Digitalisation was supposed to lead to better efficiency, productivity, and economic growth. Working hours were expected to decrease, and work satisfaction grow.
Last year, author Roope Lipasti wrote a piece for YLE called Sihteerit, tulkaa takaisin (‘Secretaries, come back’). This set off a long and winding online discussion in which doctors, nurses, teachers, and civil engineers complained about IT systems significantly occupying their working hours.
Secondary duties seemed to considerably impede the work of most professionals.
In some workplaces, employees struggle with administrative duties that have been transferred from secretaries. At the same time, the amount of documenting and reporting has increased without enough time set aside for them.
In many places, IT systems and software simply do not work; they crash, lag, or are incomprehensible.
Why is IT causing so much vexation?
“The simple reason is that the IT system does not always support the worker. The starting point should be that the system helps the work process. If it doesn’t, the worker is frustrated,” says Tomi Männistö, professor in software engineering.
Pain does not count
The frustration grows as people see how handy IT can be in their free time. Many people use online banking, for example, but the financial administration software at work makes them sweat. Both are about paying the bills, but why does it have to be so much harder at work?
Customers vote with their feet if the system is too difficult to use, says Männistö.
“The consumer market is harsh. End users seldom get to choose the software at their workplace.
Though the software might work well technically, whether it will do the right things is another matter.
According to Männistö, there are often conflicting ideas inside an organisation about what it needs from its IT system. The management usually wants reporting and data, and the system is marketed to the management. Management however does not necessarily have a good idea about what will cause pain at the practical level.
“They should cooperate with end users, and analyse work phases and how to support them. If this analysis is neglected, the system is built on suppositions or unrealistic hopes of development.”
It is not enough to have user testing at the end of development – they should be involved from the start.”
Software stumbling blocks
Software is increasing in number and complexity. When one wants to add a new feature to a system, it must be integrated with everything else.
Systems are usually compiled from existing components from other organisations and cultures. For security and maintenance reasons, often large ensembles are bought from large manufacturers. This limits the supply.
“It depends how much it can be tailored. Often, one has to accept the principles of the building block they bought,” Männistö says.
Unfinished software is also put on the market, sometimes deliberately. Errors go unfixed until enough users have complained about them. Data security and usability are most often at loggerheads, and data security is the one emphasised in workplaces.
Even mildewy houses are still built
Männistö wants to remind us that there is still a huge number of good systems in the world. The public only hears about the catastrophic ones such as the City of Helsinki’s salary-computation program, Sarastia, which left many city employees without a salary for months.
“Houses have been built quite a lot longer than IT systems. Still, we get another mildewy house now and then.
Besides Sarastia, news media have exposed issues with the HUS (Helsinki and Uusimaa healthcare region) patient data system Apotti and the IT-system acquisition problems of the police. However, there are also some successes in the public arena.
“Vero.fi [the tax administration] is good. I think they have considered how to make the path as smooth as possible for the client to reach their goal,” says Männistö.
In many workplaces, data entry has changed as well as increased. The management tasks employees with gathering data.
Often, a new IT system does not make the work any easier, but rather requires even more entry and reporting.
“The system is not marketed to the management for its usability, but rather with the fact that it will give you information and save you expenses. If you want to lead with information, you have to be able to process it automatically, and someone has to input it in that format,” Männistö explains.
Doctors, for example, have traditionally entered patient data as free text. It is then easy for another doctor to read. However, a computer does not understand a doctor’s entries. If we want to make reports and charts over numbers and expenses of care instances from a patient-data system, the information input must be structured. This means clicking on boxes and multiple choices.
“Structured data entry is advantageous not for the doctor, but for the hospital administration. It can be used to amend, for example, expensive procedures. For the doctor, it is a bad user interface for both inputting data and planning patient care.
Männistö sees big dangers in leading through information. If data entry is not useful for workers, their motivation will weaken – as will their precision. Then the input data may lose accuracy, and decisions will be made on uncertain bases.
Expensive saving attempts
Administrative programs and registering systems seem difficult to unfamiliar users, in whose work they constitute an extra distraction. But there is a group of professionals who are specialised in using them: the secretaries.
Why were these assistants let go from so many workplaces as superfluous, when it seems that it is exactly their contribution that is most needed?
“That’s an excellent question. No one wants to pay for secretaries. When an expert does the work of a secretary, the expenses disappear within the organisation. However, the resources the work requires remain, and must detract from something else, whether it’s the experts’ own specialised work or their coping ability,” Männistö points out.
