I've read that doctors now spend as much as 50% of their time documenting their work. Companies such as Epic, which provide the software that hospitals use to build databases of patient data, have been big winners in the new world of hospitals-depending-on-software. But did the doctors become more productive? By almost any measure, they became less productive.
People in tech keep thinking more tech will solve problems and they keep underestimating the flexibility of the old models. For instance, most large companies used to be run by armies of secretaries, and the senior secretaries functioned as what we would now call "project managers" -- they made calendars, oversaw who was working on what, followed up to keep track on whether work was being done, and kept a close eye on what money was being spent. The crucial thing about having humans overseeing such work is that humans can take a flexible approach to the rules: they know when to break them. By contrast, systems that are highly dependent on software tend to be more rigid. Software doesn't know when its rules should be broken.
The flexibility of the old system is constantly underestimated, the rigidness of the new systems is often misunderstood.
In his book "The Design Of Design" Fred Brooks talks about the power of trust, and he contrasts that situations where everything needs to be first negotiated and specified in a contract. High trust systems are flexible and fast, whereas a system where every detail needs to be specified in a contract is slow and rigid. We should stop and ask ourselves, our favorite Agile methodology resembles which of these? Are specifying things with needless detail?
I don’t think productivity was ever the goal of this software. It was to have a record that is standard, digital, transferable, etc. Doctors fought it as long as they could because they knew what it meant for them.
I remember pretty early demos in early/mid 2000s when I was doing some clinical grunt work in college. I had written some software to make my department’s life easier so I was offered up as the hospital’s liaison for the software evaluation. This is when I formed my “never replace a terminal based app, with a GUI based app and expect productivity gains” theory. Everyone working in the hospital knew the terminal app, they type in some random 3 letter code and a screen would pop up. Then they would memorize how many tabs each field was apart from each other. Without a mouse, people could just hum along imputing data a blazing speed once some muscle memory was in place. Everyone had little cheat sheets printed out for the less frequently used commands/codes. When you replace this with a browser/desktop GUI with selectors and drop downs and reactive components of GUI, it tends to 1) require mouse usage for most people and 2) lose the ability to do this quick data entry I described. The pretty interface becomes a steady stream of speed bumps that reduce productivity. Since then I’ve witnessed it in banking and other industries too.
IMHO, this is because the people writting GUI's these days are mostly incompetent, or hamstrung by "web" technologies.
Early GUI's didn't have the problem you describe because they were designed as discovery mechanisms to the underlying function. AKA, the idea was that after clicking File->Save a dozen times you would remember the keyboard accelerators displayed on the right hand side of the menu. Or if nothing else, Remember that the F in File was underlined along with the "S" in Save (or whatever). Which would lead people to just press ctrl-s, or Alt-F, S. Then part of testing was making sure that that the tab key moved appropriately from field to field,etc.
I remember in the 1990's spending a fair amount of time doing keyboard optimization in a "reporting" application I wrote (which also had an early touchscreen) for use by people who's main job wasn't using a computer. Then we would have "training" classes and watch how they learned to use it.
So, much of this has been lost with modern "GUI's", even the OS vendors which should have been keeping their human interface guidelines updated, did stupid things like _HIDE_ the accelerator keys in windows if the user wasn't pressing the Alt key. Which destroys discoverability, because now users don't have the shortcut in their face. Nevermind the recent crazy nonsense where links and buttons are basically the same thing, sometimes triggering crazy behaviors like context menus and the like. Or just designing UI's where its impossible to know if something is actually a button because the link text is the same color as the rest of the text on the screen..
They also fought it because they didn't go to medical school and survive residency to fill out forms all damn day—and they didn't used to have to, they had staff for that.
Then the computerized systems "replaced" that staff but all that really means is they cut the human time needed low enough that full-time workers weren't needed, but didn't eliminate it, so now that's another thing doctors have to do themselves.
AFAI can tell, the effect of tech overall is to cut some jobs while making the remaining ones harder and more stressful, while increasing so-called context switching.
As someone who worked in the electronic health records industry, closely with design teams, and has thought more deeply about certain aspects of this problem than anyone else in history (not exaggerating), I think you're missing major factors.
First, yes, productivity was one of the goals of the forced move to electronic health records systems. The federal government passed the HITECH Act in 2009 creating economic incentives for doctors to switch to EHRs because it would be better for public health, Medicare billing, and also because it would supposedly unlock doctors to spend more time with patients and be more productive, via the use of technology.
The reason that third thing has failed, to my mind, is largely because the government, in the same act, required a HUGE list of requirements be met by the software designers making the EHRs. This list, by law, needs to be prioritized in scrums over customer requests and design thinking. Sometimes it makes good UX impossible.
Ironically, the government, hearing this feedback, actually added a new requirement to the list: "Safety-Enhanced Design" [0].
Go read that regulatory requirement and see if it makes any sense to you. That's why design sucks in EHRs.
I don’t think productivity was ever the goal of this software. It was to have a record that is standard, digital, transferable, etc.
Going a little further, this was appealing in part to avoid simple medical errors & oversights. Losing the record, mixing up records, incomplete history, and so on. Eliminating medical error is incredibly valuable but doesn't show up as "productivity".
> never replace a terminal based app, with a GUI based app and expect productivity gains
I can imagine this being true. It seems that almost the whole software industry has failed to grasp the distinction between an appliance and a tool. An appliance you expect almost anyone to be able to use without training. A tool, well you are expected to learn how to use it, and after that, you are much more productive than before. And most software seems to be moving towards appliance.
>This is when I formed my “never replace a terminal based app, with a GUI based app and expect productivity gains” theory.
Not in medicine (run a small e-commerce business selling mostly used video games), but definitely noticed the same thing for us.
We have some terminal-based Python scripts I wrote to automate a lot of the data entry tasks like listing and shipping (entering tracking numbers, printing labels).
Everyone that uses the scripts is initially apprehensive, but then after maybe a day of getting used to the terminal turns into a powerful data entry God and they love it. Even had an employee gush about our shipping tool to a random supplier.
"Fun" fact: the Therac-25 tragedy was in part caused by this type of usage - folks who know it so well they just blast through the screens from memory. But the software in question wasn't resilient to this use-case, and apparently resulted in an inconsistent state.
At Uni as a summer job I worked processing Corporate Actions for a large custodial bank. We used exactly the same kind of system where every action was 4 characters. I can still remember some of them despite it being 10 years since I did that job. Even more importantly, the screens were trivially scriptable so lots of the grunt work could be handled by writing export scripts, pulling a bunch of data into excel, processing it and occasionally posting the results back the same way.
Absolutely no way a modern system could be half as efficient, short of completely automating the whole job (which involved a lot of communication with other parties and basically freeform restrictions).
This memorization and strict adherence to past ways of doing things killed me as a developer. I was tasked with maintaining and customizing an Enterprise Resource Planning system. It was a terminal based app. Sometimes system upgrades would add a field to a screen. For example, perhaps country code was added, split from the phone number in the customer screen. I would frequently be requested to suppress the upgrade, or move the new fields so they didn't 'ruin' peoples memorized routines.
As the company customized more and more of the code base, upgrades to the system became more and more difficult. Every upgrade required a manual comparison of custom code to be merged with the baseline code. This led to skipped upgrades, and eventually a cessation of upgrades. Of course, after no upgrades over a long period of time it was eventually decided to move to a new ERP system.
I am still appalled at the things sacrificed to prevent disruption of a small group of peoples work flow.
> It was to have a record that is standard, digital, transferable, etc.
Considering how often I have to fill out the same goddamn forms (sometimes literally down the hall in the same building as another doctor), I think that goal failed miserably.
> I don’t think productivity was ever the goal of this software.
Thing to remember finance/economists/rentiers have a different definition of efficiency and productivity than you do. In this case the productivity has to do with billing not the uninteresting things that doctors do. By reducing the cost of billing and forcing doctors to document more things to be billed more money can be extracted.
>I don’t think productivity was ever the goal of this software.
I'm not entirely sure about this. During the early digitization era productivity was a big driver. Modern word processors are a godsend if you've ever tried to typewrite a document for publication (forget anything with complex formulae) or dealt with actual physical spreadsheets? Office itself and it's now many clones is a fantastic set of tools for productivity.
My opinion is that we've created a world in technology now that drives technology for the sake of tech and financial drivers. I regularly deal with people who think it would be a great idea to build a system to automate some aspect of business that's already well optimized or generalize something they thing is general but is really quite niche.
There are certainly cases where it makes sense to develop a system around something but you need to consider the full cost/benefit tradeoffs, not just benefits which industry tends to do.
> [...] they type in some random 3 letter code and a screen would pop up. Then they would memorize how many tabs each field was apart from each other. Without a mouse, people could just hum along imputing data a blazing speed once some muscle memory was in place. Everyone had little cheat sheets printed out for the less frequently used commands/codes.
This comports with my most recent experience using SAP in 2018. I know, I know, SAP has GUIs and such now. This well known and profitable corporation under the Blackstone umbrella, though? Nope. It was exactly as you describe.
Those who had the time-in-service or the mentality to accept it excelled at their job, but uniformly skewed older (late 40s and up) or younger (under 25). At the time, almost everyone aged in between was entirely befuddled by it all.
Context: supply chain, procurement, purchasing, logistics, maintenance, work orders, inventory
> It was to have a record that is standard, digital, transferable, etc.
Which translates into productivity. If something is standard, digital and transferable it means you can increase the rate of output in relation to its input (which is the definition of productivity).
> People in tech keep thinking more tech will solve problems and they keep underestimating the flexibility of the old models.
Related to this, but in a completely different context, I have had similar thoughts lately when eating out at restaurants in Spain. It's incredibly frustrating from a customer's point of view when the waiter taking your group's order has to use a newfangled tablet or phone-like device and tap through each individual order, often depending on the peculiarities of the app's UI and how the designers expect the process to carry out: “Are you all having the set menu? No? OK, first I need to know how many of you are having it?" [taps count on screen] "Right, now I need the starters but ONLY for the set menu orders..." etcetera—you get the idea. Then, while going through this unnecessarily slow process, God forbid someone who ordered from the set menu wants to change their main while the waiter is already taking the à la carte orders.
