Diane speaks with Dr. Roger Kligler who is living with advanced stage cancer on why he's suing the state of Massachusetts for the 'Right to Die' and with Dr. Jessica Zitter, and intensive care and palliative care specialist on why better communication is so needed between doctors and patients facing end-of-life issues.
Advice on how to increase personal productivity is everywhere. We can download apps with algorithms to help with time management, read articles about how to avoid distractions at the office, and watch YouTube videos on the most efficient way to organize email. The latest trends come from pressure to get more done with less time and from a modern management theory that gives workers more control over how they do their jobs. While many Americans think of productivity as a virtue, others question its increasing dominance in our personal and professional lives. Diane and her guests discuss the pressure to be productive.
- Melissa Gregg Principal Engineer in User Experience Research in Intel Labs; co-Director of the Intel Science and Technology Center for Social Computing. She's the author of "Work's Intimacy."
- Erik Brynjolfsson professor, management science and director, The MIT Center for Digital Business, Massachusetts Institute of Technology.
- Dan Ariely professor of psychology and behavioral economics, Duke University and author of "Predictably Irrational."
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MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Despite a steadily improving economy, many companies continue to ask workers to do more with less. As a result, more of us are turning to technology and other self help tools to become increasing productive at work and at home. Joining me in the studio to talk about what can seem like a never-ending push to become more productive, Melissa Gregg of Intel Labs, from a studio at Duke University, behavioral economist Dan Ariely and by phone from his office in Boston, MIT management science professor, Erik Brynjolfsson.
MS. DIANE REHMAnd throughout the hour, we'll be happy to hear from you. Join us on 800-433-8850. Send an email to firstname.lastname@example.org. Follow us on Facebook or send us a tweet. And welcome to all of you.
MS. MELISSA GREGGThanks for having us.
MR. DAN ARIELYNice to be back.
MR. ERIK BRYNJOLFSSONGood to be here.
REHMErik Brynjolfsson, if I could start with you. You are the co-author of "The Second Machine Age: Work, Progress and Prosperity in a Time of Brilliant Technology," so I'm going to ask you what is productivity and how is it measured?
BRYNJOLFSSONWell, that's a good question. I'm glad you're asking because it's really widely misunderstood. A lot of people have this view that productivity means working harder and harder or even more hours. And that's almost the opposite of productivity. Productivity is not working harder. It's working smarter. It's actually a very simple formula, which is output divided by input. And in the long run, it's probably the most important single economic statistic.
BRYNJOLFSSONIt determines our living standards, the wealth of nations. It was flat for centuries and millennia even, until the industrial revolution. Since then, it's been soaring and that's the main reason we are so much wealthier than our ancestors 50, 100 or 200 years ago.
REHMNow, that's an interesting point, Melissa. Are the most productive workers seeing higher wages today?
GREGGWell, that is definitely the question that we need to ask the economist because one of the ways that I look at productivity is in terms of how workers feel. So the thing that the economic measures for productivity don’t necessarily reflect is the way in which workers choose to be productive because it feels good. But it only feels good if you have a good job. And one of the things that I think we need to introduce to the conversation about productivity is who's becoming more productive, for what purposes and is that a good that's shared across the population.
REHMAnd that is a good way to get to you, Dan Ariely. Who wins and who loses in the drive for greater productivity?
ARIELYIf we do it right, everybody wins. And I'll describe to you a little experiment we've done. So imagine experiment in which you get paid so build little Lego robots and we pay you $3 for the first one you build and $2.70 for the next one and $2.40 for the next. And every time we give you one, we say, hey, do you want to build another one for a little bit less. And at some point, you've had enough and you say, I don't want to do more of those.
ARIELYSo that's the first condition. In the second condition, we do the same thing. You build the first one. You finish. We said, do you want to build a second one and so on? But as you build the second one, we take the first one apart. So in front of your eyes, you build the first one. As you build the second, we take the first one into parts. And if you want to build a third one, we give you back the first one. So the amount of effort is actually the same, the amount of payment is that same.
