It is reasonable to suggest that inspectors and other workers given the task of ensuring compliance to regulations "auto-calibrate" and issue a constant number of citations regardless of the actual status of what they are inspecting.
Psychologists who study heuristics and decision-making tell us that humans have three calibration nodes. We are intuitively well calibrated for 50:50, 100:0 and 0:100. Actual distributions that "should" be something different, say 80:20 slide to 100:0 or 20:80 slides to 0:100.
Put yourself in the shoes of an inspector. For the sake of argument let's say you visit dairy farms and inspect the premises for compliance to State sanitation requirements.
If you never write-up a farm (0:100) then there is no point in having inspectors and you lose your job.
You might write-up half of the farms you visit. If you wrote-up the last farm then you give the next one a pass. If you gave the last farm a pass then you issue a citation for the next farm.
Alternatively, you issue a citation at every farm you visit. They might be substantial issues like dairy cows wading through udder-deep manure or they might be chicken-shit issues like light bulbs dimmed by dust. Regardless, you justify the citations because you think you are making every farm "better".
Of course, people learn to play the game. They leave one thing for the auditor or inspector to find, one thing that is easy to fix...like partially unscrewing one light bulb i.e. "burned out bulb" which is very economical to fix before the inspector's next visit.
I suspect that the administrative side of the medical business creates costs far beyond the payroll they pull down.
Some amount of administration is desirable. It is stupid to have an M.D. ordering soap and towels and scheduling housekeeping personnel.
The problem becomes administration that adds burdens rather than off-loads burdens. The problem are the administrators who police the proper use of pronouns and who mandate "fluff" education sessions on the endlessly evolving
science soap-opera of victimology rather than education about C. diff and signs of domestic violence.
Multiple layers of administration
Mark Nissen is a consultant in California and he was asked to investigate why the United States Navy had trouble keeping items like gray paint and toilet paper in stock.
The short answer is that every purchase over a million dollars required four levels of approval and the final approval had to be made by a full Admiral. The Navy is a huge organization. Nearly everything they buy is purchased in amounts that exceed a million dollars.
The problem was that each approval layer "bounced" 50% of the purchase orders for some issue over grammar or lack-of-clarity over the specifications.
If you looked at the approval process as a series of four, black-boxes then each box had twice as many P.O.s coming in as they passed on to the next black-box. Furthermore, the rejects were returned to the original submitter.
Take an imaginary week when 16 purchase orders are submitted to the Ensign on Monday. He bounces half and passes 8 on to the next desk. On Tuesday the officer at the second desk bounces four and passes 4 on to the next desk. On Wednesday the next officer bounces two purchase orders and passes two on to the Admiral. On Thursday the Admiral approves one P.O. and bounces one P.O.
On Friday the entire office goes to lunch with Air Force Purchasing and nothing gets done.
The officer tasked with buying toilet paper or ketchup or gray paint must submit the same P.O. with corrections for chicken-shit objections 16 times before it randomly rattles its way through the auto-calibrating "bounce 50%" bureaucracy and the purchase can be executed.
Why do we know they are they "chicken-shit" objections? Because the Navy has been buying toilet paper and ketchup and gray paint for a hundred years and all previous buys provided adequate cost/quantity/utility. The previous purchase orders obviously specified the product with enough detail for a successful buy to be made.
The fatal flaw
That is the fatal flaw of layered compliance administrators in Human Resources.
Additional duties are created for line personnel who are actually saving lives, additional duties that involve chicken-shit, made-up problems.
Somewhere, somehow the professional malcontents convinced policy makers that it was the organization's responsibility to make them happy...even if it made the other 95% of the workers supremely unhappy. Maybe that was the malcontents' goal all along. Misery loves company. Twisting the organization into knots makes results-oriented people very unhappy.
It used to be acceptable to tell the malcontents "If you are unhappy here, quit. I understand McDonalds is hiring."