Meanwhile, in restaurants that haven't unnecessarily techified the procesz, the waiter can take the order in the way that's most practical given the circumstances and that best fits his way of taking notes. Ah, but then how does the order reach the kitchen without the tech? I have no idea, all I can say is that it worked fine before these things were put in place, and the manual system is by far the quickest and most flexible from a customer's point of view.
Classic business process mistake of trying to change a verbal contract into a form-letter.
"I'd like a quarter pounder with cheese and fries" is utterly unacceptable for buying a house or taking out a car loan, but it's the ideal way to order lunch. The people marketing, designing, and writing the application software have never worked in the business, of course, lack of experience has never made people like that pause, so they have peculiar ideas resulting in enforcement of weird and unproductive business processes.
Here in BC, Canada, many places don't even provide you a menu. You're expected to scan a QR code on the table, then use the website it leads you to. So the table fumbles around with their phones, using a website that usually has a terrible UX, and then the server arrives and enters your order on their tablet.
At least they don't require that we install an App. But I'm sure someone's thinking that would be a good idea.
That's just shitty software though. Good software gets out of the way and improves something. We could speculate on how to fix that scenario, but there's probably no incentive - in my experience there are fixations amongst tech people on profit-less ideas that end up getting squeezed awkwardly into applications such as bill splitting, digital ordering etc.
> I've read that doctors now spend as much as 50% of their time documenting their work. Companies such as Epic, which provide the software that hospitals use to build databases of patient data, have been big winners in the new world of hospitals-depending-on-software. But did the doctors become more productive? By almost any measure, they became less productive.
It’s less the software, and more the users, site-specific configuration and the environment they work in.
Non-US Epic users spend 20-60% less time on various EHR activities than their US counterparts. One of the most dramatic differences is time spent on ordering, which you would think would be as optimized as it could be.
Time spent documenting was 40 minutes/day for US users and 30 for non-US on average. Maybe some spend 50%, but that’s far from average.
> Another study found US clinicians write 4x longer notes
I wasn't aware of this, but as the spouse of a medical provider I know that most US providers are burdened with an ever-present worry about malpractice.
> I've read that doctors now spend as much as 50% of their time documenting their work. Companies such as Epic, which provide the software that hospitals use to build databases of patient data, have been big winners in the new world of hospitals-depending-on-software. But did the doctors become more productive? By almost any measure, they became less productive.
I don't think "by almost any measure" is right. I think in a very narrow sense they've become less productive (they see fewer patients), but by your own admission they're building databases of patient data, which you seem to suppose are only useful to the likes of Epic, but obviously Epic has customers--notably healthcare researchers use this data to improve patient care, develop new medicines, and to precisely identify which medicines are likely to help on a particular patient (and which medicines may even harm them!). This is stuff clearly benefits society, and doctors' role in this should be counted as "productive", although we can quibble about the relative value of facilitating healthcare research versus seeing more patients.
Note that this isn't meant to vouch for Epic--I work for a company that consumes their data and anyone who has to integrate with them has nothing good to say about the software, but the role it plays is still incredibly important.
> notably healthcare researchers use this data to improve patient care, develop new medicines, and to precisely identify which medicines are likely to help on a particular patient (and which medicines may even harm them!)
The majority of the notes being written by doctors now is boilerplate. A lot of it is copy-pasted. It's written because of insurance companies (which have incentive to deny claims), because of liability (which gives incentive to leave a lot of notes behind to make it looks like you thought about everything under the sun even if it wasn't applicable), and because of well-meaning but ultimately overly broad laws adding additional requirements even when they don't quite make sense.
I'm sure there is a treasure-trove of valuable data in there, especially compared to when it was all hidden away on physical paper. But you could probably reduce the paperwork that doctors do these days by a factor of 4 and not loose anything of value.
Medical decisions are based primarily on financial profit, and patient outcome data is not required to determine which medicines are most profitable.
The point of extensive documentation is shielding from the worst of malpractice lawsuits. The legal system is still of the legacy opinion that doctors have a responsibility to their patients as opposed to the more modern understanding of responsibility toward pharma company bottom lines, and all patients legally deserve the 100% successful participation trophy, so a documented decision with only 95% chance of success means insurance payouts about 5% of the time, unless its carefully documented it was all the patients fault or at least the MD could not have known the outcome in advance.
This is a really good point about how we myopically understand the value stream of a process. Often, steps that we feel are bureaucratic waste provide a lot of value to someone else in the process.
With that said, I think most healthcare is correct to take a "patient centric" approach. What the OP seems to be making is a "doctor centric" take and, if one was to be overly cynical (I'm not), your post may skew to the side of a "researcher centric" or "societal centric" approach. Doctors should do what's best for their patient, not necessarily what's best for society, or themselves, or a lawyer, or a research lab. It's easy if you work in one of those tangential areas to take your eye off the ball.
Both can be true, and greater systems of medical research and analysis don’t necessarily lead to greater on-the-ground treatment.
As you’ve pointed out, access to those information systems is critical. I’d add the distribution of that information as well as the right economic incentives to participate in using that information.
I’m not sure we’ve really got any one of those things right.
Edit: adding a bit of humanity to the system, as the OP is hinting at, could very much be a part of the fix.
The last good, independent physician I had was a fellow who played Chess on the weekends downtown. His practice moved about 5 times while I was a patient and he finally was snapped up by the VA.
He habitually called me "friend" and was very frank about my insurance not paying for stuff I was asking about, which I appreciated. He also once profusely apologized to me for placing a computer in between us. He said the new requirements of his practice made it so he had to pay more attention to the computer than to me, and we were both sad about that.
The doctors I got after that make no such apologies.
That documentation time is largely driven by the insurance industry which was really painful before these systems. It’s almost shocking how much more productive doctors are inside the VA.
Insurance is part of it, but not all of it. Government regulation is also a big part. EHR mandates under the Obama administration (? who I was generally supportive of, so not a criticism of his presidency in general) created a kind of "false pressure" to move to EHR immediately, rather than "naturally" adopt it at an organic pace, adopting whatever is most beneficial due to demand. I'm not anti EHR, but the way those systems were adopted were definitely forced onto providers top-down, rather than bottom-up like traditional hospital record systems. Hospitals scrambled to implement them in time for deadlines, and there was no room for pushback against poorly implemented structures that were pushed on hospitals essentially.
More recently in my field I've seen additional layers of documentation requirements that have nothing to do with insurance, that are entirely state law.
I have no doubt in my mind that if EHR rules didn't exist, they would have been adopted much more gradually, and selection would have been dictated by the ability of EHRs to supply features in demand. More competition would have existed and it would have cost less. Maybe some government regulation would have been needed in terms of interoperability standards but it could have been rolled out much much much better.
I don't think people fully comprehend the cost overruns associated with adoption of EHRs under government mandates, or how big of a shift there was from records being in-house flexible, and provider and patient-driven, to out-of-house inflexible, and IT-corporation-driven.
I am seeing all this blah blah blah about how everything pins down to insurance.
But if medical pricing was such that insurance wasn't required, then patients would better audit their own care receipts and this fraud issue would eliminate itself, and as a side benefit we'd have sane pricing for medical care.
I'm a web developer, and about 2 years ago my company implemented a new note taking policy that takes up a very large portion of my time, makes me feel like I'm untrusted and I just don't feel as happy as I did before. We are required to write a note of everything we do through the day with time spent and submit it by the end of the day. This is in addition to our project management system where we already track our time and write our detailed notes on what we do for each task. Prior to the policy I was able to finish work on time, now I dread the note portion of my day and I usually end up spending an hour or so at the end of the day to write up my "journal" of the day. I also have zero extra time which I used to use to learn new skills and techniques. It's an absolute waste of time and is destroying my urge to learn new skills that used to help improve the company's processes and efficiency.
When I started my new role with my employer, I did this using a browser extension and a really neat time-tracker app. I forwarded every day's tracking data to my mentor and so he was able to see with a really fine grain what I was working on, and how long each task took me in a given day.
Our apps security policy put the kibosh on that and I had to destroy my account once I realized it would not be feasible to keep it going forward.
My employer is really conservative about allowing 3rd-party apps, which is great for security, and puts us in a veritable Stone Age of productivity.
I agree. Here in Finland the public healthcare organization in capital region and surrounding areas chose Epic as supplier of their new system. It has been a disaster, massive complaints from doctors about how unproductive it is to use, and also some issues that endanger patient safety. Apparently it's also programmed with MUMPS, which doesn't exactly sound a great idea in 21th century.
I'm not sure whether this choice was a case of incompetence or corruption, but the end result is clearly a giant waste of money. Maybe it generates a lot of data, but efficiency would be way more important for an organization like this which is chronically underfunded and staffed.
> I've read that doctors now spend as much as 50% of their time documenting their work. Companies such as Epic, which provide the software that hospitals use to build databases of patient data, have been big winners in the new world of hospitals-depending-on-software.
My daughter works at Epic, and she explained that one (though not the only one) of the big reasons health care is so expensive is because Drs have so many record-keeping requirements, and one reason they have these is because of liability. It would greatly help if Americans weren't so lawsuit trigger-happy. The real winners are the lawyers (and insurance companies).
You are high if you think we are better off with paper than an ePCR.
Sometimes we have to default back to paper, some times the pt record system goes down.
When that does happen, it's a literal fucking nightmare in the ER.
We plan on it happening and we train for it happening, but ePCRs have made our lives so much fucking easier. Simple fucking fact.
Have you ever had to read the pissed off notes in a hand-written chart from the last nurse who has been working 48 hours straight, taking care of 12 critical care pts? Huh? Give that a try sometime.
I talk a lot about this flexibility gap in my day job in UX. Getting an organization onto a digital platform is great but a lot of them don’t recognize all the small ways that their current system’s flexibility is helping them.
With big systems though I honestly think GUIs can only go so far, even at their very best, and any system that is required to be complex at some level will require expert knowledge of the system itself. That’s extra work and an extra burden for someone with the critical experience that an organization relies on.
For doctors and the like it would make sense to try a system where the critical person/expert has an assistant who is a systems expert and does a lot of the needed data entry and the like. Doctor doesn’t have to worry about the system, they can talk to the assistant who manages all the extra work. If the system needs to change for any reason the assistant manages that and the doctor doesn’t have to worry about it.
