Saturday, February 27, 2010

Free Speech: US Army vs UIHC

February 27, 2010, 6:40 a.m. [as updated March 1, 2010]

Hierarchical Organizations and Strategic Communications
(brought to you by*)

[Note: And don't miss the comments at the bottom of this blog entry which I am quite willing to concede are, if anything, more incisive, informed, critical, amusing and well written than my blog entry itself.]

Occasionally a news day comes along with a juxtaposition of stories that together are more dramatic than the sum of the parts. Today is such a day.

Among the qualities of hierarchical, top-down organizations can be rigidity, a uniformity (sometimes literally involving uniforms), that sometimes oozes over into attempts not only at censorship of speech but thought control.

[The Supreme Court has often interpreted "Congress shall make no law abridging the freedom of speech," the First Amendment -- which is applicable to the State, and University of, Iowa and the UIHC -- to include the "right to receive" the speech of others as well as the right to distribute one's own speech. See, seven opinions cited in "Speech: First Amendment; Right to Receive Information and Ideas," Internet Law Treatise. It is in that sense that I am using the words "censorship" and "thought control." Although I am not stating as a clear conclusion that a court would find the UIHC to have violated the Constitution in this instance, First Amendment values do have a role to play here, even if ultimately rejected.]

And what has been, until today, the classic case study of a hierarchical organization, the institution that would first come to mind? That's right, the military. It's a command and control organization, one that requires its members to be focused on the job at hand, one with real national security secrets, one with an understandable desire to control its members speech and thoughts.

Well, think again. It has today relinquished this position. The U.S. military has just announced its recognition of the value of soldiers being connected to the Internet, keeping in touch with each other with Twitter and Facebook.

Here's today's first of two stories: "Twitter permission for US troops," BBC News, February 27, 2010.

The BBC is talking about our U.S. Army! Here are some excerpts from its story this morning (complete with British spelling).

US troops are to be allowed to use social networking websites such as Twitter and Facebook following a review of internet use and security.

Defence department officials say the benefits of using social media now outweigh the risks to security.

The ruling means that a number of sites blocked by the Pentagon in 2007 - including YouTube - will be unblocked. . . .

US Defence Secretary Robert Gates has said that social networking can help the Pentagon interact with US military employees, many of whom are in their early 20s and regular users of online services.

Chief of tweets

Among the military's higher ranks, Admiral Mike Mullen, chairman of the US Joint Chiefs of Staff, has a Twitter feed with more than 16,000 followers. . . .

"We need to take advantage of these capabilities that are out there - this Web 2.0 phenomena," said David Wennergren, deputy assistant secretary of defence for information technology. . . .
Meanwhile, taking over the distinction as the number one hierarchical organization suppressing Internet access is none other than our own UIHC.

That's right, this morning's Press-Citizen headlines on page one, "UIHC to Block Twitter, Facebook." B.A. Morelli, "UIHC to block Twitter, Facebook; Hospital says Web sites are 'inappropriate,'" Iowa City Press-Citizen, February 27, 2010, pA1. [And see, this morning's (March 1) Press-Citizen comment, Editorial, "Social Networking May Hold Some Benefits for UIHC," Iowa City Press-Citizen, March 1, 2010 ("Many people in the corporate world have recognized the advantages to be gained by participating in online social networking through Facebook and Twitter. Businesspeople can reach out to their customers sometimes more efficiently than through telephone calls and e-mails. Journalists can get tips and crowd sourcing for some of their stories. Teachers can keep in touch with students over assignments and questions. And perhaps even health care providers can contact their hard to reach patients more quickly and consistently."]

I have reproduced the full text of Ken Kates' email at the bottom of this blog entry. Meanwhile, here are some excerpts from the story:

University of Iowa Hospitals and Clinics is blocking social networking sites, such as Facebook and Twitter, and other Web sites in clinical workstations, according to a letter to staff Friday.

On Monday, UIHC will implement technology that blocks access . . . Ken Kates, UIHC chief executive officer, said in a hospital-wide e-mail. . . .

"[V]iewing inappropriate Web sites . . . consumes employee time and organizational resources," Kates said. . . .

Online social networking sites . . . would be blocked, Kates said.

Login screens on clinical workstations will carry a message noting that access to selected Web sites has been blocked, he said. In addition, if access to blocked sites is attempted, a message also will appear, he said.

Patient safety, fostering a positive work environment and assuring appropriate use of resources were factors in the decision, Kates said. . . .

