The Efficiency Principle

Scenario 1: It’s 3 AM…you have a monster day tomorrow working clinically in the Emergency Department followed by a lecture to your residents that afternoon and then back to the office to scramble through the day’s 180 emails while somehow still making the 4PM and 5PM staff meetings. You’re almost finished your business statics assignment for your MBA Finance class, where the Professor is extolling the values of the Poisson process, to which your mind instantly wanders to those awesome old Grey Poupon commericals from the 80’s where the limo pulls up and asks “pardon, but do you have any Grey Poupon?” You laugh for a minute in your head and then realize its 3 AM…and your eyes are barely open. That’s when you hear the faint screams of your 18 month old …and then you lose it…and start to cry at the shear insanity of your life…but somehow, you get through the night, you catch a few hours, the shift goes well, the lecture awesome and you pound through email traffic while chiming in with a few well timed comments during your conference calls ensuring people know you’re actually on the phone. The day ends and you head home. While listening to Wilson Phillips’ “Hold on” which you would resolutely deny if questioned, on the ride home, you think, how did I get that all done? Thinking back to your social psychology class in College, or perhaps making it up in your mind, you latch on to the term, the “Efficiency Principle.”

Scenario 2: You have two interns working with you this month…One, let’s call her Georgia, she is on top of her game, has been a total rockstar in the office, but constantly has a mountain of papers strewed upon her desk built up with projects that you and various members of your team have piled on her. The other intern, Gregory, still sharp, but is clearly not at the same level as his co-intern. He has just finished a few projects and his desk appears as it was just spit shined by Mr. Clean. You have a critical and timely task that needs completion, who do you ask for help?

Common sense, which as we know, is not all that common, might tell you to let Georgia catch up with her work and assign Gregory the task, however, that would be flawed logic. The reason why Georgia has that stack on her desk is because she comes through each and every time, and folks in the office now know that she is a doer and will get it done every time. As the old saying goes, if you want something done, give it to a busy person!

Scenario 3: Let me take you through a mental walk. Break out that little figment of your imagination tucked way back in the dark corners of your mind. Think back to when you were single…it was just you…you were in medical school stressing over the final common pathway of the Krebs cycle. You felt pretty stressed…working late hours and eating Chinese take-out at 8PM…but life was pretty good. You were, after all doing what you love, even if it would take the next 16 years of your life just to financially break even.   Then, the next thing you know, you head out for a group football game outing in the beautiful Chicago Fall to see Northwestern battle Bowling Green and bam…you have a girlfriend. She quickly becomes the love of your life. You find someone to share life’s little treasures with…but now, instead of staying late to put in that central line your patient needs, you sign it out to the eager intern and head home early (read 6 PM in resident talk) so you can walk around the park and go grab dinner and drinks at that little pub downtown. The work doesn’t go anywhere, but somehow you still get it done…and spend time with your special someone. Boom, three years later, you’re married and holding your little girl in your arms…life is amazing…but, you still have your work…and it has not gotten any easier. You’re a ferocious worker, so you got promoted and you’re now Chief of the Emergency Department…and finding time to spend with your wife…and time to change diapers, feed you’re little precious, burp her, hold her tight and get up with her when she cries at midnight…and 2…and 4… and then the alarm goes off, at which time you are thankful you trained hard in residency for nights like these before the work hour rules came to be…and you get to take a nap every 2 hours during call. Yet somehow, the work still gets done. Fast forward a few more years, you now have 4 kids (ages 6, 5, 3 and 1), you try to find time to go see a movie with your wife every so often and still plan surprise treasure hunts on her birthday. You have been doing really well at work, and so you get promoted to the Exec level! More work, more time…more efficient! And you love it…so much so, that you decide to pursue an MBA…because, let’s be honest, they never taught you this stuff in med school. So, you’ve got a lot of plates in the air now…four kids, a loving wife, a challenging, yet rewarding job, and business classes…But strangely enough, you get it all done…and not only that, you really like it. How can that be? Why did we feel busy back in the day when it was just us? Easy job, no kids…it seemed tough at the time, but looking back, you cannot even imagine how you would fill the hours. Let’s call this the Efficiency Principle.