I think of this assistant role as the human API layer. It’s not far off from some social programs like insurance navigators, who help individuals find health insurance, including working through options and even—critically—filling out forms for folks.
This resonates strongly and I'm surprised more people aren't talking about it.
I recognized this problem in the 90's because I worked at a manufacturing plant where the software, even then, was getting in the way of workers needing to do something a bit non-standard (they developed workarounds over time).
It's also why I'm a big fan of the 80% solution, I think there's a level of hubris involved in going for the 100% solution for everything.
To your point about trust, it's something I've been thinking about recently. Not trust, but the authoritarian nature of software, which expresses itself and is purchased for the ability to distrust. You'll see this in things like debates about whether or not developers should be allowed to affect the deployment via yaml files or not. What makes it difficult is there is often a legitimate need for these sorts of systems, especially for regulatory compliance, but more often than not they just get in the way of actual work.
The big reason EMR is so overbearing is to optimize billing… as far as economic statistics, that should show up as positive even if less patient care is actually delivered.
> I've read that doctors now spend as much as 50% of their time documenting their work. Companies such as Epic, which provide the software that hospitals use to build databases of patient data, have been big winners in the new world of hospitals-depending-on-software. But did the doctors become more productive? By almost any measure, they became less productive.
I'd ask another question: did lawsuits decrease? I'd imagine that a lot of this software is to avoid lawsuits. America is especially litigious and that's got to correlate strongly with the increase bureaucracy.
I also suspect that a factor at play is that people are losing trust in the whole system. Most people now know that productivity has skyrocketed while salaries have remained relatively flat. With increasing economic disparity (not even just the West) it is no wonder that people become less productive. Who tries hard at a game that they believe is rigged against them? (doesn't matter if it is or isn't, just the belief)
> People in tech keep thinking more tech will solve problems
Because historically it has. But there are different types of tech. Tech enabled the modern world. It is the new medicines we have to cure illnesses that devastated populations. It is the chemicals that enable us to grow enough food to sustain our populations. It is everything from a wheel to the computers we use to make more efficient wheels that use less resources. But it is also naive to think that tech alone can solve every problem. It is also naive to think that tech can't create new problems. To create tech that solves problems we need to think long and hard about the intricate complexities involved and gather the expertise from relevant domains (an often missed, but essential, component). The other problem is that people hand wave away things like climate change saying "tech will solve it" rather than investing in said technology and waiting for it to magically appear. I do think tech is an important tool in solving many of the problems we face, but you're right that they are not all technology dependent (which is a continuous scale of weights, not a binary option).
Also, we're a tech forum. Peoples' expertise here is in tech. So they see things through that lens and it is also very likely that the most we/they can contribute to solving these problems is, in fact, through technological means. The trick is to remember that tech isn't a cure-all and that the problems we face are exceedingly complex. Over simplifying is often harmful.
This has crept into schools as well. At many (most?) preschools around here have apps to document the kids' day, they send out almost daily emails and reminders about various things. If you have kids at preschool, regular school and after-school centers you're getting a constant deluge of information. Add to it that they all have different apps that don't work well (schedule, attendance etc), so of course they use email in addition.
I love our current preschool precisely because they use very little technology: we actually talk to the teachers during drop-off and pick-up if needed, and get maybe one email a month. Their expressed philosphy is to be "present" with the kids and spend as little time as possible on other (administrative) things.
We just had a baby this month, and I was shocked by how much time the medical staff was spending entering data into Epic. So much that they couldn’t actually fully concentrate on giving medical care.
Everyone was very busy but it was very hard to get actual care.
>Software doesn't know when its rules should be broken.
Just to provide an example of this I ran into today: I'm doing a medical physics residency, and my supervisor was explaining that a new "fail-safe" incorporated into the software that reverted the collimator after every scan was now making the phototimer tests take twice as long, because we had to go back into the room and reset the collimator repeatedly. We tested a machine with the new system and one with the old system and it did in fact turn a 15-minute task into around 35 minutes.
I agree to a large extent with your comment. The "office" structure has changed a lot. Secretaries ran the show, and pretty much hand-held everyone in the office and kept the ship pointed in the right direction. Law firms and political offices still have this "outdated" model because if it ain't broken, don't fix it.
Now, your company pays insane amounts of $ for software, systems, and data! You have to do your job, schedule your meetings, keep up with the ungodly amount of email, instant message, SLACK, enter the data in your CRM, talk on the phone, schedule the video meetings, etc. while also keeping track of your personal phone because your partner called or the school called and your dog is sick. There's just so much distraction now by not having "office hours" and having our whole lives in our pockets and constant reach that I think productivity has to go down. It's impossible to focus on anything for any amount of time anymore with how accessible we are expected to be.
Last time I had a blood test it took 2 minutes to take my blood and 15 to enter crap in various forms on the computer. And I'm not even in the US. There was a lot of clicking involved.
To contrast, my first job was an accounting program. We spent weeks on making sure everything works via just the keyboard and some operations are as streamlined as possible. Because in some cases it was going to be used by people creating hundreds of invoices per day.
Figuring out the right amount of automation in business is hard. Too much automation makes the company too rigid to the point of breaking but too little reduces productivity. This is a dilemma that factories/companies have to constantly re-learn. We see it regularly. A new manager comes in and decides that a company can save a truck load of money by completely automating production. But soon finds out that there are too many variables in life and that total automation can't work. The goal should be to find the sweet spot that produces the maximum while being flexible to change. But I don't think this is why productivity is dropping.
I suspect it's related to the reduction of reliance on foreign factories. The US wants to reduce the reliance on foreign manufacturing and bring all of that production back to the US. That will take time, capital and ability to learn how to do the work here. That will hit productivity hard. All than change won't happen cost free in terms of productivity and assets. The change started a few years ago. We are beginning to see the result.
Having once worked in the EMR/EHR space, a big thing to consider is some companies come in with their own workflows, processes, and ideas that they want to push onto physicians while other companies are way more accommodating in building "bespoke" solutions to specific problems.
The latter in my experience ends up providing better results to physicians as they have been employed as domain experts in building the software solution to their specific workflow. I've seen it done for in ophthalmology, specific disease/injury specific radiology, and diabetic specific checkup and appointments where I've seen as much as a 75% reduction in the amount of time the physician has to dedicate lookup up info, cross-referencing, and documenting.
> other companies are way more accommodating in building "bespoke" solutions to specific problems.
Then you upgrade and everything breaks!
But it’s an age old battle for and against standardization. I just walk around with several charging cables because each is “the best” for charging a small li-ion battery.
More correctly, fundamentally software can never know when its rules should be broken.
Computers are just state machines, without determinism and a few other properties they do not perform work. Determinism means there is only one next possible state/action.
Breaking rules would imply there are two or more possible states or actions, and that is a class of problems that computers cannot solve (they talk about this in compiler design courses). Most people subscribe to magical thinking because they don't know how computers work, or what they are even.
Payers in general (not just insurance companies) require high levels of documentation both to prevent fraud and to increase care quality. Most healthcare providers are highly ethical and only act in their patients' best interest. But there are always a minority of bad actors who will try to boost revenue by submitting claims for procedures that weren't medically necessary, or weren't performed at all. So the system needs checks for that in order to hold down costs for everyone, and prevent iatrogenic harm.
You will also find many cases where even good providers let things slip through the cracks and fail to give some patients the appropriate level of care. For example, diabetics should generally receive annual foot exams, eye exams, and hemoglobin A1c tests. If the payer doesn't see evidence of those in the EHR then they can prompt the doctor to resolve that care quality gap.
Capitalism is trying to move to a model where everyone is atomically isolated, an independent contractor making anonymous sales in a marketplace. That means lawyers, contracts, and rigid rules and documentation. The more pure a market is, the more lawyers and rules you need to make it work. The goal is to eliminate the kind of fluid high trust social networks that characterized work life in the past. Partly because if everything is more rigid, it's easier to exert control, partly to prevent things like unions from forming. They want a perfectly abstracted workforce, free from the messy details that force you to treat your workforce as made up of people. Notice that we went from "personnel" to "human resources" to "human capital management". That's the Ayn Rand utopian dream made real. The idea is to turn people into units of production to be bought and sold, and you can't have a market for a commodity unless they are all the same. So, you must be made identical, so that the price of labor means something. Every criticism leveled against systems of control in the book "Seeing Like a State" apply to capitalism too. When people talk about a free market, remember that they're talking about a free market for labor more than anything else. You are the product in this scenario, not the customer.
But even here, the purity of the labor market is hampered by rules designed to protect the laborer- osha rules, overtime rules, rules about how much a person can be controlled, and so forth. If you eliminate all those, and focus only on the making labor freely able to be bought and sold, you can begin to see what a completely pure free market for abstracted, commodity labor would look like.
It is this: The most pure example of a free market for labor is a slave auction.
There are huge productivity gains in private practices that eliminate web pages and email and switch to paper in filing cabinets only. This is also why fax machines still exist and are exclusively used by medical practices.
my experience at a healthtech startup is that any kind of cohesive product design gets perversed by nonsensical legal requirements and leadership pressures to check the boxes of comparable products because that's how the product they've used in the past did it
US Worker productivity is 0.7 standard deviations below its average over the last 3 years. It is 3.6% below all time high. It is higher now than at any point before July of 2020. YOY Productivity growth has dipped negative and then went back to positive 20 times in the past 22 years.
To be concerned about the current level of productivity requires either the attention span or the intelligence of a goldfish.
It's just the corporation friendly mass media trying to combat calls for better worker treatment/compensation. This is just the next single from the album that brought us "quiet quitting", "the great resignation", "millennials are lazy", etc. It's important for the backers of these media outlets to float these stories out there, lest anyone become sympathetic to workers in light of the facts that minimum wage hasn't kept up with either inflation or productivity, that corporations are engaging in profit inflation, that the fed is intentionally raising rates to wrest back some power from workers, and so on.
Yeah, this "new" trend of "quiet quitting" sounds so silly. People have been behaving like that for a very long time and they've probably always done it.
> that the fed is intentionally raising rates to wrest back some power from workers
The fed is increasing interest rates to keep dollars attractive as a world currency and allows the US governments to keep increase national debt whithout sending interest rate of through the roof.
It may seem counter-intuitive, but letting inflation going out of control would have a major negative impact on demand of debt issued in dollar or, to make it short, US government debt.
