4 ideas
Su Yi-hua, a young surgeon at a large Taiwanese teaching hospital, is drawn into the contest over who will control the institution after the old leadership. Each time Su trades a small concession, a vote or silence or a favour, for protection and advancement, he rises. By the end he has the position he wanted and has become the kind of operator the novel set him against.
In a teaching hospital, surgical skill and scientific merit do not decide who rises. Advancement goes to whoever controls committee votes, patronage from outside politicians, and access to donor money. Competence is the price of entry, but alliances decide the winner.
Idealists are rarely corrupted by one large betrayal. Instead, each small accommodation is locally reasonable and makes the next one easier to justify. The accumulated debts of favours owed leave the person unable to refuse without losing everything already gained.
Look past the formal hierarchy of a public institution and ask who funds it and who protects it politically. Donors and politicians who supply resources get an unwritten veto over appointments and policy. Internal factions then compete mainly to become the preferred channel for that outside power, not to serve the institution's stated mission.