Jones & Bartlett Learning Health Blog

    Big Brother Is Watching

    Posted by sharonb on Apr 6, 2015 3:00:14 AM

    2014 Headshot_Short HairLast month, I talked about job searches from the other side of the desk, that of the candidate and how to help students avoid going into a house of horrors. In this post, I will be talking about something we don’t read a lot about in healthcare settings, but I anticipate we will be hearing more, that is employer surveillance and monitoring of employees.

    Electronic Performance Monitoring and Control Systems (EMPCS)
    We’ve all heard the announcement when we’ve called customer service lines: “This call may be monitored for quality and training purposes.” I suspect another purpose of the statement at the start of the call is to signal the customer to speak nicely to the agent. After all, isn’t the customer being monitored, too?

    Increasingly, employers are going well beyond this type of surveillance. While on the employer’s clock, workers check and respond to personal emails, update their status in social media websites, participate in personal virtual messages and chats, check sports scores, and go shopping, to name but a few of the abuses that contribute to decreased worker productivity (Ciocchetti, 2011; Sanders, Ross, & Pattison, 2013). Ciocchetti’s 2011 review of employer electronic performance monitoring and control systems (EMPCS) included the following:

    • Access panels;
    • Attendance and time monitoring;
    • Automatic screen warnings;
    • Desktop monitoring programs;
    • E-mail monitoring;
    • Filters and firewalls restricting Internet access;
    • Global Positioning Systems (GPS) and Radio Frequency Identification Devices (RFID);
    • Internet use audits;
    • Keystroke logging;
    • Physical searches;
    • Social-network and search engine monitoring;
    • Telephone, text messages, and voicemail monitoring; and,
    • Video surveillance. (Ciocchetti, 2011, pp. 302-321).

    As faculty, I’m sure we’ve all given the same lecture to our students about not posting “bad” information about personal activities or over sharing on social networking sites. However, with newer technology in play, we need to be aware of what employers can do and provide advice about EMPCS to our students.

    As we have warned our students time and again, employers often conduct Internet searches and examine social networking sites for inappropriate behaviors when considering a candidate for employment. In addition, depending on the level of the job and the security clearance required, they may also hire investigators to conduct extensive background checks. In my part of the country, many of the government agencies will send former or current FBI or ATF agents out to have face to face interviews with references. When I asked one such investigator why it couldn’t be conducted over the phone, he replied, “I need to see you and watch your body language.” Apparently the student and I passed his tests because the agency hired her.

    EMPCS in Healthcare Settings
    Once the candidate is employed in a healthcare organization, there is usually a lengthy orientation that includes a plethora of training modules for HIPAA and blood-borne illnesses, to name but a few. There is also a policy manual, either physical or electronic, that should specify any policies and procedures for employee surveillance. Even if the EMPCS are not specified, there are a number of laws that give the employer the right to use them. This doesn’t mean the employees like them or feel the use of certain invasive ones (physical search, for example) are justified.

    Here are some examples of how EMPCS are being used and can be used in healthcare settings.

    Access panels: Electronic pads or keypads allow employees with the correct code to access restricted areas, either by entering a code or by swiping with their employer identification badge (see also RFID). Ciocchetti (2011) writes that some extreme cases include access panels to rest rooms where the employee is allowed only a specific number of bathroom breaks per day.

    Attendance and time monitoring: Most healthcare organizations have done away with the physical time clock where employees lined up to punch in. Replicon, one of many technology firms specializing in time tracking, offers various approaches to attendance monitoring, from waving a badge or swiping in at an access panel, to online computer clocking in, and now mobile device clocking in to a cloud for those employees who work away from home base.

    Automatic screen warnings: These pop-ups act as warnings to the employee that their electronic journeys will be monitored. In some instances, it will appear on the screen if the employee spends too much time on the computer away from job related tasks. If the employee is supposed to be working on a financial spreadsheet and decides to go shopping online, the warning screen alerts the employee that this is not a good use of her time.

    Desktop monitoring programs: Call it spyware, if you will, this is another way an employer can assess employee productivity. If the employee likes to play solitaire, this will track time spent on the card game and report it to the supervisor. These monitoring programs can also be inserted into emails and other “private” correspondence.

    E-mail monitoring: Many companies already monitor emails for key words that can indicate a potential for violence, or other inappropriate behaviors, such as stalking or harassment. Others may be more interested in if you are sharing company secrets. In healthcare, we care most about patient privacy and securing medical information.