ARIELYBut what happens is that you see your work being destroyed in front of your eyes and what happens is that people build much fewer robots in this condition and they stop much sooner. They enjoy it less. And it also turns out that we basically are able to basically kill every joy of building Lego that they have by just destroying their labor in front of their eyes.
ARIELYSo if you think about productivity as kind of joy from building something, actually doing things the right way, enjoying, taking pride and, you know, building Legos is not like building bridges or curing cancer. It's a very small not very meaningful task. But even in that, we can find joy. Everybody wins. If you make people feel that they are productive and successful and contributing and so on, people enjoy the task more and they become -- they produce more as well.
REHMSo Melissa, you're concerned about the joy.
GREGGAbsolutely. I mean, one of the foundational principles for any kind of management practice since the beginnings of scientific management is to create incentive and that is the way that we encourage people to get pleasure out of their work. But at the same time, incentive is usually determined by the boss. So the work that I've been doing in the last few years is looking at how workers are taking control of some of those incentives themselves by turning to technology as sort of a mediator between what bosses ask us to do and what we feel is the thing that makes us have that pleasure or be more productive because we can use technology to have more control over what order we do work, what kinds of tasks we want to do, what really counts in our job.
GREGGAnd so that's the historical shift that I'm seeing in some management theory and how technology helps. It gives workers more of a sense of what they value, they can express that and they can have some say in the terms of their own incentive structure.
REHMSo Erik, has increased technology empowered or squeezed workers?
BRYNJOLFSSONWell, it's done both, actually, and that's a change from most of the historical record. For a few hundred years, it was a rising tide that lifted all boats. Productivity made the pie bigger and almost everybody benefitted. But since the late 1990s, early 2000s, we've had something that Andrew McAfee and I call "the great decoupling." Productivity has continued to grow. It's a record levels, but median income is lower now than it was back then, which means that more than half the people in the United States and it's similar in other countries, aren't participating.
BRYNJOLFSSONSo the pie is getting bigger, but not everybody is getting a share of that. It's what economists call biased technical change, technology that benefits some groups, but not others.
REHMAnd can you explain why that is? Is it that employers are saying we need fewer people to do the same job or even more, but we're going to pay you less?
BRYNJOLFSSONWell, it's not exactly that 'cause productivity has been growing throughout the past few hundred years with fewer and fewer people. You know, for instance, upwards of 90 percent of Americans used to work in agriculture and now it's less than 2 percent. So that's mostly been a good news, that people didn't have to work as hard on farming and can now do other things. What's different now is that different groups are benefiting and others are being hurt.
BRYNJOLFSSONIn particular, in the book, "Second Machine Age," we talk about three kinds of bias technical change, one is so-called skilled bias technical change, that on average, more routine jobs are being replaced and people with high school education or less are not in demand as much by employers as they used to be and their wages and employment are falling. Another is capital bias technical change. Capital owners are benefitting at the expense of people who sell labor.
BRYNJOLFSSONAnd the third we call super star bias technical change. There is a few, you know, absolute super stars who are able to reach global audiences and make very large incomes and provide a lot of entertainment and other services for the rest of us and they get a much bigger share of the pie. The top 1 percent, the top really zero point one percent are at record levels of wealth and income, but people who compete with them, who may be good, but not super stars are getting a smaller share of the pie. All three of those pieces (unintelligible) technology.
REHMSo Dan Ariely, how do you see those three biases, skill, capital and super star?
ARIELYSo I think Erik's point is correct, right. And one way to think about it is a long time ago, we had maybe a band playing in each bar and then we had something like the radio, all of a sudden, people did not have to do it, but the people who were successful, basically, got the bigger share and there was more music and people benefitted a lot, but you didn't need all the individuals or maybe you needed fewer of them and they got -- many of them got paid less and some of them got paid correctly.
ARIELYSo there's the question of technology globally, about what it does to the workforce and what it does to talent and so on. But there's also the question of small technology and how it influences our lives in a daily basis. So, for example, in the last few years, I have looked very carefully at a simple thing called the calendar. And it turns out that the calendar turns out to be a really bad representation of what we want to do in our day and how it relates to our happiness and how it relates to our productivity.
