Are efficiency initiatives productive?

Asking for more with less has top staff taking early retirement

An increasing number of organizations are under pressure to control costs. In these circumstances it is common for executives to twist efficiency improvement initiatives into vehicles for cost containment or cost-cutting. As a result HR is under pressure to reduce people-related costs.

One HR executive recently told me, HR is asked to lead initiatives to “do more with less by getting the most out of employees.” People management initiatives take on the goal of either getting more done with people working at a faster pace or reducing operational costs by reducing staff levels.

Janice Stein, in her book The Cult of Efficiency, made the observation that in the post-industrial society the cardinal transgression is inefficiency.

The drive to improve efficiency continues to receive widespread attention in private and public sectors across Canada. The goal to attain ever-increasing levels of efficiency has become an end in itself.

These efforts can achieve short-term efficiency gains but can cripple the medium- to long-term health of an organization. In the 1990s, organizations reduced staff as a cost-saving measure but failed to eliminate the equivalent amount of work.

Over time these short-term productivity gains have turned into staff burnout, increasing disability claims and employee-initiated earlier retirements, growing workplace conflict and degrading workplace performance. In short we are burning out our most experienced staff at a time when we face long-term staffing shortages.

Constructive efforts to improve efficiency need to support the longer term strategic goals and challenges facing an organization. More attention is needed on efficiency gains that enable the organization to achieve sustainable operational improvements.

The productive efficiency of a process or work group includes: quantity, quality, time, resources, effectiveness, scope and values.

The concept of productive efficiency begins with the principle that efficiency can only be assessed relative to the results from a work process. Efforts to improve or measure productive efficiency need to incorporate all of the identified factors.

Here’s how this would play out in a health-care setting.

Quantity deals with the volume of products or services provided. It is most commonly measured by determining the volume per unit of input. Hospital volume is often measured in terms of patient days or clinic visits.

Quality is meeting or exceeding expected performance requirements or standards of customers and stakeholders.

In health care, quality involves the degree of success in addressing the patient’s health needs, as well as how well the patient’s needs are met by the health team.

Quality depends on the skill of health-care professionals, the state of facilities and equipment, and the time and attention that staff can devote to meeting a patient’s needs.

Time deals with the duration of the process or activities from start to finish, as well as the timeliness or responsiveness to adjust to a change in work demands.

On a patient-care unit these days, the pressure is on minimizing the time that a patient is hospitalized. The associated measure is the average length of stay.

Resources include all of the resources or inputs used or consumed in producing the products, services and by-products. A comprehensive assessment will also include the indirect resources needed to administer and sustain the work process or work group.

Optimizing resourcing is highly complex. The challenge is to appropriately value the contribution of every type of resource and to balance the mix of resources.

In the current health-care crisis the public is demanding more doctors and nurses. Although needed, doctors and nurses are not productive if they are not properly supported by many other essential professions.

Effectiveness is doing the right things. The process or work group accomplishes what is needed, while reducing the production of undesirable by-products.

In health care, effectiveness relates to using the appropriate diagnostic technique to assess and address a patient’s heath problem. An inexpensive but inappropriate diagnostic test may appear cost effective but is not productive.

Scope deals with the breadth and time period used to assess productive efficiency. A comprehensive assessment would take a broad systems perspective.

Hospitals have improved their own efficiency by discharging patients sooner; however, a consequence has been an increase in the demand for home-care services after they have left the hospital. A broad scope analysis would consider all health-care services associated with diagnosing, treating and caring for a patient with a given medical condition.

Values include constraints on a process or work group that arise from the expectations of the organization, customers and society. It also includes requirements established through corporate policy or legislation.

In health care, Canadian values have a major impact on the way in which services are provided. As is evident in recent national debates about care options, it is the values and expectations of the public that are strong factors in defining appropriate means of providing health care which in turn determines the productive efficiency of health services.

The factors impacting productive efficiency are highly complex and require close attention, but by highlighting the range of factors involved, hopefully organizations will be encouraged to look at efficiency improvement initiatives as more than a short-term exercise to improve the balance sheet.

Properly done, productive efficiency initiatives become strategic investments in the long-term health and sustainability of any organization.

Brian Orr is vice-president of human resources and community relations with the London Health Sciences Centre in Ontario. He can be reached at [email protected].

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