If I went into a company, a private company, and said “I can save you a million dollars day,” the CEO would implement it tomorrow. If I went into a hospital and said “I can save you a million dollars a day,” they’d they have to think about it, because the CEO would have to convince people this was a good idea. It would have to be good for the doctors, good for the nurses, good for the bean counters, good for the patients, good for patient quality, good for media. … All problems become multi-criteria problems. The good new is that things are so bad in health care we can always do that.
That matches my experience from when I used to work for a hospital.
Carter’s last line may not be clear in the excerpt above. In context, he’s saying that health care is so inefficient that an operations research consultant can always find ways to improve things, even though decisions have to satisfy numerous constituencies.
Nicholas Carr said something similar in his book Does IT Matter? Carr argues for most of the book that although information technology is important, it has become a given, like electricity. Then near the end of his book, he says that because health care IT is so far behind, his remarks don’t apply there.