ARIELYSo think about it. What is the calendar good for? It's good for representing things that take between half an hour and two hours and some of the things we need to do are like that. But not everything. If you want to do something that will take 30 hours, it's not a good representation. If you want to have something that will take five minutes, it's not good. So what happened is that we have a technology called a calendar and it makes it easier for us to represent things that take an hour and harder for us to represent things that take 30 hours and because of that, it shifts what we do.
ARIELYSo we have more meetings, we do more things that are good in the short term, but not in the long term. It actually biases our ability to do things that truly make us happy and are important for us.
REHMAll right. Short break here. That was Dan Ariely of Duke University, author of "Predictably Irrational."
REHMAnd as we talk about productivity, I want our listeners to understand each of you and what it is you do. Melissa Gregg is principle engineer in user experience research at Intel Labs. She's also the author of "Works Intimacy." Joining us from Duke University, Dan Ariely, professor of psychology and behavioral economics at Duke University. He's author of "Predicatively Irrational."
REHMAnd from MIT in Boston, Erik Brynjolfsson, director of the MIT Center for Digital Business. He's co-author of "The Second Machine Age." And, Melissa, during the break I said to you, "I love my job, my work, because I can manage my own time. I know what I need to do. I know how much time I need to do it in. And I am free to do make that decision." How effective in the whole realm of productivity does that seem to you?
GREGGIt seems like the dream. I mean, to build on the idea of the super star, I think that your experience may be of the kind where you do have the autonomy to choose because you have a certain status within your profession. And the sorts of people that I study have a much more varied experience of the work that they do, in that they may be at the start of their career, or they may be between jobs, or they may be working from home sometimes because they have caring responsibilities.
GREGGAnd for workers like that who are not necessarily seeing a clear distinction between where work takes place, they're not necessarily showing up to an office or a studio for work, but they're fitting work in around other kinds of tasks and responsibilities, that makes it a different kind of question about managing time because time is also felt to be synonymous with obligations. And those obligations are sometimes called work by workers and sometimes they're called picking up my kids or running the next grocery errand.
GREGGAnd the thing that productivity technologies have recognized, I think, is how you make that sort of lifestyle more convenient, less stressful, and the design opportunity it presents for technology is that it allows people to feel more in sync, that they can manage all of these tasks.
REHMBut what you're saying also would seem to blur the lines between home and work.
GREGGSo that's exactly the emphasis a lot of my research has been looking at because these theories of time management, scientific management, efficiency have often presumed a male worker over the last century. And they've often reproduced a kind of segregation between work and home space. And I think that's the other introduction of complication that technology brings you, that it can move work with you. When your office is in your pocket then you always have the opportunity to work and demonstrate your productivity. That's the pressure (unintelligible).
REHMAnd technology has allowed us to do that more and more.
REHMDan Ariely, a shift over time, are managers giving workers more control over how they do their jobs?
ARIELYSo I think in general, yes. But they're also taking control in very interesting ways. So, again, think about something like the calendar. If you think about what we have done with the calendar, is we've allowed other people to schedule things on our time. Of course, if you're the boss of the organization nobody can touch your calendar, for other people you can basically impose on them. You can send them email invitation, you can schedule things on their calendars.
ARIELYAnd therefore, in many ways, people have less control over their times. Also, as we start working in bigger groups, control becomes harder. I've asked this question to many people. I said if you tried to meditate and you just close your eyes for 30 seconds, what happened? And most people -- and it's true for me as well -- they say that their to-do list pops up into their mind…
ARIELY…about 15 seconds into it.
ARIELYWhich basically tells you that we're all the time stressed with what we're going to do. And technology is not really reducing this stress anymore. In fact, it's making it worse. It allows us to take more projects for more long terms, have larger to-do lists. Basically, creating a world in which we're continuously stressed about what we have to do and what deadlines we're behind on and what we're missing. I think that mostly the productivity technology we've done is not helping. It's actually making things worse.
