Hospital Beuracracy at it's Worst

One of the many blogs that I read on a daily basis is the Freaknomics Blog by Steven Levitt and Stephen Dubner. I always find their articles to be thought provoking which is the same goal I have with this blog.

Anyways...earlier today they posted an article on military advancement. The article explains that in the military, promotion is awarded based on length of service, not on merit. The result of this being those who are strong performers find other careers out of frustration and the middle or low performers are promoted to the top.

I believe that hospitals in the United States operate in a very similar fashion. As an early careerist, I see that there are many individuals that are put into positions because of their seniority in the organization. Ambitious individuals are forced to move around from hospital to hospital to progress through to the executive level. This has to be a large drain on an organization's performance.

GE is famous for its move up or move out culture, creating a highly competitive workforce of high performers. This is not exactly what I am advocating, but I believe that hospitals need to start to move in this direction. Are hospitals in the United States or even the World thinking about and implementing systems that reward positions based on merit?