Regarding administrators – look at how militaries act on the field. Military staffing measures the number of support personnel to the number of combat troops. The target is about 1:7. The North Koreans and the Vietnamese against the French made do with an incredible 1:2 or even 1:1 support/combat. In the current US military, I understand it’s 30:1, which is often seen in bloated administrations.
If the analogy is extended to medicine – if 1 physician has 1 support person on their back, that’s a 50% productivity. If it’s 30:1, that’s 3% productivity. There’s no way to sustain that- it’s high-output failure.