    Filters and firewalls restricting Internet access: I know a few physicians who despise this feature on their hospital computer systems. Shopping websites have been barred from many, as well as websites that include the word “sex.” While it is likely the intention was to prevent employees from spending time on pornographic websites, the unintended consequence has been to deter physicians from providing information to patients who may have sexual issues.

    Global Positioning Systems (GPS) and Radio Frequency Identification Devices (RFID): In response to loss and theft of durable medical equipment, some hospitals have implemented the use of GPS technology to reduce the loss of these assets. The days of wheel chairs rolling out the door without return may be over. In some instances, employees’ physical movements can be monitored, as well, to ensure they are where they are supposed to be.

    Internet use audits: If a job does not require an employee to use the Internet, employees should not be surprised to find their access to the Internet is denied or restricted. Healthcare is no different from any other industry with respect to productivity expectations.

    Keystroke logging: If your graduates work for an employer that expects them to be on the computer eight hours a day, their keystrokes may be monitored and converted to readable records of what was typed. According to Ciocchetti (2011, p. 315) “keystroke logging is generally done in secret to obtain more accurate results.” In a healthcare setting, I could imagine this being used as an investigative tool if someone is suspected of committing fraud or other illegal activities.

    Physical searches: As noted before, the least justified in employee perception, as well in some courts of law, is the physical search. Employers have the right to search offices, files, lockers in some circumstances, such as suspicion of illegal activities. On two occasions, I witnessed pat downs of employees in a hospital by security personnel. Why? Because one was stealing drugs and needles and selling them on the street and the other was stealing drugs and using them.

    Social-network and search engine monitoring: Once employed, our graduates should bear in mind the same warnings we gave them before graduation. Employees should never post inappropriate information on social networks or blogs. Nor should they complain about their employer or post potentially identifying information about patients. All of these can be considered grounds for termination.

    Telephone, text messages, and voicemail monitoring: Much like email monitoring, some companies already monitor telephone, text, and voicemails for key words that can indicate a potential for violence, or other inappropriate behaviors, such as stalking or harassment. Others may be more interested in if you are sharing company secrets. As noted above, in healthcare, we care most about patient privacy and securing medical information.

    Video surveillance: So called "granny cams" in long-term healthcare settings and other settings with vulnerable populations are no longer a possibility, but a reality. Cisco’s white paper on video surveillance in hospital settings provides ten compelling reasons for using their product.

    1. Centralize patient observation;
    2. Remotely monitor the emergency department;
    3. Monitor for drug diversion;
    4. Help prevent infant abduction;
    5. Monitor patients with diminished faculties;
    6. Help prevent theft;
    7. Comply with operating room procedures;
    8. Support triage in disaster scenarios;
    9. Defend against false accidents claims; and
    10. Increase safety in public areas. (Cisco, n.d., pp. 1-5)

    With that list, why would anyone argue against video surveillance? Perhaps those who worry the video surveillance will extend to locker, changing, and rest rooms!

    As healthcare management faculty, it is important for us to stay abreast of current employer expectations and inform and advise our students about these techniques. Employers are paying employees to work, not participate in leisure activities on company time. In a fluid and dynamic industry that is determined to control costs, increase quality, and increase access, we should expect to see increased use of employer electronic performance monitoring and control systems to decrease employee abuses and increase employee productivity.

    Sharon B. Buchbinder, RN, PhD

    Sharon Buchbinder is Professor and Program Coordinator for the MS in Healthcare Management at Stevenson University in the Graduate and Professional School and former chair of the Association of University Programs in Health Administration (AUPHA). She is also the author of three books from Jones & Bartlett: Introduction to Health Care Management, Cases in Health Care Management, and Career Opportunities in Health Care Management.

    Here are some references if you are interested in this topic:
    Ciocchetti, C. A. (2011). The eavesdropping employer: A twenty-first century framework for employee monitoring. American Business Law Journal, 48(2), 285-369.

    Cisco. (n.d.) Cisco video surveillance in hospitals: Ten ways to save money and improve the patient experience: White paper. Retrieved from

    McNall, L. A., & Roch, S. G. (2007). Effects of electronic monitoring types on perceptions of procedural justice, interpersonal justice, and privacy. Journal of Applied Social Psychology, 37(3), 658-682.

    Sanders, D. E., Ross, J. K., & Pattison, P. (2013). Electronic snoops, spies, and supervisory surveillance in the workplaces. Southern Law Journal, 23(1), 1-27.

    Topics: health administration, Health Administration, Sharon B. Buchbinder, Health care, Sharon Buchbinder Blog

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