How broken is the world? How inefficient is a typical organisation? Looking at Tara Mac Aulay’s life, the answer seems to be ‘very’.

At 15 she took her first job - an entry-level position at a chain restaurant. Rather than accept her place, Tara took it on herself to massively improve the store’s shambolic staff scheduling and inventory management. After cutting staff costs 30% she was quickly promoted, and at 16 sent in to overhaul dozens of failing stores in a final effort to save them from closure.

That’s just the first in a startling series of personal stories that take us to a hospital drug dispensary where pharmacists are wasting a third of their time, a chemotherapy ward in Bhutan that’s killing its patients rather than saving lives, and eventually the Centre for Effective Altruism, where Tara becomes CEO and leads it through start-up accelerator Y Combinator.

In this episode Tara shows how the ability to do practical things, avoid major screw-ups, and design systems that scale, is both rare and precious.

People with an operations mindset spot failures others can't see and fix them before they bring an organisation down. This kind of resourcefulness can transform the world by making possible critical projects that would otherwise fall flat on their face.

But as Tara's experience shows they need to figure out what actually motivates the authorities who often try to block their reforms.

We explore how people with this skillset can do as much good as possible, what 80,000 Hours got wrong in our article 'Why operations management is one of the biggest bottlenecks in effective altruism’, as well as:

* Tara’s biggest mistakes and how to deal with the delicate politics of organizational reform.

* How a student can save a hospital millions with a simple spreadsheet model.

* The sociology of Bhutan and how medicine in the developing world often makes things worse rather than better.

* What most people misunderstand about operations, and how to tell if you have what it takes.

* And finally, operations jobs people should consider applying for, such as those open now at the Centre for Effective Altruism.