I was recently coaching a bright, energetic primary care physician in her first few years of practice. She was working through her Life’s Purpose statement, an exercise we often recommend. At the end of her admirable statement, she tagged on “with efficiency.” Naturally, we explored this a bit. Our conversation meandered toward an interesting conclusion: the more she focused on efficiency, the more likely she was to feel overwhelmed and to deny herself basic human needs (like drinks of water and potty breaks). Her effort to accomplish as much work as she could in a day was reducing her resilience.
The inverse relationship of efficiency and resilience
I became interested in the apparent inverse relationship between efficiency and resilience when I spied this headline from the Harvard Business Review: “The High Price of Efficiency.” In the article, Roger Martin, author of When More Is Not Better: Overcoming America’s Obsession with Economic Efficiency, argues that “an excessive focus on efficiency produces startlingly negative effects and creates the potential for social disorder … the remedy [is a] stronger focus on a less immediate source of competitive advantage: resilience.”
The article provides interesting examples of this phenomenon, such as the challenge facing almond growers. More than 80 percent of almonds are now grown in California. While this development enhanced efficiency, it also eliminated all “slack” in the system. One weather system or virus could wipe out the industry.
Too much efficiency?
What does this have to do with us as health care workers? I often notice that my clients believe eliminating wasted time and space would be a benefit to their practice: “If only I was more efficient with my notes. If only I had fewer steps from my workspace to my patient room. If only I had more exam rooms or OR time.” These modifications are brilliant if they provide more space for the unexpected, but they can also rob us of our breathing room, our ability to absorb the ebbs and flows of taking care of people. The ability to bounce back.
We all love to feel efficient and productive. But when does a focus on efficiency become too much? Some signs might include feeling overwhelmed, being short with staff and/or a low tolerance for the unexpected (running late, an add-on, a scheduling error, etc.).
A colleague recently described her retirement plans, which include plenty of time for boredom because that’s when creativity flows. We sacrifice something when we fill in all the open spaces with what we believe to be productive busyness.
Finding balance and flow
One might call the perfect balance between efficient productivity and resilience “flow state.” If the challenge is too great, we feel fear; if too easy, we get bored. Flow occurs somewhere in between, a sweet spot in which we stretch but don’t snap. The stress we experience in flow state – “eustress” – motivates and energizes, improving focus and performance.
Back to our hard-working PCP. By the end of our session, she made the following achievable goals: to drink water and take bathroom breaks, to come in a little earlier to start the day off well, to intentionally take a breath between visits, and to stop packing lunch so she could no longer work through that break. In a way, she would sacrifice some efficiency to create slack in her system. In our next meeting, she described less frustration and overwhelm.
Erin Maslowski is a physiatrist and physician coach.
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