That diesel maintenance example gets even more interesting when read through the lense of the ongoing Boeing threads: there, consensus is that the root problem is authority erosion for the core discipline: in old Boeing, engineering was a requirement for responsibility, but that is gone. In hospitals, the core discipline still holds on, but the blanket implicitness (or is it already a struggle? "we can't give up the diesel!"?) leads to terrible outcomes as well. Extremes rarely end well.