REHMBut, Erik, you've got tons of advice out there about how to improve your productivity. I mean, there are apps, there are all kinds of books, there are different approaches about how to increase your productivity. How important are they to the person, say just in that first, brand-new job?
BRYNJOLFSSONWell, I think that that Dan and Melissa made a very good point, that a big issue is that we're not really focusing on the right things. And I think -- I blame a lot of productivity experts and, for that matter, our whole productivity measurement apparatus. You know, there's a saying, what gets measures is what gets done. And there are certain things that we can measure very, very well. And in the U.S. productivity statistics we measure the paid value of goods and services.
BRYNJOLFSSONWe don't measure homework and we don't measure, for that matter, the quality and enjoyment of our daily lives. And similarly, in our individual lives I think people aren't necessarily focusing on the right things. So it's not a matter of doing things more efficiently. It's a matter of choosing the right things to focus on. Our government statistics are very skewed towards a few measurable things. The same thing happens within corporations. And the same thing happens at the individual level.
BRYNJOLFSSONAnd I think we all need to step back a little bit and think about what is it that we want to accomplish and what's important and not obsess over, you know, the 2.0 percent productivity growth we had by the official statistics last quarter.
REHMSo how much should we, Melissa, be paying attention to productivity, statistics and how much might corporations be pushing us in that direction, when what we need is to step back a little bit, as Erik says?
GREGGWell, I think that helps us talk about the difference between the macro-economic picture and what I've been studying, which is personal productivity -- the individual's felt sense of accomplishment. And I think that's a fairly different rubric because it brings into play a lot of the emotional elements of work, the kinds of values that people get out of performing their work and engaging with their job. So as Erik's saying, there should be a way to measure. And there is.
GREGGI mean, in a lot of workplace sociology and economic theory, people are moving towards happiness quotients, you know. And that sort of measurement wants.
REHMThey want satisfaction as well as happiness and being able to do their job.
GREGGWell, exactly. I mean, I am working in an organization where you have a compulsory calendar that anybody can put an appointment on. And it's a demonstration via technology and management theory intersecting, a corporate policy of having an open door. And, you know, that's a bizarre manifestation of a way of showing workplace openness and transparency and teamwork. When you have a cubicle culture where you don't want to necessarily be interrupting people face-to-face because you don't want to take them off the task that they want to achieve that day, but then…
REHMBut are we getting away from that cubicle culture because part of what needs to be done is that sense of cooperation and flow within the organization, also enhancing productivity?
GREGGI think that's what we -- we're aiming for in the ways that we're seeing these technologies used. Because part of what we're trying to see is how it matters that individuals themselves recognize the value of productivity. And how do we tap into that? How do we allow people to self-actualize, you know, their own ambition for work? So the best kinds of technology design are providing that kind of experience.
GREGGAnd it is an experience of going with the flow, getting rid of the organizational inefficiencies, or indeed the compulsory software packages that are preventing people from getting in touch with each other when it matters.
REHMSo, Dan Ariely, what motivates people to want to be more productive with their time? More reasons than just work?
ARIELYSo there's lot of things that motivate people and there are some things that actually demotivate people. And actually because Melissa is here I'll tell you about an experiment we did with Intel recently. So this was in factory for Intel, where people manufacture chips. And this is a good set up for us to measure productivity because we can measure how many chips people make. And people come for eight days. They work for four days. They have four days off. Work four days, four days off.
ARIELYAnd on the days that they work, they work 12-hour shift -- very long shift. And what Intel has been doing for a long time is on the first day of the first work cycle they tell people, if you perform above a certain level we will give you $25. If you perform below it, you'll get zero, above it, $25. And then the second day of the shift there's no bonus. No bonus on the third day. No bonus on the fourth. Four days off and then back to the bonus.
