Governance Structures Encourage Drft

I have spent forty years watching health systems defer the decisions that matter most. Not because their leaders lacked intelligence or commitment. Because their governance structures placed no cost on keeping decisions open. Delay looked like diligence. Deferral looked like prudence. And time — the only resource that cannot be replenished — was spent without anyone authorized to protect it. At one-fifth of U.S. GDP, that pattern is no longer just a management problem. It is a societal one.