In health care the elites are the physicians and in academics, the professors. The managers said that while in neither culture does the elite class actually run the institution, in both instances they think they should, and don't want anything important decided until it is passed through them. This makes any enterprise-wide effort difficult. This was very familiar to me because I grew up in a university town and my father was on all the important faculty committees. Let me tell you, they don't wear those medieval robes just because they like to dress up now and then.
Universities are one of the few places where class and privilege still mean something.
It is based on intellect and academic achievement instead of bloodlines, but the results are the same and it gives managers gray hairs. The PM from the university related a problem involving replacing five separate software packages with one integrated package. The matter was proposed and decided at a committee meeting, but the faculty representatives didn't think it important enough to report the change back to the departments. When the time to make the change took place, professors were literally screaming at the IT department because they didn't know about the change. Executive buy-in is the most important factor for success in everyone's year 2000 project.