Actually the issue really isn't with middle management, it is with upper management who hires the consultants who come in with the benchmarks that do not have any application to real world productivity. It is the Matrix principle in the real world.
We have a productivity tracking system here at the hospital that tracks the number of procedures done by each individual in our department in terms of "minutes." Our managers have long stopped caring whether we do a good job on anything, or even following up on what we do or do not do; instead they track our "minutes."
This has created a bizarre new reality among our staff. Instead of providing quality patient care (ha!), many people here simply find ways to generate huge numbers of "minutes" without actually doing any work. It's very Wally-esque, and it makes me think that the problem in healthcare these days isn't so much insurers as it is incompetent middle managers.