Efficiency or Effectiveness? By Geoff Ribbens Brought to you by Williams Medical Supplies

Article Published: January 30, 2008 at 12:36 pm

Content in: Issue 1, Management

Author: Geoff Ribbens

This is the first in a series of short articles about the management of people in the Primary Health Care environment.

We are going to start off with a brief discussion about the difference between people being efficient and people being effective.

This is actually very important because it is fundamental to employee selection and appraisal, both of which we will cover in future articles.

The theme of this article is that there is a difference between being efficient and being effective and that not all efficient employees are necessarily effective!

Dr Ted Johns, Chairman of the Institute of Customer Service, suggests that each employee has four important parts of his or her job:

1. They have to carry out their duties,
2. They have to anticipate events,
3. They have to improve what they do and
4. They should also be involved in change.

He describes the four parts of everyone’s job as follows:

Maintenance.
Maintenance is fulfilling ones duties, following the job description and delivering what is required for the role.
Needless to say, if employees did not carry out their duties as described in their job description, it is very likely that they would be disciplined or even dismissed.
We should be aware that, when it comes to job descriptions, there is always an element of ‘drift’.
The reason for this is two-fold.
Firstly, technology and jobs change and job descriptions often become out of date.
Secondly, all employees, over time, tend to redefine their role so they do more of the things they like and less of the things they don’t like.
In general terms, if people are fulfilling their duties they are seen as efficient.

Crisis Prevention.

There is more to a job than just fulfilling ones duties (maintenance).
In addition, we expect employees to anticipate events, identify things that could go wrong and do some ‘fire fighting’.
We expect employees to learn from mistakes and think ahead.
So ‘crisis prevention’ is an essential part of everyone’s job and it is again linked to being efficient.
Employees who are efficient are involved in ‘maintenance’ and ‘crisis prevention’.
These employees keep their jobs but they are not effective.
In management terms, efficiency is about doing things right, following the rules, doing one’s duty, anticipating events, and so on.
Effectiveness, on the other hand, means doing the right thing. Effectiveness is nearly always about getting results and improving things - not just doing what has always been done.
Effectiveness is involved in the next two aspects of an employee’s role, improving things and changing things; to be effective means that an employee is ‘adding value’.
As a Practice Manager, you employ someone to carry out the ‘maintenance’ and the ‘crisis prevention’ but you hope they do more than this, you hope they improve things and change things for the better.
Lets us look at the next two elements of an employees role, the ones that lead to effectiveness and ‘add value’.

Continuous Improvement.
Continuous Improvement is a process where an employee adds value by improving their job.
That is, improving quality, reducing costs, reducing errors, doing things more quickly and improving the service that is offered to both internal as well as external customers (other Health Care Professionals, suppliers as well as patients).
All jobs can be improved, even if it is just doing things quicker, smarter and cheaper. Many processes soon become out of date so there is usually plenty of ways people can add value in their own job by better ways of working.

When it comes to the Primary Health Care team, many of these improvements have a positive effect on the service that patients receive or improve the working life of Primary Care employees.

The Management of Change.
Although continuous improvement is about change, it is not radical change; it is more about improving some aspect of the job. The management of change is about coming up with change ideas and implementing them.
You can often identify change because it often challenges current assumptions.
Generally speaking, people resist change, they are happy in their comfort zone of experience.
It is often easy to identify change ideas but difficult to implement them.
But change means adding value, it is another way to be truly effective.

To sum up:

Efficiency is all about ‘maintenance’ and ‘crisis prevention’ and effectiveness is about adding value through Continuous Improvement and/or the Management of Change.

As a Practice Manager, you should look at your own role and estimate to what extent you are efficient and to what extent you are effective!

Many employees are efficient but not effective.

The fundamental reason is that many people are happy to be efficient, keeping their jobs, but reluctant to be effective and add value.
There are several reasons for this sad state of affairs:

• We tend to select people on the basis of ‘can they do the job?’, not on ‘can they improve the job?’.
• Poor time management often means that employees find very little time to improve things; they are too busy with ‘maintenance’ and ‘crisis prevention’.
• We appraise people on the job itself and not how they have changed or improved the job.
• Many Practice Managers and GPs do not encourage employees to think beyond the job. Innovation and change are not encouraged. In some cases senior partners may want to keep things as they are.
• Employees are not motivated to improve things, they would rather just complain.
• All change involves risk. Many people do not like taking risks, however small, there is the fear of failure.
• Those involved in change and risk fear criticism. People do not like change so they are happy to criticise those who try to improve things.
• There might be a blame culture in the PCT; it is safer not to try to improve things than to stick your neck out.
• People find it difficult to think of new ways of doing things, in management terms this is called ‘thinking outside the box’.
• Challenging current assumptions is always difficult because they are ‘current assumptions’.

Many innovations and inventions take a long time to be adopted.
Dyson invented a new form of vacuum cleaner but no manufacturer was interested.
They were more concerned about not selling their vacuum cleaner bags than thinking about the possibility that at some future date they might not be able to sell their vacuum cleaners!

So what should the practice manager do?

• Incorporate continuous improvement and the management of change in all job descriptions. Use words that incorporate improvement and change, not words like ‘to do’ or ‘carry out’ but phrases like; ‘to enhance’, ‘to improve’, ‘To add value’ and ‘change’.
• Select and appraise employees on being effective as well as being efficient. What have they done to improve their previous job over the last year? What plans do they have to improve their present job in the future?
• Praise employees for being innovative - even if the new idea or improvement does not work. Celebrate changes and improvement.
• Tell employees that if the new idea does not cost money, consume too much time and is of low risk then ‘just do it!’
• Visit other PCT’s to see new ideas at work.
• Go to conferences to share new ideas.
• Constantly ask employees about ‘how their job can be improved?’ What wastes their time? What gets in the way of customer/patient satisfaction?

What are the bottlenecks that prevent improvement and change? How can quality be improved and how can costs be reduced?

• Explore new ways of purchasing
• Look at all the systems and processes. Are they out of date? Do they slow things down? Are they necessary?
• Remember, the Practice Manager can add value through how they motivate and manage the Practice Team.

My next article will show you how you can select employees and aim to select those who are not only efficient but effective as well!

Geoff lectured in Organisational Behaviour at postgraduate level for 20 years and has wide experience as a management consultant and trainer.

He currently works for the Oxford Centre for Innovation as a ‘Leadership Development Adviser’.

He also runs regular management workshops for Reading University as well as managing his own consultancy.

Geoff Ribbens is a joint author with Greg Whitear of “Body Language” part of “Instant Manager Series” coming out this autumn published by Hodder Arnold.

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