Scenario 1

It’s 3 a.m. You have a monster day tomorrow working clinically in the emergency department, followed by a lecture to your residents that afternoon, and then back to the office to scramble through the day’s 180 emails, while somehow still making the 4 p.m. and 5 p.m. staff meetings. You’re almost finished with your business statistics assignment for your MBA finance class, where the professor is extolling the values of the Poisson process. You laugh for a minute in your head and then realize its 3 a.m. and your eyes are barely open. That’s when you hear the faint screams of your 18-month-old, and then you lose it and start to cry at the sheer insanity of your life. Somehow, you get through the night and catch a few hours of sleep. The shift goes well, the lecture awesome, and you pound through email traffic while chiming in with a few well-timed comments during your conference calls to ensure people know you’re actually on the phone. The day ends, and you head home. While listening to Wilson Phillips’ “Hold On” on the ride home, which you would resolutely deny if questioned, you think, How did I get that all done? Thinking back to your social psychology class in college, or perhaps making it up in your mind, you latch on to the term “the efficiency principle.”

Scenario 2

You have two interns working with you this month. One, Georgia, is on top of her game, has been a total rock star in the office, but constantly has a mountain of papers strewed upon her desk, built up with projects that you and various members of your team have piled on her. The other intern, Gregory, is sharp but is clearly not at the same level as his co-intern. He has just finished a few projects, and his desk appears as if it was just spit-shined by Mr. Clean. You have a critical and timely task that needs completion. Whom do you ask for help?

Common sense—which, as we know, is not all that common—might tell you to let Georgia catch up with her work and assign Gregory the task. However, that would be flawed logic. The reason Georgia has that stack on her desk is because she comes through each and every time, and folks in the office now know that she is a doer and will get it done every time. As the old saying goes, if you want something done, give it to a busy person!

Make The Efficiency Principle Work for You

The efficiency principle states, in my words at least, that the more you are given and the more your plate fills up, the more you can bang out. Surgery volume goes up, yet mortality and morbidity go down—why? You become better at the process, and then it becomes part of your culture. This is Toyota (Lean Six Sigma) at its core. When are you at your best? Is it three weeks before a deadline? Well maybe for some, but for 99 percent of us, we are at our best when the deadline is tomorrow, and still working on your kid’s diorama for art class! Setting deadlines, being organized, and knowing what is important that day or that night are key.

Innovation favors not only the creative but also the starved mind. When there is no choice to fail, the work gets done. Know in your mind that it will all get done as it always has in the past and then plow through.

We get better at things the more we do them and when we have no choice. Innovation favors not only the creative but also the starved mind. When there is no choice to fail, the work gets done. Know in your mind that it will all get done as it always has in the past and then plow through. So, as the ancient Chinese proverb goes, the journey of a thousand miles starts with a single step. Go take that step.

Dr. Kessler is deputy chief of staff at Durham VA Medical Center and associate professor of emergency medicine and internal medicine at Duke University School of Medicine in Durham, North Carolina.