The firing of secretaries and assistants started in the 1990s. The thinking then was that their work would be handled by the new IT systems for free, practically automatically. This did not come true: instead, secretarial work is now carried out on much higher salaries.
The problem of division of tasks
A large portion of supportive staff has been thrown out in the name of savings with the duties transferred to the expert level, says professor in Finnish history Juha Siltala.
“Secretaries are out of work and there is a shortage of doctors. The division of labour in society has gone awry if doctors spend their time struggling with an IT system,” he says.
Siltala estimates that the saving spree is based in the freeing of the movement of capital at the end of the 1980s. Since then, both states and companies have had to compete for invested capital, which has led to slimming down within organisations.
The public sector was rationalised through privatisation, purchaser-producer models, and management by results. The mode of operations, called the new public management, forced city and state staff to compete like in a listed company. Supporting staff was outsourced or let go.
Efficient or not?
According to Siltala, the new public management model created a system where everything is registered and documented with an emphasis on liability and preparing for legal proceedings.
The old professional ethic trusted that everything would be above board without the need to write report after report.
“There is a lot of unnecessary data entry and auditing theatrics that only produce the appearance of results. Reality is divided into result units and statistical magic is used to prove that things are under control in the light of the numbers,” Siltala says.
But has the efficiency increased in the public sector?
“Redirecting the attention of professionals from their productive work to filling in forms has hardly improved cost effectiveness in quite the way the promoters of the new public management model had hoped.”
The leap fell short
In agrarian society, everyone did everything, but the modern world is based on specialisation. Everybody does what they know best and sells the service to others.
The economy and productivity usually grow when people are transferred to more productive tasks. This happened during the big urbanisation wave and then the move towards white-collar work. What is happening now, the trickle of support duties to experts, is a move in the opposite direction.
“Digitalisation was expected to bring us a fourth or fifth great productivity leap, but it did not happen. The technical productivity increase seems to have stalled even more in Finland than elsewhere,” says Siltala.
Finnish companies spent a long time concentrating on reducing expenses, and handed out their winnings as dividends instead of making investments and conducting R&D. However, the drive to invest has lately shown signs of revival.
Piecemeal jobs distract
Siltala wants to emphasise that technology is not good or evil. The main thing is how you use it and how the proceeds are distributed. If support staff were rehired, it would improve the mental wellbeing of both over- and underworked employees. The salaries would circulate into consumption and growth.
Work productivity might even improve. It has been scientifically shown that piecemeal jobs are a distraction and slow down recovery.
“It is called the syndrome of scattered perception. When an expert’s attention is scattered, their productivity deteriorates,” says Siltala.
If everyone were allowed to concentrate on their own work, doctors could make more diagnoses, nurses could care for more people, teachers could teach more, and engineers could innovate more.
Then perhaps the economy – and contentment – would improve again.
This article was published in Yliopisto-lehti (University magazine) 4/2023. Yliopisto-lehti is a scientific magazine published by the University of Helsinki. It is bound to the rules of journalism.
Apotti is slowing down doctors
When a patient arrives in the emergency clinic, the goal is to find out what is going on within a few minutes. This is currently impossible because it is so difficult to use the medical IT system Apotti, says Minna Halinen, senior physician at the Helsinki and Uusimaa hospital region and thesis researcher.
Before she encountered Apotti, Halinen had used six different patient data systems with no problem. With a good system, the doctor would have at a glance an overview of how and where a patient has been treated previously, as well as what their medication is.
“Apotti is not intuitive. It feels like its developers have forgotten that it will be used by fallible humans. In their eagerness to gain statistics, they have forgotten why we do this work: to help the patients.
“Most doctors would rather read and write freely formulated descriptions. With Apotti, you have to enter the information structurally, i.e. by checking boxes with pre-written entries, which is slower.
“In many clinics, they have had to extend appointments from 30 to 45 minutes, though the time spent on the patient has not changed.”
In her thesis work, Halinen has noticed that over half of all notifications of patient safety incidents relate to problems with information flow. Apotti is risky since the information does not travel adequately between it and other systems. Referrals and events registered elsewhere disappear somewhere in the depths of Apotti.
“Apotti is a technical accomplishment, but it does not support my work. Using it is like trying to steer a spaceship based on my driver’s license. There’s nothing wrong with a fork, but it’s no good for eating soup,” says Halinen.
Halinen suggests that doctors should have a work partner who knows all the Apotti tricks. There are secretaries in the hospital, but plenty more should be employed.
“Our secretaries are worth their weight in gold, but they are woefully overworked.”