Randall J. Taylor was a senior administrator at a regional hospital and had risen through the ranks since obtaining his MBA from a leading business school. Randy was very enamored with saying “Uberize medicine,” by which he meant something very clever about demand flows and just-in-time staffing, or “agile workforce,” or something. Nobody was quite clear exactly what he meant, other than that he was very enthusiastic and very confident about something or other.

The administration executives held Randy in high esteem because he had cut costs, boosted revenue, and shaken up some of the overhead departments. For example, he had totally reorganized, downsized, and right-sized the quality and safety department. Gone were all the slow plodding types, and in came a brace of eager, young (cheaper) faces who were focused on rooting out anything that wasn’t value added—and by that they meant anything that didn’t bring in money. The new measurement system prioritized money.

Randy ached in every joint, and his every breath was labored.

The results of the new metrics system were profound. The C-suite rejoiced at the reduction in operating costs and the climb in profits, but the clinical leaders were less optimistic. They were pleasantly surprised that they, too, would be seeing a little productivity bonus, but there had been a growing clamor from the physicians and nurses about lengthy delays in filling vacancies, difficulties in getting new equipment, and endless issues with materials. The scrubs were low quality, the PPE was not up to scratch, and labs took longer because many routine tests were being sent to some new, faraway location. There wasn’t a day that went by, they complained, that there wasn’t a horde of people bitter about some new irritation: too few glove sizes, too many double shifts, too few basic materials, too much delay in getting new stock. The latest was the shortage in N95 masks. Staff were reusing masks several times now, where before these were regarded strictly as single-use items.

Randy was confused, and he kept trying to ask where he was, but he couldn’t talk. His awareness waned and waxed, but each dip went deeper and each climb grew slower and peaked lower.