Photo: Stone Wheels at Cawdor Castle from Fiberterian Flickr Photostream

I recently read a fascinating and perplexing tale of the contingencies of work in healthcare, where ‘state of the art’ equipment sits alongside ‘stone age’ communication devices.

The first time I saw a pager, in 1994, I thought it was a pretty clever device. You page me, I see your number, and I find a landline and give you a ring. It’s a very effective way of being contactable when you’re out and about but still need to be on-call. It’s hard to believe, though, that despite the ‘communications revolution’ of mobile telephones and wi-fi internet, the pager is still the device of first resort when a doctor needs to be called to a patient’s bed­side. And it’s not hard to believe a pager isn’t that effective in getting through to the right person

  1. Find out John’s bleep number. <– from memory? from the Intranet? From a piece of paper of the wall? Hope that it has not changed?
  2. Call the operator if you don’t know the number <– Put on hold, busy operators, does not have the number!, gives you multiple numbers to try
  3. Find a telephone nearby that no one is using <– This could be next to you, 20 metres away, 50 metres away?
  4. Bleep John. The number would usual be [John’s bleep number][your telephone extension] <– Hope you have not forgot the code
  5. Put the phone down and wait. <– Hope that no one else rings the phone, hope the phone is not needed urgently, can’t do anything else whilst waiting
  6. John’s pager goes off. <– hope he hears it, this may not be the only bleep he has received within minutes of each other
  7. He interrupts whatever he is doing. <– He could be speaking to a patient, be in the toilet, he does not know how important the call is, he might be on another call!
  8. He needs to look for a phone that no one else is using <– This can be very far away
  9. He rings your extension <– Hope you are still there, hope the phone is not engaged
  10. SUCCESS! – You are connected. <– You realise that John was not the person you needed after all, he gives you another person’s name –> Repeat steps 1-10

source: Bleep bleep stoneage technology in the 21st century NHS

The handihealth account tells us of all the contingencies and uncertainties that might get in the way of this working well, from not being able to find a phone lines that’s free, to not knowing if you’ve got in touch with the right person. It’s stressful and it takes time in cases where speed really matters. The bleeper can’t be the best technology to make the work hap­pen. But it’s cheap to run, and it’s well embedded in working practices, so perhaps it’s stuck.

As Froud et al (2011: 6) comment in relation to decisions about funding for transport infrastructure, ‘Governments decide value for money by considering only price and quality on an individual purchase basis’. By this reckoning, a bleeper is pretty cost effective. Such a concern with upfront price results from framing all forms of economic action in the language of microeconomics — simple markets and individual buyers — and hence applies crude understandings of ‘value for money’ to very complex practices of providing care. Thinking about the unit price for an individual purchase gets in the way of more subtle (but not so sub­tle as to be invisible to even a half-awake mind) thinking about what it is worth spending money on to make care possible. (The outrage earlier this year at the headline cost of the Metropolitan Police’s use of the speaking clock (£35,000 a year!) is a good comparison. Per­sonally, I’d rather not be the copper waiting to start the raid whose watch was a minute fast).

I remember some time ago watching a television programme which sent the boss back to the shop floor. A ‘top’ manager in a major supermarket chain went to work on the till, and discov­ered just how fiddly it was to remove discount stickers in order to scan the barcode beneath. The sticker glue was later changed. I have a childish idea to remove first the secretarial sup­port and then the mobiles of Jeremy Hunt, David Nicholson, the heads of various private healthcare companies competing for a share of the NHS pie, and their managerial subordi­nates. Instead, each can have a pager and shared access to a landline, and then they’ll get some insight into the challenges of working in an old-tech world.

Reblogged (in slightly edited form) from Http://, a sociological space about work.