The only alternative would be to fund government spending with government revenues. Which means, increase taxes for categories of revenues which amount the most in national revenues.
> "In the first half of 2022, productivity — the measure of how much output in goods and services an employee can produce in an hour — plunged by the sharpest rate on record going back to 1947, according to data from the Bureau of Labor Statistics."
It annoys me that an article about a big drop in workplace productivity doesn't actually say how big the drop is. If it's only 3.6%, then that explains why they glossed over that part, as it would have undermined their narrative.
It serves the important function of giving journos an opportunity to interview business consultants about what CEOs think of their employees' poop breaks.
Which, in generating lots of hate clicks, is a huge economic boost in terms of Nonfarm Business Sector Labor Productivity!
> In the first half of 2022, productivity — the measure of how much output in goods and services an employee can produce in an hour — plunged by the sharpest rate on record.
Given the sharpness of the drop, the timing with wonkiness in a whole slew of other economic indicators, it's bizarre to me that the author (and experts interviewed) would immediately assume that something changed with workers vs the metric is behaving weirdly.
Thanks for adding some context. The "max" or 25 year view on that chart provides some perspective. Still unusual that there's been a recent decrease, but almost every measure of the economy has seen some really weird values in the past 2 years.
The Washington Post is Bezos's mouthpiece - lower worker productivity hurts his bottom line so we have to suffer through his paper complaining about it.
Also Bezos would like to normalize the intense surveillance, speed focus, and corner-cutting that leads his warehouses to have injury rates 80% higher than the rest of the industry.
These things always really need a giant flashing neon note that "productivity" doesn't mean how much workers get done but how much money is made off of what workers get done. They're only loosely connected, and most productivity gains have come from workers having to "do less" to "make more".
Weird story: From the mid-1970s to the mid-1990s, as-measured productivity significantly declined and then stayed at a lower level. This was during the initial few generations of technological impact on industry, including "just-in-time" inventory which kind of requires computerization. Yet, at this same time, "bosses and economists" were seen in public wondering if computers weren't a net negative on industrial production.
In addition to being weirdly defined, productivity is, as the graph demonstrates, very unstable over the short term.
That really was a net negative eventually. Covid managed to completely wreck the worldwide supply chains because of that idiotic approach. God forbid anyone keep any buffer in case anything happens.
> "productivity" doesn't mean how much workers get done but how much money is made off of what workers get done
This is so true. The amount of bureaucracy has actually increased. This makes every worker work more. But this bureaucracy is unproductive work, thus does not lead to a rise in income (for the company).
E.g. my healthcare provider uses fax machines (yes that FAX) to communicate with insurance providers. Fax is asynchronous and without confirmation/tracking of work done. Often, the fax is sent but the other side simply files it in a random place or forgets to process the work. So, I (the patient) now needs to follow up for weeks with insurance and healthcare provider to check on the status of that FAX.
This is unproductive work and yet, it is taking a toll on every individual involved in this process.
It's even stupider than that: it divides this figure by a largely fabricated estimate of how many hours people actually worked. This is a SWAG metric that is largely made up. The commentary is most likely irrelevant.
I'm really curious how you think it's defined or measured then. I'm obviously abstracting a bit, but a lot of people in the replies here seem to think it's related to how much time you spend watching cat videos on company time and it's definitely not that.
from FRED: "The efficiency at which labor hours are utilized in producing output of goods and services, measured as output per hour of labor."
The solow residual is technically total factor productivity but is generally accepted as labor productivity. it's just an accounting identity that is estimated along with GDP and other vaguely useful but not very accurate measurements like the unemployement numbers.
Perhaps people have had to expend more energy just keeping their personal life together in the last few years. People with children have had to deal with the constant school closings, childcare facility closings, etc. and that has taken its toll. They may have family members who got Covid or had treatment for other ailments delayed by the pandemic's rush to treat Covid patients. They could've experienced a huge shift in the switch to remote working in 2020, and are now expected to make another huge shift back to in-office working.
This doesn't even account for the incredible decline in civility from customers if you work a customer-facing job. The slightest inconvenience or mistake can end up in a tantrum by an American adult that only sometimes gets captured on video. And in the meantime, a bunch of people walk around opining that "Nobody wants to work anymore" as if they deserve to be waited on hand and foot regardless of circumstance.
During Covid, people were hiding in their homes, quarantined, with nothing to do but work.
This year, companies expect workers to return to office, despite little change in conditions, except now we have to deal with all of the above issues you've just mentioned, AND the fact that employees have now proven they can work remotely perfectly well.
It should neither be surprising that in a system where healthcare is tied to employment, that productivity jumped while people were locking themselves in their houses from a plague, or that productivity dropped afterwards, or that it might drop given the complete callousness of our current system.
All of what you've both said, plus the number of people who thought or still think COVID-19 is "no big deal" who now have a pulmonary deficiency and long-term mental fog.
HN aside, most people don't have jobs that you can do more of at home than at the office / factory / lab / school.
Heck, with school it's quite obvious that "teaching hours delivered" sustained during pandemic, but "education learned" dropped by probably half.
I think you’re really on the right track with caregiving, and would add the blind push to force people back into offices without any recognition of the costs of those policies (or, often, perceptible benefits). Going into the office is fairly expensive in any case but it especially pushes parents towards needing daycare and aftercare services which were already expensive before the pandemic and became more so after a non-trivial number of providers found other jobs, became too sick to work, died, or decided the health risk wasn’t worth it after seeing that happen to other people. Our local parents group has had stories about people choosing not to go back to professional jobs because the employers insisting on RTO weren’t paying enough to make up for that, especially if they weren’t accommodating when someone’s schedule is disrupted.
You're right about daycare/school closings. Even now, essentially post-covid, if our two-year-old gets COVID, that's a 10-day quarantine from daycare.
That's 10 days where one of the parents has to work from home and be horribly unproductive because they are watching a child at the same time. And you can get COVID repeatedly. It often from the daycare itself, but also from a sibling who is in school. Even with full, boosted vaccinations, they can still catch it. They don't get very sick, but they have to quarantine.
It's unsustainable.
I'm sure that's not the only cause, but it's definitely a factor.
This is exactly why many people intentionally avoid testing themselves or their children. If you don't have a positive test then officially you don't have COVID-19 and can continue your normal life (symptoms permitting). (I'm not claiming that this is a good practice necessarily but it's what most parents do.)
Not only that, but sometimes even the threat of an outbreak can hamper the availability of childcare. Last winter, a few staff members were exposed to a close contact, so they held them out of work as a precaution - but that resulted in one of the rooms having to close for a week.
sounds like washington state lol. one of the reasons we moved from there.
now at my kids preschool, if a kid gets sick they stay home, if they are better the next day they come back. no PCR tests, no missing 2 weeks if any member of the family was sick, its great
>This doesn't even account for the incredible decline in civility from customers if you work a customer-facing job.
Not sure if you're in a customer facing job, but I've personally noticed that there seem to be noticeably fewer Karens now compared to pre-pandemic levels. (There was a spike during the first lockdown, but that died down within a few months.)
Everyone seems to be used to random disruptions now, and I think all of the campaigns about retail worker abuse have really made customers stop and think.
The working environment changed. Bit by bit I moved from an environment with gentleman's agreements and so on towards something in which everything was codified, safetyism became rampant, etc.
In the UK over the past few years I went from going into a nice office in a number of beautiful old buildings, getting my stuff done with cameraderie, having lunch together and playing board games, having a laugh in the board room, perhaps a pub visit after work - to sitting alone at home for 8 hours staring at a screen.
So I quit. My productivity - gone. And I fear it's never coming back unless that environment comes back; because I can't effectively function at a "job" with zero human interaction for an entire day, I've had to replace traditional work with other activities.
But is it just me? My friends in retail and other low skill jobs - half the workforce seems to have disappeared so they're all being asked to do far more than is realistically possible. My friends who are in education - the entire job changed, no more giggling and laughing children, you were playing a video game with half the class absent. Perhaps they're back now - but they're dysfunctional because their development was neglected for years. My friends who are in law - the entire job changed, no more travel, no dressing up, sit at home with a screen. My friends who are in medicine - christ, let's not even go there, eh?
I can't speak for those people. But I know that I need a reset, because this "new world" is one I'm just not built for.
> towards something in which everything was codified, safetyism became rampant
Those "gentleman's agreements" were not that great if you happened to be a woman, gay or any other minority. The upsides to HR, employment regulation and so on has been making the office a far better place to work for a lot of people.
While I agree that there are rampant problems in a lot of sectors, from low skilled to medical, there have been some wins. My team went fully remote for 2 years and now most people still work 3 days a week from home. We were able to build up a large and talented team during the lockdowns with most of my co-workers and those I manage 3 timezones away. We adopted more flexible working hours and we've never been happier. My manager can take time in the morning to get his kids to creche and I can take a longer lunch to check in on elderly relatives. I no longer spend 2 hours a day stuck in traffic. Our productivity has skyrocketed. We may be privileged tech workers, but the change in work styles has definitely boosted our company as a whole.
I totally agree. Where I work, in-person work became optional. Strangely, everyone 35 or younger decided to work from home (most of them don't have kids, which would be the one decent excuse), but the older people mostly come in. At 34, I'm sort of in-between, but enjoyed bantering with people my age or younger.
So I get the worst of both worlds: my boss can still come in my office at any random time and bug me about whatever, but not the social life or the ability to bounce ideas off each other when designing a new system. All-online communication simply does not work for creative or complex tasks.
The youngsters get practically nothing done -- I worked with them for several years before the pandemic, so I know for a fact that their productivity specifically went down 90% -- and guess who gets to pick up the slack? It turns out that even relatively motivated PhD students actually need in-person accountability and direction, or they just spin their wheels at best, or goof off at worst. No matter what excuses they make, it's not good for them in the long run, since it will be reflected in their CV. I'm not against fun, even during work hours, but you have to get the job done.
It's a medical research institution with a small clinic, so there are, as you suggest, additional issues there. I think science, in particular, requires in-depth, in-person conversations and that is where most of the really good ideas come from.
This has been my experience as well at 32. The commercial real estate firm I work at has a 4 days in the office policy, so we have a fairly robust social atmosphere. You can't design a building on a webinar, you need to sit together in a conference room, roll the blueprints out on the table and point to things, sketch changes, review pro formas.. it can't be replaced digitally.
