Administrative Evil and Patient Health: A Critique of the Impact of Manufacturing Systems on Health Care

Manufacturing systems principles underpin enterprise information systems. Nowadays these principles, and the systems that accompany them, are widely applied across various sectors, including health services management systems. The question arises: To what extent are these principles appropriate for health care management applications?This chapter explores the question from a human-centered systems perspective by examining the rationalities and assumptions that underpin manufacturing systems and applying these ideas to health care contexts. Human-centered systems have a long theoretical tradition within the automation and control community stretching back at least into the 1970s. It is a particularly strong theme in manufacturing systems research. As automation and control systems are increasingly important outside the factory, many researchers are revisiting core concepts within this tradition. One particularly important sector is health care, which, in recent years, has implemented a range of AMAT (automation and machine-assisted thinking)-type solutions not the least of which are enterprise resource planning systems (ERPs). These implementations have been accompanied by highly publicized systems failures. Ethical problems have also arisen. The chapter exposes an 'administrative evil' that relegates the patient to the status of a subassembly, a component in an ever-more complex health care production line. Humans are dehumanized in the rationality of our health care administrative systems.The chapter concludes that health care systems projects should adopt a human-centered approach that draws on research in manufacturing, automation, and control engineering as well as other disciplines.