Efficiency. Hospital administrators and other bureaucrats say that they want it. Medical group leaders parrot it. But is efficiency really the goal? Is it really what’s important? Or is it simply something that (they think) can be measured? And, of course (not) what can be measured can be managed.
Let’s do a simple thought experiment. The efficiency measure is “turnaround time” in the cath lab. Turnaround time is the lag between which Patient A is wheeled out to recovery and Patient B is wheeled into the cath lab. That lag time is generally used as a measure of the anesthesiologist’s “efficiency.” After all, “we” don’t want the anesthesiologist delaying cases.
Assume for purposes of our thought experiment that the patient suffers a heart attack between pre-op and the cath lab. Should the anesthesiologist do what’s most “efficient” in terms of turnaround time and take the patient to the cath lab anyway?
So what we’re really after is efficacy, not efficiency. But that’s harder to measure. Like love, you know it when you feel it, but we can’t objectively measure it.
There’s nothing wrong with measurement as long as we’re measuring what’s important, and as long as we understand that some things can’t ever be measured.