ARIELYSo we got them to agree to also run two other condition. First of all, we had the control condition. Right. So not paying people anything. And then two other conditions. And one of them is instead of giving people $25, we promised people pizza. Right? Not exactly money, but, you know, something that is a bit more social. And then we had another condition in which we offered people a nice word from the boss. If you perform above this level you get a text message from the boss saying, work well done.
ARIELYSo we did this. And on the first day of the first shift, all of those three methods increased performance in the same way. So paying people, giving them pizza, giving them a complement all worked very well to motivate people to perform.
ARIELYBut what happened on the next day?
ARIELYWhat happened on the second day on the shift?
ARIELYNow, the people who got paid on the first day of the shift, backfired, and performed 15 percent below the control condition. It's as if people said, you know, yesterday you paid me, I worked hard. Today you're not paying me, I'm not interested. And in total Intel paid people money and lost 5 percent of productivity compared to the control condition. Now, what happened in the condition with the text message? That one when up just the same as the money condition. And it went down slowly, never backfired.
ARIELYAnd what happened to the pizza? The pizza was between them. By the way, the pizza was a voucher for pizza. I think if we actually got them pizza at home…
ARIELY…it would have been better. And -- but if you think about this, right, it tells you that sometimes we try to pay people to increase motivation. And we might be able to do it at the spot at the moment that we paid them, but we actually change how people think about work and decrease their overall motivation for that. So we have really a lot of bad intuitions about what get people to be connected and sometimes we do things that actually harm more than help.
REHMAnd you're listening to "The Diane Rehm Show." So, Erik Brynjolfsson, what is it that really helps to understand and react to pressures from employers about productivity? What are the magic words? What are the magic ways? What are the manners in which productivity can be increased?
BRYNJOLFSSONWell -- and let me just say it is important to increase productivity if you measure it correctly. A big part of the problem is we've been focusing too much on a few narrow measures, but if you think about it more broadly, creating more value with less cost, that's always going to be a good thing. It gives you more opportunities to do other things. Historically, what's allowed us to do that have been two things. One is new technologies, inventions like the steam engine, electricity, computers, especially so-called general purpose technologies.
BRYNJOLFSSONThe second thing is new techniques of production, new ways of doing things, whether it's the assembly line or total quality management or Amazon's new retailing model. I think some of the ideas that Dan was just mentioning about new ways of motivating people, we're constantly trying to understand better how we can organize work and organize ourselves in order to be more -- both effective and more efficient.
BRYNJOLFSSONThat's an ongoing area of research. And as the economy changes and becomes less focused on routine repetitive tasks, the ability to inspire innovation and creativity becomes proportionately more important. And that's a new set of techniques.
REHMNow, isn't there also some thought about a theory that working fewer hours, Erik, could actually mean greater productivity?
BRYNJOLFSSONOh, definitely. I mean, because remember, productivity is output per unit input per hour. So it's very easy to see how output per hour could go up. A different question is would total output go up? That would be surprising, but not impossible. I could imagine situations where at some point the additional hours are destructive. But certainly in terms of output per hour it -- there's lot of evidence that it goes up if you have more leisure time, especially when it comes to creative types of tasks.
REHMYeah, I was about to ask you, Melissa, what about personal satisfaction with fewer hours? Doesn't that create an overall better sense of productivity?
GREGGI think it's a little bit dependent on the next job you have coming, if you have one. So there's some famous research done on the difference in the quality of life between those on salaried work hours and those on contracts. And I think that the amount that people can enjoy those leisure hours, all those reduced hours, often depends on their sense of confidence that there will be more work coming. I think that's something important to keep in mind when we're talking about the use of leisure time.
GREGGBecause so much of the work condition today is usually about preparing for or anticipating the next kind of work that you need to do. Whether it's checking the emails that you need to attend to when you actually do start work the next day, knowing what's coming is one of the reasons people find themselves connected to technology so much.
REHMMelissa Gregg and Dan Ariely, Erik Brynjolfsson, they're all there to answer your questions. We're going to take a short break. When we come back, time to open the phones, read your email. Stay with us.
REHMAnd it's time to open the phones. We're first going to go to Martha in Mountain View, Ark. Hi there, you're on the air.
