Call centre technology creates an ‘electronic panopticon’ that allows the supervisory power of management to be ‘rendered perfect’ (Bain and Taylor (2000).
Discuss this statement in relation to the NHS direct case study (Smith et al 2008)
The NHS Direct case study (Smith et al 2008)
The NHS is a large public sector organization with 1.2 million staff many of whom are professionally qualified nurses that have maintained a long standing tradition of autonomy and responsibility at work. The NHS Direct case study shows the ways in which the organization of call centre work was influenced not primarily by technology but by the ways in which specific organizational choices, professional practices and values influenced how work was carried out in relation to the new system. Two key points to bear in mind are that:
• There is an important element of job rotation in the NHS direct system. Nurses move between face to face and tele-nursing unlike ‘customer service representatives’ (CSR’s) found in private sector call centres.
• NHS Direct is a ‘nurse led’ service in which nurses (rather than managers or doctors) are the dominant group.
You should also note however that there are important similarities with the work of CSRs namely that NHS Direct nurses follow a script set by the Clinical Decision Support Software (CDSS) as they question callers and assess the urgency of patient needs. While nurse can deviate from this script and make alternative decisions, they nevertheless interact with patients as caller/customers. These interactions focus on the individual problem symptoms of many patients rather than longer term relations with fewer patients. Calls are continuously streamed to Nurse Advisors (NA’s) who experience a sense of being ‘paced by the machine’. Finally NHS direct nurses do not respond to calls as specialists but as generalists. Nurses come into NHS from different backgrounds, and they rely on a Clinical Assessment System (CAS) to support them in reaching clinical judgements. Because nurses are generalists this increases their dependency on CAS and breaks the link between knowledge and action thus creating the potential for technology to be substituted for the professional judgements of nurses.
The NHS Direct case allows us to question the labour process theory that technology is inevitably shaped by managerial concern with deskilling, and control. NA’s working in NHS Direct carry out a wide variety of tasks; they make important professional judgements when using call centre technology and they are able to override the highly scripted and routinised procedures laid down by the CDSS. They are thus able to maintain a very substantial measure of responsible autonomy when deciding on how precisely to answer calls from the public. You should note, however that the authors speculate that call centre technology may provide opportunities for enhanced control of nurses in future. These contrasting aspects of the case remind us of the fundamentally contested, open ended and emergent nature of technological change at work.
• Clarity of exposition and argument
• Awareness of social process approach and use of analytic frameworks (eg Harris and McLoughlin)
• Use of case study evidence
• Essay structure, referencing and presentation
Key issues
• Bain and Taylor 2000 critique of ‘electronic panopticon’ as totalised managerial control
• Control imperatives of call centres vs NHS direct?
• Organizational context and ethos?
• Strategic world views and choices of relevant actors?
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