By Siew Kien Sia, May Tang, Christina Soh & Wai Fong Boh
Initially I found the paper interesting because it reminded me of another paper (Doolin, 2004) which I read when I was doing an essay entitled ‘Measuring the Value of Information’ for Information Management last year. It was based on a New Zealand hospital where management hoped to influence behaviour through the increased visibility of a similar system, and which was resisted by doctors to the extent that the information system was reinterpreted and relegated. The two case studies strike similar chords with each other, although resistance, empowerment and control seem to be less obvious in the Singapore paper (perhaps due either to the less confrontational nature of Singapore people, or to the authors’ interpretation of events, or because the ‘resistors’ in Singapore were nurses, and in New Zealand were doctors).
The concept of the ‘panoptic gaze’ appears to me to be a negative take on the notion of ‘transparency’ as publicly endorsed by the Irish educational system, but which is consciously resisted by both management and teachers’ unions. In a ‘transparent’ system what individual teachers do (year plans, lesson plans, assignments, lecture notes, grading criteria etc) should be accessible by and available to management, other staff and students alike. However, most teachers resist this concept and are very protective over and really don’t like other people commenting on how their classes run and how they teach, thus treating the concept of ‘transparency’ as if it were a ‘panopticon’, supporting this papers’ argument, although in a different (non-technological) context.
I was surprised at how little resistance there actually was to the system – a system is introduced by management with little to no choice on the ground which gives very little, if any, benefit directly to the clinicians, involves duplication and workarounds of process which previously worked, is used by management to control and audit them, generally makes them feel more pressurised and distracts them from their primary care duties. My feeling are that either there was more resistance to the system which was not documented, or the hospital had a very docile staff.
The idea that control and empowerment are not mutually exclusive was a novel one – controlled empowerment, or empowered control. Challenges for management include how to deal with the control/empowerment issue. In this case they promoted the control aspects and suppressed the empowering aspects of the system, but this is not the only option. As suggested by the paper, they could have put in place formal supports for promoting empowerment among staff such as changed job specifications or methods of promotion.
Empowerment is defined by the paper as the ability to make decisions and having added flexibility. This could be argued, as surely empowerment is also about being able to do your job efficiently and effectively with empowering support services which allow you to concentrate on the job at hand (such as patient care), and not be distracted by unimportant decision making (such as how many labels to print).
How do you, or indeed can you, implement a process oriented system into a departmentalised structure? Ideally, it would be best to start with a clean slate, and organise activities around processes but where a system exists, and people have contracts, job specifications and unions, making a change from a departmentalised structure to a process oriented structure is nigh on impossible. That said, implementing a process oriented system on-top-of or alongside a departmentalised structure is sure to cause confusion and irritation where people are required to cross departmental boundaries to complete a job which may be outwith their formal job description.
The research for the paper began at the last phase of the projects implementation. This means that the authors may have missed a lot of the ‘political’ manoeuvring undertaken at the projects inception (Gallacher, Williams & Procter, 2001).
The paradoxical notion of a ‘best practise’ which removes reconciliation checks because they are too localised to build into a generic system.
The generic nature of ERPs may necessitate manual workarounds for process which are not part of the system. This creates more work, which may in itself be non-standard.
Another significant aspect of the paper was where it identified that the information system, rather than management, was implicated in the increased control and visibility the system allowed. This is a bonus for management in that it lessens their perceived responsibility in the eyes of other employees. It is however a strategy commonly used by management and one which might wear thin over time.
It is interesting to see that they use a 5-point Likert scale correctly to measure perception, but incorrectly convert that scale to numeric and proceed to do statistical analysis. This statistical analysis is flawed as, had the numbers been assigned in reverse order, different results would be generated.
As control structures (reconciliation checks) are removed, some people become more powerful. Others who depend on these people to do their jobs correctly are more compromised than before, as they still have responsibility for getting the job done, but less control over it. If the procurement officer is derelict, the accounts payable clerk will bear the impact. Also finance now has to share control with the business office, but presumably is still responsible for financial data accuracy. Responsibility without control is not enviable.
Where control is changed, responsibility should change also. This may involve changing job descriptions, promotion structure and bonus mechanisms.
The nurses may have been genuine where they say that the potential extra work (even though it may make their jobs easier) also distracts them from their real work of looking after patients. The authors, however, seem not to sympathise with the nurses’ situation.