The young people we're getting are like they're from another planet. They think it's' fine to come in late and leave early every day, they only do the bare minimum of work assigned and show zero engagement to help the firm beyond the scope of their assigned tasks. They're all coming from colleges that were remote or jobs that were work from home. How can you learn as a young professional in a work from home setting? You need to sit in on meetings, phone calls and discussions, you need to absorb the whole office around you, not just sitting alone at your computer.
>It turns out that even relatively motivated PhD students actually need in-person accountability and direction, or they just spin their wheels at best, or goof off at worst.
You don’t have the data to shows that in-person is necessary. And there are plenty of remote-only companies that make it work. It sounds like you’ve decided that there can only be one possible solution and then given up. That kind of thinking might explain a whole lot about the situation.
No. I go into the office every day because I feel the same. I need to get out of the house and see people. (It is OK if you, reader, do not feel this way! People are different!) There's a handful of other folks who come in every day. I'm starting up a project this week to revive our office culture a bit, to try to spring back from the COVID devastation.
I think a lot of us work-from-home preferrers also like (good) offices better than WFH, just not to the tune of hundreds of dollars and tens of hours lost per month.
I've been working from home since about 2017. I kind of echo this. In the beginning it was nice, I had a HUGE productivity boost. After a while I became disconnected from everything. The other day I realized the only adult I talk to reguarly in person is my wife. Somtimes on weekends I talk to a store clerk. Zoom meetings don't fill that missing spot, it's just work, and I have very little personal connection with any of my coworkers... Days and weeks and months seem to merge.
I'm an introverted person, I like solitude. But I guess all things in balance, it would be nice to talk to another adult once in a while about something that's not work.
I got really into Crypto, because Crypto seems to have a heavy focus on community. It was fun to fly to NY and talk to others in the community. But then I flew home, and the spot was missing again.
Exact same boat dude. I miss the before-fore times a lot and still cannot believe how we got to this position.
Still trying to figure out whats next for me. This WFH shit is gonna stick around in our industry for a while... and it just isn't compatible with how I function. I have no clue what to do next.
I don't consider myself particularly outgoing, but I'm glad to be back in the office 4 days a week. I really enjoy collaborating in person over a laptop or whiteboard, and shooting the breeze with my colleagues.
That said, I don't have an overly long commute, so I totally get it for those that are able to be more productive due to not spending hours in the car every day.
I notice that when I'm working from home, I'm much more likely to goof off and be less focused. Plus my wife being there is always distracting me with one thing or another. I'm pretty sure I'm quite a bit less productive working from home.
I love that this comment defines productivity as lunches, jokes, playing board games, and going to the pub. Though, I agree all those things are more fun than sitting at a computer.
The very important context is that productivity sharply rose in 2020, in the middle of the Covid recession. The recent drop in productivity is mostly just a return to pre-pandemic baseline.
The simplest explanation is probably just that the workers who were laid off during Covid were the least productive, and so average worker output went up, then fell as they re-entered the labor force. Or maybe even just there was some sort of abberation with how the complex statistic or productivity was calculated (e.g. inflation was actually here earlier than measured by CPI, and output was deflated incorrectly).
Either way, this is much more likely a pandemic related disruption and return to normalcy, rather than an indication that anything fundamental is "broken"
I’m not sure if this is your point, or just that it’s population level, but there is certain to be lag in the measure. I.e. if I contribute $10B to GDP in Q3, and lay off 10% of the workforce, my productivity looks great, but a large portion of that contribution will stem from work done by a larger workforce in Q2, Q1, and before, perhaps well before.
So the measurement during periods of recession or expansion will always be artificially elevated or suppressed.
I'd argue it was also due to lack of alternative options for leisure time. When everyone was stuck at home there's only so much Netflix the avg person can watch. People likely spent some extra time on work because it was something to do.
Now with everything reopened there are many more options.
There is a similar effect in some countries with strict labor laws which make it difficult to fire employees. Unemployment rates end up being high, but productivity is also high because companies are only willing to hire the most productive workers and won't take a chance on anyone else.
Similar things happened during the Great Depression. Many things made in that era before the war are highly sought after since the craftsmen who had jobs at the time were often among the best in their field.
Yale’s new employee tour was like that, too. They walked us around campus and one of the things they highlighted was how much nicer the Depression-era stuff was than the decades before or after because the amount planned suddenly bought a lot more and they apparently had a windfall in the form of top-notch Italian stone workers who’d immigrated because the job market was even worse back home.
Note that this is like, how every recession works -- we lay off people, and productivity spikes. The fact that we did the same thing during a government imposed recession shouldn't be surprising at all.
it reads "annual percentage change in labor output"... which I take to mean "rate of change of per capita productivity" over time, not actual measured productivity.
So that graph does not say we've dropped below pre-pandemic levels.... according to this report (https://www.bls.gov/news.release/prod2.nr0.htm): "Output and hours worked in the nonfarm business sector are now 3.1 percent and 1.5 percent above their fourth-quarter 2019 levels, respectively."
Not OP, but your reply comes off as pretty rude, especially as I think its pretty off base.
The chart is showing "annual percentage change in labor output", not "gross productivity" which I think supports the OPs point.
If it went up 10% in 2020, and 6.3% in 2021 (or whatever the graph is showing), just because there is a -7.4% drop in 2022 doesn't mean its "far below any pre-pandemic baseline".
In fact it's probably ABOVE pre-pandemic levels, even with the drop. I can't be certain from graph.
It could also be a generalized disillusion in the system. I believe what pushed americans through for generations was the american dream. No american believed to be poor, they were all simply "future millionaires".
But what if people realized that it was only a delusion, that it can never be that everyone is rich, because then who would do the dirty jobs? There is no social pyramid without a base, this system is litterally designed to have a class of poor people forced to do shitty jobs to survive.
If you take away the hope of a wealthy future, there are no reasons left to slave away your life on a corporate ladder.
consider that small business people had done their daily things for thirty years, not been chatting on the Internet; many of those local biz people relied on walk-in customers, and many of those local biz people are part of the Boomer generation. Those people paid their bills and participated in the general economy.
At the same time, corporate outsourcing reached epic proportions, with the associated transfer of power in the HR and Exec realms.
The history of that EPI report is useful to know. Early versions of it showed a large gap between rising productivity and stagnating employee compensation.
Some critics then pointed out problems with the analysis [1]. The report performed an apples-to-oranges comparison of productivity of (A) all non-farm workers adjusted over time with a (B) GDP deflator-based inflation index compared with the compensation of (A) a limited subset of employees adjusted over time with a (B) CPI-based inflation index. A more useful comparison would use the same inflation index for both data sets and would exclude from the productivity measure the workers that are also excluded from the compensation measure. When this is done, the growth in productivity and pay rise and nearly in lockstep, thus effectively refuting the majority of the point that the original report was trying to make.
Since then, the EPI report has been updated to be more nuanced, which can be especially seen when one expands the 'click here for more...' sections. The new conclusion from the report is that productivity and compensation increases have been increasing primarily for a subset of workers while a broad subset of workers have not seen large productivity and compensation growth. This is true (as far as I can tell), but it's also a different story with different policy implications than the original story which implied diverging productivity and pay within the same set of workers.
It's supply and demand - the supply of workers has doubled the last decades while demand has remained roughly the same. I think it's a miracle that salaries are so high currently.
Assuming that's true--and I'm not sure it is--mass retirement of baby boomers, which has already begun due to forced retirement during the pandemic, is going to absolutely decimate the labour supply, which has enormous knock-on effects (including a rise in inflation).
> Productivity kept on climbing and wages stagnated post ~1980
The growth of government sopped up the difference. Nothing the government does comes for free, and then there's all the additional costs of complying with regulations and doing all the paperwork.
Readit News
People in tech keep thinking more tech will solve problems and they keep underestimating the flexibility of the old models. For instance, most large companies used to be run by armies of secretaries, and the senior secretaries functioned as what we would now call "project managers" -- they made calendars, oversaw who was working on what, followed up to keep track on whether work was being done, and kept a close eye on what money was being spent. The crucial thing about having humans overseeing such work is that humans can take a flexible approach to the rules: they know when to break them. By contrast, systems that are highly dependent on software tend to be more rigid. Software doesn't know when its rules should be broken.
The flexibility of the old system is constantly underestimated, the rigidness of the new systems is often misunderstood.
In his book "The Design Of Design" Fred Brooks talks about the power of trust, and he contrasts that situations where everything needs to be first negotiated and specified in a contract. High trust systems are flexible and fast, whereas a system where every detail needs to be specified in a contract is slow and rigid. We should stop and ask ourselves, our favorite Agile methodology resembles which of these? Are specifying things with needless detail?
I remember pretty early demos in early/mid 2000s when I was doing some clinical grunt work in college. I had written some software to make my department’s life easier so I was offered up as the hospital’s liaison for the software evaluation. This is when I formed my “never replace a terminal based app, with a GUI based app and expect productivity gains” theory. Everyone working in the hospital knew the terminal app, they type in some random 3 letter code and a screen would pop up. Then they would memorize how many tabs each field was apart from each other. Without a mouse, people could just hum along imputing data a blazing speed once some muscle memory was in place. Everyone had little cheat sheets printed out for the less frequently used commands/codes. When you replace this with a browser/desktop GUI with selectors and drop downs and reactive components of GUI, it tends to 1) require mouse usage for most people and 2) lose the ability to do this quick data entry I described. The pretty interface becomes a steady stream of speed bumps that reduce productivity. Since then I’ve witnessed it in banking and other industries too.
Early GUI's didn't have the problem you describe because they were designed as discovery mechanisms to the underlying function. AKA, the idea was that after clicking File->Save a dozen times you would remember the keyboard accelerators displayed on the right hand side of the menu. Or if nothing else, Remember that the F in File was underlined along with the "S" in Save (or whatever). Which would lead people to just press ctrl-s, or Alt-F, S. Then part of testing was making sure that that the tab key moved appropriately from field to field,etc.
I remember in the 1990's spending a fair amount of time doing keyboard optimization in a "reporting" application I wrote (which also had an early touchscreen) for use by people who's main job wasn't using a computer. Then we would have "training" classes and watch how they learned to use it.