MARTHAGood morning. I am talking to you as a teacher on a snow day.
REHMI see. Oh, my gosh. How much snow do you have, Martha?
MARTHAI think we got a couple of inches but since we're kind of southern, this is kind of a lot.
REHMI understand. Go right ahead.
MARTHAI appreciate this conversation. I notice that it's very much irrelevant to teacher however. We work all day, all night, all weekend. We bring our own supplies to school. We are largely female. We work at home. So my question basically is twofold. Have you all taken a look at how any of your findings affect the teacher world? And I forgot the other one.
REHMOkay. Let's go to Erik and see what he has to say.
BRYNJOLFSSONWell, teaching is a great example of something that -- where a lot of the outputs are very difficult to measure. And of course there's a lot of research going on as to whether we can measure the outputs of teaching better. And that's a classic example of sometimes we focus on the things that are easy to measure. You can more easily measure, say, math scores than improvements in creativity.
BRYNJOLFSSONAnd one of the risks is that you end up overemphasizing techniques and methods that improve the measurable part as opposed to the less measurable part. Ideally you'd like to have some kind of a balance. And in the case where you can actually do harm by focusing too much on the traditionally measured parts of productivity.
GREGGWell, as a daughter of a teacher, I completely appreciate the question because I saw up close the amount of work that was happening after hours in my mother's experience when I was growing up. And I think the thing that's also a part of the question perhaps is the impact of measuring and auditing technologies and capacities that are now applied to teachers, which means that the things that maybe the values the teachers have to join the profession in the first place aren't part of the efficiency metrics that are applied to their jobs.
GREGGOne thing that I've noticed particularly in the studies that I was doing working from home, people were often involved in answering all kinds of emails and parents' inquiries beyond the traditional classroom or schoolyard now because there's an incentive to have children using technology and also the parents in getting involved in the education system. So I think there's lots of ways that technology is also affecting the experience of teachers on top of those original forms of contribution that took place beyond the school.
REHMAll right. To Tim in Palm Desert, Calif.
ARIELYWait, wait. I don't get to answer this question?
REHMHi there, Tim.
TIMGood morning and thank you. Mine is a technical question. Where workers have to do the same work for less pay, in terms of macroeconomic analysis, does that pencil out as an increase in productivity even where nothing more is produced?
ARIELYI had such a lovely answer for the last question, so we're going to answer a little bit...
BRYNJOLFSSONWhy don't we swap, Dan, because -- why don't you take the last question again. I think I have a good answer for this new question.
BRYNJOLFSSONSo why don't you say what you have on the last question?
ARIELYActually I was going to suggest that as well. And so if you think about the experiment they described about Intel, this is an experiment about what's called intrinsic and extrinsic motivation. And teachers, you know, go to their profession mostly because of reasons of mission, an intrinsic motivation. And it turns out that we can pay teachers like we have done in the No Child Left Behind policy in a way that is going to decrease their motivation.
ARIELYWe can also create restrictions on teachers like in terms of grades and performance of the school in a way that is going to not increase motivation but decrease motivation and increase cheating, increase dishonesty because -- on the exams and all kinds of other things. And in one of the most interesting experiments on teachers has been to try all kinds of incentives to teachers. But the best things has been to give the good teachers time to teach the not-so-good teachers.
ARIELYAnd if you think about that, it really is a question of why are teachers who are not good, not good? Is it because they don't care about the kids? Is it because if they only got paid a few more dollars they would care all of a sudden? No. It's because teaching is a really hard profession. Figure out what's right, how you do it the right way, it's really tough. I've been teaching for 20 years, Erik a couple of more years than I have. It is really tough to figure out how to teach well.
ARIELYSo if we think about what are the real barriers for motivation, in the teacher's case it's not knowing how to teach better and not having the freedom to do what they want and so on. So if want to incentivize teachers we really need to find out what is holding them back. And what's holding them back is not another $300 a year.
REHMAll right. So Erik, why don't you take the most recent question.
