A few years ago, when I had a major surgical procedure at a major university hospital, I was impressed with the cheerfulness of the employees and their attention to my care. I learned that this was due to the relentless focus of the hospital administrator and his team on the quality of patient care. I am confident though that accounting rules would book their salary and benefits as mere "administrative costs."
Since 1970, the number of administrators in health care has risen over 3000%. That’s factual, from the US board of labor statistics. If you don’t deal with that, you cannot decrease costs.
Ultimately, how well you do in the hospital is a function of how vigilant, knowledgeable, experienced, and caring your physician is - including an element of clinical insight that you can’t easily teach. It’s also a function of the vigilance of the nurses, and the efforts of those directly involved in patient care in some manner.
Having said that, most of the ‘administrative’ incursions into medicine, particularly those that have some basis in federal mandates, take caretakers away from the bedside and put them in front of computers - checking boxes and doing very general documentation that is more often than not only marginally related to the particular patients they are taking care of.
Having a caring and capable hospital administrator is a good thing, but hospitals have always had a head administrator (even those that were run by nuns - who often did a very good job). What’s different now is that the number of administrators has grown dramatically. This doesn’t lead to high quality efficient machine. It leads to increasing costs, busy work that doesn’t positively impact patient care (and often diminishes patient care), and more money going to people who don’t take care of patients.
I’m very happy your surgery went well. I’ve been a doc for a long time now, always at ‘major university hospitals’ as you put it. As part of outreach efforts, I’ve also spent time at affiliate hospitals. I’ve seen great patient care, and not so great patient care - with missed diagnoses and inappropriate treatment at both. None of those cases would have been prevented by administrators or more regulation. The administrators would have no clue about the diagnostic and therapeutic issues involved in those cases. Further, in none of those cases would the care have been flagged in any way based on the general ‘quality’ measures that are used almost universally these days. It all would fly under the radar - which it did.