The Efficiency Principle states, in my words at least, that the more you are given… the more your plate fills up, the more you can bang out…surgery volume goes up, yet mortality and morbidity go down, why? You become better at the process…and then it becomes part of your culture. This is Toyota (lean/6 sigma) at its core. When are you at your best? Is it 3 weeks before a deadline? Well maybe for some, but for the 99% of us, we are at our best when the deadline is tomorrow, and you are still working on your kid’s diorama for art class! It is when the final exam is tomorrow, not in 3 weeks. We are driven by deadlines, by the need to get things done…and most of us wait till that last minute…and you know what, it always gets done. Setting deadlines, being organized and knowing what is important that day or that night is key…always being in the moment. How often do we have a pile of work and our kid’s birthday is that weekend, so you’re thinking about which inflatable blow up you’re putting in the backyard and which pizza place to order from, while knowing you have to go to the Subaru dealer b/c you got an email saying there was a recall on the brake line and then …and then you have lost 30 minutes thinking about things that didn’t get done…Instead, we require laser like focus, Ninja (Phil Jackson) type Zen focus to stay in the moment…and get those references back to HR so you can actually hire an office assistant allowing you to stop running to the scanner 6 times a day…again, efficiency principle at work.

We get better at things the more we do them… and when we have no choice. Innovation favors not only the creative, but the starved mind. When there is no choice to fail, the work gets done. People spend so much time stressing about an upcoming test, deadline, project that they end up spending more time worrying than actually doing the work for the project…In essence, killing their efficiency. Know in your mind, that it will all get done as it always has in the past and then plow through. So, as the ancient Chinese proverb goes…the journey of a thousand miles starts with a single step. Go take that step.

CK

5 Tips for a more “efficient” life

• Don’t let them tell you you can’t. You can do it all! From someone who’s been there and know it can be done…when your awesome boss/CEO leaves the office at 4:30, so should you. Go home, be with your kids, coach soccer, watch your daughter ice skate…the work will still be there when they’re asleep…and you know what, it will get done.
• 2) Harness the power of the fruit. Did you ever have a colleague tell you to shut off when you leave? Of course you did! It happens all the time. Do you know who tells you to turn it off? The folks that come in at 5 am and leave at 7…and that may work for them, but you know what, I’d rather get there at 8, leave at 5, enjoy the time with my family and still get my work done. There is plenty of time to answer email after soccer, when the kids go to bed or on line at the bank (does anyone actually go to the bank anymore?). Use your fruit (whatever fruited device you see fit…apple, blackberry, blueberry, etc…) to go through those emails that do not require much thought. Triaging, as I learned in my Emergency Medicine residency days, is likely the most important skill I took away from those fun years. Although, I will say there is nothing quite like sticking a needle into someone’s pericardium hoping that you pull something out and get a rhythm back, but I digress.

• The American Idol Principle…create the win-win! Some real business geniuses started this phenomenon. People line up, often times in the cold, for hours if not days, to come on television and compete to be the next American Idol…all the while making tons of money for Fox or Nigel something or the other. This is an absolute win-win. Create this in your workplace. You can get more done when you collaborate, whether working with med students, other service chiefs, the Critical Care committee. Spread the love and engage others in your work. You will all be more productive and it really does benefit all parties. For example, Johnny, the 3rd year gunner med student looking to publish, gets research experience and a letter for residency…and all the while, you have an opportunity to continue work on that grant you really don’t have time for and writing more papers to help further the cause. Yet another striking instance of the efficiency principle at work.  

• You gotta love what you’re doing…especially at 11 o’clock at night…otherwise, it just aint happenin’. You are not going to be efficient at anything if you do not really enjoy what you are working on. I remember the time I was doing my thesis work in medical education…looking at consultations out of the ED. We went into great detail to train our resident physicians in these ways of communication (the 5Cs: Contact, Communicate, Core Question, Collaborate and Close the Loop). We randomized them to two groups, rated them and found the ones who got trained consulted so much better. Many a night I was up listening to recorded conversations and crunching data. When it’s 11 pm, you’re exhausted and the NBA Playoffs are on, you better love the stuff or else it will sit on the back burner for quite a while.
• 5) Be uber-productive at work. I’d rather have the time at home, so focus on getting all your work done…there are ample opportunities to mess around and chat it up.   Decide what’s important to you…if you would rather have time at home/with kids/family, then spend your time at work, well working…churn thru the emails, read the papers at lunch, sign what you need to sign and get on home. That is not to say, be a social leper at work…Again, (see tip 1) you can do it all!