BRYNJOLFSSONSure. And this is where theory and practice really diverge. The way the theory is supposed to work for productivity is if you just change the price, that would not -- or the amount of the wages, that should not change productivity. So if you pay a worker less, that does not improve productivity. For that matter, if the price of the thing you're selling goes down, that doesn't hurt productivity.
BRYNJOLFSSONBut in practice we can't keep track of these price changes very effectively. And so in practice, both corporations and the government statistics are very influenced by changes in price. An extreme case of that is that there are a lot of free goods available now, like Wikipedia. And they count zero in our GDP statistics, and therefore they contribute zero to our productivity statistics. But in fact, they're creating enormous amounts of value.
BRYNJOLFSSONWe did some research in Wikipedia and other free goods and services on the internet, at about $300 billion to consumer surplus each year, value that is completely missed by first GDP and then since productivity is based on GDP, also by our productivity statistics. And that gap is growing larger. Meanwhile, as we hire low-wage labor for tasks especially from overseas, that also skews our productivity statistics in the opposite direction. So we have a worse and worse gap between what's really happening in the economy and what we're measuring in our statistics.
REHMAll right. And to Thomas in Phoenix, Ariz., you're on the air.
THOMASHi. Thank you very much for taking my question.
THOMASI wanted to get into the subject of -- I'm a practicing optometrist in the Phoenix area, and have been for over 13 years. And how this actually affects, and if there's any research on the doctor-patient relationship, because as someone who's worked in practice and has a staff, I appreciate the technology. I've been using electronic medical records for years. It's great for patients, for doctors and for efficiency.
THOMASBut when you're dealing with a climate in the medical industry, whether it's my industry or primary care doctors, etcetera, the private insurance reimbursements keep decreasing. That affects, in a sense, how many patients in a sense a doctor has to see, which can lead to things being missed. It can lead to patients waiting too long in -- for their appointments. It leads to increased staff stress, happiness of overall patients, stress of staff. This is an issue that affects us all, whether you're a patient or a doctor.
REHMI fully agree. I think that you're seeing that happen from so many different angles.
ARIELYCan I take this one?
REHMHow do you take a look at that, Michelle? (sic)
GREGGI'm looking at it from the point of view of the data and the amount of extra auditing and accountability that comes with electronic medical records, as much as the people that are taking the calls to get scheduled into the doctor's surgery. And then the extent to which the doctor is using the technologies, even in the place of consultation, it adds all of these layers of labor and perhaps potential inefficiency.
GREGGI think most people would agree that the health industry is requiring a lot of structural transformation classes.
REHMExactly. And Melissa, don't you think something is really missing when instead of the doctor's gaze being on that patient's eyes, face, body, but instead listening only to the voice, something is lost.
GREGGWell, it's the emotional and human connection that people are also asking for when they go to see an expert, which is to say, how are you going to give me confidence in your diagnosis too.
REHMSo Dan Ariely, how do you see that, that doctor-patient relationship being effected by employers, hospitals, clinics saying, you must see that patient in less time and you must keep records while you're doing it?
ARIELYSo we have this distinction called market norms and social norms. And here's a way to think about it. Imagine I said, would you help me change the tire on my car, back up my computer, something like that? And most people would say, yes, I'll be happy to help you for a few minutes. What if I said, would you help me to do these things? I'll give you three dollars. Now you could say, oh, this is helping plus $3, people should be more likely to help. But actually people are less likely to help. Now of course if you pay people hundreds of dollars, they can work again.
ARIELYBut the point is that you can take something that people feel happy about and happy to help, happy to contribute and so on. You can add money to the equation and all of a sudden they feel worse about it. And this is basically called crowding out, that we add the motivation, we change the rules of engagement and all of a sudden people feel differently about it. And I think that is happening in medicine. It happens in education, that all of a sudden you don't really -- we don't really understand what the motivations are that are driving people to do those things.