Filtering is common in many large health care organizations and other industries, Kates said.
(And see, Diane Heldt, "UI Hospitals and Clinics to Filter Web Sites," The Gazette, February 27, 2010, p. A1.) "Filtering is common," that is, in large organizations other than the U.S. military.

Now I don't deny that the UIHC has limited legal rights to control its employees' speech, or that there may be some inappropriate computer use by some employees. How could I know? There certainly are other institutions that also take a very ham-handed approach to controlling employees' computer use. And I am in no sense suggesting that it should be OK for employees in any organization to shirk their responsibilities -- especially those who have responsibility for maintaining the highest standards of patient care -- as a result of their personal computer use "on company time."

I just find the juxtaposition of the two stories this morning striking, and worthy of comment.

And note the timing. The policy is unilaterally announced on a Friday and implemented on a Monday! ("Anne Gentile-Archer, a nurse at University of Iowa Hospitals and Clinics and president of the hospital’s SEIU chapter, says there was no discussion between labor and management about the new policy." From Diane Heldt's Gazette story, immediately above.)

(I'll bet the Iowa City Community School District superintendent and school board members would sure like to learn how to do that. They're still patiently getting "community input" about boundary changes months after beginning the process. See, e.g., this morning's B.A. Morelli, "Feelings mixed on new scenarios; High school boundaries a concern," Iowa City Press-Citizen, February 27, 2010, p. A1.)

On a more serious note, here are my thoughts regarding what was wrong with this action:

(1) If there is no widespread endemic problem involving large numbers of UIHC employees' computer use, it might better have been dealt with by supervisors' one-on-one conferences with the offending employees.

(2) At a minimum, the procedure for the creation and implementation of such a policy should not have involved an announcement on Friday and implementation on the following Monday.

(3) There may have been a series of prior meetings between administrators, supervisors, and employees; I'm not in a position to know. But, if not, there should have been -- because it's the decent thing to do, because the policy needs employee buy-in to be effective, and because an ex cathedra announcement of this kind will not be well received.

(4) Doing it this way, with an APB email impliedly critical of employees, that was certain to leak, was bound to create the dual public relations problem that it has fomented. It is a self-inflicted black eye to tell the public the UIHC has problems of this kind; and it is predictable there will be at least some adverse reaction to both its content and the procedure used in creating and announcing it.

(5) If large numbers of employees are involved, and their behavior is seriously interfering with patient care (both of which I doubt), it raises questions as to (a) why persons so lacking in common sense and standards of professionalism were hired in the first place, and (b) once there, why their behavior was not known and dealt with by hospital administrators long ago. For example, if a part of the problem involves the online computer screen public display of pornographic images (which is not clear from the Kates email), that could well qualify as "sexual harassment" under UI policy. If there have been numerous, regular instances in which employees are so distracted or delayed in treating patients as a result of their computer usage that an unacceptably low (or negligent) level of health care and treatment results, that is obviously a much more serious matter than what they do during break time.

(6) Scenarios (1) through (5) necessarily raise questions regarding the quality and effectiveness of UIHC administration.

(7) The policy is going to be hard to rigorously enforce.

(8) The policy is of questionable validity when applied to breaks, and when different standards of conduct are to be applied to different areas of the hospital.

(9) The policy will not resolve the asserted problem. Today's technology is such that person-to-person electronic communication, and Internet access, is not limited to desktop and laptop computers. Cell phone voice calls and voice mail, texting, tweets, and smart phone Internet access can easily substitue for the use of more conventional computers.

(10) Who will decide which are to be the acceptable and unacceptable sites for employees to view, and what are the standards they will use in coming to their decisions? A year ago there were 232 million Web sites on the Internet. By now there are far more. Picking and choosing will not be an quick or easy task.

(11) Blocking sites can be a tricky and imprecise business, as many a high school principal and public librarian have discovered. Researchers have often found themselves unable to do breast cancer research on the Internet as a result of filters and blocked sites. What are the other potential downsides of this decision in the UIHC context?

"One hospital employee who did not want to be identified . . . said he doesn’t see Internet abuse as a rampant problem at the hospital. He also wondered if YouTube will be filtered. Some medical students use the site to watch videos when they’re learning about procedures, he said. 'Something like that online might actually be really valuable. . . . That’s the whole chilling effect — is this going to push out use­ful sites?'” Diane Heldt, "UI Hospitals and Clinics to Filter Web Sites," The Gazette, February 27, 2010, p. A1.

