numerous errors by chance, we were given no extra time to do this, but were expected to do it on top of the jobs we already had!

But I made time, and found that there was scarcely a single record which had all these basic details correct.

Of course, all these errors make more work further down the line, so don't save time at all. But as long it looks OK on paper, staff can be seen to be working hard, get promoted, etc., etc.

Same in healthcare...? My medical records would suggest so.

 

[Chrisb]

This is what happens when you put accountants in charge of everything. Just as long as you're counting things it doesn't matter what the numbers represent.

 

[barbc56]

Expediency at the cost of services. @Esther12 if I remember correctly, you have talked about this issue but can't remember if the word you used is expediency. I took a history course on this subject back in the day and it was fascinating! Is expediency the word you used? Help!

@MeSci

I saw this with education and social services. Like you say, in the long run, it often turns out to be detrimental. Unfortunately, politicians as well as others who are accountable to the public will spout these goals as it sounds good, gets votes as well as people falling for this.

For the latter, I don't think people are entirely to blame Especially in this day and age, where immediate results are expected. Institutions should know better! That's my short version!

This is what happens when you put accountants in charge of everything. Just as long as you're counting things it doesn't matter what the numbers represent.

My ex was an accountant! Need I say more?

Barb

ETA An example I experienced, rather almost experienced, was the call to evaluate teachers by student grades as well as using how well your school district performed to get grants. This sometimes led to teachers "teaching the test" and some teachers as well as administrators faking the data.

Students not performing up to standards? Well it has to be the teacher's fault. The same for parents. It's actually more complicated than that and short sited.

My students who had pretty severe emotional problems. This had such an impact on them that sometimes barely keeing their heads above water made it almost impossible to learn let alone taking tests. That's why we focused on the emotional problems first along with learning strategies for those who could.

Try telling a student laying on the floor in a fetal position to learn their times tables!

I'll stop now.

 

[Esther12]

Expediency at the cost of services. @Esther12 if I remember correctly, you have talked about this issue but can't remember if the word you used is expediency. I took a history course on this subject back in the day and it was fascinating! Is expediency the word you used? Help!

I have no idea, but I often find myself liking old posts of mine, having totally forgotten ever writing them, so will assume that if I said it I was right. tbh, I opened this thread when it was first posted, decided it looked interesting, and then decided I didn't have time to read another interesting article at the moment.

 

[MeSci]

For the latter, I don't think people are entirely to blame Especially in this day and age, where immediate results are expected. Institutions should know better! That's my short version!

Institutions are made of people. But institutions do seem to develop lives and cultures of their own, with a group-think that individuals feel pressurised to adhere to. I studied this in my social psychology course, and it was fascinating.

 

[Chrisb]

Institutions are made of people. But institutions do seem to develop lives and cultures of their own, with a group-think that individuals feel pressurised to adhere to. I studied this in my social psychology course, and it was fascinating

I find this is a very interesting area. I tend to be rather literalist and argue that institutions, corporations, companies are all only legal fictions, existing only in the human "mind". All that there are are people, behaving in particular ways, buildings, pieces of paper purporting to provide authority, etc. One of the main uses seems to be to avoid or evade personal responsibility. One can always blame corporate culture.

 

[MeSci]

I find this is a very interesting area. I tend to be rather literalist and argue that institutions, corporations, companies are all only legal fictions, existing only in the human "mind". All that there are are people, behaving in particular ways, buildings, pieces of paper purporting to provide authority, etc. One of the main uses seems to be to avoid or evade personal responsibility. One can always blame corporate culture.

People can genuinely feel intense pressure to do what they think is expected of them, not just what they are directly instructed to do (as in the Milgram experiments), especially if there is explicit peer pressure.

 

[Chrisb]

I thought that recent evidence had largely undermined the Milgram experiments-but I may be wrong.

 

[jimells]

I studied this in my social psychology course, and it was fascinating.

Do social psychologists ever consider alternatives to hierarchical institutions imposed by violence/coercion? Have they built on the concepts described in "The Peter Principle"? ("managers rise to the level of their incompetence")

Chomsky has written at least one essay on how academia quietly ignores the concept of the manufacture of consent. I suspect there is little incentive to study the failings of how society is organized and how it might be done better.

 

[Chrisb]

I always assumed Whitehall and D.C. to operate on the Peter Principle. However, having now heard of the Dilbert Principle, one has to wonder.

 

[MeSci]

I thought that recent evidence had largely undermined the Milgram experiments-but I may be wrong.

You may be right. I know there has been controversy about them. This Wikipedia page talks of alternative explanations and attempts to replicate.

 

[MeSci]

Do social psychologists ever consider alternatives to hierarchical institutions imposed by violence/coercion? Have they built on the concepts described in "The Peter Principle"? ("managers rise to the level of their incompetence")

Chomsky has written at least one essay on how academia quietly ignores the concept of the manufacture of consent. I suspect there is little incentive to study the failings of how society is organized and how it might be done better.

I think that good social psychologists do consider a wide range of possibilities. My own course was 16 years ago, but it covered approaches from Freud through to neurology (including scanning) and encouraged students to think and question. I recall selecting a project that required me to prove or disprove free will, which was quite mind-blowing, disturbing and ultimately elating!

 

[Chrisb]

I thought that this article seemed very timely:

http://www.theguardian.com/society/...the-quality-of-their-service-has-deteriorated

 

[barbc56]

It finally came to me. The word I couldn't think of is Pragmatism, where results are emphasized over substance.

So in a word, that describes what the above article is talking about. Taylorism, like that!

It's a fascinating topic.

 

[CFS_for_19_years]

This doctor (ZDoggMD) has a concierge practice in Las Vegas called Turntable Health.

The electronic health record (EHR) is supposed to help, but he's sure that bad software only makes things worse. (Hotmail is now "Hot Male"; 30 clicks for an Ambien). My post may only be tangential to the original topic, but please be kind. ZDoggMD is on Twitter if you like him. Hope you enjoy.

 

[*GG*]

Funny video, sure lots of Drs can relate to that! My CFIDS Dr is still on paper

GG

 

[barbc56]

@CFS_for_19_years

Hysterical! I love ZDoggMD but had kind of forgotten about him. I'll plan to go watch more of his videos. He's done a lot of good things. Thanks!

Barb

Here's more about him. I wasn't aware that he's won so many awards!

https://en.m.wikipedia.org/wiki/ZDoggMD