ARIELYWe add rules, regulations, restrictions. We make the relationship much more transactional in nature. What am I getting, what am I giving? And all of a sudden people are less motivated. We did an art show here at Duke and artists come and do art on social science. And one of the artists, her project was when she thought about a painting she was doing for her father's birthday, she thought about the cost of everything. She thought about the cost of the brush and of the paint and her time to go and get something. And she said it was an awful process and she didn't enjoy drawing and she didn't enjoy the gift and she didn't enjoy giving it to her father.
ARIELYAnd you can see how it basically undermines the human spirit. I mean, doctors go to become physicians because they want to help their patients. And if we stop getting to think about their value in their patient's life and we just start to get them to think about themselves as bureaucrats and paper-pushers and documents, and every 15 minutes you have to go to do something else, it really undermines the real interest in patient's motivation.
ARIELYNow we might get more efficiency at the moment, but are those doctors going to think about their patients at night? Are they going to read more medical journals? Are they going to try and improve over time? Are they going to call the patient if they have another suggestion that they didn't think about during the 15 minutes they saw them? We're basically killing the extra human motivation that could go a long way.
REHMAnd you're listening to "The Diane Rehm Show." Erik.
BRYNJOLFSSONYeah, I would like to point out, I agree with what Dan is saying but also we need to understand that the reason that a lot of managers have focused on this kind of micromanaging is because it's worked for certain categories of tasks. And as the economy changes, we need to realize we need to reinvent a new set of approaches.
BRYNJOLFSSONDan Pink wrote a terrific book where he emphasized the importance of autonomy, mastery and purpose, especially for more creative kinds of tasks. technologies of the second machine age have automated a lot of routine kinds of tasks where micromanaging worked well. Henry Ford's assembly line was highly productive in its day. But those kinds of jobs are mostly disappearing because machines can do them so well. And what's left is a residue of more unstructured tasks, more creative and innovative tasks. And those require us all to reinvent the way we manage workers, and for that matter, we manage ourselves.
GREGGWell, I think it's interesting the three categories are also quite coincidental with the ways that technology delivers productivity to individuals. Autonomists, mastery and purpose are interesting ways to think about what productivity apps are delivering to people for instance. Autonomy, mastery of time and the thing that may be missing, I think, that we haven't talked about much today, is the purpose of all this productivity.
REHMAnd how would you define that?
GREGGIf you really want my answer, I think that we have a really big problem in the U.S. because one of the ways that productivity was first made a moral good, the way you use your time was through a protestant ethic. This is what sociologists have told us. The protestant ethic was the spirit of capitalism for many, many years. And now we're living in a secular society where lots of different people are motivated by different purposes. And productivity, in this case, becomes something of a fetish. It becomes the stand-in word that we use to talk about the right use of time, the most efficient way to give your contribution back. But the purpose may not be shared.
REHMLet's go to Donna in Indianapolis. Hi there.
DONNAHello. I am a 70-year-old politically progressive retired lower-middleclass woman. And I'm dismayed that we can talk about our dysfunctioning employment sector without talking about the decline of respect for unions. None of my younger friends, even politically center left friends, understand the demonstrative value of unions. They work at home in their jammies and slippers and there're so many negative caricatures of unions. But real measurements show a virtual cycle of rewards for workers, employers and a well-functioning society when workers are fairly compensated and have a good environment.
REHMMelissa, how has the decline of unions affected this whole idea of measuring productivity?
GREGGWell, I think that's a really important factor that we need to consider in this conversation because there's so many reasons by this autonomist individualized relationship to work has occurred in tandem with management and technology combining to create isolation. And working from home may feel like freedom when you get to wear your pajamas and not go into work, but at the same time it means that you're far away from any colleagues.
GREGGAll of your interactions with colleagues become mediated through technology, which again, as to the burden of how people can create efficiency and human relationships, which is what they value in work.
REHMReally a fascinating conversation. I'm sure this will come up again. Melissa Gregg, Dan Ariely, Erik Brynjolfsson, thank you all so much for joining us.
ARIELYIt's a pleasure.
REHMAnd thanks for listening all. I'm Diane Rehm.
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