The problems of governance and management in health care systems is a long standing dilemma. Back in 1955, Smith identified what he described as the "two lines of authority" - physicians and administrators. While there have been adjustments over time, these two lines still exist.

Research indicates that if greater governance and management authority is assigned medical staff, there are improvements in quality and cost of care (with higher quality actually driving the lower cost). It can also foster innovation and alternative care. Prime examples of this approach is seen with Kaiser (California) and Inter-mountain (Utah). 

However, in our current health system, any such increased and singular authority by physicians can lead to increased costs since the incentives are aligned for them to maximize their income. And there is a large body of evidence that physicians will resist innovations or alternative approaches to care if it reduces their income. Hence the plodding.