While local autonomy has strengths—fostering specialization,
innovation, and improvisation—it can also be a
weakness. For example, in thinking that this is not a team
endeavour, physicians deny or avoid confronting their own
vulnerability and assume they have to be ‘‘iron men’’ who
can do everything themselves, learn everything themselves,
and work long hours without sleep.33 Personal accountability
easily shades into ‘‘shame and blame’’ of healthcare
professionals who are seen as not up to the challenge.32
Doctors rarely ask for help and do not take kindly to someone
telling them how to practice medicine.34 It is challenging to
standardize practices that vary by region, hospital, and
physician, up to 85% of which have not been tested
empirically.35 Each professional and each hospital wants to
be known for inventing something new, not copying others.
Not surprisingly, healthcare administrators may respond
with elements of design that increase standardization and
compliance with best practices, as discussed in the next
section