Michael Lissack
profits and lower costs. The localities involved saw a loss of local institu- tions and the substitution of McCare. The backlash has forced the chains to devolve, to put back more autonomy at the local level and to rebuild both community and doctor relations. This tension between standardization and localization has only in- tensified in contemporary healthcare, where physicians must simultane- ously function as clinicians, administrators, data managers, and financial stewards—roles that often have conflicting demands and success criteria. The doctor who spends time entering data into electronic health records to satisfy administrative requirements may feel this detracts from their primary role as healer and patient advocate. Organizations that fail to acknowledge and address these role conflicts typically experience higher burnout rates and lower quality outcomes. The contrast between the operating style of Whole Foods and the op- erating style of these “proclaimed unity” corporations is like night and day. Decision making at Whole Foods is located where it will make a differ- ence, local for some things, national for another. At the unity companies, the proclamations say “we care” and the actions say “only about ourselves.” Or, as one of our friends puts it, “The lips are flapping but the feet ain’t moving.” Failure to respect the multiple roles of employees, citizen, cus- tomer, and supplier has cost these firms dearly. Epitomizing this type of decline is Apple computers. The cutting-edge technology spirit of Apple, its “all for oneness,” was undercut once the project teams charged with de- veloping the Macintosh and the Lisa (a little remembered, very powerful and too expensive failed product line from Apple) went into competition. The Mac team was even allowed to fly its own flag above its building on the Apple campus. The Apple hardware model - we build it, you buy it - was the very opposite of the PC makers, who had clones and clones of clones. The Apple world was a closed system. It proclaimed unity to the world and drove out those who could not buy into its enforced synthesis. And what happened is that the world quietly passed Apple by (al- though by 1998, Steve Jobs was back - a coherent force - to attempt a final rescue). Customers who had their needs ignored or who were told “we
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