I’ve not read Mark Fisher’s book, but apparently he’s incensed about workplace management audits. I’ve read his latest post, which also links to the podcast of a talk he gave recently about the book. Keeping track your own performance is worse than a waste of time, says Mark, because it prevents you from doing more useful work. Of course no one really believes that these audits help improve performance, he asserts; they’re only representations of performance staged for the Big Other. It’s “nuBureaucracy” — an absurd simulation of market forces perpetrated by government as a means of perpetuating the class distinction between workers and managers.
The k-punk post cites Michelle on healthcare auditing:
“getting “good” results from audits is probably a lot worse on the whole than getting “poor” ratings… nuBureaucracy is not only psychologically destructive, it can actually kill people.”
Does anybody besides me find this line of argumentation offensive? Why shouldn’t the government be concerned about the quality of healthcare its citizens receive? Isn’t it possible to identify specific standards of adequate care? Isn’t it in the public’s best interest to evaluate the extent to which these standards are being met? If the standards are wrong or the measures inappropriate, change them. But to claim that the measurement apparatus itself is killing people, rather than the faulty processes of care which the measures are trying to identify — that’s just fucked up.
Mark argues that nuBureaucracy constitutes a simulation of market forces in an environment of heavy government regulation. Twice in his podcast he says that allowing the free market to operate, where maximizing profits is the explicit objective, might be better than the “market Stalinism” of nuBureaucracy. It seems that Mark’s biggest objection to performance auditing is that it stifles workers’ freedom, choice, and flexibility. This sounds a lot like a libertarian argument. Industry has made similar objections to governmental auditing of environmental pollutants, pharmaceutical side effects, and risky lending practices.
I don’t understand why work audits should be dismissed as a spectacle staged for the Big Other. I thought we were talking about systematic empirical evaluations conducted on behalf of the public, which pays for the work being evaluated and which suffers the consequences of poor performance. The public is the Big Other now? That sounds like a good thing.
I understand that audits are often used to punish individuals for systemic failures and to justify getting rid of workers when money is being squandered on bailing out big financial institutions and so on. I also agree that some measures really are worthless indicators, and that collecting some kinds of data isn’t worth the time and effort. But tell me this: if the workers actually controlled the means of production, would they no longer regard it as important to evaluate whether they’re doing a good job or not? Should workers’ freedom really take precedent over those for whose benefit they’re doing the work? Is it really that much to ask of hospital workers that they keep the nosocomial infection rates down, or of doctors that they adequately manage their diabetic patients’ blood sugar levels? Should the citizenry simply take the healthcare workers’ word for it that they’re doing a good job?
Mark contends that work audits serve as a mere substitute for real marketplace forces. But how is someone undergoing bypass surgery to evaluate whether this doctor or that hospital is better than any other? It’s not like you buy bypass procedures every couple of months: hopefully it’s a one-time-only purchase. Readily accessible market indicators like price or the hospital’s location or the shininess of the doctor’s shoes aren’t of much use in being an informed healthcare consumer. What you really want to know is whether this doctor and this hospital are demonstrably good at what you need done. The relevant information can be obtained only by compiling and analyzing aggregated data — that is, via performance audit. Otherwise you have to rely on marketing and hearsay.
I’m familiar with the contention that standardizing work processes stifles innovation, and this may be true. But shouldn’t the innovative worker be able to handle the routine stuff as well? It’s like arguing that students shouldn’t have to be able to do algebra because it gets in the way of their learning calculus. In most fields of endeavor progress is incremental, built on a foundation of lower-level skills. Most of the time people who can’t do the basics well aren’t very good at the advanced stuff either.
If you’re a professor with a Ph.D. you almost surely think you’re smarter, more creative, etc. than the people who think up the measurements schemes by which you’re evaluated. It’s possible, of course, that the measurement types might be just as smart and creative as you are, but their jobs don’t provide them with as much opportunity to express their brilliance as your faculty position does. Besides, how much does brilliance really factor in to how good you are as a teacher? Do students pay tuition, do citizens pay taxes, in order to subsidize your brilliance, or to educate people? If existing measurement systems don’t accurately distinguish between good and bad teaching, maybe there’s not really much of a distinction to be made.
Maybe I’m just sensitive to this shit because I have measured healthcare work processes and outcomes as a job. Maybe it bugs me when somebody claims that, while I thought I was contributing to systemic improvements in quality of care, I was actually killing people. Or maybe I think it’s disingenuous when somebody claims that getting “good” (note the irony quotes) ratings on, say, keeping people alive post-surgery is probably worse than getting “poor” ratings.