So, much of this has been lost with modern "GUI's", even the OS vendors which should have been keeping their human interface guidelines updated, did stupid things like _HIDE_ the accelerator keys in windows if the user wasn't pressing the Alt key. Which destroys discoverability, because now users don't have the shortcut in their face. Nevermind the recent crazy nonsense where links and buttons are basically the same thing, sometimes triggering crazy behaviors like context menus and the like. Or just designing UI's where its impossible to know if something is actually a button because the link text is the same color as the rest of the text on the screen..
Then the computerized systems "replaced" that staff but all that really means is they cut the human time needed low enough that full-time workers weren't needed, but didn't eliminate it, so now that's another thing doctors have to do themselves.
AFAI can tell, the effect of tech overall is to cut some jobs while making the remaining ones harder and more stressful, while increasing so-called context switching.
First, yes, productivity was one of the goals of the forced move to electronic health records systems. The federal government passed the HITECH Act in 2009 creating economic incentives for doctors to switch to EHRs because it would be better for public health, Medicare billing, and also because it would supposedly unlock doctors to spend more time with patients and be more productive, via the use of technology.
The reason that third thing has failed, to my mind, is largely because the government, in the same act, required a HUGE list of requirements be met by the software designers making the EHRs. This list, by law, needs to be prioritized in scrums over customer requests and design thinking. Sometimes it makes good UX impossible.
Ironically, the government, hearing this feedback, actually added a new requirement to the list: "Safety-Enhanced Design" [0].
Go read that regulatory requirement and see if it makes any sense to you. That's why design sucks in EHRs.
[0] https://www.healthit.gov/test-method/safety-enhanced-design
Going a little further, this was appealing in part to avoid simple medical errors & oversights. Losing the record, mixing up records, incomplete history, and so on. Eliminating medical error is incredibly valuable but doesn't show up as "productivity".
I guess they also make more sense to management since it looks like something they could do themselves, or at least understand.
I can imagine this being true. It seems that almost the whole software industry has failed to grasp the distinction between an appliance and a tool. An appliance you expect almost anyone to be able to use without training. A tool, well you are expected to learn how to use it, and after that, you are much more productive than before. And most software seems to be moving towards appliance.
Not in medicine (run a small e-commerce business selling mostly used video games), but definitely noticed the same thing for us.
We have some terminal-based Python scripts I wrote to automate a lot of the data entry tasks like listing and shipping (entering tracking numbers, printing labels).
Everyone that uses the scripts is initially apprehensive, but then after maybe a day of getting used to the terminal turns into a powerful data entry God and they love it. Even had an employee gush about our shipping tool to a random supplier.
Absolutely no way a modern system could be half as efficient, short of completely automating the whole job (which involved a lot of communication with other parties and basically freeform restrictions).
As the company customized more and more of the code base, upgrades to the system became more and more difficult. Every upgrade required a manual comparison of custom code to be merged with the baseline code. This led to skipped upgrades, and eventually a cessation of upgrades. Of course, after no upgrades over a long period of time it was eventually decided to move to a new ERP system.
I am still appalled at the things sacrificed to prevent disruption of a small group of peoples work flow.
Considering how often I have to fill out the same goddamn forms (sometimes literally down the hall in the same building as another doctor), I think that goal failed miserably.
Thing to remember finance/economists/rentiers have a different definition of efficiency and productivity than you do. In this case the productivity has to do with billing not the uninteresting things that doctors do. By reducing the cost of billing and forcing doctors to document more things to be billed more money can be extracted.
I'm not entirely sure about this. During the early digitization era productivity was a big driver. Modern word processors are a godsend if you've ever tried to typewrite a document for publication (forget anything with complex formulae) or dealt with actual physical spreadsheets? Office itself and it's now many clones is a fantastic set of tools for productivity.
My opinion is that we've created a world in technology now that drives technology for the sake of tech and financial drivers. I regularly deal with people who think it would be a great idea to build a system to automate some aspect of business that's already well optimized or generalize something they thing is general but is really quite niche.
There are certainly cases where it makes sense to develop a system around something but you need to consider the full cost/benefit tradeoffs, not just benefits which industry tends to do.
This comports with my most recent experience using SAP in 2018. I know, I know, SAP has GUIs and such now. This well known and profitable corporation under the Blackstone umbrella, though? Nope. It was exactly as you describe.
Those who had the time-in-service or the mentality to accept it excelled at their job, but uniformly skewed older (late 40s and up) or younger (under 25). At the time, almost everyone aged in between was entirely befuddled by it all.
Context: supply chain, procurement, purchasing, logistics, maintenance, work orders, inventory
Which translates into productivity. If something is standard, digital and transferable it means you can increase the rate of output in relation to its input (which is the definition of productivity).
Productivity is indeed a selling point.
I will also tell you that EHR software is universally hated by doctors. Does not matter who makes it. The company that cracks that will make billions.
One interesting idea was a voice assistant wired up to take inputs as doctors did their work. I don't think it went anywhere (yet).
Well, EHR is a glorified billing platform.
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Related to this, but in a completely different context, I have had similar thoughts lately when eating out at restaurants in Spain. It's incredibly frustrating from a customer's point of view when the waiter taking your group's order has to use a newfangled tablet or phone-like device and tap through each individual order, often depending on the peculiarities of the app's UI and how the designers expect the process to carry out: “Are you all having the set menu? No? OK, first I need to know how many of you are having it?" [taps count on screen] "Right, now I need the starters but ONLY for the set menu orders..." etcetera—you get the idea. Then, while going through this unnecessarily slow process, God forbid someone who ordered from the set menu wants to change their main while the waiter is already taking the à la carte orders.
Meanwhile, in restaurants that haven't unnecessarily techified the procesz, the waiter can take the order in the way that's most practical given the circumstances and that best fits his way of taking notes. Ah, but then how does the order reach the kitchen without the tech? I have no idea, all I can say is that it worked fine before these things were put in place, and the manual system is by far the quickest and most flexible from a customer's point of view.
"I'd like a quarter pounder with cheese and fries" is utterly unacceptable for buying a house or taking out a car loan, but it's the ideal way to order lunch. The people marketing, designing, and writing the application software have never worked in the business, of course, lack of experience has never made people like that pause, so they have peculiar ideas resulting in enforcement of weird and unproductive business processes.
At least they don't require that we install an App. But I'm sure someone's thinking that would be a good idea.
It’s less the software, and more the users, site-specific configuration and the environment they work in.
Non-US Epic users spend 20-60% less time on various EHR activities than their US counterparts. One of the most dramatic differences is time spent on ordering, which you would think would be as optimized as it could be.
Time spent documenting was 40 minutes/day for US users and 30 for non-US on average. Maybe some spend 50%, but that’s far from average.
https://jamanetwork.com/journals/jamainternalmedicine/fullar...
Another study found US clinicians write 4x longer notes (cited in above).
Now, does any of this improve clinical outcomes?
I wasn't aware of this, but as the spouse of a medical provider I know that most US providers are burdened with an ever-present worry about malpractice.
I don't think "by almost any measure" is right. I think in a very narrow sense they've become less productive (they see fewer patients), but by your own admission they're building databases of patient data, which you seem to suppose are only useful to the likes of Epic, but obviously Epic has customers--notably healthcare researchers use this data to improve patient care, develop new medicines, and to precisely identify which medicines are likely to help on a particular patient (and which medicines may even harm them!). This is stuff clearly benefits society, and doctors' role in this should be counted as "productive", although we can quibble about the relative value of facilitating healthcare research versus seeing more patients.
Note that this isn't meant to vouch for Epic--I work for a company that consumes their data and anyone who has to integrate with them has nothing good to say about the software, but the role it plays is still incredibly important.
The majority of the notes being written by doctors now is boilerplate. A lot of it is copy-pasted. It's written because of insurance companies (which have incentive to deny claims), because of liability (which gives incentive to leave a lot of notes behind to make it looks like you thought about everything under the sun even if it wasn't applicable), and because of well-meaning but ultimately overly broad laws adding additional requirements even when they don't quite make sense.
I'm sure there is a treasure-trove of valuable data in there, especially compared to when it was all hidden away on physical paper. But you could probably reduce the paperwork that doctors do these days by a factor of 4 and not loose anything of value.
The point of extensive documentation is shielding from the worst of malpractice lawsuits. The legal system is still of the legacy opinion that doctors have a responsibility to their patients as opposed to the more modern understanding of responsibility toward pharma company bottom lines, and all patients legally deserve the 100% successful participation trophy, so a documented decision with only 95% chance of success means insurance payouts about 5% of the time, unless its carefully documented it was all the patients fault or at least the MD could not have known the outcome in advance.
With that said, I think most healthcare is correct to take a "patient centric" approach. What the OP seems to be making is a "doctor centric" take and, if one was to be overly cynical (I'm not), your post may skew to the side of a "researcher centric" or "societal centric" approach. Doctors should do what's best for their patient, not necessarily what's best for society, or themselves, or a lawyer, or a research lab. It's easy if you work in one of those tangential areas to take your eye off the ball.
As you’ve pointed out, access to those information systems is critical. I’d add the distribution of that information as well as the right economic incentives to participate in using that information.
I’m not sure we’ve really got any one of those things right.
Edit: adding a bit of humanity to the system, as the OP is hinting at, could very much be a part of the fix.
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He habitually called me "friend" and was very frank about my insurance not paying for stuff I was asking about, which I appreciated. He also once profusely apologized to me for placing a computer in between us. He said the new requirements of his practice made it so he had to pay more attention to the computer than to me, and we were both sad about that.
The doctors I got after that make no such apologies.
It may or may not be true (I suspect some of the stories on that site are made from whole cloth), but it speaks to your post.
More recently in my field I've seen additional layers of documentation requirements that have nothing to do with insurance, that are entirely state law.
I have no doubt in my mind that if EHR rules didn't exist, they would have been adopted much more gradually, and selection would have been dictated by the ability of EHRs to supply features in demand. More competition would have existed and it would have cost less. Maybe some government regulation would have been needed in terms of interoperability standards but it could have been rolled out much much much better.
I don't think people fully comprehend the cost overruns associated with adoption of EHRs under government mandates, or how big of a shift there was from records being in-house flexible, and provider and patient-driven, to out-of-house inflexible, and IT-corporation-driven.
