AI and Data-intensive Surveillance in Professional Work: Transforming Discretion and Accountability

In this chapter we interrogate how digital surveillance technologies in healthcare may transform professional work and impact professional knowledge, discretion, and accountability by functioning as algorithmic management and reinforcing existing regimes of control and responsibilization. We present a case study on the implementation of an AI-based surveillance technology used for the remote monitoring of discharged patients from a Danish hospital ward. In this new arrangement of work, where data act as proxies for the embodied patient, we explore how nurses’ professionalism and accountabilities are challenged and reconfigured. In relation to this, we stress how the use of the AI-based surveillance technology creates new visibilities, allowing for new modes of monitoring and control of professionals’ (re)actions and decision-making, underlining the multidirectional character of surveillance (Lyon, 2018). We demonstrate how a combination of expanded tasks and opacity leads to intensified work and strain for the nurses and their professional relationships, as it simultaneously expands their responsibilities, impedes their professional assessments, and makes their assessments visible and open for surveillance to colleagues and management. Also, the study suggests that testing being a permanent situation, changes work and challenges professionalism in complex ways, and frames the room for co-determination differently from regular implementation of new technology. Our study emphasizes how transformation of power relations may unfold in complex and sometimes subtle ways. Taking as a starting point recent reforms based on digitalization, we describe an increased responsibilization of the professionals, while their powers to deal with possibly conflicting demands and opportunities to prioritize, are not increased.