Hopefully, our medical students will be able to find some Army friends on the front lines in Afghanistan who can access YouTube for them, a place where the Army now finds the online site even useful, and certainly less harmful than UIHC administrators believe it to be when available to hospital workers in the U.S.

I can't believe the UI's new Vice President for Strategic Communications would have recommended this decision, wording of the email, or procedure. [Apparently my belief was correct; see the first comment added to this blog, below.] His is, after all, a position created, at least in part, to avoid the public relations disasters created by UIHC decisions such as asking patients for contributions to the UI Foundation before checking them into the clinics, deciding to refuse to pay patients' mounting parking fees that result from their having to wait hours beyond their appointment times, and then, befuddled by how "customer satisfaction" might be improved, deciding the remedy was for top administrators to take a few days off at Disney World in Florida.

I do wish VP Tysen Kendig well. I really do. I want him, and the university he serves, to succeed in the quest to find "strategic communications." But as this latest episode indicates, he may find he has been handed what is literally an impossible job.

One more coincidental juxtaposition. The BBC also began this morning a new subject in its "Monday Documentary" series: "The Virtual Revolution; The Great Leveling: has the internet lived up to the ideals of its founders?" Well, I guess it has in the U.S. military.

The text of the Kates email follows:

This message is sent on behalf of Ken Kates, Chief Executive Officer, UI Hospitals and Clinics, and Associate Vice President, UI Health Care.

In the interest of patient safety, fostering a positive work environment, and assuring appropriate use of resources, UI Hospitals and Clinics on Monday, March 1, will implement technology that blocks access from all clinical workstations to Web sites that are inappropriate in the health care workplace. These include online social networking sites, gaming sites, and “malicious” sites that attempt to infect computer workstations.

Such filtering of inappropriate sites—which is common in many large health care organizations and other industries—is in response to concerns voiced by patients, visitors, staff members, and supervisors. While filtering currently applies only to clinical workstations (computers on nursing units, in outpatient clinics, and other clinical/procedural areas, etc.), evaluation is under way for application in other areas of UI Hospitals and Clinics.

UI Health Care continues to support an open work environment. However, viewing inappropriate Web sites for non-work-related purposes consumes employee time and organizational resources. Moreover, access to inappropriate sites creates the potential for a negative experience for patients, visitors, employees, and students.

Login screens on clinical workstations will carry a message noting that access to selected Web sites has been blocked. In addition, if access to blocked sites is attempted, a message will also appear.

Questions or concerns should be directed to department administrators and/or managers.


* Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source -- even if I have to embed it myself.
-- Nicholas Johnson
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Anonymous said...

Tysen Kendig does not have authority over the hospital's communication operations. They have their own communications and marketing department that makes decisions like this with little or no input from university relations. Tysen, in fact, understands the use and increasing ubiquity of social media as a communications tool and I'm sure does not support this decision at all (though he won't be able to say that publicly, of course).

Anonymous said...

1. Rather that use motivation, inspiration, and good leadership, Kates and his cronies use draconian and dictatorial powers over their workers. That is likely because despite the administrations rather bloated salaries they cannot provide what they are compensated to provide: solid leadership, reasonable decisions, and good espirit.

2. Who are they scared of? Some nurse bidding on Ebay? Or someone actually reading about corruption in health care operations, health care execs giving themselves huge bonuses?

3. Who is the elite that determines what internet sites the infantile workers, students, and staff of the UIHC can observe? Would that be Mr Kates and Dr. Robilliard the two brightest visionaries in the universe? Will they gently feed the UIHC workers from the wisdom of the censorship breast?

Surprised that a subversive site such as FromDC2Iowa makes it past the censor's knife.

Wonder why no comment in this post about:

1. The infringement of freedom of speech in an academic environment. True there are common mundane employees accessing these computers, but also students in a public-funded institution.

2. The action of censorship. Who is the 1984, Big Brother authority with the paternal knowledge to ban information?

Compare this BS ('protect the patients', seriously that should be laughed off the paper) with edicts that place smilies and mirrors on the nurse's computers so they are reminded to be friendly and to check their makeup and hair.

Really, this is a pathetic administration that operates without common sense and operates with a huge belief of elite entitlement.

Ask the administration about all the medical errors propagated by their new medical records software. Where is that censorship? Where is that accountability?

Considering the success of their various software blunders it remains to be seen if they can actually implement this new policy in a coherent way.