Force #4: Decisions made far from the clinic floor. There was a time in academic medicine when most decisions were made within earshot. You walked down the hall. You knocked on the department chair’s door, or the hospital administrator’s door if it was a clinical issue. You talked it through. A new piece of equipment. A schedule change. A clinical protocol. A hire. It wasn’t perfect, but it was human. Decisions were made by the people closest to the work. The people who under
