Unbelievably, the medication example the author uses is a system I have direct experience with. It is a group whose job it is to make the decision of whether insurance covers a drug that a doctor has prescribed.

The triage is more sophisticated than a queue management ritual, but also has elements of it in it.

Some insurer programs require that the patient be declined by another one before paying for the prescription, so the doctors fill out hopeless requests because they need the rejection letter to achieve their outcome. This fills the decision queues, and everyone experiences the lag. Consider doctors handwriting as a next order CV problem, and then think about the attitude of the user demographic who doesn't feel obligated to be clear about their intentions - now design a digital product for them.

Bureaucracy in real life is a kind of cluster-governance, where nobody serves each other, and everyone presumes everyone else is coming to them to be regulated. Further, they really do think their job is to avoid obligations to others unless they are somehow mandated to have one.

I can say that agile development methods are disrupting bureaucracy in a big way. You don't see it, but every online license renewal and filing system wipes out layers of bureaucracy. The systems take years to develop because the personal/business relationships that made those systems work need to be identified and unraveled before you implement them in code. I would argue you don't understand stakeholder management unless you have spent time in a bureaucracy, and the people who do succeed at it in the private sector often do so as the result of both luck and negative anti-patterns.

I saw how the internet changed government almost 20 years ago, and can say that cloud and microservices are now also revolutionary.

Tech is an expression of how its users want to relate, and in this way it's culture. When we impose tech on institutions, it realigns them to organize around the relational patterns in the tech.

Bureaucracy is an active ingredient, and the tech we develop changes it. Want a better DMV? Build one.