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There is one simple reason why the last 150 years have been years in which one institution after the other has become autonomous: the task-centered and autonomous institution is the only one that performs. Performance requires clear focus and narrow concentration. Multipurpose institutions do not perform. The achievements of the last 150 years in every single area are achievements of narrow focus, narrow concentration, and parochial self-centered values. All performing institutions of modern society are specialized. All of them are concerned only with their own task. The hospital exists to cure sick people. The fire department exists to prevent and to extinguish fires. The business enterprise exists to satisfy economic wants. The great advances in public health have largely been the result of freestanding organizations that focus on one disease or on one part of the human body and disregard everything else (consider the American Cancer Society, the American Heart Association, the American Lung Society, the American Mental Health Society, and so on).

Whenever an institution goes beyond a narrow focus, it ceases to perform. Hospitals that tried to go beyond sickness care into "health education" and "illness prevention" have been miserable failures. There