The question you pose is one that can be applied to a lot of things. Being a change agent and a process guy (kinda hate that label but whatever) here’s a quick take.
Institutions of any kind, generally speaking, run into what I find is a very interesting paradox. On one hand it’s important to have controls and processes in place that deliver what you know historically works. On the other hand institutions need to break their own rules and experience a certain degree of chaos in order to evolve and innovate into new and more effective directions.
One side of that spectrum reduces and controls risk, the other side is inherently risky but offers otherwise important learning and potential.
It’s a tension that is necessary and is dynamic. But shift the scale too heavy handed in either way and problems - sometimes big problems - show up.
I suspect many rehab and other programs are faced with typical organizational problems in seeing this and managing it appropriately. The bigger an organization becomes the more explicitly the issue needs to be managed.
A lot of organizations have executive management too invested in working in the business vs on the business. In those conditions it’s easy to miss important paradigm shifts, even when they are right in front of your face.
Think Blockbuster video or even Kodak cameras. Giants of market share one day, basically gone the next.
Generally speaking of course.
TLDR; organizations and institutions must adapt to change to thrive, most conventional management processes control or promote status quo vs innovation - especially in lieu of outside market pressure. It’s easy to miss the need for change despite it being in front of your nose.
B