Cerner has a contract to fix that.
But if medical pricing was such that insurance wasn't required, then patients would better audit their own care receipts and this fraud issue would eliminate itself, and as a side benefit we'd have sane pricing for medical care.
Our apps security policy put the kibosh on that and I had to destroy my account once I realized it would not be feasible to keep it going forward.
My employer is really conservative about allowing 3rd-party apps, which is great for security, and puts us in a veritable Stone Age of productivity.
https://www.youtube.com/watch?v=xB_tSFJsjsw
I'm not sure whether this choice was a case of incompetence or corruption, but the end result is clearly a giant waste of money. Maybe it generates a lot of data, but efficiency would be way more important for an organization like this which is chronically underfunded and staffed.
My daughter works at Epic, and she explained that one (though not the only one) of the big reasons health care is so expensive is because Drs have so many record-keeping requirements, and one reason they have these is because of liability. It would greatly help if Americans weren't so lawsuit trigger-happy. The real winners are the lawyers (and insurance companies).
You are high if you think we are better off with paper than an ePCR.
Sometimes we have to default back to paper, some times the pt record system goes down.
When that does happen, it's a literal fucking nightmare in the ER.
We plan on it happening and we train for it happening, but ePCRs have made our lives so much fucking easier. Simple fucking fact.
Have you ever had to read the pissed off notes in a hand-written chart from the last nurse who has been working 48 hours straight, taking care of 12 critical care pts? Huh? Give that a try sometime.
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With big systems though I honestly think GUIs can only go so far, even at their very best, and any system that is required to be complex at some level will require expert knowledge of the system itself. That’s extra work and an extra burden for someone with the critical experience that an organization relies on.
For doctors and the like it would make sense to try a system where the critical person/expert has an assistant who is a systems expert and does a lot of the needed data entry and the like. Doctor doesn’t have to worry about the system, they can talk to the assistant who manages all the extra work. If the system needs to change for any reason the assistant manages that and the doctor doesn’t have to worry about it.
I think of this assistant role as the human API layer. It’s not far off from some social programs like insurance navigators, who help individuals find health insurance, including working through options and even—critically—filling out forms for folks.
ETA: It’s a thing! I didn’t know: https://en.wikipedia.org/wiki/Medical_scribe
I recognized this problem in the 90's because I worked at a manufacturing plant where the software, even then, was getting in the way of workers needing to do something a bit non-standard (they developed workarounds over time).
It's also why I'm a big fan of the 80% solution, I think there's a level of hubris involved in going for the 100% solution for everything.
To your point about trust, it's something I've been thinking about recently. Not trust, but the authoritarian nature of software, which expresses itself and is purchased for the ability to distrust. You'll see this in things like debates about whether or not developers should be allowed to affect the deployment via yaml files or not. What makes it difficult is there is often a legitimate need for these sorts of systems, especially for regulatory compliance, but more often than not they just get in the way of actual work.
I'd ask another question: did lawsuits decrease? I'd imagine that a lot of this software is to avoid lawsuits. America is especially litigious and that's got to correlate strongly with the increase bureaucracy.
I also suspect that a factor at play is that people are losing trust in the whole system. Most people now know that productivity has skyrocketed while salaries have remained relatively flat. With increasing economic disparity (not even just the West) it is no wonder that people become less productive. Who tries hard at a game that they believe is rigged against them? (doesn't matter if it is or isn't, just the belief)
> People in tech keep thinking more tech will solve problems
Because historically it has. But there are different types of tech. Tech enabled the modern world. It is the new medicines we have to cure illnesses that devastated populations. It is the chemicals that enable us to grow enough food to sustain our populations. It is everything from a wheel to the computers we use to make more efficient wheels that use less resources. But it is also naive to think that tech alone can solve every problem. It is also naive to think that tech can't create new problems. To create tech that solves problems we need to think long and hard about the intricate complexities involved and gather the expertise from relevant domains (an often missed, but essential, component). The other problem is that people hand wave away things like climate change saying "tech will solve it" rather than investing in said technology and waiting for it to magically appear. I do think tech is an important tool in solving many of the problems we face, but you're right that they are not all technology dependent (which is a continuous scale of weights, not a binary option).
Also, we're a tech forum. Peoples' expertise here is in tech. So they see things through that lens and it is also very likely that the most we/they can contribute to solving these problems is, in fact, through technological means. The trick is to remember that tech isn't a cure-all and that the problems we face are exceedingly complex. Over simplifying is often harmful.
I love our current preschool precisely because they use very little technology: we actually talk to the teachers during drop-off and pick-up if needed, and get maybe one email a month. Their expressed philosphy is to be "present" with the kids and spend as little time as possible on other (administrative) things.
Everyone was very busy but it was very hard to get actual care.
Just to provide an example of this I ran into today: I'm doing a medical physics residency, and my supervisor was explaining that a new "fail-safe" incorporated into the software that reverted the collimator after every scan was now making the phototimer tests take twice as long, because we had to go back into the room and reset the collimator repeatedly. We tested a machine with the new system and one with the old system and it did in fact turn a 15-minute task into around 35 minutes.
Now, your company pays insane amounts of $ for software, systems, and data! You have to do your job, schedule your meetings, keep up with the ungodly amount of email, instant message, SLACK, enter the data in your CRM, talk on the phone, schedule the video meetings, etc. while also keeping track of your personal phone because your partner called or the school called and your dog is sick. There's just so much distraction now by not having "office hours" and having our whole lives in our pockets and constant reach that I think productivity has to go down. It's impossible to focus on anything for any amount of time anymore with how accessible we are expected to be.
To contrast, my first job was an accounting program. We spent weeks on making sure everything works via just the keyboard and some operations are as streamlined as possible. Because in some cases it was going to be used by people creating hundreds of invoices per day.
Figuring out the right amount of automation in business is hard. Too much automation makes the company too rigid to the point of breaking but too little reduces productivity. This is a dilemma that factories/companies have to constantly re-learn. We see it regularly. A new manager comes in and decides that a company can save a truck load of money by completely automating production. But soon finds out that there are too many variables in life and that total automation can't work. The goal should be to find the sweet spot that produces the maximum while being flexible to change. But I don't think this is why productivity is dropping.
I suspect it's related to the reduction of reliance on foreign factories. The US wants to reduce the reliance on foreign manufacturing and bring all of that production back to the US. That will take time, capital and ability to learn how to do the work here. That will hit productivity hard. All than change won't happen cost free in terms of productivity and assets. The change started a few years ago. We are beginning to see the result.
The latter in my experience ends up providing better results to physicians as they have been employed as domain experts in building the software solution to their specific workflow. I've seen it done for in ophthalmology, specific disease/injury specific radiology, and diabetic specific checkup and appointments where I've seen as much as a 75% reduction in the amount of time the physician has to dedicate lookup up info, cross-referencing, and documenting.
Then you upgrade and everything breaks!
But it’s an age old battle for and against standardization. I just walk around with several charging cables because each is “the best” for charging a small li-ion battery.
Computers are just state machines, without determinism and a few other properties they do not perform work. Determinism means there is only one next possible state/action.
Breaking rules would imply there are two or more possible states or actions, and that is a class of problems that computers cannot solve (they talk about this in compiler design courses). Most people subscribe to magical thinking because they don't know how computers work, or what they are even.
I know many Drs and especially nurses who CYA on all their documentation otherwise insurance will try to pin them on an adverse reaction.
You will also find many cases where even good providers let things slip through the cracks and fail to give some patients the appropriate level of care. For example, diabetics should generally receive annual foot exams, eye exams, and hemoglobin A1c tests. If the payer doesn't see evidence of those in the EHR then they can prompt the doctor to resolve that care quality gap.
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In case it's of interest I wrote an article a couple of days ago on how "Digital Systems Fail Institutions" [1].
[1] https://techrights.org/2022/10/26/when-digital-systems-fail/
But even here, the purity of the labor market is hampered by rules designed to protect the laborer- osha rules, overtime rules, rules about how much a person can be controlled, and so forth. If you eliminate all those, and focus only on the making labor freely able to be bought and sold, you can begin to see what a completely pure free market for abstracted, commodity labor would look like.
It is this: The most pure example of a free market for labor is a slave auction.
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What's the source?
In a way, all might be a huge early optimization.
To be concerned about the current level of productivity requires either the attention span or the intelligence of a goldfish.
https://tradingeconomics.com/united-states/productivity
The fed is increasing interest rates to keep dollars attractive as a world currency and allows the US governments to keep increase national debt whithout sending interest rate of through the roof.
It may seem counter-intuitive, but letting inflation going out of control would have a major negative impact on demand of debt issued in dollar or, to make it short, US government debt.
The only alternative would be to fund government spending with government revenues. Which means, increase taxes for categories of revenues which amount the most in national revenues.
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It annoys me that an article about a big drop in workplace productivity doesn't actually say how big the drop is. If it's only 3.6%, then that explains why they glossed over that part, as it would have undermined their narrative.
Which, in generating lots of hate clicks, is a huge economic boost in terms of Nonfarm Business Sector Labor Productivity!
Given the sharpness of the drop, the timing with wonkiness in a whole slew of other economic indicators, it's bizarre to me that the author (and experts interviewed) would immediately assume that something changed with workers vs the metric is behaving weirdly.
My niche has shot through the roof for demand salary and remote with no sign of turning back.
My only macro explanation is 20% left the gig totally.
https://thesoc.org/amazon-primed-for-pain/
It seems like the median journalistic piece assumes this of the reader anyways?
Good thing I have both.
In addition to being weirdly defined, productivity is, as the graph demonstrates, very unstable over the short term.
If you want a longer version of the graph in the article, see "The 1990s Acceleration in Labor Productivity: Causes and Measurement" from 2006 (https://files.stlouisfed.org/files/htdocs/publications/revie...), page 190 (10 of 22).
That really was a net negative eventually. Covid managed to completely wreck the worldwide supply chains because of that idiotic approach. God forbid anyone keep any buffer in case anything happens.
*in the USA.
The post-bretton woods era is one of globalization, with American jobs being sent overseas (to more productive labor forces)
This is so true. The amount of bureaucracy has actually increased. This makes every worker work more. But this bureaucracy is unproductive work, thus does not lead to a rise in income (for the company).
