See also the current HR story on Intel [1].
>biggest and most well funded dev team was the one that worked on Revenue Cycle
> no incentive to...
I am working hard to not build and fuel a fully loaded Boeing 787 into high-earth orbit and crash land it on the not-my-problem, told'ya, it's all corrupt-all-the-time, MONEY! money-is-the-measurement-of-all-things, it's bad-here-so-I-left city center fecklessness of it all.
Toyota at its peek performance (say late 1980s) was making king-kong sized money top and bottom line. No manager would ever say their only incentive or even primary care is cash. "Our only incentive is walk around with cash. Cash in the hand, cash in the brief-case, cash in the pocket, cash on the boss' desk. Show me the cash." has never spoken in companies knowing about TQM.
Instead there were aware of the numerous cross-cutting factors that, in net, determine what kind the money the company can make
Maybe medicine cares about cash so much, because it's broke or close to broke all the time. Hmmmm.
There are ton's of great incentives for the docs, the nurses, the customers, and the company's top/bottom-line to name just a few.
Somehow, someway, one day, one time management will have to get sick and tired of the on-going mediocracy. And until then I guess medicine doesn't suck hard enough. Eventually, like in Voltaire's Candide, they'll have to get into lockup, when the lady in the other cell says (paraphrasing): "You think that's bad? Big deal. I only have one ass-cheek" and goes on to tell a serious tale of woe. We're not sure yet if medicine is the one-cheeked lady, our Candide and his charges in the other cell. Only time will tell!
My extended family:
* runs several hospitals in the US
* owned a radiology business w/ multiple branches for a while
* worked at major city trauma care university hospitals that eventually went bust and had to stop operating
A few things I can tell you about them when we spoke about how the US does 16% of GDP on medicine with its high costs, and sometimes poor outcomes in what should be routine stuff,
- On the people: doctors, and nurses love to help and can be counted on same. Wonderful people.
- They did not tolerate quitters
- Good incentives (carrots) and incentives for dumb (sticks) are not per-se key, but rank in the top 10 with several other things to right the ship.
- Crummy hospitals run by crummy people (esp admin, senior staff, and management) that can't even break even can't help patients, because the unit has to close. There was serious contempt for anything contributing to that eventuality
- They tried in some cases to focus on process improvement, and process simplification instead of more automation for crummy processes.
- They were at times despondent about the sectionalism and the fact that software is too compartmentalized by discipline because the IT stuff often came from vendors that could have some integration but certainly not enterprise integration.
[1] https://stratechery.com/2024/intels-humbling/