Super-efficient is not super-effective

I have osteoarthritis. I’ve already had my right hip replaced but my left hip has not progressed enough for surgery, so I was prescribed physiotherapy (outsourced to a private company).

This turned out to be the most efficient but least effective service I have ever experienced.

During that process all my appointments were met – but with a different physio each time to make sure I was seen. Every appointment was allocated about 20 minutes but was usually done within 10 (very efficient).

Time-saving efficiencies included emailing me exercises that I had to do at home rather than teaching me during the session. For one appointment, which I had to miss because I was unwell, they were on the phone to me the same day asking if I could speak to the physio instead (so they could tick the ‘patient dealt with’ box).

At no point was I given the space to take my time to discuss my pain – I was just asked to score it out of 10 – or my lifestyle, to help me cope.

So, guess what – a real waste of time as I don’t feel I got any real benefit out of those appointments.

This is why it drives me absolutely bonkers when I hear politicians bang on about efficiency cost savings, as if that is what the problem in our public services is.

It seems to me that prioritising efficiency can often be at the price of what actually works. ‘Penny-wise, pound-foolish’ springs to mind.

This is particularly relevant to our sector. For example, in the debt advice sector contracts put providers under pressure to be efficient: it’s efficient to see 100 clients in a day.

But to achieve that you can only spend 10 minutes with them, which is about the least effective way of helping people to get out and stay out of debt. Debt is often a symptom of something else – and you need way more than 10 minutes to get to the bottom of why they are in trouble and provide the support they need.

When folk bang on about efficiency they usually mean doing things cheaper. And if you do things cheaper, more often than not you do them less well.

A thing done well the first time is in fact more efficient – because you don’t get folk coming back again and again because you didn’t really help them the first time.

It’s going to cost the NHS more to treat me now because efficiency was prioritised over effectiveness.

And for the absence of doubt: 1. I’m not blaming them – they are being forced to make daft decisions because ‘efficiency savings’; and 2. Of course I am taking responsibility for my own health.

So, my message to our sector. Beware the word ‘efficient’. Focus instead on being effective – because when you talk about effectiveness you will naturally consider cost and resource effectiveness as part of how you judge what works and what doesn’t.

And make that point to your funders! Effectiveness costs because it works.

If your beneficiaries and service users are hobbling away from your services, it’s entirely possible you’ve been super-efficient but not at all effective.

This article was originally published on the Third Sector website, take a look here.