Are you referring to medical operations, or IT operations, in hospitals? I think he is referring to medical operations, where I would expect the relevant professions to be doctors and nurses, not engineers.

The point stands. I've been involved in big hospital management and at a FAANG. Hospitals are a horror show if you see behind the curtain in both respects, and others.

Medicine works not because we have learned to scale it in any sense, but on the contrary, because we still rely on individual physicians and nurses to provide care. So like the HR system of large hospitals is probably better/bigger than small ones in terms of on boardinging doctors, but the care at a large center is only as good as the individual physician or nurse caring for patients. Probably bigger, academic centers are (very slightly) better (though this is an active debate with recent literature in high profile journals on both sides), but if they are, I suspect its because they can recruit better individual doctors. This is very different from saying that their scale provides them some competitive advantage in providing care.

Actually large hospital systems tend to hire one or two systems engineers to be part of the QI department. But yeah, most QI is front line staff.

QI department?

Quality improvement.