I spent quite a long time (from - say - 1985 to 2010) trying in all possible ways to reform (or at least prevent the rapid decline and corruption of) the areas in which I was employed and worked without the slightest degree of success.
The reason was simple, and I expressed it most fully in relation to science; and it was that the rot was already too extensive, and there were insufficient people who wanted to reform the subjects.
There are, indeed, (here and now) extremely few people who work in any area, that have any kind of vocation for work - almost everybody has a careerist attitude; and is therefore obedient primarily. So when it comes to stopping the rot; the rot itself isn't usually very keen to make an effort, or even to be associated with an effort. Typically, people just melt-away...
So - despite writing about things, speaking about things in lectures, seminars etc, making-waves as and when - I just watched the whole horror story unfold.
This has had a permanent effect on my attitude; because I realise that when the mass of people in an organisation, an institution, a profession, a nation... are complicit in corruption, when they are careerist, when they are motivated by short-termism, by the attempt to maximise pleasure and status or minimise suffering or risk... then there is no realistic prospect of overall and positive reform.
(This fact of what people were like was one of the great disappointments of my life - and I found it dominant everywhere and everwhere worsening, although not everywhere equally bad.)
Minor specific victories, or delays; when all around is collapsing and stampeding in the wrong direction, are really not worthwhile - and, indeed, I have experienced a success being twisted round and used in exactly the opposite way from that intended.
This happened from about 1990 when I initiated an idea of a 'core and options' medical curriculum, which was taken up by the General Medical Council and adopted widely - but not to enhance the depth of understanding of a specific subject, but instead to destroy the vital educational aspects of traditional medicine, such as gross anatomy. 'Core and options' therefore overall did more harm than good; or else was merely used to do something bad that would have been done anyway, but perhaps with a different excuse.
Anyway, my lesson was that all systems depend on people; and goodness depends on good people - which means people motivated by good. And this in turn depends on the definition of good.
If/ when good is defined in a broadly utilitarian fashion, as in all modern societies through the West, then goodness is equated with happiness, pleasure, absence of suffering - and all systems (science, medicine, psychiatry, universities, nations etc) are always and necessarily corrupted. How could they not be?
With the prevalent utilitarian morality as bottom line - there will be generalised corruption, and there will not be any traction to deal with it - so corruption will continue. Modern institutions cannot ever be reformed because they do not want to be reformed.
Only if, or when, people adopt a transcendental, religious, god-centred morality can there be any reform of institutions. In the meantime, we can only reform our-selves (and perhaps a few loved ones).