There are quite a lot of downsides, although none of them absolute showstoppers (so I'm still here). Kaiser is an opaque bureaucracy worse than any I've seen elsewhere, and that includes government organizations in the 3rd world. The culture reveres the idea of "partnering" and consensus seeking, which in practice seems to almost guarantee a lack of clear decisions or paths of escalation for problem resolution. Problems and issues don't get resolved at Kaiser, they just linger and morph and come back every year, with a slightly different twist. So there is a huge and unending amount of re-inventing the wheel here.
I think top management is aware of these problems, and there are growing attempts at reform. However, much of the middle and senior management in Kaiser is dominated by a sort of "old girls network" and this network does not want change. They're comfortable, counting the days to retirement, and since change would take them out of their comfort zone, they steadfastly resist it.
Too much of the work and budget within Program Offices is ultimately decided on the basis of personal relationships, and not on the basis of quantitative measures. Honestly I don't think a lot of the P.O. management understands common accounting measures, I know for a fact that many cannot compute a simple ROI (return on investment), which is a travesty.
