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
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://nowaytomakealiving.net, a sociological space about work.