E.g. my healthcare provider uses fax machines (yes that FAX) to communicate with insurance providers. Fax is asynchronous and without confirmation/tracking of work done. Often, the fax is sent but the other side simply files it in a random place or forgets to process the work. So, I (the patient) now needs to follow up for weeks with insurance and healthcare provider to check on the status of that FAX.
This is unproductive work and yet, it is taking a toll on every individual involved in this process.
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The solow residual is technically total factor productivity but is generally accepted as labor productivity. it's just an accounting identity that is estimated along with GDP and other vaguely useful but not very accurate measurements like the unemployement numbers.
This doesn't even account for the incredible decline in civility from customers if you work a customer-facing job. The slightest inconvenience or mistake can end up in a tantrum by an American adult that only sometimes gets captured on video. And in the meantime, a bunch of people walk around opining that "Nobody wants to work anymore" as if they deserve to be waited on hand and foot regardless of circumstance.
This year, companies expect workers to return to office, despite little change in conditions, except now we have to deal with all of the above issues you've just mentioned, AND the fact that employees have now proven they can work remotely perfectly well.
It should neither be surprising that in a system where healthcare is tied to employment, that productivity jumped while people were locking themselves in their houses from a plague, or that productivity dropped afterwards, or that it might drop given the complete callousness of our current system.
That's 10 days where one of the parents has to work from home and be horribly unproductive because they are watching a child at the same time. And you can get COVID repeatedly. It often from the daycare itself, but also from a sibling who is in school. Even with full, boosted vaccinations, they can still catch it. They don't get very sick, but they have to quarantine.
It's unsustainable.
I'm sure that's not the only cause, but it's definitely a factor.
now at my kids preschool, if a kid gets sick they stay home, if they are better the next day they come back. no PCR tests, no missing 2 weeks if any member of the family was sick, its great
Well, you kids have fun.
sound of me closing the door in my pyjamas with a nice hot coffee in my other hand
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Not sure if you're in a customer facing job, but I've personally noticed that there seem to be noticeably fewer Karens now compared to pre-pandemic levels. (There was a spike during the first lockdown, but that died down within a few months.)
Everyone seems to be used to random disruptions now, and I think all of the campaigns about retail worker abuse have really made customers stop and think.
https://www.youtube.com/watch?v=3yUMIFYBMnc
The working environment changed. Bit by bit I moved from an environment with gentleman's agreements and so on towards something in which everything was codified, safetyism became rampant, etc.
In the UK over the past few years I went from going into a nice office in a number of beautiful old buildings, getting my stuff done with cameraderie, having lunch together and playing board games, having a laugh in the board room, perhaps a pub visit after work - to sitting alone at home for 8 hours staring at a screen.
So I quit. My productivity - gone. And I fear it's never coming back unless that environment comes back; because I can't effectively function at a "job" with zero human interaction for an entire day, I've had to replace traditional work with other activities.
But is it just me? My friends in retail and other low skill jobs - half the workforce seems to have disappeared so they're all being asked to do far more than is realistically possible. My friends who are in education - the entire job changed, no more giggling and laughing children, you were playing a video game with half the class absent. Perhaps they're back now - but they're dysfunctional because their development was neglected for years. My friends who are in law - the entire job changed, no more travel, no dressing up, sit at home with a screen. My friends who are in medicine - christ, let's not even go there, eh?
I can't speak for those people. But I know that I need a reset, because this "new world" is one I'm just not built for.
Those "gentleman's agreements" were not that great if you happened to be a woman, gay or any other minority. The upsides to HR, employment regulation and so on has been making the office a far better place to work for a lot of people.
While I agree that there are rampant problems in a lot of sectors, from low skilled to medical, there have been some wins. My team went fully remote for 2 years and now most people still work 3 days a week from home. We were able to build up a large and talented team during the lockdowns with most of my co-workers and those I manage 3 timezones away. We adopted more flexible working hours and we've never been happier. My manager can take time in the morning to get his kids to creche and I can take a longer lunch to check in on elderly relatives. I no longer spend 2 hours a day stuck in traffic. Our productivity has skyrocketed. We may be privileged tech workers, but the change in work styles has definitely boosted our company as a whole.
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You just say that like it's a fact, but... why would that be the case?
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So I get the worst of both worlds: my boss can still come in my office at any random time and bug me about whatever, but not the social life or the ability to bounce ideas off each other when designing a new system. All-online communication simply does not work for creative or complex tasks.
The youngsters get practically nothing done -- I worked with them for several years before the pandemic, so I know for a fact that their productivity specifically went down 90% -- and guess who gets to pick up the slack? It turns out that even relatively motivated PhD students actually need in-person accountability and direction, or they just spin their wheels at best, or goof off at worst. No matter what excuses they make, it's not good for them in the long run, since it will be reflected in their CV. I'm not against fun, even during work hours, but you have to get the job done.
It's a medical research institution with a small clinic, so there are, as you suggest, additional issues there. I think science, in particular, requires in-depth, in-person conversations and that is where most of the really good ideas come from.
The young people we're getting are like they're from another planet. They think it's' fine to come in late and leave early every day, they only do the bare minimum of work assigned and show zero engagement to help the firm beyond the scope of their assigned tasks. They're all coming from colleges that were remote or jobs that were work from home. How can you learn as a young professional in a work from home setting? You need to sit in on meetings, phone calls and discussions, you need to absorb the whole office around you, not just sitting alone at your computer.
You don’t have the data to shows that in-person is necessary. And there are plenty of remote-only companies that make it work. It sounds like you’ve decided that there can only be one possible solution and then given up. That kind of thinking might explain a whole lot about the situation.
No. I go into the office every day because I feel the same. I need to get out of the house and see people. (It is OK if you, reader, do not feel this way! People are different!) There's a handful of other folks who come in every day. I'm starting up a project this week to revive our office culture a bit, to try to spring back from the COVID devastation.
I appreciate your message. Good luck.
I'm an introverted person, I like solitude. But I guess all things in balance, it would be nice to talk to another adult once in a while about something that's not work.
I got really into Crypto, because Crypto seems to have a heavy focus on community. It was fun to fly to NY and talk to others in the community. But then I flew home, and the spot was missing again.
Still trying to figure out whats next for me. This WFH shit is gonna stick around in our industry for a while... and it just isn't compatible with how I function. I have no clue what to do next.
Just wanted you to know that you're not alone.
That said, I don't have an overly long commute, so I totally get it for those that are able to be more productive due to not spending hours in the car every day.
I notice that when I'm working from home, I'm much more likely to goof off and be less focused. Plus my wife being there is always distracting me with one thing or another. I'm pretty sure I'm quite a bit less productive working from home.
More generically: young kids require attention, then we grow up and most adults desire attention but only get a little.
Even very high status individuals often seek attention (Elon & sinks?). I wonder how much of our status economy is about getting attention?
Giving great attention can be quite the aphrodisiac.
The simplest explanation is probably just that the workers who were laid off during Covid were the least productive, and so average worker output went up, then fell as they re-entered the labor force. Or maybe even just there was some sort of abberation with how the complex statistic or productivity was calculated (e.g. inflation was actually here earlier than measured by CPI, and output was deflated incorrectly).
Either way, this is much more likely a pandemic related disruption and return to normalcy, rather than an indication that anything fundamental is "broken"
Productivity almost always goes up in a recession, especially one accompanied with massive layoffs (like early COVID).
Productivity is going down right now compared to 2020 because we are pretty much at full employment.
These productivity measurements aren’t really tracking individual productivity at all.
So the measurement during periods of recession or expansion will always be artificially elevated or suppressed.
Now with everything reopened there are many more options.
Musical instruments from the 30’s are legendary.
Their chart shows we are far below any sort of pre-pandemic baseline.
So that graph does not say we've dropped below pre-pandemic levels.... according to this report (https://www.bls.gov/news.release/prod2.nr0.htm): "Output and hours worked in the nonfarm business sector are now 3.1 percent and 1.5 percent above their fourth-quarter 2019 levels, respectively."
The chart is showing "annual percentage change in labor output", not "gross productivity" which I think supports the OPs point.
If it went up 10% in 2020, and 6.3% in 2021 (or whatever the graph is showing), just because there is a -7.4% drop in 2022 doesn't mean its "far below any pre-pandemic baseline".
In fact it's probably ABOVE pre-pandemic levels, even with the drop. I can't be certain from graph.
https://www.epi.org/productivity-pay-gap/
Productivity kept on climbing and wages stagnated post ~1980
Time for the workers to reap some of that benefit.
But what if people realized that it was only a delusion, that it can never be that everyone is rich, because then who would do the dirty jobs? There is no social pyramid without a base, this system is litterally designed to have a class of poor people forced to do shitty jobs to survive.
If you take away the hope of a wealthy future, there are no reasons left to slave away your life on a corporate ladder.
At the same time, corporate outsourcing reached epic proportions, with the associated transfer of power in the HR and Exec realms.
The history of that EPI report is useful to know. Early versions of it showed a large gap between rising productivity and stagnating employee compensation.
Some critics then pointed out problems with the analysis [1]. The report performed an apples-to-oranges comparison of productivity of (A) all non-farm workers adjusted over time with a (B) GDP deflator-based inflation index compared with the compensation of (A) a limited subset of employees adjusted over time with a (B) CPI-based inflation index. A more useful comparison would use the same inflation index for both data sets and would exclude from the productivity measure the workers that are also excluded from the compensation measure. When this is done, the growth in productivity and pay rise and nearly in lockstep, thus effectively refuting the majority of the point that the original report was trying to make.
Since then, the EPI report has been updated to be more nuanced, which can be especially seen when one expands the 'click here for more...' sections. The new conclusion from the report is that productivity and compensation increases have been increasing primarily for a subset of workers while a broad subset of workers have not seen large productivity and compensation growth. This is true (as far as I can tell), but it's also a different story with different policy implications than the original story which implied diverging productivity and pay within the same set of workers.
[1] https://www.heritage.org/jobs-and-labor/report/workers-compe...
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The trend is towards less immigration and thus lower demand for goods/services and lower supply of labor.
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The growth of government sopped up the difference. Nothing the government does comes for free, and then there's all the additional costs of complying with regulations and doing all the paperwork.