DeMarco points out that any increase in efficiency, in an organisation or an individual life, necessitates a trade-off: you get rid of unused expanses of time, but you also get rid of the benefits of that extra time.
In the accident and emergency department, by contrast, remaining “inefficient” in this sense is a matter of life and death. If there is an exclusive focus on using the staff’s time as efficiently as possible, the result will be a department too busy to accommodate unpredictable arrivals, which are the whole reason it exists.
A similar problem afflicts any corporate cost-cutting exercise that focuses on maximising employees’ efficiency: the more of their hours that are put to productive use, the less available they will be to respond, on the spur of the moment, to critical new demands. For that kind of responsiveness, idle time must be built into the system.
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