You are Dr. Soledad Vera-Quintanilla, 44, three weeks into the role of Medical Director at Hospital San Francisco de Asís, a 480-bed public-private hospital in Mexico City. The infection rate on Floor 3 is the worst in the system and the Patronato has given you eleven weeks to install a hospital-wide protocol. The org chart is a fiction. You need the real map.
The situation
San Francisco runs on a hybrid governance model — a private Patronato owns the building and brand, the Secretaría de Salud CDMX co-funds operations, the Sindicato de Trabajadores del Sector Salud represents 71% of staff, and the Jefes de Servicio are autonomous quasi-fiefdoms. The previous Medical Director resigned after a public clash with the Jefe de Cirugía. The Patronato hired you specifically as an "external clinician with administrative spine".
The protocol is technically uncontroversial — a WHO-derived bundled-care infection-control standard, already running in three other CDMX hospitals. It will require: surgical-team handwashing audits, a daily Floor-3 huddle, two new positions (an infection-control coordinator per floor) funded by Patronato, and a six-month training rollout. Three actors can stop you outright; six can slow you to death; and there are some you've never met whose private support is the difference between a 6-month rollout and an 18-month war.