Designing Work That Doesn’t Hurt People: Post 5

When Efficiency Undermines Care

The hidden cost of doing more with less

Efficiency is often treated as an unquestioned good.

Shorter appointments.
Tighter schedules.
More patients per day.

In theory, efficiency improves access, productivity, and sustainability. In practice, when efficiency becomes the primary goal without guardrails, it can quietly undermine both care quality and team well-being.

Efficiency is not inherently harmful.
Unexamined efficiency is.

The Difference Between Efficiency and Effectiveness

Efficiency focuses on speed and output.
Effectiveness focuses on outcomes and quality.

When organizations prioritize efficiency without equal attention to effectiveness, teams are pushed to move faster without the conditions needed to do good work well.

Research in healthcare consistently shows that excessive time pressure is associated with increased error rates, reduced communication quality, and moral distress among clinicians (Shanafelt et al., 2015; Hall et al., 2016).

When speed becomes the metric, something else always pays the price.

A Familiar Pattern in Veterinary Medicine

In veterinary settings, efficiency often shows up as pressure to keep moving.

Shortened conversations with clients.
Less time for teaching or mentorship.
Decisions made under constant interruption.

None of these choices are made lightly. They’re usually responses to demand, staffing limits, and financial pressure.

But over time, teams begin to feel the tension between what they know is right and what they have time to do.

That tension has a name.

Moral Distress: When Values and Systems Collide

Moral distress occurs when professionals know the appropriate action to take but are constrained from taking it by organizational barriers (Epstein & Hamric, 2009).

In veterinary medicine, this can look like:

Rushing care that deserves more time
Limiting communication that supports informed consent
Prioritizing throughput over thoroughness

Repeated exposure to moral distress is strongly linked to burnout, disengagement, and turnover (Hamric et al., 2012).

Efficiency that repeatedly places teams in value conflict is not neutral.
It is harmful.

Why Leaders Often Miss the Cost

Efficiency metrics are visible.
Human cost is quieter.

Leaders see numbers improve while:

Emotional exhaustion increases
Trust erodes
Learning declines
Compassion fatigue deepens

Because the system keeps functioning, the strain is easy to overlook.

But people feel it long before metrics change.

Efficiency Without Slack Is Fragile

High-reliability research shows that systems without slack are brittle. They perform well until they don’t, and then failure is sudden and severe (Weick & Sutcliffe, 2015).

Slack is not waste.
It is capacity.

Time to think.
Time to communicate.
Time to recover.

Without it, teams are forced into constant improvisation under pressure.

Designing Efficiency With Care in Mind

Emotionally intelligent leaders ask different questions about efficiency.

They ask:

What is being sacrificed to move faster?
Where are teams absorbing invisible costs?
Are people given time to do work ethically and well?
Is efficiency supporting care or competing with it?

Better design doesn’t reject efficiency.
It redefines it.

What Healthier Efficiency Looks Like

Healthier efficiency includes:

Realistic time expectations
Protected space for communication
Built-in recovery and transition time
Permission to slow down when complexity demands it

When efficiency is aligned with care, teams feel supported instead of rushed.

The Takeaway

Efficiency should make work better, not harder to live with.

When systems ask people to move faster than their values allow, burnout is not a personal weakness. It is a predictable outcome.

Designing work that doesn’t hurt people means ensuring that efficiency serves care, not the other way around.

Reflection Question for Leaders

Where might efficiency goals be placing your team in conflict with their professional values?

References

Epstein, E. G., & Hamric, A. B. (2009). Moral distress, moral residue, and the crescendo effect. Journal of Clinical Ethics, 20(4), 330–342.

Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O’Connor, D. B. (2016). Healthcare staff wellbeing, burnout, and patient safety: A systematic review. BMJ Open, 6(2), e011006. https://doi.org/10.1136/bmjopen-2016-011006

Hamric, A. B., Borchers, C. T., & Epstein, E. G. (2012). Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Primary Research, 3(2), 1–9. https://doi.org/10.1080/21507716.2011.652337

Shanafelt, T. D., Dyrbye, L. N., & West, C. P. (2015). Addressing physician burnout: The way forward. JAMA, 313(22), 2277–2278. https://doi.org/10.1001/jama.2015.5071

Weick, K. E., & Sutcliffe, K. M. (2015). Managing the unexpected: Sustained performance in a complex world (3rd ed.). Wiley.