16 Taylorism, Fordism, and modern bureaucracy

The idea of interdependent systems functioning harmoniously to produce an end product with maximum efficiency and predictability, may seem like a familiar and taken-for-granted concept today, but it was literally revolutionary only a few centuries ago. The mass production of goods and services only became thinkable with the Industrial Revolution. But it was not until the early 20th century that production line manufacturing created commodities in such quantities for today’s culture of consumption to exist.

The transformation in what was essentially applied functionalism came to be known as Fordism (after the American car manufacturer, Henry Ford), and Taylorism (after engineer Frederick W Taylor). Both Ford and Taylor were heavily influenced by the work of Herbert Spencer, mentioned earlier, whose organic analogy explained how society could be understood as functioning reductively. Spencer’s work also heavily influenced Talcott Parsons, who contributed to the growing field of systems theory, and the belief that society could be understood as a series of inputs and outputs (think here of the way healthcare today is understood as admissions and discharges). But it was his influence on Ford and Taylor that has been most enduring.

Henry Ford revolutionised manufacturing in America in the early years of the 20th century, creating production lines that broke down the task of building cars in his Ford Motors plants, and gave each person a discrete responsibility. Raw materials entered at one end, and a car appeared at the other. Ford dispensed with the idea of skilled craftsmen who could build a car from scratch by hand, and replaced it with an army of low-paid, relatively unskilled workers, each with a highly efficient, predictable, and repeatable task. Production in Ford’s factories never stopped and labour became entirely replaceable; at first by other unskilled labour, then by machines. At the same time, Frederick Taylor was applying his interest in mechanical engineering to the scientific management of work organisation, arguing that it was in the interests of both workers and management to increase productivity. Managers would increase profits, and workers would increase pay. Taylor argued that maximum efficiency could only be achieved where the ‘physical movements in the workplace were meticulously timed and studied’ ^[1], and pay was linked to productivity.

Nigel Malin has suggested that the work of Taylor and Ford embodied ‘principles of work organisation, notably the transfer of all discretion from workers to management and the fragmentation and simplification of tasks, including managerial control over the pace of work’ ^[2]. You can see this in the emphasis we now place on efficiency and organisation in healthcare, for instance, in the ‘production-line’ mentality that drives a lot of decision-making around patients’ admission, assessment, treatment, and discharge from care in publicly-funded healthcare; and in the emphasis on managerialism and streamlined ‘customer-focused’ services. But a version of Taylorism and Fordism has always resided within physiotherapy too, and this helps explain why the profession has remained an important agent of social progress in many (Western) healthcare systems.

Physiotherapy has always been oriented towards maximising the efficiency of function and movement. There is little place in physiotherapy for convalescence, relaxation, and rest ^[3], and the profession’s focus has always been centred on the productive, working, active, able body. It has always seen itself as an important and distinguishable cog within the machine that is the orthodox healthcare system. And in recent years its professional educators, leaders, and researchers have wholly embraced the objectivity and scientific reductionism of quantitative research and evidence-based practice. All of these are classical traits of functionalism, and tie physiotherapy closely to the goals of industrial capitalism, medicine, and the modern state.