It sounds a lot like “one fish, two fish, red fish, blue fish” doesn’t it? Well with apologies to Dr Seuss, here is what I am thinking about today:

Example One: You go on line to get an airline ticket. After putting in the same information multiple times (find the airport code, use the little interactive calendar, check the “agony index,” –thank you Hipmunk for that accurate term– compare flight times and costs, etc.) the site crashes repeatedly. Finally, in desperation, you call the airline. After 25 minutes on hold, you finally reach an agent that will indeed sell you a ticket, but for an additional $25 fee. The airline’s “efficiency” has been improved but the cost has been absorbed by the customer.

Example Two: You are a radiologist in a high volume trauma hospital medical center. You read maybe 40-50 cases a day– CT scans, MRIs, ultrasounds,and so on – filled with complex images. There are few “normals” in a trauma level 1 or 2 hospital, just various kinds of disasters ranging from motorcycle accidents to strokes to tumors. Each case is dictated to a trained medical transcriptionist who can type as fast as she or he can hear, with extraordinary accuracy and full command of the medical terminology. These are solidly middle class positions, with median salaries of about $35K, with the top 10% making about $50K, according to the Bureau of Labor Statistics. They require a high school degree and additional training, often at a community college, but not a Bachelor’s degree. But your hospital decides that it will save money by laying off all of the transcriptionists and replacing them with voice recognition software. Anyone who has used this software knows how inaccurate it can be. In medicine, it might have 95% accuracy! But that means your doctor has to correct 5 out of every 100 words. Is that good enough? And now your radiologist spends twice as much time dictating as he used to. His or her day has gone from 8am to 6pm to 7 or even 8 pm, depending on case volume and complexity. (One scan might yield 1500 images!), and s/he still has to actually treat people! The hospital’s “efficiency” has improved, but at the expense of both the transcriptionist and the doctor.

We all have examples of this from our own experience. Sometimes it is the dead end phone tree. Why do I have to say my credit card number over and over again, when they will ask me for it again once I get a live person when I call my credit card company? Why does the cable company not fully staff its customer support number? I waited on the phone for ADT’s customer support for 51 minutes recently! These processes are deliberate—they improve the “efficiency” of the company, by requiring fewer people to answer calls because the extended wait times make people give up! The company’s “efficiency” has improved, but the cost in time (and frustration) has been paid by the consumer.

So here is my question for today: Can we get a better definition of efficiency than “fewer people doing more work” along with making the consumer do as much of the work as possible, despite their lack of specialized training? Or as I put it to myself: Eff  ≠  (roadblocks + hurdles) – employees!