The "biosecuritization" of healthcare delivery: Examples of post-9/11 technological imperatives

This paper develops the concept of "biosecuritization" to describe new instantiations of the technological imperative in healthcare. Many discourses and practices surrounding hospitals' new investments in information and communication technologies tend to revolve around security provision. Oftentimes, however, scenarios of extreme and exceptional circumstances are used to justify the implementation of identification and tracking technologies that may be more about managerial control than patient care. Drawing upon qualitative research in 23 U.S. hospitals from 2007 to 2009, our analysis focuses on hospitals' deployment of identification and location technologies that manage patients, track personnel, and generate data in real-time. These systems are framed as aiding in the process of managing supplies and medications for pandemic flu outbreaks, monitoring exposure patterns for infectious diseases, and helping triage or manage the location and condition of patients during mass casualty disasters. We show that in spite of the framing of security and emergency preparedness, these technologies are primarily managerial tools for hospital administrators. Just as systems can be used to track infection vectors, those same systems can be used on a daily basis to monitor the workflow of hospital personnel, including nurses, physicians, and custodial staff, and to discipline or reward according to performance. In other words, the biosecuritization modality of the technological imperative leads to the framing of medical progress as the "rationalization" of organizations through technological monitoring, which is intended to promote accountability and new forms of responsibilization of healthcare workers.