Hawthorne Effect vs Big Brother: The Thin Line Between Oversight and Oppression

In 1924, a group of researchers at Western Electric's Hawthorne Works factory made an observation that would change the way we think about human productivity. They found that when workers knew they were being observed, their performance changed. This became known as the Hawthorne Effect: the idea that people work harder, follow ideal workflows, and behave differently when they know they’re being watched.

Fast-forward a century, and we live in a world where oversight can easily evolve into something Orwellian. Cameras in every workplace, keystroke tracking on computers, AI-driven performance analytics, and even biometric surveillance in some industries. The line between "helpful oversight" and "Big Brother" has never been thinner.            

So how do we strike the right balance? This conversation is urgent in healthcare, and dentistry is no different. We need to ensure that we can positively harness the power of the Hawthorne effect, but make sure we’re not sliding fast down that slippery slope.                                  

Hawthorne effect    

Being social creatures, we’re usually more moral and harder working when someone else is in the room. Especially if that other person is equally expert. I’m not wading into the work from home debate here, but rather - think of two surgeons working in tandem. Or two engineers doing pair programming.            

In plainer words, If we know someone in the room can “call bullshit” on our work, we usually work extra hard and carefully to avoid ignominy.        

Why the Hawthorne effect needs to be harnessed

           
• Psychological – Just like athletes perform better when coaches are watching, employees and clinicians tend to operate at a higher standard when they know their actions are watched and measured.
   
• Debugging – Linus Torvald of Linux, once said ‘given enough eyeballs, all bugs are shallow’. Engineering and software development has known the importance of debugging for decades. Medicine is yet to truly catch up to the power of collaboration and on the fly contrarian opinions.
     

We know through CoTreat data, that dentists make less diagnostic errors, and even make more revenue when supported by AI. This happens primarily through the two above mechanisms, and is especially prominent in orthodontics, and implant workflows.            

Hawthorne to Big Brother    

But here’s where it gets tricky. If oversight crosses a certain threshold, it stops being a tool for improvement and starts feeling like surveillance. When people feel scrutinised instead of supported, the Hawthorne Effect could give way to something far more insidious.            

           
• Creativity dies under the weight of oversight – People perform better under reasonable observation, but excessive monitoring can stifle liberty, creativity and performance.
   
• Trust is undermined – If employees, clinicians, or even patients feel like they’re being watched not for their growth but for compliance and hitting metrics, they begin to disengage.
     

Preventing Big Brother    

The key to leveraging the Hawthorne Effect without descending into Big Brother territory lies in transparency. The best systems:            

• Provide insights, not just oversight – Data should be a tool for better decisions, education and empowerment, not a mechanism for punishment.
   
• Decentralise and democratise data - Data should be shared with stakeholders of different levels, rather than be hoarded centrally.
   
• Have ethical guardrails – Transparency on how data is used ensures trust is maintained with different stakeholders.p

Encourage this discourse in dentistry, because if we don’t get this correct now, the implications are very significant.