Great post by Mark Addleson on the problems with efficiency:
Put these problems down to the desire for greater efficiency, rather than better care. Efficiency and care are not the same. At best there is a weak correlation between numbers and care. One is a technical consideration (How many patients do medical and administrative personnel see or talk to each day? How long do patients have to wait for an appointment? How long does a doctor spend with a patient?) the other is a matter of human feelings, attitudes, emotions, relationships, including the capacity and desire to do good work.
Short of keeping a very close eye on what is going on between administrators and patients and doctors and patients, and asking patients about their experiences, there is no simple, and certainly no unambiguous way of assessing the quality of care that veterans receive. Under the misguided assumption that a few numbers will convey to people ‘higher up,’ who are not involved in the work, whether the those doing the work of providing care are doing it efficiently, someone sets performance targets. This puts the ‘machine’ bureaucracy into motion and initiates a bureaucratic response. (Remember that bureaucracies, where employees follow rules and cannot use their initiative, are archetypes of efficiency.) Employees tasked with providing the numbers (mostly clerks and administrators) are going to be judged not by the quality of the care they provide and not by their patients, but, based on data they receive, by their superiors who are also administrators. Neither health nor care really feature in this process.