Heroes Not Zombies

In 1911 Frederick W Taylor published the “The Priniciples of Scientific Management”. This approach to work had a profound influence, leading to the use of the term “Taylorism” to capture the essence of his message. It’s a message which still holds sway today. In fact, the term “Taylorism 2.0” is being used to describe the modern form.

It’s clear that Taylor’s idea of science was not that curious, exploratory discipline based on wonder, but the desire to control – the desire to produce pre-determined outcomes through systems created by measuring what could be measured.

Right there, in that text is his declaration of intent – one which chills me every time I read it!

In the past the man has been first; in the future the system must be first

If there was one thing I would say to try to improve health care, for example, it would be put the human beings first, and the system second – the system and the management created to deliver the system, should, in my opinion, be the servants of those human beings who are caring for, and trying to help, the other human beings (the patients).

Is it any wonder that professional satisfaction amongst doctors is so low when they’ve signed up to something they probably didn’t understand was “Taylorism 2.0”

So what is this “Taylorism 2.0”?

I first came across it in an article about workers in a French supermarket internet-ordering section. Let’s call it “click and collect” – in the UK, there are now many “click and deliver” services from supermarkets, but in France, the delivery bit doesn’t seem to have taken off yet. Instead you can order your shopping online, then you go to the “Drive” and pick up your order.

But what happens between clicking on the items you want on the web catalogue and finding your shopping at the counter in the “Drive” building of the supermarket?

Well, you have staff who are called “pickers” – they go round picking the products off the shelves  – either of a supermarket (often a “hypermarket”), or from a warehouse (more commonly the former so far) – and collecting them into boxes ready to be handed to the customer when they turn up at the “Drive” counter.

These pickers are managed not just according to the principles of “Taylorism” – which involves measuring whatever can be measured and setting the targets and goals to be achieved i.e. the time taken to get a particular item from the shelf, the number of items an individual “picks” in an hour, in a shift, or whatever. As the article made clear every aspect of the job which could be measured was measured and monitored. Each picker has a portable device strapped to their wrist and receives the instructions for what to pick next from the computerised control office. The device shows exactly where they are at all times of the day, and measures the time taken for each and every action. What can’t be measured and monitored this way is the interaction between the staff and customers, so that is controlled by teaching them scripts which they have to learn by heart and stick to – you’ll know the kind of thing – “have a nice day”, “happy to be of service”, “thank you for waiting” and so on….

What takes all this measurement and control to the next level is not just the introduction of the new technologies which allow better monitoring and measuring, but the introduction of game theory.

Yes, you read that right. Game theory. The big new addition is “gamefication” – or how to introduce principles from cognitive behavioural psychology and game theory to get the most out of the workforce.

Just to give you a taste of this, it can include awarding points for numbers of items picked and delivered, numbers of customer orders completed, shortest times taken to get frozen goods from the shelf to the customer and so on. The points are fed back to individuals and teams and the scores are ranked. So an individual can see instantly at all times their best times, their highest number of order completions and so on….which inspires them to try to always get personal bests. But more than that, the team, or all the members of a particular shift will get collective scores and be ranked against other teams, other shifts or even other stores across the country – an enormous expansion of the “employee of the month” idea.

There can be a number or rewards attached to the rankings as extra incentives.

There’s a lot more involved than this but maybe this introduction will give you an idea.

So, what’s this got to do with health care?

Again, just as an example, let’s look at one particular system – the application of “QOF” (“Quality Outcomes Framework”) points in Primary Care in the UK.

General Practitioners have a substantial amount of their income pegged to their “QOF” points – these are points allocated for achieving particular targets on management-set protocols, mostly they related to the numbers or percentages of patients in a practice who have been entered onto particular disease registers, who have been asked about smoking habits, have had a BP check and so on, or the numbers of percentages of patients with specific conditions who have been prescribed the recommended drugs.

Not only does this prioritise the things in health care which can be measured at the expense of things which can’t (like communication skills, empathy, creation of therapeutic alliances, depth of understanding, caring etc) but it gamefies the whole system by awarding points, ranking individuals and practices, and rewarding points with income. So the doctors motivate themselves to try to achieve what the management want them to achieve.

Welcome to Taylorism 2.0 – where the system comes first – more now than ever before.